Posts Tagged ‘President Obama’

Spaghetti Ice Cream?

August 15th, 2012

August is a cruel month for dieticians and food advocates like Michelle Obama. Folks on vacation feel at liberty to reward their months of dietary restriction with burgers and fries. OK, no big deal. But state fairs for some time have been the R&D centers of heart-stopping (literally) food products.

Mariella Mosthof’s blog, Food in Politics, reported yesterday that Michelle Obama had banned the President from having a deep-fried Twinkie at the Iowa State Fair but he did get a chorus of “Four More Beers, Four More Beers.”  The Braiser: Obama Fried Twinkie

Michelle might swoon if she knew what is going on at state fairs around the country. Here is a sampling:

At the Iowa State Fair, items returning from last year include a number of favorites served on sticks: deep-fried butter, Snickers and cheesecake on. New items include: deep-fried pickle dawg (pickle, pastrami or ham and cream cheese on a cardboard boat (the stick didn’t work); deep-fried turkey eggs, and  pork-chops on a stick; NYT: Dining at the Iowa State Fair

Patch journalist Lyssa Beyer reports that the Wisconsin State Fair has served 375,000 cream puffs in addition to Deluxe Deep Fried Bacon Wrapped Cheddar Hot Dog on a Stick, Fat Elvis On a Stick (Peanut butter cup in banana batter with bacon), Firecracker Chicken on a stick (mesquite jalapeno cornbread batter-fried chicken on a stick), Pork Donut (sugared Bismark stuffed with BBQ Pork) , and fried oreos Patch Port Washington: Wisconsin State Fair.

The Kentucky State Fair is featuring hamburger on a glazed donut; spicy fried breaded chicken breast served on a raspberry jelly donut, deep fried Girl Scout cookies; deep-fried Kool Aid, spaghetti and meatballs ice cream (hey folks I don’t make this stuff up) Courier Journal: KY STATE FAIR


What is the Supreme Court Up to?

November 20th, 2011

This week the Supreme Court agreed to hear a legal challenge to the Affordable Care Act (ACA), President Obama’s signature health care reform legislation. The issues around the “individual mandate” have been well discussed. Timothy Jost, professor of law at William and Mary University School of Law and an insightful thinker on health care law. In a new post, he points to two critical issues in the Supreme Court’s review which are now below the radar but could become extremely compelling. The first is that the Supreme Court added review of the ACA’s expansion of Medicaid. This is not only a key channel for expanding health care coverage but the theory of the challenge, namely that Congress can use its spending power to unconstitutionally coerce states into certain programs. Such use of the spending power is common throughout many government programs. Overturning or even questioning the use of the spending power in this way could raise challenges to a host of federal programs.

The other issue is a more technical, legal issue of severability. Briefly, severability raises the question that, if the individual mandate (or any specific provision) is declared unconstitutional, does the rest of the law remain in place or is the entire statute voided. The Supreme Court has reserved specific time for arguments on both issues. High Court To Review ACA’s Minimum Coverage Requirement, Medicaid Expansion – Health Affairs Blog

STOP Pushes Obesity Tx as “Essential Benefit”

September 26th, 2011

As readers know, President Obama’s health care reform legislation has a critical provision for covering millions of uninsured persons for what are termed “essential benefits.” These benefits were undefined in the legislation.  Now, what will be covered and what will not be covered is becoming a major issue. In a recent Huffington Post, STOP Executive Director Christine Ferguson discusses STOP’s position on including obesity treatments as “essential benefits. Christine Ferguson: Giving Obesity Equal Weight in the Health Care System


September 27th, 2010

July 28,2010                                                                                                                      
Child exposure to food ads may be declining. A new study indicates that daily average exposure to  food ads between 2003 and 2007 fell by 13.7% among young children age 2-5 and 3.7% among 6-11 years old but increased by 3.7% among 12-17 year olds. Exposure to sweet food ads was down as were beverage ads “with a substantial decline in the most heavily advertised sugar-sweetened beverages.” Exposure to fast food ads increased.″>Trends in Exposure to Television Food Advertisemen… [Arch Pediatr Adolesc Med. 2010] – PubMed result

July 24, 2010

Analyses throw doubts on fruits and vegetables, physical activity to control obesity. A review of the relationship between fruit and vegetable intake with adult and childhood obesity casts doubt on how strong it the relationship with weight management. The review was undertaken by TA LeDoux and colleagues from the Department of Pediatrics at the USDA/Agricultural Research Service Childrens’ Nutrition Research Center at Baylor College of Medicine. They found that, after reviewing 772 studies, increased food and vegetable consumption (in conjunction with other behaviors) contributed to reduced adiposity among overweight or obese adults but no association was shown among children. While the quality of the studies varied widely, the relationship between high fruit and vegetable consumption and low obesity among “was weak” and among children “unclear.” The study can be accessed at″>Relationship of fruit and vegetable intake with ad… [Obes Rev. 2010] – PubMed result

In a separate study, doctors in Plymouth, United Kingdom following 202 children for 7 to 10 years, found that overweight preceded physical inactivity, not the other way around.  As most childhood obesity interventions assume inactivity precedes obesity, this study, if validated, indicates a change in strategy to combat childhood obesity. See

July 22, 2010
The Department of Health and Human Services today announced regulations implementing provisions of the health care reform legislation signed into law in March by President Obama. The regulations strengthen the rights of consumers to appeals claims denials and recissions. In addition, an external review procedure will be available to review initial claims decisions. Many persons with obesity have had problems in getting insurance coverage of bariatric surgery and other interventions and have been frustrated with the appeals process.  Plans that pre-existed enactment of health care reform and have not changed are considered ‘grandfathered’ and are exempt from these regulations unless their plans change. See more at”>Administration Announces New Affordable Care Act Measures to Protect Consumers and Put Patients Back in Charge of Their Care

July 21, 2010

Because of ‘stealth’ provision, millions will see an expansion of intensive counseling for obesity. See The Daily Downey.
April 30, 2010

Gallup Survey of over 670,000 Americans finds obesity rates continue to rise. Americans Making No Progress on Obesity

April 7, 2010

Consumer Alert: FDA issues warning on “fat burning” injections using such names as mesotherapy, lipozap, lipotherapy, or injection lipolysis. See Issues Warning Letters for Drugs Promoted in Fat Elimination Procedure

March 31, 2010

Orexigen Therapeutics Submits new obesity drug to FDA for approval Orexigen(R) Therapeutics Submits Contrave(R) New Drug Application to FDA for the Treatment of Obesity

March 31, 2010

Department of Health and Human Services addresses similarities between obesity and addiction. Common Mechanisms of Drug Abuse and Obesity, March 28, 2010 News Release – National Institutes of Health (NIH)


Questions and Answers

By Morgan Downey, J.D.

March 23, 2010

With Sunday’s vote in the House of Representatives, the long-awaited health care reform legislation is on track become law. A great deal has been written about health care reform during the past year but little attention has been paid to how reform might affect the obesity epidemic.

Obesity is the most prevalent, fatal, chronic disease in the United States. 68% of American adults are overweight or obese, constituting a majority of the US population. This Q&A is not intended to cover the entire scope of the health care reform legislation but only to explain how it is likely to affect persons with obesity and the future of the obesity epidemic. (N.B. At several points, the legislation incorporates recommendations of the U.S. Preventive Services Task Force (USPSTF) meaning that these recommendations become covered services. The USPSTF has two obesity specific recommendations at level B: one for screening for obesity and the second for intensive behavioral counseling. The intensive behavioral counseling could open the door for extensive new services.)

1. What does the bill do to help the millions of Americans with obesity?

Briefly:If you have obesity, have a medical condition and have not had health insurance for six months, you will be able to purchase coverage through a temporary high risk pool. (The pool is ‘temporary’ until the health exchanges are implemented).

If you have obesity and receive Medicare or Medicaid, you will see more preventive services fully covered.

If you have obesity and employer provided health insurance several provisions may affect you.

A. If you have had claims denied because of a pre-existing condition (either obesity or an obesity-related co-morbid condition), you should have an easier time getting such claims paid starting in 2014.

B. If you have reached lifetime caps on coverage, within six months of enactment, insurers will be prohibited from placing lifetime limits on the dollar value of coverage and from rescinding coverage, except in the case of fraud. Insurance companies will also be prohibited from canceling policies on people who get sick. (These are called recissions and ‘height and weigh’ is one of the four most common health reasons for a recissions according to a December 2009 report from the National Association of Insurance Commissioners).

C. Six months after enactment, private, qualified health plans will have to provide, without cost-sharing, preventive services with an A or B recommendation of the U.S. Preventive Services Task Force.

D. More expensive “Cadillac” health plans will start being taxed in 2018. To the extent that these plans may provide coverage of bariatric surgery and related services, they may scale back.

2. Is it all good?

Briefly, yes and no.

If you have obesity and have employer-paid health insurance, you may be paying more – potentially a lot more-for it. While the new law will ban discrimination on the basis of health status, an exception exists whereby persons in an employee wellness program can be charged up to 50% of the value of their health insurance premium if they do not meet specific health criteria, such as weight. Intensive behavioral counseling for obesity will become more available. Whether insurers will have to provide bariatric surgery or drugs for treating obesity will be decided by a Health Benefits Advisory Board which will make recommendations to the Secretary of Health and Human Services.

Third, the tax deduction for medical expenses will change. Currently, individuals can deduct unreimbursed medical expenses (including physician recommended weight loss costs) to the extent they exceed 7.5% of adjusted gross income. The threshold will rise to 10%. This potentially hurts individuals with multiple chronic conditions and/or high, unreimbursed medical costs.

3. Does Medicare coverage of obesity change?

Medicare beneficiaries would receive a comprehensive health risk assessment and a personalized prevention plan. Incentives would be provided to Medicare beneficiaries to compete behavioral modification programs.Medicare’s current coverage of bariatric surgery does not change.The ban for drugs to treat obesity under Part D continues in effect.

4. What about coverage of obesity in Medicaid?

Current state-by-state coverage in Medicaid for bariatric surgery and drugs to treat obesity should not change. (Medicaid may cover drugs for obesity if the state applies for a waiver from a prohibition in the Medicaid statute.)

The Medicaid program will go through its largest expansion since its inception. If cost-sharing is removed for covered recommendations of the US Preventive Services Task Force (see above), state Medicaid programs will have their federal matching rates increased. The Secretary of Health and Human Services (HHS) is also instructed to develop preventive and obesity-related services for Medicaid enrollees, including obesity screening and counseling for children and adults. Each state is directed to develop a public awareness campaign to educate Medicaid enrollees regarding the “availability and coverage of such services with the goal of reducing incidences of obesity.”

HHS will develop incentives to encourage behavioral change in Medicaid enrollees. A new state option will be developed for Medicaid, allowing enrollees with multiple chronic conditions to select a medical home.

5. What does the law do about childhood obesity?

While often overlooked, the expanding coverage includes providing health insurance to millions of children whose parents do not have coverage now. For the increasing numbers of children and adolescents with obesity, their related conditions, like type 2 diabetes and hypertension, will now be covered. Starting in 6 months, children cannot be denied coverage because of pre-existing conditions. In addition to the coverage components, the law provides funding for a childhood obesity demonstration project.

6. What about prevention of obesity?

The bill establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness and public health activities and develop a national strategy to improve the nation’s health. The strategy is due one year after the enactment. A Prevention and Wellness Trust is authorized to carry out the national strategy. A grant program is developed for 5 years to support the delivery of evidence-based and community based prevention and wellness service aimed at reducing chronic disease rates.

Under Section 4201, the Secretary of HHS shall develop a competitive grant program for states and local governments for “the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions and address health disparities.”

i. This includes creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of health lifestyle, emotional wellness, and prevention curricula.”

ii. Also included are “developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity;”

iii. “assessing and implementing worksite wellness programming and incentives; working to highlight healthy options at restaurants and other food venues.

iv. Grantees must report changes in weight, nutrition, physical activity.

b. Section 4202(a) provides a health aging program. Grants are to be provided to states and local governments for the 55 to 64 year old population “to improve nutrition, increase physical activity.” Covered are screenings to identify those with risk factors for cardiovascular disease, cancer, stroke and diabetes.” Those identified with such risk factors are to be referred to clinical services.

c. Section 4202(b) provides for an evaluation and plan for community-based prevention and wellness programs for Medicare beneficiaries to reduce their risk of disease, disability and injury by making healthy lifestyle choices, including exercise, diet and self-management of chronic diseases.

7. Does the law affect research on obesity?

a. The bill establishes a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research which compares the clinical effectiveness of medical treatments. This is effective on enactment.

b. Section 4301 provides for research on optimizing the delivery of public health services.

c. Section 399MM1 provides for studies of worksite health policies and programs. No part of such recommendations, data or assessments can be used to mandate requirements for workplace wellness programs.

d. Section 4402 also provides for effectiveness research of health and wellness programs for federal employees.

e. Under the reconciliation changes passed by the House of Representatives and on its way for approval by the Senate, the Administrator of the Centers for Medicare and Medicaid will identify the most cost-intensive services for Medicare which shall ‘inform’ research priorities within the Department of Health and Human Service to improve prevention, treatment or cure of such diseases and conditions.

8. What are the other parts of the bill affect obesity?

The Secretary of HHS is mandated to develop, within one month of passage, an education and outreach campaign regarding preventive health services. The campaign must address proper nutrition, regular exercise and obesity reduction. It is mandated that the Secretary develop a website for health care providers and consumers to provide science-based information on guidelines for nutrition, exercise, obesity reduction and specific chronic disease prevention. Another website is to be developed with a “personalized prevention plan tool. This would include determining individual disease risk, based in part on Body Mass Index.

a. Of particular value for persons with morbid obesity, Section 4203 provides for the removal of barriers to medical devices for individuals with disabilities. Under this provision, standards will be developed to ensure that medical diagnostic equipment used in physician’s offices, clinics, hospitals and other medical settings to ensure that the equipment is accessible to and usable by individuals with accessibility needs to allow independent entry to and use of such equipment.

b. Restaurants which are part of a chain of 20 or more locations doing business under the same name must disclose for ‘standard menu items’ the nutrient content including calories in the item with the suggested daily caloric intake on the menu as well as a drive-through menu board. Self-service items must also display the calorie information. Restaurants and others, such as vending machine operators, may voluntary register to be part of the program. Regulations must be issued within a year of enactment.

c. In some studies, breast-feeding has been found to be preventive for the development of obesity in the child. For breast-feeding women, employers with over 50 employees must a reasonable break time to express breast milk for one year after the child’s birth, each time the employee has a need to express the milk and a place, other than a bathroom that is shielded from view and free from intrusion. Employers need not provide compensation for such time.

d. The Secretary of Labor is authorized to set up a grant program for employer wellness programs. Behavioral change is encouraged which provides for altering employee healthy lifestyles through counseling, seminars, on-line programs or self-help materials. Obesity is specifically listed as a focus. Participation cannot be mandated or conditioned on obtaining a health insurance premium discount, rebate or other financial reward.

9. What is not in the bill?

A proposed tax on sugar-sweetened beverages is not in the legislation.

10. What next?

The bill is large and complex. Many issues, especially regarding inclusion of surgery and drugs in health benefit plans, be have to be resolved by regulations from the Department of Health and Human Services. For example, while the USPSTF recommendation for intensive behavioral counseling does not include frequency, intensity and duration. These will need to be specified.

March 20, 2010

Employers are increasingly using punitive measures against employees’ health status according to annual Hewitt Associates annual survey of 600 U.S. companies. Over half of employers plan to monitor employee behavioral changes or behavioral modification.″>Hewitt Survey Shows Employers Continuing to Invest in Health of Workers Despite Uncertainty of Future Health Care Landscape – Hewitt Associates – Human Resources Consulting and Outsourcing – About Hewitt – Newsroom

March 19, 2010

Extreme Obesity increases in children

A new study from Kaiser Permanente finds alarming increases in extreme obesity in children. Using electronic medical records of 710,949 patients ages 2 to 19 enrolled in Kaiser health programs in Southern California, researchers found about 6.4% of children have extreme obesity. (The researchers used a relatively new definition of extreme obesity from the Centers for Disease Control of 120% of the 95 percentile of weight for age). 7.3% of boys and 5.5% of girls were described as have extreme obesity.”>Extreme Obesity Found in 6.4% of Children, Kaiser Study Finds – BusinessWeek

Does increasing physically activity in kids prevent obesity in adults?

Many campaigns for the prevention of obesity in children, including efforts of First Lady Michelle Obama,  stress physical activity under the belief that patterns of physical activity will continue through life and will avoid obesity. It may not be that easy. A study out of Canada followed 374 participants age 7 to 18 years of age for 22 years. They found that only 18% of the most physically active children remained physically active in later life. In contrast 38% of the heaviest children, by BMI, continued to have a high BMI as adults. 83% of overweight youth remained overweight as adults while 85% of adults were not overweight as children. Almost all healthy weight adults had been healthy weight as children.″>Tracking of obesity and physical activity from chi… [Int J Pediatr Obes. 2009] – PubMed result. Earlier studies found that physical activity in adolescence may track into adulthood for women but not for men.″>Risk of obesity in relation to physical activity t… [Med Sci Sports Exerc. 2006] – PubMed result.

March 18, 2010

The STOP Obesity Alliance conducted a press conference on March 16, 2010, releasing a survey of physicians and patients on primary care for patients with obesity as well as a white paper on the topic. See,”></a> and,

Coverage included:”>”>The Checkup – You get weighed at the doctor’s office. Then what?

Physician interactions with patients who are obese is a hot topic. Other recent stories include,”>amednews: Obese patients say some doctors disrespectful :: Nov. 23, 2009 … American Medical News;sq=obesity&amp;st=cse”>Essay – For Obese People, Prejudice in Plain Sight –

March 7, 2010

Social pressure keeps weight of Japanese women low…but not for men and children.”>Big in Japan? Fat chance for nation’s young women, obsessed with being skinny – Meanwhile, stress of White House bringing poor habits and excess weight to Obama advisor.;hpw=&amp;adxnnlx=1267980789-auEREV8zyhS1D+W8ygEvBg”>David Axelrod, Obama’s Message Maven, Finds Fingers Pointing at Him –

March 3, 2010

New study shows presence of multiple inflammation markers in  obese children as young as 3 years old. Inflammation is considered to cause long term damage to the heart.;ordinalpos=1″>Multiple Markers of Inflammation and Weight Status… [Pediatrics. 2010] – PubMed result

March 2, 2010

Childhood obesity continuing to increase”>Child Obesity Rates Going Up – US News and World Report  as children are seen as constantly eating. ttp://″>Snacks mean U.S. kids moving toward constant eating | Reuters Article exposes fallacy of addressing obesity by making “little changes.””>In Obesity Epidemic, What’s One Cookie? – Well Blog – In the meantime, President Obama’s liking of burgers and smokes shows he’s a ‘regular guy.’”>THE 44TH PRESIDENT – The Caucus Blog –

Survey provides reinforcement that most Americans think they are healthy…it’s the other guy who isn’t living a healthy lifestyle.”>Most Americans Think It’s Others Who Are Unhealthy – iVillage Your Total Health

The most recent study on mortality and obesity was published in February 2010;ordinalpos=4″>Individual and aggregate years-of-life-lost associ… [Obesity (Silver Spring). 2010] – PubMed result. The research by Eric Finkelstein et al found that overweight and low level obesity were not associated with a reduction in life expectancy. However, higher BMI levels are associated with reduced life expectancy. Overall, excess body weight is associated with 95 million Years of Life Lost (YLL). White females account for more than 2/3 of this amount. The authors predict that, unless the rising prevalence of those with BMIs over 35 is reduced, or improvements in medical care are made, overall life expectancy in the US will decrease. The article notes that the mortality rate for obesity might be higher if not for improved medical treatments. They note that 10 of the 25 most prescribed medications are for obesity related conditions.

February 28, 2010

USA Today story describes middle age weight losers hitting a brick wall.”>Middle-aged dieters hit a brick wall after 10 pounds or so –

February 26, 2010

Institute of Medicine announces program to examine front-of-package nutrition labeling requirements.”>Examination of Front-of-Package Nutrition Rating Systems and Symbols – Institute of Medicine

(Footnote:  About time! I raised the proposal for putting calorie information on the front of packaged foods in 2003. <a″>US Food and Drug Administration: 03n-0338-tr00002

February 25, 2010

California Governor Arnold Schwarzenegger announces plan to combat obesity in California.”>Ca. Gov. Schwarzenegger Announces Actions to Fight Obesity, Promote Healthy Living : Thu, 25 Feb 2010 : California Newswire™

February 23, 2010

President Obama’s health care proposal includes obesity

President Obama’s health care proposal, announced on before the ‘health care summit’ contains funding for state and local governments to develop strategies for chronic diseases “including those associated with obesity and tobacco use.” The proposal also promises “unprecedented investments in disease research and prevention” while at the same time requiring posting of calorie information in restaurants and in vending machines.

States and health care providers would receive evidence-based recommendations on preventive and “obesity-related” services for Americans on Medicaid. States will be encouraged to develop innovative childhood obesity preventive programs. Small businesses will be allowed to compete for grants to develop wellness programs through the CDC. For Medicare beneficiaries, annual wellness visits will be fully covered as well as personalized prevention plans. Co-payments for preventive care will be waived.”>Title IV. Prevention of Chronic Disease and Improving Public Health | The White House

The Kaiser Family Foundation reports that the Administration bill does include the Safeway provision which could penalize employees who do not meet certain health standards, including weight.”> The bill does not specify minimum benefit packages. There is no mention of a tax on sugar-sweetened beverages.

February 21, 2010

New study by Kenneth Thorpe and Lynda Ogden in Health Affairs finds rising Medicare costs from chronic diseases, many related to obesity – hypertension, hyperlipidemia, diabetes, heart disease, liver disease, cancer, mental disorders and asthma. Spending has also shifted from inpatient hospital care to outpatient visits and drugs. Most all Medicare patients utilize these services″>Chronic Conditions Account For Rise In Medicare Spending From 1987 To 2006 — Thorpe et al., 10.1377/hlthaff.2009.0474 — Health Affairs

February 20, 2010

First Lady Michelle Obama’s childhood obesity initiative (see”>Let’s Move)  produces attack from Glenn Beck″>Beck attacks Michelle Obama for trying to raise awareness of and combat childhood obesity | Media Matters for America  and defense from Mike Huckabee″>Huckabee warns that “conservatives are going to” attack Michelle Obama’s obesity initiative — but Glenn Beck already has | Media Matters for America, See preview of Huckabee’s interview with Michelle Obama <a href=””>Huckabee –

February 19, 2010

Harvard researchers wanted to look at childhood chronic health conditions over time to see what fluctuations, if any, took place. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions and behavior/learning problems. Three cohorts of children were examined: those born in 1988, 1994 and 2000. Rates of maternal obesity increased in each cohort. The prevalence of any chronic condition increased with each cohort. The study found remission in several chronic conditions, except for obesity which increased substantially over time. Associations were found between maternal obesity and any chronic condition and with minority race.;ordinalpos=1″>Dynamics of obesity and chronic health conditions … [JAMA. 2010] – PubMed result

Researchers are increasingly looking at early life factors. A study of 1,100 children found that being female, having diabetes exposure in utero, larger size for gestational age, shorter breastfeeding duration and rapid infant weight gain predicted higher childhood BMI.;ordinalpos=3″>Early-Life Predictors of Higher Body Mass Index in… [Ann Nutr Metab. 2010] – PubMed result

February 16, 2010

The folks at the Economic Research Service of the United States Department of Agriculture have come out with the Food Atlas, a comprehensive map down to the county level from fast food outlets to taxes. Check it out at <a href=””>Food Environment Atlas. Thanks to a grant from the Robert Wood Johnson Foundation, the University of Wisconsin  has issued county health maps comparing the health in counties with others in the state. All counties in the United States are included, except for the District of Columbia which is left out. Cost is also left out as a factor in health care access. <a href=””>County Health Rankings

February 16, 2010

The debate over bariatric surgery for adolescents heats up”>Weight Loss Surgery for Teens – Well Blog – Fueled by part by new study from Australia;ordinalpos=2″>Laparoscopic adjustable gastric banding in severel… [JAMA. 2010] – PubMed result

February 13, 2010

The Tipping Point for Childhood Obesity may be as young as 3 months to 2 years of age. In a new study published in the journal Clinical Pediatrics, researchers conducted a retrospective chart review of 184 children between 2 and 20. More than half the children became overweight before age 2 and all patients were obese or overweight by age 10. The authors note that food preferences are also set at an early age, probably by age 2. The rate of gain was approximately 1 excess BMI unit per year. The study indicates that the critical period for preventing childhood obesity is during the first 2 years and for many it may as little as 3 months of age. The study looked at two different socioeconomic groups and found the same pattern. Pediatricians were urged to take BMIs earlier and look for ‘small’ changes which can lead to obesity.;ordinalpos=2″>Identifying the “Tipping Point” Age for Overweight… [Clin Pediatr (Phila). 2010] – PubMed result

Some positive news comes in another study showing that pre-school children exposed to 3 routines: regular evening family meals, adequate sleep and limited screen viewing had approximately 40% lower prevalence of obesity compared to those exposed to none of these routines.;ordinalpos=12″>Household Routines and Obesity in US Preschool-Age… [Pediatrics. 2010] – PubMed result

Unfortunately, the effectiveness of weight loss interventions for children under 5 leave a lot to be desired. See two reviews:;SRETRY=0″>Systematic review of the effectiveness of weight management schemes for the under fives. M. Bond. 2010; Obesity Reviews – Wiley InterScience, and;ordinalpos=13″>Interventions to prevent obesity in 0-5 year olds:… [Obesity (Silver Spring). 2010] – PubMed result

In addition, pediatricians may lose interest in weight management over time.;ordinalpos=1″>Applying practice recommendations for the preventi… [Clin Pediatr (Phila). 2010] – PubMed result

February 11, 2010

First Lady Michelle Obama launches national childhood obesity initiative”>First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise a Healthier Generation of Kids | The White House after President Obama signs Executive Memorandum calling for a plan on childhood obesity in 90 days.”>Presidential Memorandum — Establishing a Task Force on Childhood Obesity | The White House

February 4, 2010

Study finds workers with obesity pay for health insurance through lower wages

A new study has confirmed that obese employees with employer-provided health insurance are paid less that their peers because of higher health care costs. Stanford University researchers analyzed data from the Bureau of Labor Statistics, the National Longitudinal Survey of Your and the Medical Expenditure Panel survey. They found that, on average, obese employees with health insurance were paid $1.42 an hour less that non-obese workers. Women had a higher wage penalty than men. Women with obesity whose employers provided health insurance paid a wage penalty of $2.64. The article is  “The incidence of the healthcare costs of obesity,” by Jay Bhattacharya, M.D., Ph.D., and M. Kate Bundorf, Ph.D., M.P.H., M.B.A., in the 2009 <em>Journal of Health Economics</em> 28, pp. 649-658.

February 3, 2010

A new study from Europe indicates that a significant portion of persons with morbid obesity (Body Mass Index greater than 40)  are missing a section of their DNA. The authors from the Imperial College London and ten other European centers indicate that the missing DNA may have a dramatic effect on some people’s weight. Approximately seven in every thousand people with morbid obesity are missing some 30 genes. See Science Daily report at”>Some morbidly obese people are missing genes, shows new research. Abstract at”>Access : A new highly penetrant form of obesity due to deletions on chromosome 16p11.2 : Nature
January 29, 2010

First Lady Michelle Obama, HHS Secretary Kathleen Sebelius and Surgeon General Release National Call to Action on Obesity”

Most of the document is similar to other DHHS statements on  obesity but there is one new aspect. The report draws special attention to the role of obesity in mental illness and calls on the medical community to promote awareness about the connection between mental and addiction disorders and obesity (See the Research Section) and to consider weight neutral medications for persons with severe mental illness.

January 27, 2010

New research indicates physicians can be effective in achieving weight loss in persons with severe obesity.

A study out of Pennington Biomedical Research Center in Baton Rouge, LA, indicates that, with training, primary care providers can achieve weight loss and reduction in metabolic factors with medical intervention alone. Among those who completed the study, 31% in the intensive medical intervention group achieved a weight loss of 5% or more and 7% achieved a 20% or more weight loss compared to 9% and 1% in the usual treatment group.;ordinalpos=11″>

Nonsurgical weight loss for extreme obesity in pri… [Arch Intern Med. 2010] – PubMed result. The results come none too soon. A study from Ireland of 700 individuals with obesity over a BMI of 30, found the highest BMIs occurred among those who reported onset of overweight before age 15. The BMI group over 50 was notably younger and had higher metabolic problems. They also had lower rates of marriage and higher unemployment.;ordinalpos=19″>BMI = 50 kg/m2 is associated with a younger age … [Public Health Nutr. 2010] – PubMed result

January 25, 2010

Fetal anomalies in children of mothers with obesity may be more due to diabetes than weight alone. High BMIs may be a surrogate for pregestational diabetes.;ordinalpos=13″>Fetal anomalies in obese women: the contribution o… [Obstet Gynecol. 2010] – PubMed result


January 23, 2010

The Food and Drug Administration has issued a consumer warning about counterfeit versions of Alli™ being sold over the Internet.”>UPDATED Public Health Alert: Counterfeit Alli containing sibutramine

Obesity by any measure found to increase risk of ischemic stroke;ordinalpos=1″>Race– and Sex-Specific Associations of Obesity Mea… [Stroke. 2010] – PubMed result

SAFETY ALERT:   FDA Issues Warning on Meridia.

The Food and Drug Administration (FDA) has notified health care professionals of increased risk of heart attack and stroke for patients taking sibutramine, marked as Meridia by Abbott Labs. The FDA found increased risk in patients with a history of cardiovascular disease, including coronary artery disease, stroke or transient ischemic attack, heart arrhythmias, congestive heart failure, peripheral arterial disease or uncontrolled hypertension.”>Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review</a> European authorities have taken the drug, called Reductil in Europe,  off the market  citing the high prevalence of heart problems in persons with obesity many of which may be undiagnosed. <a href=””>Obesity drug used by 86,000 patients is suspended over heart attack fears | Mail Online<

Intervene earlier and more aggressively:  New recommendations for screening and intensive counseling for youths 6-18  get impetus from finding high lipid levels in adolescents. Almost back-to-back two government agencies have reinforced the need for earlier, more aggressive intervention in children and adolescents with obesity. The United States Preventive Services Task Force has updated its recommendation that clinicians screen children and adolescents between 6  and 18 years of age for obesity and refer those at risk to programs designed   to improve their weight status by utilizing three components:  counseling for weight loss or a healthy diet, for physical activity, and  behavioral management techniques such as goal setting and self monitoring. Moderate- to high-intensity programs involve more than 25 hours of contact with the child and/or the family over a 6-month period. Combining counseling with either sibutramine or orlistat was found to result in modest improvements for children age 12 and over.”>Screening for Obesity in Children and Adolescents. The recommendations and evidence statement are available at the journal Pediatrics web site,;HITS=10&amp;hits=10&amp;RESULTFORMAT=&amp;fulltext=obesity&amp;searchid=1&amp;FIRSTINDEX=0&amp;sortspec=date&amp;resourcetype=HWCIT”>Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF — Whitlock et al., 10.1542/peds.2009-1955 — Pediatrics

On January 22, 2010 the Centers for Disease Control and Prevention reported that 20.3% of adolescents aged 12-19 had abnormal lipid levels, a known risk factor for cardiovascular disease. Youths were overweight or obese had higher lipid rates than those with normal weight. Based solely on BMI, 32% of all youths should be candidates for lipid screening.”>MMWR – MMWR Weekly” target=”_blank”>Physicians Getting Active on Obesity

Did you know 3,693 Americans become obese everyday? Check <a href=””>Quick Facts

Has America Reached its Tipping Point on Obesity?”

The two most recent surgeons general, Dr. David Satcher, left, and Richard H. Carmona, center, join Morgan Downey, right, at the STOP Obesity Alliance panel discussion at the Newseum in September. The recommendations of the group will provide policymakers guidelines in dealing with obesity in forthcoming reform bills. Obesity Alliance

The Message or the Messenger, Part 2

September 27th, 2009

July 30, 2009 :: By Morgan Downey

The debate over President Obama’s selection of Dr. Regina Benjamin as the next Surgeon General has focused on whether someone who appears to be somewhat overweight can carry the messages of the public health community to eat better food and less of it and exercise more to achieve a healthy weight.

While the debate ranges over the BMI range of the top government spokesperson, no one, it seems, is looking at the message itself.

One can well question whether the educational messages are working. One recent study showed that adherence to the federal government’s five recommendations for healthy living has decreased from 15% to 8%. Adherence to healthy lifestyle habits in US adults…[Am J Med. 2009] – PubMed Result This has occurred during an extensive educational campaigns about obesity during this period.

Given the investment in getting out the message of the values of living a healthy lifestyle, there are some disconcerting findings. For example, a new, small study indicated that messages to exercise may lead to greater food intake. Immediate increase in food intake following exerci…[Obesity (Silver Spring). 2009] – PubMed Result This experiment showed that when subjects were receiving information on exercise from actual campaigns, their consumption of available foods increased over the control group which did not get the messages.

As much as I am wary of anecdotal messages, I am reminded of a recent meeting of persons wanting to lose weight. One woman said she was the mother of five children and they had a family gathering (Thanksgiving, Christmas, Easter, Passover, weddings, graduation, christenings, bar mitzvahs, bat mitzvahs, etc. ..fill in the blanks.) One daughter told the mother she needed to eat better. The mother was resentful. But when another daughter talked to her about changing her food choices, she was receptive. The second daughter was overweight and struggling with it; the first daughter was always lean.

We have assumed that the best messenger was one who walked the walk. But does that mean only a lean person can be the messenger? OR would we rather have a leader who is like us…strugglingsometimes failing and trying to get back into the saddle?

Health Care Reform and Obesity – The Issues

September 27th, 2009

The current health care reform debate has crucial implications for the prevention and treatment of obesity. This debate will be followed closely in the months, if not years, ahead. Here is my view of some of the critical issues in the current debate. MD

October 16, 2009

Senate Finance wellness loophole undercuts reform goals.  Wellness Incentives Could Create Health-Care Loophole –


Has America Reached its Tipping Point on Obesity?


The two most recent surgeons general, Dr. David Satcher, left, and Richard H. Carmona, center, join Morgan Downey, right, at the STOP Obesity Alliance panel discussion at the Newseum in September. 

The recommendations of the group will provide policymakers guidelines in dealing with obesity in forthcoming reform bills. STOP Obesity Alliance 

Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) 

David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) 

Jeff Levi, Ph.D., Trust for America’s Health Jeff Levi, Ph.D., Trust for America’s Health 

Christine Ferguson, J.D., STOP Obesity Alliance. Christine Ferguson, J.D., STOP Obesity Alliance Director. 


Helen Darling, National Business Group on Health Helen Darling, National Business Group on Health 



August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth –

July 27-29

Centers for Disease Control and Prevention hold Weight of the Nation Conference in Washington, D.C. Speakers include former President Bill Clinton and HHS Secretary, Katherine Sebelius. For full conference information go to CDC Features – Weight of the Nation

July 12, 2009

From Morgan Downey: The ways in which health care reform can address obesity

  1. Prevalence of Obesity in Uninsured Population

There appears to be a high prevalence of overweight and obesity in the uninsured population. A study published in 2000, indicated that, “Smokers, obese individuals, and binge drinkers, were more often uninsured than adults without these risk factors. In contrast, people with self-reported hypertension, diabetes mellitus, and elevated cholesterol were less likely to be uninsured than adults without these conditions.” Ayanian, JZ, Weissman, JS, Schneider EC, Unmet Health Needs of Uninsured Adults in the United States, JAMA, 2000;284:2061-2069. Free full text at Unmet Health Needs of Uninsured Adults in the United States — Ayanian et al. 284 (16): 2061 — JAMA

Likewise, it is estimated that nearly half of all uninsured, non-elderly adults report having a chronic condition. Common reported chronic conditions are diabetes, hypertension, arthritis-related conditions, high cholesterol, asthma and heart disease, all of which are either caused by or highly associated with, overweight and obesity. “Uninsured American with Chronic Health Conditions: Key Findings from the National Health Interview Survey, Uninsured Americans With Chronic Health Conditions: Key Findings from the National Health Interview Survey – RWJF

2. Limiting Use of Pre-Existing Conditions

When individuals, outside of group plans, with obesity try to purchase health insurance policies on an individual basis, they find they are unwelcome. Many private health insurance programs exclude individuals with certain Body Mass Index from accessing individual policies. According to F as in Fat report by the Trust for America, many companies will charge additional premiums for persons with a BMI between 30 and 39. Over a BMI of 39, a person may find no company willing to provide individual coverage. Other plans may classify persons as “unhealthy” or “uninsurable” due to obesity. Companies are free to make their own definitions of these terms. Few states restrict these practices. 14-14 (See F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF)

Even if the person with obesity can overcome the weight hurdle, their coverage may be limited by the use of the common ‘pre-existing condition’ requirements which restrict a person for a period of time from accessing their plan’s benefits. As indicated above, many chronic diseases are associated with obesity and these can form additional hurdles to obtaining needed care.

Some health insurance plans have started to take very small steps to deal with obesity. For the most part, these efforts include bariatric surgery for additional premiums or offering employer’s a worksite wellness program, also for an additional payment.

Finally, few states have any kind of mandated benefits related to obesity treatment or prevention. In such cases, the insurance industry typically fights such proposals extremely vigorously. (See statement of Bob Clegg former Republican majority Senate leader, New Hampshire at The Challenge of Obesity for Policy Makers: Recommendations for the Next Administration: Republican Convention Forum –

  1. Coverage of Obesity Interventions

Once insured the question arises, “Will offered health plans address obesity prevention and treatment?” If the uninsured health plan does not address the, or one of the, root cause of an individual’s health concerns, will any progress be made in using this entire health reform effort to improve individual and public health? The current situation of health insurance, in its avoidance of obesity prevention and treatment, perpetuates a focus on the conditions caused by obesity. Millions spent on heart disease or type 2 diabetes (not to mention the other ill effects, see above) will only continue. Only by addressing the root problem will Americans and America’s health see improvement.

The question has been raised of using the Medicare and Medicaid coverage criteria as the model for the legislation’s covered services. In terms of obesity, these programs cover obesity treatment and prevention inconsistently and inadequately. Regarding Medicare,

  1. In 2004, Medicare eliminated language in its coverage manual to the effect that obesity was not a disease. This opened the door to treat obesity in its own right as a disease.
  2. In February 2006, CMS significantly expanded its national coverage policies to cover more bariatric surgery procedures when performed in designated centers of excellence.
  3. Medicare Part D does not cover drugs for the treatment of obesity.
  4. Medicare does not cover physician or dietetic counseling for weight loss.

Regarding Medicaid,

  1. Most Medicaid plans have no to limited coverage of drugs for the treatment of obesity. The Medicaid statute actually bans states from including such pharmaceutical products but allows a waiver on request of the state. Few states have sought or received such a waiver.
  2. Bariatric surgery, while nominally covered in many states, is subject to such low reimbursement rates that few surgeons want to provide it. Other limitations on is provision further limit its ability to help individuals who meet the NIH recommendations from receiving the surgery.

The Internal Revenue Service, through a change in a revenue ruling in 2000, allows individuals to deduct the costs of weight loss programs upon recommendation of a physician. Of course, taxpayers must meet the threshold of 7.5% of adjusted gross income to qualify for the medical deduction at all. Therefore, Congress should use the expert, evidence-based recommendations of the NIH to decide covered services. (See,

Similar recommendations adopted by the American Academy of Pediatrics and 15 national medical societies should be adopted by children and adolescents as indicated. (See, Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report — Barlow and and the Expert Committee 120 (4): S164 — Pediatrics)

The Baucus Plan (Call to Action Health Reform 2009, November 12, 2008, Senate Finance Committee) would leave coverage decisions to a new independent health coverage council. This is probably insufficient and Congress should make this decision on coverage of obesity interventions, both prevention and treatment, itself. This would be consistent with the Baucus Plan’s goal, “Prevention must become a cornerstone of the health care system rather than an afterthought. This shift requires a fundamental change in the way individuals perceive and access the system and community-based wellness approaches at the Federal, state, and local levels. With a national culture of wellness, chronic disease and obesity will be better managed and, more importantly, reduced.” (See, (at p. 28)

5. Eliminating the Itemized Deduction

As mentioned earlier, in 2000, the Internal Revenue Service issued a revenue ruling allowing the expenses for weight control which were recommended by a physician to be deductible as a medical expense. While the scope of this ruling is constrained by the limitation that such expenses must exceed 7.5% of adjusted gross income, it is nevertheless the only federal financial support for treatments for obesity outside of the Medicare coverage of bariatric surgery (which is limited to Medicare elderly and non-elderly disabled populations). As such, it should not be modified or repealed unless Congress mandates the benefit package described above.

6. Taxing Sugar-sweetened beverages

The role of sugar sweetened beverages in the increase of obesity, particularly childhood obesity, has been well documented. The evidence from epidemiological and experimental studies indicates that a greater consumption of sugar sweetened beverages is associated with weight gain and obesity.( See, Malik VS, Schulze MB, Hu FB, Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-88. Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result) Replacing sugar sweetened beverages with water could result in an average reduction of 235 calories per day. ( See, Wang YC, Ludwig DS, Sonneville K, Gortmaker SL, Impact of changes in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med 2009 Apr; 163(4):336-43.Impact of change in sweetened caloric beverage con…[Arch Pediatr Adolesc Med. 2009] – PubMed Result)

The Senate Finance Committee options, however, do not indicate the level of taxation under consideration. Only a significant tax level is likely to affect consumption and its effect on obesity is predicated on the sugar sweetened beverage not being replaced by foods or beverages of similar caloric value. A significant tax, however, is likely to presage decline in consumption over time with an accompanying decline in tax revenue over that time. Therefore, its contribution to financing tax reform would be offset by its value in reducing obesity. As no state or jurisdiction has undertaken this policy option, there is no way of knowing with some certainty whether obesity levels would fall. This may not be a reason not to impose such a tax.

8. Tax on ‘Cadillac Plans’

Also, proposals have been made to treat as income to employee the costs of “Cadillac” health insurance plans, i.e. those that have extensive benefit packages, very low co-payments or deductibles or both. In regard to obesity, probably most of the health insurance plans which now cover surgery, drugs and behavioral modification for persons with obesity would be regarded as such a plan. To tax the employee for these benefits may undo the goals of obesity prevention and reduction. The time has come for employers and payors to provide comprehensive coverage of obesity treatments. Enactment of a tax on the extra costs of such plans is likely to have a negative effect. (See, Swallowing the Cost of Obesity Treatment |

April 21, 2009

Somerville MA tagged as model for health care reform Mass. town takes steps to trim fat (really), health care costs –

March 5, 2009

Obama addresses obesity at close of national health care forum The White House – Press Office – Closing Remarks by the President at White House Forum on Health Reform, followed by Q&A, 3/5/09

Feb 4, 2009

President Obama Signs SCHIP Bill, Includes Childhood Obesity Demonstration Project.

The new SCHIP legislation contains a requirement for the Secretary of HHS in consultation with the Centers for Medicare and Medicaid Services to conduct a “systematic model for reducing childhood obesity.” The model is intended to identify behavioral risk factors for obesity through self-assessment, identify, through self-assessment, needed clinical preventive and screening benefits among children identified as target individuals on the basis or such risk factors and provide ongoing support to such individuals to reduce risk factors and promote use of preventive and screening benefits and “be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services available under Title 19 (Medicaid) or Title 21.

November 30, 2008

CEO’s Talk Up Obesity CEOs’ Healthcare-Reform Priorities: Obesity and Tort Reform, But Not Universal Coverage | BNET Healthcare Blog | BNET

August, 2008

For the first time in history, the two major political parties in the United States recognized the importance of obesity in their respective party platforms

Democratic Party Platform addresses obesity

The Democratic Platform, adopted in Denver, Colorado on 25 August 2008, refers to obesity three times:

“Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar is spent on prevention and public health.” (p 8)

An Emphasis on Prevention and Wellness. Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension.” (p 9)

Public Health and Research. Health and wellness is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce and government at all levels. We will ensure that Americans can benefit from healthy environments that allow them to pursue healthy choices. Additionally, as childhood obesity rates have more than doubled in the last 30 years, we will work to ensure healthy environments in our schools.” (p 10)

A forum on obesity was held by the Obesity Society. The forum at the Democratic National Convention, held on 25 August 2008 at the Denver Art Museum, featured Gary Foster, president, James Hill and Robert Eckel of the University of Colorado, past presidents, and Caroline Apovian with Melody Barnes, Director of Policy for the Obama for President Campaign, and Karen Kornbluh, principal author of the 2008 Democratic Party Platform. Also presenting were Congressman and chairman of the Congressional Black Caucus John Conyers (D-MI-14), Jim Rex, Superintendent of Education in South Carolina and R.T. Rybak, Mayor of Minneapolis, Minnesota. Sally Squires, former columnist for the Washington Post and founder of the Lean Plate Club, moderated the event. Discussions ranged far and wide about expanding treatment and improving prevention of obesity, especially the role of schools in childhood obesity.

The Republican Party Platform, adopted a week later in St Paul, Minnesota, provides:

“Prevent Disease and End the ‘Sick Care’ System. Chronic diseases—in many cases, preventable conditions—are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children.”

On 2 September 2008, The James L. Hill Research Library in St Paul, Minnesota, was the scene of the Republican forum. Speakers included Caroline Apovian, Eric Finkelstein, and Michael Jensen, also a past president of the Society. Allen Levine and Charles Billington (another past president) presented welcoming statements from the University of Minnesota. Lesley Stahl, correspondent on CBS News’ 60 Minutes, moderated a panel consisting of former Secretary of Health and Human Services, Tommy Thompson, representing the campaign of Senator John McCain, former Presidential candidate and Arkansas Governor, Mike Huckabee and State Senator Bob Clegg of New Hampshire. Huckabee enthralled the audience with accounts of trying to get attention to health care issues and obesity in the presidential debates and within his own party. Bob Clegg told his personal story of his fight with obesity and subsequent bariatric surgery. Clegg was the Republican majority leader in the New Hampshire State Senate, and push through the legislature, a bill mandating insurance companies cover bariatric surgery. His personal story combined with the legislative maneuvering was compelling.

Video and transcript of Republican National Convention Forum is available at:

Video and transcript of Democratic National Convention Forum is available at:

The video and transcript of the 19 September 2007 forum on what the next administration should do can be found at: