September 8, 2011, Los Angeles Times, Jeannine Stein
Medicare could save billions of dollars if people who were pre-diabetic or at risk for cardiovascular disease took part in community-based weight-loss programs, a study finds.
Researchers projected cost savings for the government healthcare program if millions of people in the U.S. age 60 to 64 participated in a program that helped them lose weight and gain more healthful lifestyle habits. They based their findings on an existing YMCA diabetes prevention program that is, as of this year, at 50 facilities in 24 states. In a study of a similar program, participants lost an average 7% of their body weight and maintained that over 2.8 years. The prevalence of diabetes went down 71% among people age 60 and older.
Their projection was based on a scenario in which the program would roll out across the country and target adults age 60 to 64–those not eligible for Medicare yet–who are pre-diabetic, with a body mass index greater than 24 (considered overweight or obese), and who show risk factors for cardiovascular disease. Under the proposal, funding would come from the Centers for Disease Control and Prevention’s National Diabetes Prevention Program and the Prevention and Public Health Trust Fund. Both were established by the Affordable Care Act.
The study authors estimated Medicare savings over a 10-year period as well as for a person’s lifetime, and based them on two participation rates from results of a pilot study: one in which 70% of people took part, and one in which 55% of people took part.
If 70% of eligible people age 60 to 64 with a BMI of 24 or higher enrolled, the program would cost $590 million. But that would also mean a net savings of $2.3 billion to Medicare over 10 years and a net lifetime savings of $9.3 billion. At the 55% participation rate, the net savings would be $1.8 billion over 10 years and $7.3 billion over participants’ lifetime.
Include overweight and obese people who also have the cardiovascular disease markers of high blood pressure and high cholesterol (even if they’re not pre-diabetic) and that would add an additional $1.4 billion in savings over 10 years and an extra $5.8 billion in lifetime savings, with 70% enrollment. With 55% participation there would be a net savings of $1.2 billion over 10 years and $4.6 billion in lifetime savings.
“Diabetes is expensive to treat,” says Kenneth Thorpe, a professor at Emory University, in a news release. Thorpe, lead author of the study that was released Thursday in the journal Health Affairs, added, “Most of the growth in health care spending is linked to rising rates of diabetes, cholesterol, and high blood pressure–all conditions that weight loss can help reduce. Why not shift the focus to keeping people healthy?”
via Enrolling in weight-loss programs could save Medicare billions – latimes.com.
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June 23, 2011, Bloomberg News, Oliver Renick
Newly diagnosed cancer cases cost the global economy $300 billion in 2010, as illnesses once believed to be largely confined to wealthier countries took hold in developing nations, a Harvard University economist said.
Tobacco use, alcohol intake, obesity and decreased physical activity have grown in poorer countries, causing the rise of cancer and diabetes, said David E. Bloom, professor of economics and demography at Harvard’s School of Public Health in Boston. Bloom and other researchers held a briefing today in advance of the United Nations High Level Meeting on noncommunicable diseases.
The Sept. 19-20 meeting will be the first gathering of the UN Assembly dealing with cancer, cardiovascular illness, chronic lung conditions and diabetes. These diseases cause 60 percent of deaths worldwide, killing 36.1 million people annually, according to an April report by the World Health Organization.
“Noncommunicable diseases will evolve into a staggering economic burden in the coming years,” Bloom said. “It’s a huge impediment to the mitigation of poverty.”
Bloom said treating newly diagnosed cancer cases cost $300 billion globally in 2010, and obstructive pulmonary disease — often correlated with smoking tobacco — costs $400 billion a year.
Not Confined to Health
“Economic policy makers like ministers of finance and ministers of planning see noncommunicable diseases as an issue confined to the health sector,” a misperception that needs to be addressed, Bloom said. “Dangers of NCDs are well-ensconced in the business screen of the world community,” he said.
The global decline in productivity due to illness and deaths from noncommunicable diseases will reach $35 trillion by 2030, Bloom said, an amount seven times larger than the current level of global health spending. Noncommunicable diseases undermine physical and human capital, as losses of labor put a burden on developing countries, he said.
“The main asset the poor possess is their labor, and that is the most threatened by the noncommunicable diseases,” Bloom said.
Cary Adams, chief executive officer of the Union for International Cancer Control, said people in poorer countries were “getting fatter, lazier, smoking too much tobacco, and eating unhealthy food.”
“It is the poorest people in the poorest nations that suffer the most,” said John Seffrin, CEO of the American Cancer Society, at the briefing.
Poverty Cycle
Seffrin said more than 80 percent of noncommunicable diseases occur in low and middle-income countries. “Noncommunicable diseases perpetuate the poverty cycle,” he said.
The estimate of the costs of noncommunicable diseases includes medical care, transportation, information and education campaigns, and productivity losses from those who die, Bloom said. Of 14,000 business executives surveyed worldwide, he said half believed that noncommunicable diseases would have a negative impact on their bottom line.
“Think about health spending as not consumption but investment,” said Bloom. “As investment that yields a handsome rate of return.”
“This is a moral issue,” Seffrin said. “Unlike other health problems in the past, we know what’s coming.”
via Global Rise in Cancer Cost $300 Billion in 2010, Harvard Economist Says – Bloomberg.
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June 20, 2011, Financial, Nina Burjanadze
After having two children 41 year old Marekhi Papuashvili started to put on weight and subsequently lost her job position. Marekhi faced an obesity problem that dramatically changed her life for the worse.
“I spent most of my time at home and didn’t even want to go out. I simply lost the joy of living,” said Papuashvili.
In Georgia people with obesity problems face unemployment more often than others. Their rights are quite limited in terms of employment, career development and social status. Employers always avoid talking about this “trend” at their companies, but the fact is that you rarely find overweight people among front desk personnel and services personnel.
“There are certain professions like model, sportsman or fireman for whom stable weight control is essential. If they put on weight they will be fired immediately,” said Endocrinologist Elene Giorgadze.
We looked at the current vacancies announced by the leading companies in Georgia, “Good Looking” is always included in the paragraph of requirements.
As Papulashvili explained, complaints and remarks about her appearance from family members were nothing more than additional stress. The stress consequently increased her feelings of hunger and so she consistently continued to put on weight.
“I needed a stimulus to lose weight rather than the comments I received which only succeeded in negatively affecting me. Somehow they caused an internal protest within me. I was sure I could become slimmer, but I didn’t want to anymore,” added Papuashvili.
After Marekhi noticed that the seat in the minibus she used had become too small for her, she completely lost the will to go out anymore.
“Then my husband forced me to come to Bormental. I know now that nothing is impossible and my emotions at the time were possibly wrong. Anyone can lose weight if they learn how to manage their emotions and sense of hunger,” Papuashvili said.
Weight-based discrimination consistently affects every aspect of employment, from hiring to firing, promotions, pay allocation, career counselling and discipline, according to Roehling’s work.
“The bias appears to be most prominent during the hiring process, when an employer knows a potential employee the least and therefore is most likely to be influenced by stereotypes (such as fat people are lazy), says Cort Rudolph, a Wayne State University researcher. The bulk of research has also shown that the bias tends to be felt most by overweight white women,” reported Forbes magazine.
Corresponding to the report of Forbes magazine obesity tends to be more dramatic for women in Georgia than for men. 22 year old Tazo Kupreishvili is a young journalist who weighs almost 120 kilos. He can’t remember any discriminative facts or issues he has had to overcome due to his weight. Tazo feels absolutely happy with his appearance and doesn’t plan to go on any diets or visit any endocrinologist for the purpose of losing weight.
As he added, he went on a diet 3-4 years ago because of the pleas of his family members. The only problem Tazo has experienced from the extra kilos he carries is connected with clothes.
“Mostly my taste in clothing is made for slimmer men. Except for this, I can’t see how my weight might be damaging my private and professional lives,” said Kupreishvili.
Kakha Bendukidze, former State Minister and Minister of the Economy is one of the wealthiest and most successful businessman in the country these days despite his sizeable girth.
Natia Chkheidze, 31, considers obesity the main reason for her depression. In the past she was among a number of people suffering from obesity.
“I lost my self-confidence,” noted Chkheidze.” My husband was happy as I was spending more time at home.”
Endocrinologists Elene Giorgadze said that in recent times the number of her overweight patients has significantly grown. The explanation for their increase is the pandemic growth of obese people all over the world. The prevalence of young female patients is evident Giorgadze claims. Although a number of men are included in her patients as well.
80% of Bormental patients are also women. A significant growth of patients is obvious in the spring. As psychologist of Bormental Tamta Lapachi explained the centre offers a psychological method of weight loss.
“During the four day long psycho-therapeutic course our patients learn how to distinguish hunger from appetite,” explained Lapachi. “Frequently overweight people pretend that they don’t eat much. Nobody puts on weight without eating and getting unnecessary calories. It causes digestive disorders and a person permanently puts on weight. We train our patients to withdraw their appetites.”
Endocrinologist Giorgadze claims that wilful diets can damage the health and psyche of an individual. The correct definition of a diet is a physiological process, which means getting the right nourishment.
via The FINANCIAL – How being Overweight can Affect Your Career.
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Los Angeles Times, Lily Kuo, October 31, 2010
Reporting from Beijing — Tian Ning shuffled unsteadily across his room at a weight loss clinic in Beijing, not exactly looking like the picture of health, but triumphant nonetheless.
In six months, Tian has gone from the unglamorous subject of a reality intervention television show called “Tian Weighs 462 Pounds, Beijing’s Fattest Man,” to a man eagerly approaching his ideal weight of 220. His meals are monitored and a machine jiggles his midsection for an hour of exercise each day at the Kelikexin International Weight Loss Club. For a bit of extra exercise, he goes for walks by himself.
“When I get down to [220 pounds], I’ll be ready to go home,” the 29-year-old Beijing resident said recently. “I can live a normal life.”
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To Tian, his progress represents a new lease on life — one he hopes will include a job in computer programming and a happy marriage — as long as he can control himself in a city where inexpensive, unhealthy food abounds and exercise is not part of the daily lifestyle.
Throughout China, but especially in cities such as Beijing, Shanghai and Tianjin, the ongoing fight against growing waistlines has developed a few new wrinkles. Diet fads and weight loss centers are on the rise as the traditional Chinese diet of vegetables and rice in many cases has been expanded, adding meat, oil and plenty of sugary snacks and drinks available at fast food chains and neighborhood shops dotting city corners.
Experts say reasons for the weight gain other than lousy eating habits include poor city planning — the dearth of green space and parks in Chinese cities — and general attitudes toward exercise and leisure. Bicycling, a key way for many Chinese to remain lean, is out of fashion.
An estimated 200 million Chinese adults are considered overweight and of those about 75 million are heavy enough to be categorized as obese, according to health experts. While not as severe a problem as in the United States, where estimates place more than 60% of adults as overweight or obese, experts say China increasingly faces a population coping with heart disease, diabetes and other weight-related illnesses.
Drugs, treatment and access to good doctors are expensive and beyond the reach of average Chinese. The government is spending $125 billion to revamp the health system to cover all Chinese citizens by 2020, but the plan is not expected to cover common diseases associated with weight.
Chen Chunming, who leads research teams at the Chinese Center for Disease Control and Prevention, an agency of the Ministry of Health, said government officials have initiated efforts to address the health risks.
“The government understands that if the situation is not controlled it can get serious,” Chen said. “We’ve already started to pay attention to the issue of obesity and overweight so we’re not pessimistic about the future.”
In Beijing, the city critics have called China’s fattest, the municipal government last year announced a campaign called “Healthy Beijinger: A 10-year Plan to Improve People’s Health.”
The campaign is aimed at overall health but one of its specific goals is reducing the amount of fat Chinese adults eat each day. Officials hope to reduce the number of overweight children in high school and primary schools from 17% to 15% by 2018.
The initiative has included sending informational nutrition pamphlets as well as 600,000 tape measures to schools with instructions from the Beijing Municipal Commission of Education that students should measure their parents’ as well as their own waistlines and endeavor to lose weight over the Chinese New Year holiday.
For employees of state-owned companies, communist-style group exercise, or “radio calisthenics,” were brought back in August and will become mandatory sometime in 2011. The Beijing Federation of Trade Unions has hired 5,000 instructors to teach employees how to maximize the eight-minute exercise routine.
Higher incomes have meant more people are eating rich, high-caloric diets and following sedentary lifestyles, a scenario that has also translated into a thriving weight loss industry. The weight loss center that hosted Tian for free, for example, has expanded to 1,000 locations across the country since it opened in 1993.
But the ongoing growth of China’s economy — and a quest for the good life — is bound to continue influencing how the population responds to calls for healthy eating and fitness, said Paul French, co-author of the recent book, “Fat China: How Expanding Waistlines are Changing a Nation.”
“The idea of going and mucking around in your garden, that’s like being a peasant,” French said. “Why would you ride a bicycle when you can drive a car? Luxury is idleness.”
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The Huffington Post, Craig Cooper, September 22, 2010
Approximately 1.6 billion adults are now considered overweight by the World Health Organization with at least 400 million considered obese (1). Most of these adults live in the United States with 30 percent of Americans now considered obese. Blacks have a 51 percent higher prevalence of obesity, and Hispanics have a 21 percent higher obesity prevalence compared with whites (2). That’s an enormous number any way you look at it.
And with excess weight comes an excess of problems which have a snowball effect on productivity and the health of the nation. For example, joint pain and arthritis is the number one contributor to days lost in the workforce with excess weight being one of the most significant risk factors for osteoarthritis of the knee and inflammatory disease.
It’s trite to say that America needs to become a healthy nation (financially and physically) and this involves a massive shift in lifestyle and habits. Unfortunately, in the recession, more people are forced to choose less healthy foods because being healthy and maintaining your weight is expensive, whether it be through eating better foods or paying for a gym membership. Sure you can just go for a run and all you need is shoes and running gear but a focused weight loss and management program involves more than just exercise; it’s a total lifestyle plan.
And when times are tough, it’s hard to shop at Whole Foods and justify organic and non-processed food purchases and it’s also hard to commit to a wellness plan when you are trying to pay the bills and avoid foreclosure.
But the costs of not doing so are even greater and everybody ends up paying.
Consider the following:
- In 2006, 9.1 percent of total U.S. medical expenses were as a result of obesity, compared with 6.5 percent in 1998 (3).
- The total costs associated with obesity in the U.S. are at least $215 billion (4).
- An obese individual spends $1,429 more per year on medical costs (42 percent more) than a person of normal weight (5).
If current trends continue, 110 million Americans will be obese by 2018 with $344 billion in health care costs being attributed to obesity in 2018. That’s only eight years away!
And there are the further indirect costs due to inflammatory disease such as diabetes, cancer, heart disease etc, all with strong associated markers to obesity. Take diabetes for example. Being overweight or obese is a major risk factor for type 2 diabetes and diet and exercise are considered two of the major lifestyle changes you can make to decrease the risk of getting this disease. The prevailing belief about the cause of type 1 diabetes is that although someone may have a genetic predisposition for developing type 1 diabetes, it takes an environmental trigger or series of triggers (e.g., virus, toxins, drugs) to set the autoimmune process in motion. Maintaining a healthy diet, exercise and a strong immune system is therefore vital to decrease the risk factors.
New research was also recently presented at the American Heart Association’s Cardiovascular Disease Epidemiology and Prevention annual conference in San Francisco which showed that over the last decade, soda consumption has conservatively caused:
- 130,000 new cases of diabetes; and
- 14,000 new cases of heart disease (6)
130,000 diabetes cases from soda! If you are concerned about your diabetes risk, here is a risk assessment test. If you know your risk, you can help lower it by eating nutritious meals and staying active.
In the next 25 years, the number of Americans living with diabetes will nearly double, increasing from 23.7 million in 2009 to 44.1 million in 2034. Over the same period, spending on diabetes will almost triple, rising from $113 billion to $336 billion, even with no increase in the prevalence of obesity, researchers based at the University of Chicago report in the December issue of Diabetes Care (7).
The number of those with diabetes covered by Medicare will rise from 8.2 million to 14.6 million, the researchers predict. Medicare spending on diabetes will jump from $45 billion to $171 billion. “If we don’t change our diet and exercise habits or find new, more effective and less expensive ways to prevent and treat diabetes, we will find ourselves in a lot of trouble as a population,” said the study’s lead author Elbert Huang, MD, assistant professor of medicine at the University of Chicago.
So yes, it takes effort and commitment to be healthy, but the costs of not doing so are worn by all at the end of the day. And its getting worse not better and our kids will bear the burden. So put down the soda, get off the couch and get your body moving. And resist the temptation at the Golden Arches. Rich nations do not live any longer than those that are less economically powerful, in fact the opposite is true. Simple lifestyles and simple eating have been shown to lead to the greatest longevity. And it doesn’t take that much to eat like a Greek!
And remember, you are also the best role model for your children’s habits. If you eat well and lead a healthy lifestyle, chances they will also.
]]>The Washington Post, Sandra g. Boodman, September 21, 2010
Although obesity is a major public health problem – two-thirds of American adults are overweight or obese — “there’s relatively little coverage” for treatment of the condition, said Jeffrey Levi, executive director of Trust for America’s Health, a nonprofit Washington-based research group with expertise in obesity policy.
Lee and her colleagues reported in a recent study that many states allow insurers to charge obese patients higher premiums or deny coverage of the condition altogether. They also found that only a handful mandate coverage for any of the three evidence-based treatment methods: bariatric surgery, medications, and nutritional assessment and behavioral counseling, which are classified as lifestyle measures.
Many doctors, Lee observes, fail to even discuss weight with their patients. One-third of obese adults have never received advice about exercise from their doctors or been told they weigh too much, according to the federal Agency for Healthcare Research and Quality.
That may be about to change. Provisions of the new health-care overhaul law that take effect Thursday will require insurers to cover preventive services recommended by theU.S. Preventive Services Task Force, a group of experts that assesses the effectiveness of preventive care. Although obesity screening and intensive behavioral counseling by physicians will be covered without cost sharing, the frequency and duration of those sessions has not been established. Many plans won’t be affected immediately because their old coverage provisions will remain in place if the plans meet certain criteria.
Some public health advocates predict this inclusion will make it easier for consumers to access obesity treatment, although other coverage details of the new law won’t be known for months, and some provisions don’t kick in until 2014.
The law also contains public health initiatives aimed at changing behavior, such as the requirement that food sold by chain restaurants with 20 locations and vending machines bear nutrition labels with calorie counts.
But, experts caution, the legislation does not guarantee treatment or payment for gym memberships, special meals or therapy. An advisory board will make recommendations to the secretary of health and human services about payment for bariatric surgery and obesity drugs, which have demonstrated modest success but in some cases have raised concern about serious side effects; comparative effectiveness research will guide other coverage decisions.
“It’s more than what we’ve got now,” said Morgan Downey, a lawyer and former chief executive of the American Obesity Association, who closely tracks federal regulations as publisher of the Downey Obesity Report. “Globally, health reform has a number of opportunities to expand insurance coverage for obesity.” For decades, he said, “there’s been this nihilism about treating obesity, an assumption that nothing’s going to work.”
Small losses, big benefits
That pessimism and spotty coverage, some experts contend, reflect moralistic judgments, the paucity of effective lifestyle treatments, and concerns about the financial implications.
“I think the cost of offering treatment to this many people is a big part of it,” said weight-loss researcher Adam Gilden Tsai, an assistant professor of medicine at the University of Colorado in Denver.
“Obesity has been regarded not as a disease worth treating but as a character flaw,” said Walter Lindstrom, a California lawyer who represents severely obese patients seeking weight-loss operations.
While some insurers explicitly exclude bariatric surgery, Lindstrom said, a growing number are following Medicare’s example and covering it, after studies documented its safety and effectiveness. But such operations are suitable only for a small subset of patients who are classified as morbidly obese and for whom nothing else has worked.
Surgery may be the most drastic treatment, but it is also the most well-studied and arguably the most effective. Johns Hopkins researchers reported last month in theArchives of Surgery that nearly 85 percent of 2,235 adults who underwent gastric bypass between 2002 and 2005 were able to stop taking drugs for Type 2 diabetes two years after the operation. Previous studies have reported similar results for a variety of weight-related conditions, including high blood pressure.
Even relatively small reductions in weight can have big benefits. Tsai said that researchers typically define success as a 5 to 10 percent weight loss over a period of three to six months, maintained for at least a year. That amount, according to the Centers for Disease Control and Prevention, can improve blood pressure, blood sugar and cholesterol levels.
Spurred by research showing that lifestyle treatment can be beneficial, some insurers are ramping up coverage. UnitedHealth Group recently launched a program, available at no extra cost in some employer-sponsored plans, that will pay health coaches at YMCAs to work with patients at high risk of Type 2 diabetes by helping them lose moderate amounts of weight. The program is modeled after the landmark Diabetes Prevention Program sponsored by the National Institutes of Health, which was replicated at YMCAs in Indianapolis. Researchers found that regular exercise and modest weight loss sharply reduced the risk of developing diabetes — more than medication did — a benefit that has persisted for more than a decade.
BlueCross BlueShield of North Carolina has expanded its Healthy Lifestyle Choices program, launched five years ago, to more than 1 million members. The program covers up to four visits with a physician that focus only on weight loss and a maximum of six visits with a nutritionist annually, as well as the use of obesity drugs, which the insurance company’s chief medical officer, Don Bradley, said are little-used, in part because of concerns about their side effects.
“We knew there wasn’t a lot shown to be effective [in 2005], but we knew we couldn’t do nothing,” said Bradley, after data revealed that overweight and obese members cost the plan 18 percent and 32 percent more, respectively, than their normal-weight counterparts. Of the 100,000 participants, 17 percent achieved a 5 percent weight loss and kept it off for at least six months, while 6 percent reached a normal weight. The average loss was about seven pounds.
“It’s really a matter of baby steps over time,” Bradley said. While the program hasn’t saved the plan money, “we are seeing moderating trends in overall costs.”
Misconduct or chemistry?
Physician Arthur Frank, founder and co-director of the GWU Weight Management Program, says the demand for proof that programs like his work is often used by insurers as a smokescreen to deny payment. “They can’t demonstrate efficacy in the treatment of Alzheimer’s disease or pancreatic cancer or even the common cold,” he said, “but insurance pays for those.”
Frank says the lack of insurance coverage is predicated on the view that nonsurgical treatment rarely works and that obesity is a matter of “personal misconduct,” not faulty neurochemistry.
“It can be done,” he said. “We view obesity as a disease that needs careful management, much like diabetes.”
He has not published results because his is not a “reproducible model,” Frank said, adding that 45 percent of about 200 GWU patients have come within 10 percent of their goal weight, although some of them remain obese. Case in point: a 300-pound woman who once needed a wheelchair but lost 110 pounds and can now walk.
Frank is skeptical much will change, because the new law fails to specify the treatments insurers must cover and focuses more on public health measures.
But Jeff Levi of Trust for America’s Health is more optimistic. He sees parallels to an earlier epidemic. “I think we are sort of at that cusp,” he said, where smoking was 30 years ago.
With insurers slow to cover obesity treatment, patients often must foot the bill.
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WHEN I stock up on ibuprofen (my painkiller of choice), I typically buy a 500-count bottle of a store brand like Kirkland or Rite Aid. After all, ibuprofen is ibuprofen. Each pill costs me about 3 cents — or only one-third the cost of 9-cent Advil.
Yet, when it comes to vitamins — which I take only when I feel run down — I turn to name brands like Centrum or Nature Made. My thinking has been: Why mess around with quality when it comes to the essential ABCs?
But now that I’ve done some research, I might soon change my vitamin-buying ways. Read on to find out why.
Americans love vitamins. About half of adults take a daily multivitamin, according to industry data. And according to some theories, the economic downturn has inspired them to fortify themselves by swallowing more.
Sales over the last decade had been growing by about 4 percent annually. But this year, as more people are taking their health into their own hands, perhaps hoping to stave off doctor bills, vitamin sales are expected to grow by 8 percent to a total of $9.2 billion, according to Nutrition Business Journal, a market researcher and publisher.
About 42 percent of shoppers purchase their vitamins at natural and specialty retail outlets, like GNC and Whole Foods, according to the journal, while only 23 percent take the discount approach and buy their bottles at supermarkets and club stores. The other 35 percent buy through mail order or from a health care provider.
Of course, it’s controversial whether we should be taking vitamins at all. Recent studies have indicated that taking a multivitamin won’t protect you from heart disease or cancer. And experts maintain that if you eat well, you don’t need vitamin supplements.
“The evidence shows that a healthy diet and exercise are the best way to ward off disease; a vitamin cannot replace those benefits,” says Eric Rimm, associate professor of epidemiology and nutrition at the Harvard School of Public Health.
But what if you don’t eat well or are chronically stressed out? Then, Professor Rimm says, there may be some benefit from taking a multivitamin. “Certain subgroups, including women of child-bearing age attempting to get pregnant, may need specific supplements, like folic acid and omega-3,” he added.
As for the matter of cost: If you take only a daily multivitamin mainly as a medicalinsurance policy, it certainly won’t hurt your health — as long as you do not already eat a lot of fortified food. And it could help. But it will require spending some money. And if you take a multivitamin and a few individual vitamins and minerals, it’s even more worth your while to make sure you’re not paying more than you need to.
Here’s how to get the most vitamin for the least money.
USE ONLY WHAT YOU NEED Popping too many vitamin pills is not only a waste of money but can be bad for your health. Talk to your doctor about what added vitamins or minerals you might require; you can ask for a blood test to learn what you might be lacking.
For example, if you don’t get enough vitamin D — many people who live in the northern states or who wear sunscreen everyday are low on this crucial vitamin — then buy just a D supplement. Standard multivitamins will probably not have the levels of D you require (many doctors suggest taking 1,000 to 2,000 international units a day).
If your doctor recommends a specific supplement, like omega-3, ask in what form you should be taking it.
FIND A REPUTABLE SOURCE Vitamins and minerals are commodity items, and every manufacturer has access to the same ingredients. For that reason, researchers and scientists say paying more for a name brand won’t necessarily buy you better vitamins.
“When we measure levels of vitamins in the blood, we find the levels are the same whether the person was taking a generic brand or a name brand,” says Dr. Rimm, who has been studying the effects of vitamins for 20 years.
That said, don’t be too cheap. Purchase your vitamins from well-known retailers that do a brisk business and restock frequently, whether that’s Costco or Drugstore.com. Vitamins lose their potency over time and must be stored at, or below, room temperature. If bottles are sitting on a shelf in warm room or in direct sunlight, they may degrade even before their expiration date.
PRICE MAY NOT MEAN QUALITY While the Food and Drug Administrationregulates vitamins as part of the nutritional supplement industry, it does not test them before they are put on the shelves. The F.D.A. places the responsibility on the manufacturer to ensure that its dietary supplement products are safe before they are marketed. All of which means that no matter what the price, quality is not assured.
ConsumerLab.com, a company based in White Plains that tests hundreds of vitamins each year, finds that 30 percent of multivitamins have a quality problem: the pills might have more or less of a stated ingredient, or they might not dissolve properly.
“We haven’t found any brand with a broad product line that makes every product well,” says Dr. Tod Cooperman, president of the company.
Taking exception to such assertions is the vitamin industry’s trade group, the Council for Responsible Nutrition. In response to questions, the council released a statement from Andrew Shao, a vice president for scientific and regulatory affairs.
Mr. Shao said that the F.D.A. allowed for “a reasonable amount of variation” — which he characterized as up to 15 percent more of an ingredient than the label might indicate. Mr. Shao said that manufacturers frequently add slightly more of an ingredient to ensure that the amount is at least at the level claimed on the label as the product nears the end of its shelf life.
In any case, ConsumerLab.com says it has found a few patterns that consumers may find helpful. Products sold by vitamin chains tend to be more reliable than drugstore brands, and Wal-Mart and Costco’s vitamin lines are usually worth considering. In a recent test of multivitamins, ConsumerLab.com found that Equate-Mature Multivitamin 50+ sold by Wal-Mart was just as good as the name brand Centrum Silver, but at less than a nickel a day is half the price.
Puritan’s Pride, a catalog and online retailer, also has very good prices, and Dr. Cooperman says that its products are generally good.
Curious consumers can subscribe to ConsumerLab.com for $30 a year and learn how other supplement brands fare in the lab’s tests.
CERTIFICATION SYMBOLS One quality check you can make, although it is not a perfect screening, is to see whether a product is certified by one of several nonprofit organizations that check supplements for purity and quality.
The two most commonly used groups are the United States Pharmacopeia (www.usp.org) and NSF International (www.nsf.org), according to Mr. Shao. Manufacturers voluntarily submit a product for review and, if it passes, the product can bear an approval seal, such as USP or NSF. Because the process is voluntary, Mr. Shao points out, the absence of the seal does not necessarily mean the product is of poor quality.
But at least the seal should mean you know what you’re getting. And with vitamins, anything beyond that simple assurance may not be worth paying for.
Patient Money – When Buying Vitamins, Know What’s Worth Paying For – NYTimes.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.
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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.
]]>(The Pittsburgh Post-Gazette, August 2, 2009)
Obesity and its impact on health care costs have taken center stage in the debate about national health care reform.
And it seems there may be as many ideas about how to address the problem as there are people who are obese.
The issues converged last week when a national study estimated the cost of obesity at $147 billion annually, nearly double what it was 10 years ago; the Centers for Disease Control and Prevention held its first Weight of the Nation conference in Washington, D.C., and Congress debated how to account for wellness programs in the health care reform package.
“If obesity was an infectious disease, it would be an epidemic,” said Dr. Daniel Bessesen, professor of medicine at the University of Colorado at Denver and chief of endocrinology at the Denver Health Medical Center.
“To ignore the problem, you’re keeping your head in the sand. If you could fix the obesity problem … you would make a huge impact on the nation’s health care costs.”
But obesity is not just a health problem. It’s a national economic problem that will become more prominent as the country debates the cost of health care reform.
“These results reveal that obesity continues to impose an economic burden on both public and private payers,” writes Dr. Eric Finkelstein, director of the Public Health Economics Program at the North Carolina-based RTI International, which produced the national study.
“The connection between rising obesity rates and rising medical spending is undeniable.”
The CDC estimates nearly 40 percent of American adults are considered obese based on their body mass index, a mathematical formula that considers a person’s height and weight. That extra weight frequently leads to additional health problems such as heart disease, diabetes, high blood pressure and pulmonary difficulties.
A RTI study estimates $1,429 a year is added to the nation’s health care costs for each obese patient. The overall cost is about 42 percent more annually for obese people and even higher for obese patients on Medicare. Obesity adds 9.1 percent to the annual cost of health care.
The study was published in the magazine “Health Affairs” as a followup to a similar study 10 years ago and includes data through 2006.
Allegheny County hasn’t analyzed the cost of obesity, but a 2002 survey found about 59 percent of adults either overweight (a lower category) or obese, comparable to the national average of 59.2 percent and the state average of 59.5 percent. The county will begin a new telephone health survey tomorrow in which 5,000 randomly chosen people will answer 185 questions about their health and lifestyle.
“People will see tangible results if they eat better and exercise more,” said Dr. Bruce Dixon, director of the Allegheny County Health Department. “But it’s a very difficult issue that involves a lifestyle change. I think people have to ingrain it in their daily lives.”
Most experts agree that is the solution, but the debate centers on how to get there. That was one of the key topics at the inaugural Weight of the Nation conference.
Kathleen Sebelius, U.S. Health & Human Services secretary, told the conference she’s particularly concerned about obese children. Statistics compiled by the CDC show that 25 percent of obese children stay obese as adults and have a raft of serious health problems.
“If there was an epidemic of little kids getting cancer, it would be a national crisis,” Ms. Sebelius said. “But because it’s obesity and the damage doesn’t come until later in life, we’ve been slow to act. We can’t ignore this problem any longer.”
Obesity among children is a major focus of the Robert Wood Johnson Foundation, a Princeton, N.J., organization that helps to fund health care initiatives. It has committed $500 million to help reduce childhood obesity by 2015.
The call for health care reform is causing greater emphasis on the cost of obesity, but there seems to be no consensus on the best approach to dealing with it.
Dr. William Dietz, a co-author of the RTI study, said he believes the key is offering people healthy options such as healthy snacks and drinks in schools, supermarkets with fresh fruits and vegetables in poor neighborhoods and neighborhoods with sidewalks to encourage walking.
He cited Pennsylvania’s Fresh Food Initiative, which provides grant money to help build grocery stores in underserved areas, as a positive approach. The program provided $1 million to help build a new Kuhn’s grocery in the Hill District.
“You can’t expect people to make good choices where they don’t have choices to make,” said Dr. Dietz, who also is director of the CDC’s division of nutrition and physical activity. “Just looking at communities with a different eye would help, allowing supermarkets and movie theaters to be close enough to housing so people could walk to them.”
He cited Shelby County, Ala., as a community that has taken such an approach over the last decade and seen positive results. Alabama has the nation’s highest percentage of obese people.
Dr. Bessesen said it will take a different approach that involves better teaching for doctors and almost individual programs to change the lifestyle of each patient on a trial-and-error basis to find which approach works best for each one. He called obesity “a symptom of a lifestyle that really has gotten out of control.”
“People don’t like to be heavy,” he said, pointing to widespread dieting and other efforts at weight control.
“Our bodies are really engineered for physical activity, but our lifestyle has evolved into spending a lot of time working at a desk or sitting in front of a television or a computer. It’s going to take long-term treatment to change that.”
Locally, insurance provider Highmark offers a raft of programs aimed at improving customer health. Its wellness program offers employers the opportunity to provide workers with programs to lose weight, quit smoking and exercise, among others, while its Health High 5 program has committed $100 million over five years to improving the health of children.
Highmark tries out programs on its employees first, said Dr. Mary Goessler, medical director of quality and medical permanent management. For example, the agency saw the number of employees who get annual physicals increase from about 10 percent to just under 70 percent when it offered a financial incentive.
She acknowledges the numbers on obesity nationwide continue to grow.
“The progress is slow because there isn’t one thing that works for everybody,” she said. “Everybody has to take personal account for the changes they need to make.”
Calls for a focus on preventative health care are rising as Congress grapples with the hard financial realities of how to pay for the health care of a population of more than 300 million.
Ms. Sebelius told the CDC conference a significant amount of the $1 billion Congress appropriated in stimulus money for prevention and wellness will go “to help states and communities attack obesity.”
“Reducing obesity — especially for children — would be one of the biggest steps we could take toward this country’s health future,” said Ms. Sebelius.
In Congress, legislators are having a hard time determining how to include preventive programs in the health care package because the Congressional Budget Office has had a difficult time assessing the savings they could generate, said Rep. Jason Altmire, R-McCandless. He’s a former UMPC executive and a member of the House Education and Labor Committee.
Read more:http://www.postgazette.com/pg/09214/988131-114.stm#ixzz0N3vyU3Ui