Pace of obe­sity growth slows

Fed­eral ef­forts cited, but ‘lot more work to be done’

Modern Healthcare - - THE WEEK IN HEALTHCARE - Rich Daly

The Cen­ters for Dis­ease Con­trol and Preven­tion hinted at promis­ing news on the obe­sity front last week. The CDC’s an­nual sur­vey of the health sta­tus of Amer­i­cans re­vealed obe­sity rose in 2012 at its slow­est pace in a decade and, sta­tis­ti­cally speak­ing, may not have risen at all. Some ex­perts said more slowly ex­pand­ing waist­lines may be a sign peo­ple are fi­nally re­spond­ing to a smat­ter­ing of pol­icy ini­tia­tives and an out­pour­ing of national con­cern about its long-term im­pact on the na­tion’s econ­omy.

The adult obe­sity rate ticked up slightly to 28.9% in 2012. The 0.2% in­crease from the 2011 rate was the slow­est rise in adult obe­sity since 2003.

“We’re get­ting close to be­ing able to start turn­ing back the obe­sity epi­demic, but there’s still a lot of work to be done,” Richard Ham­burg, deputy di­rec­tor of the Trust for Amer­ica’s Health, said about the new CDC fig­ures.

Amer­i­cans now rank among the fat­test peo­ple on earth af­ter the national obe­sity rate rose from 19.4% in 1997 to 28.9% in 2012. The slower growth rate more re­cently may be an ef­fect of the grow­ing num­ber of fed­eral ini­tia­tives aimed at de­creas­ing calo­rie-in­take and en­cour­ag­ing more ac­tive life­styles. First lady Michelle Obama has made fight­ing child­hood obe­sity a centerpiece of her time in the White House.

The Obama ad­min­is­tra­tion is pour­ing about $70 mil­lion a year into lo­cal health pro­mo­tion ef­forts through a Preven­tion and Pub­lic Health Fund, which in­cluded $10 mil­lion in fis­cal 2012 to bol­ster state pro­grams on “nu­tri­tion, phys­i­cal ac­tiv­ity and obe­sity,” ac­cord­ing to HHS. An­other $5 mil­lion was spent on child-fo­cused obe­sity preven­tion pro­grams.

How­ever, the au­tho­riza­tion has come un­der re­peated as­sault on Capi­tol Hill, where last April the House of Rep­re­sen­ta­tives voted largely along party lines to elim­i­nate the pro­grams along with the rest of the Pa­tient Pro­tec­tion and Af­ford­able Care Act’s 10-year, $15 bil­lion ap­pro­pri­a­tion for pub­lic health. Repub­li­cans branded it a “slush fund” for HHS.

Yet there is ris­ing sup­port across the na­tion and on both sides of the aisle to con­tinue do­ing some­thing about the obe­sity prob­lem. Last week, the Amer­i­can Med­i­cal As­so­ci­a­tion voted to label obe­sity a dis­ease, which sup­port­ers hope will spur pay­ers to fund med­i­cal ap­proaches to treat­ment. Medi­care is also be­ing pushed to ex­pand its anti-obe­sity ef­forts for the el­derly and dis­abled.

A bi­par­ti­san bill was in­tro­duced last week that would re­quire Medi­care to cover anti-obe­sity drugs and ther­apy. Pre­vi­ous leg­is­la­tion spon­sored by Sen. Tom Carper (D-Del.) went nowhere. “The obe­sity epi­demic re­quires more than just diet and ex­er­cise and surgery; they need a full ar­ray of treat­ment op­tions and that’s what this leg­is­la­tion is meant to ad­dress,” said Rep. Ron Kind (D-Wis.), a spon­sor of the House bill, which would re­quire the agency to cover an­tiobe­sity drugs. Medi­care al­ready funds weight­loss surgery, but not drugs.

A few anti-obe­sity med­i­ca­tions have re­ceived Food and Drug Ad­min­is­tra­tion ap­proval in re­cent years, but in­dus­try an­a­lysts said their growth has been limited by in­sur­ers’ re­fusal to cover them. “It ought to be a part of the Part D plan,” Kind said.

Among the new leg­is­la­tion’s sup­port­ers, ac­cord­ing to a list from Carper’s of­fice, is John­son & John­son. That com­pany’s mi­graine and epilepsy drug, Topa­max, is a key in­gre­di­ent of one of the high­est pro­file new anti-obe­sity drugs, Qsymia. The com­pany con­trib­uted $3,500 to Carper and $4,000 to Kind in the last elec­tion cy­cle, ac­cord­ing to the Cen­ter for Re­spon­sive Pol­i­tics.

Other anti-obe­sity bills, mean­while, con­tinue to draw fierce op­po­si­tion from the food and restau­rant in­dus­tries. A bill spon­sored by Sen. Tom Coburn (R-Okla.) that would bar the use of food stamps to buy soda and other sug­ar­laden junk food is given lit­tle chance of pas­sage. The AMA en­dorsed such an ap­proach for the first time last week. A 2012 study by the Yale Rudd Cen­ter for Food Pol­icy & Obe­sity con­cluded the Sup­ple­men­tal Nu­tri­tion As­sis­tance Pro­gram spent more than $2 bil­lion an­nu­ally on bev­er­ages sweet­ened with sugar.

“SNAP may ac­tu­ally be ex­ac­er­bat­ing the prob­lem” of obe­sity, Coburn said. Se­nate lead­ers re­fused to al­low a vote on an amend­ment to the mas­sive farm bill now be­fore Congress that would al­low state pilot projects to test lim­its on junk food pur­chases un­der the food stamp pro­gram.

The bill drew the same in­dus­try op­po­si­tion as New York City Mayor Michael Bloomberg’s ef­fort to ban jumbo soft-drink con­tain­ers, which was slapped down by the courts in March. Bloomberg threw his sup­port be­hind the Coburn bill.

But Repub­li­cans in the House re­main staunchly op­posed to reg­u­la­tory ap­proaches to curb­ing the obe­sity epi­demic. “It be­comes aw­fully tricky, as far as where you draw the line in what food choices and op­tions are avail­able,” Kind said. “So I’m not sure how re­cep­tive the over­all Congress would be to that ap­proach.” Kind said Repub­li­cans would con­sider leg­is­la­tion that gave peo­ple more food stamps if they used them to buy lo­cally pro­duced food.

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