Obese and overweight patients are just as likely to get recommended preventive medical care as normal-weight patients, and in some cases, treatment of the heavyset is more likely to meet standard guidelines for care, a new study shows.

Previous research has shown that some physicians find it awkward to work with obese patients and have low expectations for success. And heavy patients have reported feeling that doctors are biased and disrespectful because of their extra weight.

To examine whether such attitudes translate into differences in actual practice, researchers at the University of Pennsylvania School of Medicine and the Philadelphia Veterans Affairs Medical Center evaluated the medical care of nearly 70,000 patients. They were Medicare beneficiaries or received care from Veterans Affairs (VA) hospitals.

The scientists compared how likely heavy and normal-weight people were to meet standard guidelines for preventive care, including diabetes care (eye exams, sugar and cholesterol testing), flu vaccines, pneumonia vaccines and screenings for breast, colorectal and cervical cancers.

Among the findings reported in Wednesday’s Journal of the American Medical Association:

•Obese and overweight patients were just as likely to have all those tests and procedures as normal-weight patients in both the Medicare and VA populations.

•Obese and overweight patients were actually more likely to get recommended care on several measures. The largest advantages were seen on cholesterol and sugar testing in obese Medicare patients with diabetes.

“Physicians appear to be doing a good job at preventive care, despite surveys suggesting that physicians have negative attitudes toward obesity and patients’ perceptions that their doctors are biased,” says lead author Virginia Chang, an assistant professor of medicine and sociology at the University of Pennsylvania.

About one-third of adults in the USA are obese, which is roughly 30 or more pounds over a healthy weight, according to government data. Obesity increases the risk of heart disease, diabetes, several types of cancer and other diseases.

“It’s important to ensure that obese patients are getting equitable preventive care, as these services can save lives and reduce costs down the road,” Chang says.

Still, questions remain. “Our findings do not address patients’ satisfaction with their care,” she says. “And these findings may not be true of younger populations where the stigma of obesity may be greater.”

via Obese patients aren’t left out of preventive care – USATODAY.com.

Weve resolved to eat better, lace up the running shoes, shed a few pounds, quit smoking and lead healthier lives.

If we could keep our promises beyond the first weekend of the new year, perhaps our health care system wouldnt be as bloated as it is.

Indeed, some of the responsibility for health care costs sits squarely on the shoulders of consumers who make unhealthy choices – by supersizing meals, quenching thirst with sugar-laden sodas, filling lungs with tobacco and taking a less active role in maintaining their overall fitness.

“As important as health reform is, the real answer in reforming Americas health care system is to empower individuals to make better choices about what we eat and how we live,” said Daniel Zingale, a senior vice president at the California Endowment, a health foundation.

While debate remains in Congress over health care legislation, wellness advocates are hopeful that less controversial provisions promoting healthy living will remain in any bill that reaches the presidents desk.

“As preventable illnesses and injuries are the most significant drivers of increasing health care costs,” the Oakland-based Prevention Institute said in a letter to the White House, “it is essential that we reorient our health care system from an after-the-fact approach to one that focuses on keeping people healthy in the first place.”

The House bill includes $34 billion for a public health investment fund, including $15.4 billion for prevention and wellness programs.

The Senate bill is less generous, providing $15 billion for a prevention and public health fund, some of which could be used for so-called community transformation grants to fund parks and urban trails and to promote access to nutrition.

The Senate bill also would establish a national council that takes a broad approach to drafting a health care strategy that integrates transportation, agriculture, education and employment policies. And it would adopt Californias pioneering law requiring fast-food outlets and chain restaurants to provide nutrition information.

“This is the first time in recent history that community and government strategies will align to help support us in the resolutions we make on New Years Day,” said Larry Cohen, the Prevention Institutes executive director.

Wellness and prevention have been “totally lost in the discussion over the health care bill,” Cohen said, “because its … been recognized by both sides as being worthwhile.”

Wellness programs spread

By 2017, U.S. health care could account for $4.3 trillion in annual spending, or a fifth of every dollar spent in the overall economy, according to the National Coalition on Health Care. Much of that could go to preventable conditions linked to obesity, smoking, diabetes and heart disease.

Indirect and direct costs of smoking are now $193 billion a year, about half spent on medical expenses, according to the U.S. Centers for Disease Control and Prevention.

In 2007, diabetes accounted for $116 billion. In 2009, heart disease was expected to cost the country $305 billion for care services, medication and lost productivity, according to the CDC.

Obesity costs the nation as much as $147 billion annually, according to a government study released in July.

In California, the national symbol for healthy living, one in every four people is now considered obese. In 1985, when the CDC began measuring the nations expanding girth, 9 percent of the states residents were classified as obese.

“Sugar-sweetened beverages are the single-biggest culprit in the obesity epidemic,” said Harold Goldstein, executive director of the Davis-based California Center for Public Health Advocacy.

“The simplest thing people can do is drink water instead of soda. It would save everybody money in these hard economic times … and it would have a dramatic impact on the obesity epidemic.”

For years, experts have preached healthy living to reduce the rates of chronic conditions.

To save on costs and boost productivity, employers and insurers over the years launched wellness programs to promote healthy habits.

via Better habits can help trim bloated health care system – Health, Fitness & Medical News – sacbee.com.

Nearly a decade ago, Dr. David Satcher, 16th surgeon general of the United States, declared that overweight and obesity “have reached epidemic proportions” in the 2001 Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. The evidence base has steadily improved about how to prevent overweight and obesity, as well as how to help people successfully lose weight. Health system reform can and should be based on this evidence of best practices.

Today, by working together in a nonpartisan way we can better inform our political leaders, our communities, our families and ourselves on the critically important need to end the obesity epidemic and how we can accomplish that goal.

We are deeply concerned about the fact that for far too long our nation has turned a blind eye or, worse yet, taken the wrong path in trying to end the epidemic of obesity.

Many of us supersized our meals when we should have downsized them. We often drove our cars to purchase processed food when we could have been getting exercise by taking daily walks or growing our own fresh food.

The nation has begged, educated, scolded and stigmatized people who are obese or overweight — but those countless messages, programs, guidelines and warnings have not ended the epidemic or changed the sedentary lifestyles of the American people.

The burdens caused by the obesity epidemic are unsustainable. Unless we do something now, the cost burden of obesity — currently nearly $150 billion each year — will be an ever-tightening yoke around the neck of future generations of Americans. The emotional burden from stigma bears down on our neighbors and friends every day in the form of an inability to be successful at school, work and in numerous other unseen ways.

In addition to these costs, the actual health burden of obesity is threatening to crush our already tenuous “sick care” system. Obesity accelerates heart disease, type 2 diabetes, some types of cancer, stroke, high blood pressure, breathing issues, sleeping problems and psychological disorders. These are the types of chronic diseases — largely preventable — that cost us 75 cents of every dollar spent on health care today.

Despite the clear harm being done to our nation, current discussions on health system reform are informed more by partisan politics than by evidence and accurate information. Mixing political agendas and public health is counterproductive for the nation and for the individuals who are struggling with weight issues and the associated chronic diseases. Our leaders need to set political aspirations aside and act in the best interest of our nation’s physical, mental, economic and spiritual health.

Health system reform must address the obesity epidemic by incorporating the many practices known to be effective in preventing and reducing the burden obesity places on the nation. We need to promote standardized health and medical treatments that produce effective outcomes. We need to focus on incentives for prevention and reverse the all-too-common progression from being overweight to becoming obese. We need to engage with communities in order to bring what we know from research to what we do in our everyday lives. We also need to make sure researchers continue to find solutions to the many inequities in health related to being overweight or obese.

A lack of clear understanding of this complex health issue, exacerbated by poor health literacy, is a challenge to successfully addressing the obesity epidemic.

For example, we all need to understand that obesity is not a simple matter of personal lifestyle choice. People do not become overweight or obese all on their own. The reality is that their communities may not include safe places to exercise. Their incomes may not allow them to purchase healthy food. Their workplaces may not offer a wellness program. Genetics can also be a reason why some people become overweight or obese more easily than others and struggle unsuccessfully to lose pounds.

A healthy future for America is in peril. Children as young as 10 are now being diagnosed with chronic conditions often related to weight that previously only affected adults, including type 2 diabetes and high blood pressure.

We are at a critical point. At the recent Weight of the Nation Conference in Washington, D.C., our friend and colleague Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, explained that “the average American is now 23 pounds overweight and collectively we are 4.6 billion pounds overweight.”

Dr. Frieden is correct. The data is in and the truth is that we cannot wait any longer. Helping Americans make healthier choices and enjoy a better quality of life can no longer be compromised by political bickering or continued inaction. Instead it must be a national priority.

Dr. David Satcher, director of The Satcher Health Leadership Institute and Center of Excellence on Health Disparities and Poussaint-Satcher-Cosby Chair in Mental Health Morehouse School of Medicine, was U.S. surgeon general from 1998 to 2002. Dr. Richard H. Carmona, president of the Canyon Ranch Institute and distinguished professor at the University of Arizona, was U.S. surgeon general from 2002 to 2006.

via U.S. turns blind eye to obesity as health costs soar  | ajc.com.

JULIE STEENHUYSEN, REUTERS

Obesity-related diseases account for nearly 10 percent of all U.S. medical spending or an estimated $147 billion a year, researchers said on Monday.

They said U.S. obesity rates rose 37 percent between 1998 and 2006, driving an 89 percent increase in spending on treatments for obesity-related diseases such as diabetes, heart disease, arthritis and other conditions.

Obese people spent an extra $1,429 per year or 42 percent more for medical care in 2006 than did normal weight people, with most of that spent on prescription drugs, the researchers said.

The study, published in the journal Health Affairs, was released at the U.S. Centers for Disease Control and Prevention’s Weight of the Nation conference in Washington, where the CDC issued 24 new recommendations on how communities can fight back.

“It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation,” CDC Director Dr. Thomas Frieden said in a statement.

For the study, Eric Finkelstein of the non-profit research institute RTI International and researchers at the CDC and the Agency for Healthcare Research and Quality analyzed national medical cost data from 1998 and 2006.

More than 26 percent of Americans are obese, which means they have a body mass index of 30 or higher. BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall becomes obese at 180 pounds (82 kg).

Finkelstein’s team found obesity accounts for 9.1 percent of all medical spending in the United States, up from 6.5 percent in 1998.

“What we found was the total cost of obesity increased from $74 billion to maybe as high as $147 billion today, so roughly double over that time period,” Finkelstein said in a telephone interview.

Obesity accounts for 8.5 percent of health costs among people on Medicare, the federal program for the elderly and disabled, and 11.8 percent of costs from Medicaid, the joint state-federal program for the poor.

An obese Medicare beneficiary spends an $600 more per year on drug costs than a normal weight person on Medicare, the team found.

“One of the big drivers is diabetes, which has been estimated to cost as much as $180 billion per year. There is evidence that most of the diabetes in the U.S. is caused by excess weight,” Finkelstein said.

To address these issues, the CDC has devised 24 obesity prevention strategies being tested in Minnesota and Massachusetts.

They aim to address issues in the environment — lack of access to healthy food in poor neighborhoods and sedentary lifestyles — that contribute to the nation’s weight problem.

“All of these factors just make it easier to be overweight and harder to be thin,” Finkelstein said.

via Obesity costs US health system $147 billion: Study .

Whatever Washington does this year to try to lower medical spending almost certainly will be swamped by the nation’s rising weight. Obesity lurks as a cause behind the top chronic illnesses — heart disease, diabetes, stroke and colon, breast and prostate cancers, among many others. Treatment of each individual case routinely cost hundreds of thousands of dollars.

As recently as 1985, less than 10 percent of New York adults were obese; now nearly a quarter are.

Every third child born in 2000 is likely to wind up diabetic. Obesity strikes hardest at the poor and minorities; black women are nearly 40 percent more likely to contract heart disease than white women. Fifty-nine percent of New York adults are overweight or obese.

Obesity is causing “death and illness on a massive scale,” according to a new study by University of Virginia and Urban Institute researchers.

Obesity is all but impossible to treat.

“Rising obesity rates are increasing health care expenditures per person in a way that is going to be very difficult to finance,” said Jay Bhattacharya, a doctor and health economist at Stanford University’s Center for Primary Care and Outcomes Research. “Unless there is some vast improvement in the efficiency of the health care system — and I mean vast — we’re going to be spending a lot more just because a lot more people will have diabetes” and other obesity-related diseases.

Prevention is the only cure. Yet while health care legislation in Congress would raise spending on prevention of chronic disease, it does little to tackle the underlying obesity epidemic directly; in fact, most of the bills are silent on what many contend would be one of the most effective weapons: a tax on soda.

Junk food taxes are part of a growing consensus among public health experts to adapt the successful fight against tobacco to the more complex obesity epidemic.

New York City and four counties — Westchester, Rockland, Ulster and Suffolk — require menus to be labeled with nutrition information in restaurants because of legislative changes. Albany County passed a law Aug. 10 to require menu labeling.

Still, the struggle remains for small gains against a barrage of junk food marketing, sedentary lifestyles, cheap food economics and perverse federal farm and transportation policies.

Many efforts to reduce obesity are focused on the youngest New Yorkers. Sen. Kirsten Gillibrand, D-N.Y., and New York City Council Speaker Christine Quinn announced a joint effort Aug. 12 to improve nutrition in-state and around the country.

Gillibrand plans to introduce the Lowering Urban Nutrition Costs for Healthy Eating at Schools Act to make free and nutritious meals more accessible to students. Also, the city council is organizing urban leaders from across the country to help lobby Congress for improvements to the Child Nutrition Act.

“As Congress debates how to improve health care access and lower health care costs, we must also pursue a strategy to tackle childhood obesity and improve the health of our future generations,” Gillibrand said.

Read more:  Health reform’s biggest threat: expanding waist lines — Page 1 — Times Union – Albany NY:3097:.

The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children.

Objective: To model the health benefits and cost-effectiveness of banning television (TV) advertisements in Australia for energy-dense, nutrient-poor food and beverages during children’s peak viewing times.Methods:Benefits were modelled as changes in body mass index (BMI) and disability-adjusted life years (DALYs) saved. Intervention costs (AUD$) were compared with future health-care cost offsets from reduced prevalence of obesity-related health conditions.

Changes in BMI were assumed to be maintained through to adulthood. The comparator was current practice, the reference year was 2001, and the discount rate for costs and benefits was 3%. The impact of the withdrawal of non-core food and beverage advertisements on children’s actual food consumption was drawn from the best available evidence (a randomized controlled trial of advertisement exposure and food consumption). Supporting evidence was found in ecological relationships between TV advertising and childhood obesity, and from the effects of marketing bans on other products.

A Working Group of stakeholders provided input into decisions surrounding the modelling assumptions and second-stage filters of ‘strength of evidence’, ‘equity’, ‘acceptability to stakeholders’, ‘feasibility of implementation’, ‘sustainability’ and ‘side-effects’.Results:The intervention had a gross incremental cost-effectiveness ratio of AUD$ 3.70 (95% uncertainty interval (UI) $2.40, $7.70) per DALY. Total DALYs saved were 37 000 (95% UI 16 000, 59 000). When the present value of potential savings in future health-care costs was considered (AUD$ 300m (95% UI $130m, $480m), the intervention was ‘dominant’, because it resulted in both a health gain and a cost offset compared with current practice.

Conclusions:Although recognizing the limitations of the available evidence, restricting TV food advertising to children would be one of the most cost-effective population-based interventions available to governments today. Despite its economic credentials from a public health perspective, the initiative is strongly opposed by food and advertising industries and is under review by the current Australian government.International Journal of Obesity advance online publication, 4 August 2009;

via The cost-effectiveness of removing television adve…[Int J Obes (Lond). 2009] – PubMed Result .

The extra medical costs that severely overweight people add to health care spending are ballooning, a new study shows.

While Congress works with President Obama to reform health care, the question of what to do about the obesity epidemic in our country should be front and center in the debate. As the study by RTI International documents, as much as $147 billion every year is spent on obesity-related ailments and conditions.

Just over 10 years ago, medical spending related to obesity was $78.5 billion. Now that’s super-sizing.

“There is an undeniable link between rising rates of obesity and rising medical spending,” the RTI report says.

If we’re going to reduce health care costs, we have to get serious about taking better care of ourselves.

Roughly half of medical spending on obesity’s ills, such as heart disease and diabetes, is spent by taxpayer-funded Medicaid and Medicare. But private insurance is equally burdened by obesity costs.

Across all payers, public and private, RTI found, the average cost per person is $1,429 higher for the obese than for the average weight person. That’s 42 percent more spending per person. Only 10 years ago, the extra per-person cost was several hundred dollars less.

Across all payers, RTI found, the percentage of total spending related to obesity treatments was 6.5 percent in 1998, and 9.1 percent in 2008.

Complicating the problem, there is no simple medical way to treat obesity. Surgery and medications play a minuscule role in reducing the problem. Prevention programs and personal accountability are necessary.

In our technologically advanced nation, it is far too easy for even the very young among us to exercise little or not at all. Obesity is a huge problem among children.

But, so far, prevention programs have largely failed. Though national, state and local efforts to address obesity have been in place, obesity rates have grown 37 percent since 1998, according to RTI.

Still, we ought to continue to promote awareness throughout our communities about the benefits of regular aerobic exercise and the kinds of foods that constitute a healthy diet.

Schools also need to continue or bolster their health education programs — even with declining budgets and accountability standards to worry about. And there must be time for recess.

Off and on during the health care reform debate, the idea has been floated to offset costs by charging a sin tax on sugary drinks and salty, fatty foods. While we think such a tax is a dangerous road to start down, consumers should take note that RTI’s findings will only encourage some lawmakers to take that kind of action.

The RTI study suggests prevention can work, even if programs so far haven’t stemmed the epidemic. Lawmakers ought to seek out prevention and education programs that have a proven track record, and support their use more broadly.

Bulging waists creating waste – The Denver Post.

Medical spending on obesity-related conditions is estimated to have reached $147 billion a year in 2008, according to the new study, published online on Monday in the journal Health Affairs. That figure represents almost 10 percent of all medical spending, the study found.

Obese Americans spend about $1,429 more on health care each year than the roughly $3,400 spent by normal-weight Americans.

Most of the excess spending is for prescription drugs needed to manage obesity-related conditions, said Eric A. Finkelstein, one of the study’s authors and the director of the public health economics program at the Research Triangle Institute, a nonprofit research organization.

The results were presented on Monday at the first Weight of the Nation conference, which was held in Washington by officials at the Centers for Disease Control and Prevention.

“Obesity, and with it diabetes, are the only major health problems that are getting worse in this country, and they’re getting worse rapidly,” Dr. Thomas R. Frieden, director of the C.D.C., said.

The average American consumes 250 more calories per day than just two decades ago, Dr. Frieden noted, and the rising obesity rate is the single greatest contributor to a national epidemic of diabetes.

via Obese Americans Spend Far More on Health Care – NYTimes.com.