Jane Anderson

Almost all primary care physicians want to help obese patients lose weight, but they say that no one in their practice knows enough to adequately deal with weight-related issues, a survey revealed.

The survey of 290 primary care physicians (PCPs), conducted by Harris Interactive late in 2009 and sponsored by the STOP (Strategies to Overcome and Prevent) Obesity Alliance, indicated physicians agree that a 5%–10% weight loss would help their obese patients.

But a companion survey of American adults released at the same time by the alliance found that only 39% of obese adults (those with a body mass index of at least 30 kg/m

Those adults whose physicians used the term obese also said that the physician recommended they lose weight. But about one in three of these said that their physicians never discussed the mechanics of how to go about losing weight, the survey of 1,002 U.S. adults reported.

This results in a disconnect between the information that obese patients need from their physicians and what physicians actually tell them about losing weight, according to presenters at a briefing on the results from the two surveys.

“Patients want more information about weight management; they're hungry for it, and they don't know what information to believe,” said Roz Pierson, Ph.D., Harris Interactive vice president of health policy research. “But a lot of primary care physicians said they or no one in their office had been trained to discuss weight issues. If you don't feel like you have the training to deal with weight issues, you can see why there is a lack of willingness to have a dialogue.”

Both PCPs and patients agree that even a small amount of weight loss is beneficial, according to the surveys. In all, 80% of patients who consider themselves overweight or obese, along with 91% of physicians, agree that the risk of disease is reduced “a great deal” or “somewhat” following a weight loss of 5%–10%.

The PCPs told surveyors that they recommended a variety of strategies to patients for weight loss, including improving their diets, counting calories, and reading a book or visiting a Web site. Physicians also said they recommended that their overweight or obese patients see a weight loss specialist, enroll in community-based organizations, consider clinical programs for weight loss, or even have bariatric surgery.

However, the PCPs told surveyors that they didn't have the training or tools to properly counsel patients on weight, and they also lacked the time needed with those patients to do the job right.

Former U.S. Surgeon General Richard Carmona, who serves as health and wellness chairperson of the STOP Obesity Alliance, said at the briefing that solving the problem of time to deal with obesity and other preventive health issues would require a health system overhaul. Still, he urged physicians to take the time if possible under the current system. “You can say, 'I'd like to take the time, but I don't have the time.' But would you say that if patient walked in with chest pains? In diabetic acidosis? With a broken arm?” Dr. Carmona asked.

Dr. William Bestermann Jr., medical director of Holston Medical Group Integrated Health Services in Houston, agreed that a health system overhaul would be needed to give physicians ample time to counsel patients on weight loss. “The system produces the results it was designed to produce,” he said.

“We do all this pricey stuff at the end of the game. We need to shift some of those resources from the end game” in order to help people lose weight and lower their risks of chronic and acute health issues from the beginning, he urged.

Almost all primary care physicians want to help obese patients lose weight, but they say that no one in their practice knows enough to adequately deal with weight-related issues, a survey revealed.

The survey of 290 primary care physicians (PCPs), conducted by Harris Interactive late in 2009 and sponsored by the STOP (Strategies to Overcome and Prevent) Obesity Alliance, indicated physicians agree that a 5%–10% weight loss would help their obese patients.

But a companion survey of American adults released at the same time by the alliance found that only 39% of obese adults (those with a body mass index of at least 30 kg/m

Those adults whose physicians used the term obese also said that the physician recommended they lose weight. But about one in three of these said that their physicians never discussed the mechanics of how to go about losing weight, the survey of 1,002 U.S. adults reported.

This results in a disconnect between the information that obese patients need from their physicians and what physicians actually tell them about losing weight, according to presenters at a briefing on the results from the two surveys.

“Patients want more information about weight management; they're hungry for it, and they don't know what information to believe,” said Roz Pierson, Ph.D., Harris Interactive vice president of health policy research. “But a lot of primary care physicians said they or no one in their office had been trained to discuss weight issues. If you don't feel like you have the training to deal with weight issues, you can see why there is a lack of willingness to have a dialogue.”

Both PCPs and patients agree that even a small amount of weight loss is beneficial, according to the surveys. In all, 80% of patients who consider themselves overweight or obese, along with 91% of physicians, agree that the risk of disease is reduced “a great deal” or “somewhat” following a weight loss of 5%–10%.

The PCPs told surveyors that they recommended a variety of strategies to patients for weight loss, including improving their diets, counting calories, and reading a book or visiting a Web site. Physicians also said they recommended that their overweight or obese patients see a weight loss specialist, enroll in community-based organizations, consider clinical programs for weight loss, or even have bariatric surgery.

However, the PCPs told surveyors that they didn't have the training or tools to properly counsel patients on weight, and they also lacked the time needed with those patients to do the job right.

Former U.S. Surgeon General Richard Carmona, who serves as health and wellness chairperson of the STOP Obesity Alliance, said at the briefing that solving the problem of time to deal with obesity and other preventive health issues would require a health system overhaul. Still, he urged physicians to take the time if possible under the current system. “You can say, 'I'd like to take the time, but I don't have the time.' But would you say that if patient walked in with chest pains? In diabetic acidosis? With a broken arm?” Dr. Carmona asked.

Dr. William Bestermann Jr., medical director of Holston Medical Group Integrated Health Services in Houston, agreed that a health system overhaul would be needed to give physicians ample time to counsel patients on weight loss. “The system produces the results it was designed to produce,” he said.

“We do all this pricey stuff at the end of the game. We need to shift some of those resources from the end game” in order to help people lose weight and lower their risks of chronic and acute health issues from the beginning, he urged.

Almost all primary care physicians want to help obese patients lose weight, but they say that no one in their practice knows enough to adequately deal with weight-related issues, a survey revealed.

The survey of 290 primary care physicians (PCPs), conducted by Harris Interactive late in 2009 and sponsored by the STOP (Strategies to Overcome and Prevent) Obesity Alliance, indicated physicians agree that a 5%–10% weight loss would help their obese patients.

But a companion survey of American adults released at the same time by the alliance found that only 39% of obese adults (those with a body mass index of at least 30 kg/m

Those adults whose physicians used the term obese also said that the physician recommended they lose weight. But about one in three of these said that their physicians never discussed the mechanics of how to go about losing weight, the survey of 1,002 U.S. adults reported.

This results in a disconnect between the information that obese patients need from their physicians and what physicians actually tell them about losing weight, according to presenters at a briefing on the results from the two surveys.

“Patients want more information about weight management; they're hungry for it, and they don't know what information to believe,” said Roz Pierson, Ph.D., Harris Interactive vice president of health policy research. “But a lot of primary care physicians said they or no one in their office had been trained to discuss weight issues. If you don't feel like you have the training to deal with weight issues, you can see why there is a lack of willingness to have a dialogue.”

Both PCPs and patients agree that even a small amount of weight loss is beneficial, according to the surveys. In all, 80% of patients who consider themselves overweight or obese, along with 91% of physicians, agree that the risk of disease is reduced “a great deal” or “somewhat” following a weight loss of 5%–10%.

The PCPs told surveyors that they recommended a variety of strategies to patients for weight loss, including improving their diets, counting calories, and reading a book or visiting a Web site. Physicians also said they recommended that their overweight or obese patients see a weight loss specialist, enroll in community-based organizations, consider clinical programs for weight loss, or even have bariatric surgery.

However, the PCPs told surveyors that they didn't have the training or tools to properly counsel patients on weight, and they also lacked the time needed with those patients to do the job right.

Former U.S. Surgeon General Richard Carmona, who serves as health and wellness chairperson of the STOP Obesity Alliance, said at the briefing that solving the problem of time to deal with obesity and other preventive health issues would require a health system overhaul. Still, he urged physicians to take the time if possible under the current system. “You can say, 'I'd like to take the time, but I don't have the time.' But would you say that if patient walked in with chest pains? In diabetic acidosis? With a broken arm?” Dr. Carmona asked.

Dr. William Bestermann Jr., medical director of Holston Medical Group Integrated Health Services in Houston, agreed that a health system overhaul would be needed to give physicians ample time to counsel patients on weight loss. “The system produces the results it was designed to produce,” he said.

“We do all this pricey stuff at the end of the game. We need to shift some of those resources from the end game” in order to help people lose weight and lower their risks of chronic and acute health issues from the beginning, he urged.

FDA Wants Pediatric Device Data

The Food and Drug Administration said it will require device manufacturers to include in their applications any available data on products' effects in children, even if the device in question is intended for adult use. An applicant also must predict pediatric use of its product and a description of any pediatric subpopulations that might benefit from the device, the FDA said. The effort is intended to reveal which devices that were developed for adults should be assessed or modified for use in pediatric populations. The information requirements were mandated by a 2007 law.

Minority Children Face Inequities

Minority children in the United States have a higher overall death rate than do white children and higher incidences of several dangerous diseases and conditions, according to a report in Pediatrics. Compiled for the American Academy of Pediatrics' Committee on Pediatric Research from studies spanning more than 50 years, the report also found widespread racial and ethnic disparities in pediatric care. Minority children have a higher incidence of HIV/AIDS, sexually transmitted diseases, asthma, attention-deficit/hyperactivity disorder, and certain types of cancers, according to the report. Some minority groups face greater violence than white children do. Other common disparities for minority children included higher rates of obesity and lower rates of breast-feeding, immunizations, and proper nutrition, the report said. Compared with white children, minorities have less insurance coverage, less access to adequate health care, less time with doctors, fewer screenings, and longer times for diagnosis for some conditions, according to the report.

EPA to Scrutinize Bisphenol A

The Environmental Protection Agency said it would take several steps to address the potential health effects of bisphenol A, a chemical used in the manufacture of some plastics and other products. The EPA said it would focus on the environmental impacts of BPA, but also will evaluate the potential impact on children from exposure to BPA from sources other than food packaging. (In January, the FDA said it would study BPA in food packaging.) “We share FDA's concern about the potential health impacts from BPA,” said Steve Owens, assistant administrator of the EPA's Office of Prevention, Pesticides, and Toxic Substances. The environmental agency said it will require manufacturers to test BPA's effects, and it will seek to add the chemical to its list of chemicals of concern.

Companies Get Fs for Marketing

The healthful-eating advocacy group Center for Science in the Public Interest has given most food and entertainment companies F grades for their policies on marketing food products to children. A report card on 128 companies' marketing practices gave 95 Fs, along with a smattering of Cs and Ds, the group said. “Despite the industry's self-regulatory system, the vast majority of food and entertainment companies have no protections in place for children,” the group's nutrition policy director, Margo Wootan, D.Sc., in a statement. The group is particularly concerned, Dr. Wootan said, because most of the marketing was for sugary cereals, fast food, snack foods, and candy. Candy manufacturer Mars Inc. received the highest grade awarded, B+, not for its products but for its marketing policy, which abstains from most of the key marketing tactics used to reach children under 12, the CPSI said.

Many Parents Neglect Boosters

Although nearly all parents use appropriate car seats for their children who are 5 years or younger, use of booster seats drops to just 40% by age 8, according to a national children's health survey. The poll from the C.S. Mott Children's Hospital in Ann Arbor, Mich., found that three-fourths of children aged 4–8 years use booster seats. However, half of parents didn't know their state booster seat law, and another 20% said they knew the law but were mistaken about the age requirement. Although studies show that booster seats can reduce the risk of injury in car crashes by up to 50%, almost half of parents said they wouldn't use booster seats for children aged 7–8 if the law didn't require it. “Not much is known about how parents get information about seat belt and booster seat use as [children] age,” Dr. Michelle Lea Macy, a University of Michigan pediatric emergency room physician, said in a statement. During well-child exams is a good time for doctors and parents to discuss when children should transition from car seats to booster seats and seat belts, said Dr. Macy.

Schools Have Cut Sweet Drinks

Three years after manufacturers agreed to reduce the number of beverage calories available to children during the school day, they are in compliance in almost all schools, according to the final report on the impact of the voluntary guidelines. As a result, the number of beverage calories shipped to schools has dropped by 88% and the overall volume of full-calorie carbonated soft drinks shipped to schools has fallen by 95%, said the report from the advocacy group Alliance for a Healthier Generation, which negotiated the original agreement.

FDA Wants Pediatric Device Data

The Food and Drug Administration said it will require device manufacturers to include in their applications any available data on products' effects in children, even if the device in question is intended for adult use. An applicant also must predict pediatric use of its product and a description of any pediatric subpopulations that might benefit from the device, the FDA said. The effort is intended to reveal which devices that were developed for adults should be assessed or modified for use in pediatric populations. The information requirements were mandated by a 2007 law.

Minority Children Face Inequities

Minority children in the United States have a higher overall death rate than do white children and higher incidences of several dangerous diseases and conditions, according to a report in Pediatrics. Compiled for the American Academy of Pediatrics' Committee on Pediatric Research from studies spanning more than 50 years, the report also found widespread racial and ethnic disparities in pediatric care. Minority children have a higher incidence of HIV/AIDS, sexually transmitted diseases, asthma, attention-deficit/hyperactivity disorder, and certain types of cancers, according to the report. Some minority groups face greater violence than white children do. Other common disparities for minority children included higher rates of obesity and lower rates of breast-feeding, immunizations, and proper nutrition, the report said. Compared with white children, minorities have less insurance coverage, less access to adequate health care, less time with doctors, fewer screenings, and longer times for diagnosis for some conditions, according to the report.

EPA to Scrutinize Bisphenol A

The Environmental Protection Agency said it would take several steps to address the potential health effects of bisphenol A, a chemical used in the manufacture of some plastics and other products. The EPA said it would focus on the environmental impacts of BPA, but also will evaluate the potential impact on children from exposure to BPA from sources other than food packaging. (In January, the FDA said it would study BPA in food packaging.) “We share FDA's concern about the potential health impacts from BPA,” said Steve Owens, assistant administrator of the EPA's Office of Prevention, Pesticides, and Toxic Substances. The environmental agency said it will require manufacturers to test BPA's effects, and it will seek to add the chemical to its list of chemicals of concern.

Companies Get Fs for Marketing

The healthful-eating advocacy group Center for Science in the Public Interest has given most food and entertainment companies F grades for their policies on marketing food products to children. A report card on 128 companies' marketing practices gave 95 Fs, along with a smattering of Cs and Ds, the group said. “Despite the industry's self-regulatory system, the vast majority of food and entertainment companies have no protections in place for children,” the group's nutrition policy director, Margo Wootan, D.Sc., in a statement. The group is particularly concerned, Dr. Wootan said, because most of the marketing was for sugary cereals, fast food, snack foods, and candy. Candy manufacturer Mars Inc. received the highest grade awarded, B+, not for its products but for its marketing policy, which abstains from most of the key marketing tactics used to reach children under 12, the CPSI said.

Many Parents Neglect Boosters

Although nearly all parents use appropriate car seats for their children who are 5 years or younger, use of booster seats drops to just 40% by age 8, according to a national children's health survey. The poll from the C.S. Mott Children's Hospital in Ann Arbor, Mich., found that three-fourths of children aged 4–8 years use booster seats. However, half of parents didn't know their state booster seat law, and another 20% said they knew the law but were mistaken about the age requirement. Although studies show that booster seats can reduce the risk of injury in car crashes by up to 50%, almost half of parents said they wouldn't use booster seats for children aged 7–8 if the law didn't require it. “Not much is known about how parents get information about seat belt and booster seat use as [children] age,” Dr. Michelle Lea Macy, a University of Michigan pediatric emergency room physician, said in a statement. During well-child exams is a good time for doctors and parents to discuss when children should transition from car seats to booster seats and seat belts, said Dr. Macy.

Schools Have Cut Sweet Drinks

Three years after manufacturers agreed to reduce the number of beverage calories available to children during the school day, they are in compliance in almost all schools, according to the final report on the impact of the voluntary guidelines. As a result, the number of beverage calories shipped to schools has dropped by 88% and the overall volume of full-calorie carbonated soft drinks shipped to schools has fallen by 95%, said the report from the advocacy group Alliance for a Healthier Generation, which negotiated the original agreement.

FDA Wants Pediatric Device Data

The Food and Drug Administration said it will require device manufacturers to include in their applications any available data on products' effects in children, even if the device in question is intended for adult use. An applicant also must predict pediatric use of its product and a description of any pediatric subpopulations that might benefit from the device, the FDA said. The effort is intended to reveal which devices that were developed for adults should be assessed or modified for use in pediatric populations. The information requirements were mandated by a 2007 law.

Minority Children Face Inequities

Minority children in the United States have a higher overall death rate than do white children and higher incidences of several dangerous diseases and conditions, according to a report in Pediatrics. Compiled for the American Academy of Pediatrics' Committee on Pediatric Research from studies spanning more than 50 years, the report also found widespread racial and ethnic disparities in pediatric care. Minority children have a higher incidence of HIV/AIDS, sexually transmitted diseases, asthma, attention-deficit/hyperactivity disorder, and certain types of cancers, according to the report. Some minority groups face greater violence than white children do. Other common disparities for minority children included higher rates of obesity and lower rates of breast-feeding, immunizations, and proper nutrition, the report said. Compared with white children, minorities have less insurance coverage, less access to adequate health care, less time with doctors, fewer screenings, and longer times for diagnosis for some conditions, according to the report.

EPA to Scrutinize Bisphenol A

The Environmental Protection Agency said it would take several steps to address the potential health effects of bisphenol A, a chemical used in the manufacture of some plastics and other products. The EPA said it would focus on the environmental impacts of BPA, but also will evaluate the potential impact on children from exposure to BPA from sources other than food packaging. (In January, the FDA said it would study BPA in food packaging.) “We share FDA's concern about the potential health impacts from BPA,” said Steve Owens, assistant administrator of the EPA's Office of Prevention, Pesticides, and Toxic Substances. The environmental agency said it will require manufacturers to test BPA's effects, and it will seek to add the chemical to its list of chemicals of concern.

Companies Get Fs for Marketing

The healthful-eating advocacy group Center for Science in the Public Interest has given most food and entertainment companies F grades for their policies on marketing food products to children. A report card on 128 companies' marketing practices gave 95 Fs, along with a smattering of Cs and Ds, the group said. “Despite the industry's self-regulatory system, the vast majority of food and entertainment companies have no protections in place for children,” the group's nutrition policy director, Margo Wootan, D.Sc., in a statement. The group is particularly concerned, Dr. Wootan said, because most of the marketing was for sugary cereals, fast food, snack foods, and candy. Candy manufacturer Mars Inc. received the highest grade awarded, B+, not for its products but for its marketing policy, which abstains from most of the key marketing tactics used to reach children under 12, the CPSI said.

Many Parents Neglect Boosters

Although nearly all parents use appropriate car seats for their children who are 5 years or younger, use of booster seats drops to just 40% by age 8, according to a national children's health survey. The poll from the C.S. Mott Children's Hospital in Ann Arbor, Mich., found that three-fourths of children aged 4–8 years use booster seats. However, half of parents didn't know their state booster seat law, and another 20% said they knew the law but were mistaken about the age requirement. Although studies show that booster seats can reduce the risk of injury in car crashes by up to 50%, almost half of parents said they wouldn't use booster seats for children aged 7–8 if the law didn't require it. “Not much is known about how parents get information about seat belt and booster seat use as [children] age,” Dr. Michelle Lea Macy, a University of Michigan pediatric emergency room physician, said in a statement. During well-child exams is a good time for doctors and parents to discuss when children should transition from car seats to booster seats and seat belts, said Dr. Macy.

Schools Have Cut Sweet Drinks

Three years after manufacturers agreed to reduce the number of beverage calories available to children during the school day, they are in compliance in almost all schools, according to the final report on the impact of the voluntary guidelines. As a result, the number of beverage calories shipped to schools has dropped by 88% and the overall volume of full-calorie carbonated soft drinks shipped to schools has fallen by 95%, said the report from the advocacy group Alliance for a Healthier Generation, which negotiated the original agreement.

Unhealthy behaviors such as a lack of exercise and a poor diet explain a substantial part of differences in mortality between the well off and those low on the socioeconomic ladder, study findings show.

An assessment of smoking, alcohol consumption, diet, and physical activity among civil servants living in London over a 24-year period found “a clear social gradient in mortality, with lower socioeconomic position being associated with higher mortality,” the authors said (JAMA 2010;303:1159-66).

“Unhealthy behaviors such as smoking, unhealthy diet, and low levels of physical activity were strongly related to mortality, as well as nonconsumption of alcohol,” the authors wrote. Heavy alcohol consumption was more prevalent among participants in the highest socioeconomic bracket.

The researchers, led by Silvia Stringhini of the Centre for Research in Epidemiology and Population Health in Villejuif, France, and her associates, sought to examine unhealthy behaviors as they relate to the association between socioeconomic position and mortality. To do this accurately, they assessed behaviors in the 10,308 study participants five times: once at the beginning of the study and four times during the follow-up period.

The participants' socioeconomic position was determined from their civil service employment grades at the beginning of the study, when they were aged 35-55 years.

A total of 654 participants died during the study, and after adjustments for sex and age, the researchers determined that those with the lowest socioeconomic position had a risk of dying that was 1.6 times higher than those in the highest socioeconomic bracket.

Overall, unhealthy behaviors noted at the beginning of the study explained 29% of cardiovascular disease mortality, 61% of mortality not related to cardiovascular disease, and 42% of overall mortality.

By the end of the study, the researchers found these unhealthy behaviors explained 45% of cardiovascular disease deaths, 94% of mortality not related to cardiovascular disease, and 72% of deaths overall.

Smoking rates stayed fairly constant at around 32%–35% throughout the study. However, mortality risk rose in relation to diet (from 7% to 17% for all-cause mortality), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality).

The authors noted that mortality risk for moderate drinkers was lower compared with both nondrinkers and heavy drinkers. Participants who abstained from alcohol completely were at higher risk for death from cardiovascular disease, while those who drank heavily had a higher cancer death risk.

The study results show that health behaviors explain more of socioeconomic differences in death rates than what has been observed in previous studies, James R. Dunn, Ph.D., of McMaster University in Hamilton, Ont., wrote in an accompanying editorial (JAMA 2010;303:1199-200).

However, the findings don't suggest that socioeconomic differences in health status can be reduced simply to socioeconomic differences in unhealthy behaviors, Dr. Dunn said. “Accordingly, it would be incorrect to infer that there is no need to be concerned with social and economic justice, only health behavior,” he said.

Evidence suggests that early childhood development involving stress management capabilities and health behavior may play a role in empowering adults to choose healthier behaviors, he said. Children with lower socioeconomic status are more likely to have deficits in these areas.

Disclosures: Neither Ms. Stringhini nor Dr. Dunn reported any financial disclosures. The study has been supported by grants from the British Medical Research Council, the British Heart Foundation, the British Health and Safety Executive, and the British Department of Health; a grant from the U.S. National Heart, Lung, and Blood Institute; and grants from the U.S. National Institute on Aging.

Unhealthy behaviors such as a lack of exercise and a poor diet explain a substantial part of differences in mortality between the well off and those low on the socioeconomic ladder, study findings show.

An assessment of smoking, alcohol consumption, diet, and physical activity among civil servants living in London over a 24-year period found “a clear social gradient in mortality, with lower socioeconomic position being associated with higher mortality,” the authors said (JAMA 2010;303:1159-66).

“Unhealthy behaviors such as smoking, unhealthy diet, and low levels of physical activity were strongly related to mortality, as well as nonconsumption of alcohol,” the authors wrote. Heavy alcohol consumption was more prevalent among participants in the highest socioeconomic bracket.

The researchers, led by Silvia Stringhini of the Centre for Research in Epidemiology and Population Health in Villejuif, France, and her associates, sought to examine unhealthy behaviors as they relate to the association between socioeconomic position and mortality. To do this accurately, they assessed behaviors in the 10,308 study participants five times: once at the beginning of the study and four times during the follow-up period.

The participants' socioeconomic position was determined from their civil service employment grades at the beginning of the study, when they were aged 35-55 years.

A total of 654 participants died during the study, and after adjustments for sex and age, the researchers determined that those with the lowest socioeconomic position had a risk of dying that was 1.6 times higher than those in the highest socioeconomic bracket.

Overall, unhealthy behaviors noted at the beginning of the study explained 29% of cardiovascular disease mortality, 61% of mortality not related to cardiovascular disease, and 42% of overall mortality.

By the end of the study, the researchers found these unhealthy behaviors explained 45% of cardiovascular disease deaths, 94% of mortality not related to cardiovascular disease, and 72% of deaths overall.

Smoking rates stayed fairly constant at around 32%–35% throughout the study. However, mortality risk rose in relation to diet (from 7% to 17% for all-cause mortality), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality).

The authors noted that mortality risk for moderate drinkers was lower compared with both nondrinkers and heavy drinkers. Participants who abstained from alcohol completely were at higher risk for death from cardiovascular disease, while those who drank heavily had a higher cancer death risk.

The study results show that health behaviors explain more of socioeconomic differences in death rates than what has been observed in previous studies, James R. Dunn, Ph.D., of McMaster University in Hamilton, Ont., wrote in an accompanying editorial (JAMA 2010;303:1199-200).

However, the findings don't suggest that socioeconomic differences in health status can be reduced simply to socioeconomic differences in unhealthy behaviors, Dr. Dunn said. “Accordingly, it would be incorrect to infer that there is no need to be concerned with social and economic justice, only health behavior,” he said.

Evidence suggests that early childhood development involving stress management capabilities and health behavior may play a role in empowering adults to choose healthier behaviors, he said. Children with lower socioeconomic status are more likely to have deficits in these areas.

Disclosures: Neither Ms. Stringhini nor Dr. Dunn reported any financial disclosures. The study has been supported by grants from the British Medical Research Council, the British Heart Foundation, the British Health and Safety Executive, and the British Department of Health; a grant from the U.S. National Heart, Lung, and Blood Institute; and grants from the U.S. National Institute on Aging.

Unhealthy behaviors such as a lack of exercise and a poor diet explain a substantial part of differences in mortality between the well off and those low on the socioeconomic ladder, study findings show.

An assessment of smoking, alcohol consumption, diet, and physical activity among civil servants living in London over a 24-year period found “a clear social gradient in mortality, with lower socioeconomic position being associated with higher mortality,” the authors said (JAMA 2010;303:1159-66).

“Unhealthy behaviors such as smoking, unhealthy diet, and low levels of physical activity were strongly related to mortality, as well as nonconsumption of alcohol,” the authors wrote. Heavy alcohol consumption was more prevalent among participants in the highest socioeconomic bracket.

The researchers, led by Silvia Stringhini of the Centre for Research in Epidemiology and Population Health in Villejuif, France, and her associates, sought to examine unhealthy behaviors as they relate to the association between socioeconomic position and mortality. To do this accurately, they assessed behaviors in the 10,308 study participants five times: once at the beginning of the study and four times during the follow-up period.

The participants' socioeconomic position was determined from their civil service employment grades at the beginning of the study, when they were aged 35-55 years.

A total of 654 participants died during the study, and after adjustments for sex and age, the researchers determined that those with the lowest socioeconomic position had a risk of dying that was 1.6 times higher than those in the highest socioeconomic bracket.

Overall, unhealthy behaviors noted at the beginning of the study explained 29% of cardiovascular disease mortality, 61% of mortality not related to cardiovascular disease, and 42% of overall mortality.

By the end of the study, the researchers found these unhealthy behaviors explained 45% of cardiovascular disease deaths, 94% of mortality not related to cardiovascular disease, and 72% of deaths overall.

Smoking rates stayed fairly constant at around 32%–35% throughout the study. However, mortality risk rose in relation to diet (from 7% to 17% for all-cause mortality), physical activity (from 5% to 21% for all-cause mortality), and alcohol consumption (from 3% to 12% for all-cause mortality).

The authors noted that mortality risk for moderate drinkers was lower compared with both nondrinkers and heavy drinkers. Participants who abstained from alcohol completely were at higher risk for death from cardiovascular disease, while those who drank heavily had a higher cancer death risk.

The study results show that health behaviors explain more of socioeconomic differences in death rates than what has been observed in previous studies, James R. Dunn, Ph.D., of McMaster University in Hamilton, Ont., wrote in an accompanying editorial (JAMA 2010;303:1199-200).

However, the findings don't suggest that socioeconomic differences in health status can be reduced simply to socioeconomic differences in unhealthy behaviors, Dr. Dunn said. “Accordingly, it would be incorrect to infer that there is no need to be concerned with social and economic justice, only health behavior,” he said.

Evidence suggests that early childhood development involving stress management capabilities and health behavior may play a role in empowering adults to choose healthier behaviors, he said. Children with lower socioeconomic status are more likely to have deficits in these areas.

Disclosures: Neither Ms. Stringhini nor Dr. Dunn reported any financial disclosures. The study has been supported by grants from the British Medical Research Council, the British Heart Foundation, the British Health and Safety Executive, and the British Department of Health; a grant from the U.S. National Heart, Lung, and Blood Institute; and grants from the U.S. National Institute on Aging.

Treatment for melanoma costs Medicare about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues.

Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years, they suggested.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler, who is with the department of dermatology at Emory University in Atlanta, and her associates (Arch. Dermatol. 2010;146:249-56).

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” the investigators wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase.

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators.

Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat.

“The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” Dr. Seidler and her associates noted.

The authors reported no financial conflicts of interest.

Treatment for melanoma costs Medicare about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues.

Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years, they suggested.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler, who is with the department of dermatology at Emory University in Atlanta, and her associates (Arch. Dermatol. 2010;146:249-56).

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” the investigators wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase.

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators.

Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat.

“The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” Dr. Seidler and her associates noted.

The authors reported no financial conflicts of interest.

Treatment for melanoma costs Medicare about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues.

Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years, they suggested.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler, who is with the department of dermatology at Emory University in Atlanta, and her associates (Arch. Dermatol. 2010;146:249-56).

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” the investigators wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase.

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators.

Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat.

“The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” Dr. Seidler and her associates noted.

The authors reported no financial conflicts of interest.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Government Workers Covered

Two-thirds of the nation's nearly 20 million state and local government workers got their health insurance through their employers in 2008, a much higher percentage than among private sector workers, according to the Agency for Healthcare Research and Quality. Premiums for one-person plans ranged from $4,560 to $6,631, while family plan premiums cost between $12,068 and $16,965 per year. New England government workers had the highest average premiums, and workers in New Jersey, New York, and Pennsylvania contributed the least to their premiums for both one-person and family coverage, the report said.

Seniors Hit by Drug Expenses

Medicare Part D enrollees who used high-cost, “specialty tier” drugs are much more likely than other beneficiaries to reach the “doughnut hole,” when they must pay 100% of prescription costs until the totals they and the plans pay reach $6,154, according to a Government Accountability Office report. More than half of Medicare beneficiaries with drug coverage who took one or more of the high-cost drugs spent at least $4,645 out of their own pockets in 2007 and reached the high end of the doughnut hole, or catastrophic threshold, beyond which the government pays at least 80% of all drug costs. Meanwhile, only 8% of beneficiaries who did not use specialty tier–eligible drugs reached the catastrophic threshold. Specialty tier drugs include immunosuppressant drugs, those used to treat cancer, and antiviral drugs. Medicare supplement-plan sponsors told the GAO that they had little leverage to negotiate price concessions for most specialty tier–eligible drugs.

Public Health Funding Is Down

Federal funding for public health has remained flat for nearly 5 years and states have cut a total of nearly $392 million in public health programs in the past year, a report from the Robert Wood Johnson Foundation and the Trust for America's Health shows. That has left communities around the country struggling to deliver basic disease prevention and emergency health preparedness services, the report said. “Chronic under-funding for public health means that millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed, and our workforce is not as healthy as it needs to be to compete with the rest of the world,” said Jeffrey Levi, Ph.D., who is the trust's executive director. States in the midwest received the least funding for disease prevention in public health in fiscal year 2009—a total of $16.50 per person, compared with $19.80 per person in the northeast, $19.22 per person in western states, and $19.75 in southern states.

Food Poisoning Cost Is Sickening

Each case of foodborne illness, such as from Escherichia coli and Campylobacter, costs an average of $1,850 in treatment and other health costs, totaling $152 billion for the nation annually, according to a study by the Pew Charitable Trusts at Georgetown University. Cases related to tainted produce cost $39 billion in just medical costs per year. “Although this study only addresses the health-related costs of foodborne illness, the total cost of foodborne illness also includes … costs to industry and government from outbreaks,” according to the report. According to the Centers for Disease Control and Prevention, 76 million new cases of food-related illness result in 5,000 deaths and 325,000 hospitalizations in the United States each year.

Massachusetts Care Still Short

Despite the 2006 passage of health care reform in Massachusetts, some groups—including young adults, low-income residents, and Hispanics—still have low rates of annual checkups and limited access to providers, according to the CDC. Overall, insurance coverage in the state increased from 89% in 2005 to 97% in 2008 as a result of the reform law, providing coverage for an estimated 300,000 additional individuals. Hispanics benefited the most from the law, with a 14% increase in insurance coverage, the report said. But that group and some other traditionally underserved groups still lag behind in basic health care: Only about 75% of Hispanics, men aged 18-34, people in low-income households, and those with less than a high school diploma reported having a personal physician in 2008.

FDA Warns on Food Labels

The Food and Drug Administration has notified 17 food manufacturers, including Gorton's Inc. and Nestle, that labeling for some of their food products violates the Federal Food, Drug and Cosmetic Act. Violations cited in the warning letters include unauthorized health claims, unauthorized nutrient-content claims, and the unauthorized use of terms such as “healthy,” the FDA said. Nestle, for example, was warned about using “100% juice” to describe a product that had added flavors, while the FDA told Gorton's in its letter that its fish fillet packages need to disclose high levels of sodium, saturated fat, and total fat to accompany the claim of zero trans fats.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Government Workers Covered

Two-thirds of the nation's nearly 20 million state and local government workers got their health insurance through their employers in 2008, a much higher percentage than among private sector workers, according to the Agency for Healthcare Research and Quality. Premiums for one-person plans ranged from $4,560 to $6,631, while family plan premiums cost between $12,068 and $16,965 per year. New England government workers had the highest average premiums, and workers in New Jersey, New York, and Pennsylvania contributed the least to their premiums for both one-person and family coverage, the report said.

Seniors Hit by Drug Expenses

Medicare Part D enrollees who used high-cost, “specialty tier” drugs are much more likely than other beneficiaries to reach the “doughnut hole,” when they must pay 100% of prescription costs until the totals they and the plans pay reach $6,154, according to a Government Accountability Office report. More than half of Medicare beneficiaries with drug coverage who took one or more of the high-cost drugs spent at least $4,645 out of their own pockets in 2007 and reached the high end of the doughnut hole, or catastrophic threshold, beyond which the government pays at least 80% of all drug costs. Meanwhile, only 8% of beneficiaries who did not use specialty tier–eligible drugs reached the catastrophic threshold. Specialty tier drugs include immunosuppressant drugs, those used to treat cancer, and antiviral drugs. Medicare supplement-plan sponsors told the GAO that they had little leverage to negotiate price concessions for most specialty tier–eligible drugs.

Public Health Funding Is Down

Federal funding for public health has remained flat for nearly 5 years and states have cut a total of nearly $392 million in public health programs in the past year, a report from the Robert Wood Johnson Foundation and the Trust for America's Health shows. That has left communities around the country struggling to deliver basic disease prevention and emergency health preparedness services, the report said. “Chronic under-funding for public health means that millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed, and our workforce is not as healthy as it needs to be to compete with the rest of the world,” said Jeffrey Levi, Ph.D., who is the trust's executive director. States in the midwest received the least funding for disease prevention in public health in fiscal year 2009—a total of $16.50 per person, compared with $19.80 per person in the northeast, $19.22 per person in western states, and $19.75 in southern states.

Food Poisoning Cost Is Sickening

Each case of foodborne illness, such as from Escherichia coli and Campylobacter, costs an average of $1,850 in treatment and other health costs, totaling $152 billion for the nation annually, according to a study by the Pew Charitable Trusts at Georgetown University. Cases related to tainted produce cost $39 billion in just medical costs per year. “Although this study only addresses the health-related costs of foodborne illness, the total cost of foodborne illness also includes … costs to industry and government from outbreaks,” according to the report. According to the Centers for Disease Control and Prevention, 76 million new cases of food-related illness result in 5,000 deaths and 325,000 hospitalizations in the United States each year.

Massachusetts Care Still Short

Despite the 2006 passage of health care reform in Massachusetts, some groups—including young adults, low-income residents, and Hispanics—still have low rates of annual checkups and limited access to providers, according to the CDC. Overall, insurance coverage in the state increased from 89% in 2005 to 97% in 2008 as a result of the reform law, providing coverage for an estimated 300,000 additional individuals. Hispanics benefited the most from the law, with a 14% increase in insurance coverage, the report said. But that group and some other traditionally underserved groups still lag behind in basic health care: Only about 75% of Hispanics, men aged 18-34, people in low-income households, and those with less than a high school diploma reported having a personal physician in 2008.

FDA Warns on Food Labels

The Food and Drug Administration has notified 17 food manufacturers, including Gorton's Inc. and Nestle, that labeling for some of their food products violates the Federal Food, Drug and Cosmetic Act. Violations cited in the warning letters include unauthorized health claims, unauthorized nutrient-content claims, and the unauthorized use of terms such as “healthy,” the FDA said. Nestle, for example, was warned about using “100% juice” to describe a product that had added flavors, while the FDA told Gorton's in its letter that its fish fillet packages need to disclose high levels of sodium, saturated fat, and total fat to accompany the claim of zero trans fats.

Want more health reform news? Subscribe to our podcast – search 'Policy & Practice' in the iTunes store

Government Workers Covered

Two-thirds of the nation's nearly 20 million state and local government workers got their health insurance through their employers in 2008, a much higher percentage than among private sector workers, according to the Agency for Healthcare Research and Quality. Premiums for one-person plans ranged from $4,560 to $6,631, while family plan premiums cost between $12,068 and $16,965 per year. New England government workers had the highest average premiums, and workers in New Jersey, New York, and Pennsylvania contributed the least to their premiums for both one-person and family coverage, the report said.

Seniors Hit by Drug Expenses

Medicare Part D enrollees who used high-cost, “specialty tier” drugs are much more likely than other beneficiaries to reach the “doughnut hole,” when they must pay 100% of prescription costs until the totals they and the plans pay reach $6,154, according to a Government Accountability Office report. More than half of Medicare beneficiaries with drug coverage who took one or more of the high-cost drugs spent at least $4,645 out of their own pockets in 2007 and reached the high end of the doughnut hole, or catastrophic threshold, beyond which the government pays at least 80% of all drug costs. Meanwhile, only 8% of beneficiaries who did not use specialty tier–eligible drugs reached the catastrophic threshold. Specialty tier drugs include immunosuppressant drugs, those used to treat cancer, and antiviral drugs. Medicare supplement-plan sponsors told the GAO that they had little leverage to negotiate price concessions for most specialty tier–eligible drugs.

Public Health Funding Is Down

Federal funding for public health has remained flat for nearly 5 years and states have cut a total of nearly $392 million in public health programs in the past year, a report from the Robert Wood Johnson Foundation and the Trust for America's Health shows. That has left communities around the country struggling to deliver basic disease prevention and emergency health preparedness services, the report said. “Chronic under-funding for public health means that millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed, and our workforce is not as healthy as it needs to be to compete with the rest of the world,” said Jeffrey Levi, Ph.D., who is the trust's executive director. States in the midwest received the least funding for disease prevention in public health in fiscal year 2009—a total of $16.50 per person, compared with $19.80 per person in the northeast, $19.22 per person in western states, and $19.75 in southern states.

Food Poisoning Cost Is Sickening

Each case of foodborne illness, such as from Escherichia coli and Campylobacter, costs an average of $1,850 in treatment and other health costs, totaling $152 billion for the nation annually, according to a study by the Pew Charitable Trusts at Georgetown University. Cases related to tainted produce cost $39 billion in just medical costs per year. “Although this study only addresses the health-related costs of foodborne illness, the total cost of foodborne illness also includes … costs to industry and government from outbreaks,” according to the report. According to the Centers for Disease Control and Prevention, 76 million new cases of food-related illness result in 5,000 deaths and 325,000 hospitalizations in the United States each year.

Massachusetts Care Still Short

Despite the 2006 passage of health care reform in Massachusetts, some groups—including young adults, low-income residents, and Hispanics—still have low rates of annual checkups and limited access to providers, according to the CDC. Overall, insurance coverage in the state increased from 89% in 2005 to 97% in 2008 as a result of the reform law, providing coverage for an estimated 300,000 additional individuals. Hispanics benefited the most from the law, with a 14% increase in insurance coverage, the report said. But that group and some other traditionally underserved groups still lag behind in basic health care: Only about 75% of Hispanics, men aged 18-34, people in low-income households, and those with less than a high school diploma reported having a personal physician in 2008.

FDA Warns on Food Labels

The Food and Drug Administration has notified 17 food manufacturers, including Gorton's Inc. and Nestle, that labeling for some of their food products violates the Federal Food, Drug and Cosmetic Act. Violations cited in the warning letters include unauthorized health claims, unauthorized nutrient-content claims, and the unauthorized use of terms such as “healthy,” the FDA said. Nestle, for example, was warned about using “100% juice” to describe a product that had added flavors, while the FDA told Gorton's in its letter that its fish fillet packages need to disclose high levels of sodium, saturated fat, and total fat to accompany the claim of zero trans fats.

Treatment for melanoma costs the U.S. Medicare program about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study reported in the March issue of the Archives of Dermatology.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues. Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler of the department of dermatology at Emory University in Atlanta and her associates.

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” they wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase (Arch. Dermatol. 2010;146:249-56).

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators. Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat. “The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” the investigators noted.

The authors reported no financial conflicts of interest.

Treatment for melanoma costs the U.S. Medicare program about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study reported in the March issue of the Archives of Dermatology.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues. Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler of the department of dermatology at Emory University in Atlanta and her associates.

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” they wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase (Arch. Dermatol. 2010;146:249-56).

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators. Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat. “The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” the investigators noted.

The authors reported no financial conflicts of interest.

Treatment for melanoma costs the U.S. Medicare program about $249 million annually, but effective prevention and early detection could reduce expenses by up to 60%, according to a new study reported in the March issue of the Archives of Dermatology.

Treatment expenses for each patient who died from melanoma totaled more than $28,000 on average from the time of diagnosis until death, according to Dr. Anne M. Seidler and her colleagues. Policymakers should consider crafting guidelines for melanoma screening that reflect increased risks for patients older than age 65 years.

Although relatively few elderly patients die of melanoma, per-patient expenses are particularly high in cases of advanced disease, noted Dr. Seidler of the department of dermatology at Emory University in Atlanta and her associates.

“The majority of consumption is attributable to advanced-stage disease and the terminal phase of treatment,” they wrote. “If all patients were diagnosed and effectively treated in stage 0 or I, we estimate that the annual direct costs for the population 65 years or older would be between $99 million and $161 million, or 40% to 65% of their current value of $249 million.”

The researchers used Surveillance, Epidemiology, and End Results (SEER) data from 1,858 Medicare beneficiaries with a confirmed melanoma diagnosis and calculated cost by stage and treatment phase (Arch. Dermatol. 2010;146:249-56).

Average monthly per-patient melanoma charges were $2,194 during the initial 4 months of treatment. After this initial treatment phase, monthly costs fell to $902, but then increased to $3,933 if the cancer spread and became terminal, according to the investigators. Total costs may be higher than found based on how much patients spent on copayments and deductibles.

A total of 263 patients died of melanoma during the 6 years studied. These patients lived an average of 26 months after diagnosis, and their care cost an average of $13,020 per year, the study reported.

Early-stage melanoma costs appeared similar to those of prostate cancer, while late-stage melanoma costs resembled those of colon cancer, which generally is more expensive to treat. “The lack of definitive, effective therapy for melanoma, which may result in utilization of multiple chemotherapeutic agents in these later stages, likely drives up the costs,” the investigators noted.

The authors reported no financial conflicts of interest.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment to the period Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for again extending the funding break, through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. The Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Sixty percent of practices that got the reports said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18–64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology-products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230–43). The approved applications were for 18 new drugs and 35 additional indications for already approved drugs. The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment to the period Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for again extending the funding break, through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. The Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Sixty percent of practices that got the reports said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18–64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology-products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230–43). The approved applications were for 18 new drugs and 35 additional indications for already approved drugs. The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment to the period Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for again extending the funding break, through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. The Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are more than a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Sixty percent of practices that got the reports said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18–64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology-products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230–43). The approved applications were for 18 new drugs and 35 additional indications for already approved drugs. The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit.

Children snack an average of nearly three times each day, most often consuming desserts and sweetened beverages, and more than 27% of their daily calories are coming from snacks, according to a new study.

The study, conducted by investigators at the University of North Carolina at Chapel Hill, found that children have greatly increased their snacking habits since 1977, adding more than one snack per day along with 168 calories per day to their average daily snack intake.

Children aged 2–6 years had the largest caloric increase—182 calories—which the researchers said suggests they are developing an unhealthy eating pattern early in life.

“Kids still eat three meals a day, but they're also loading up on high-calorie junk food that contains little or no nutritional value during these snacks,” Barry Popkin, Ph.D., professor of nutrition at the university, said in a statement. “Such findings raise concerns that more children in the United States are moving toward a dysfunctional eating pattern, one that can lead to unhealthy weight gain and obesity.”

Researchers incorporated data from four separate food intake surveys conducted over the past 3 decades, and included 31,337 children aged 2–18 years in their analysis (Health Affairs 2010;29:3:1–7[doi:10.13/hltaff.2009.0666]).

In 1977, 74% of children ate snacks, while by 2006, 98% ate snacks, according to the study. Also, in 1977, most children ate fewer than two snacks per day, while in 2006 they ate nearly three snacks per day, Dr. Popkin and his associates reported.

Salty snacks, such as chips and crackers, comprised the largest increase in the types of snacks children ate during the three-decade period, the study found. In addition, children are eating more candy at snack time, which Dr. Popkin pointed out can lead to both weight gain and cavities.

At the same time, children now are less likely to drink milk or eat fruit, instead consuming fruit juice or sweetened beverages such as sports drinks, the study reported.

Dessert consumption at snack time declined from 1977 to 2006, although dessert-type snacks still contribute more daily calories than any other category, the study found.

Additionally, the energy density of snacks remained fairly constant over the course of the study.

“Our findings suggest that children ages 2–18 are experiencing important increases in snacking behavior and are moving toward a consumption pattern of three meals plus three snacks per day,” the investigators concluded. “This raises the question of whether the physiological basis for eating is becoming dysregulated, as our children are moving toward constant eating.”

Financial support for the study was provided by the National Institutes of Health. Dr. Popkin reported no relevant conflicts of interest.

Children snack an average of nearly three times each day, most often consuming desserts and sweetened beverages, and more than 27% of their daily calories are coming from snacks, according to a new study.

The study, conducted by investigators at the University of North Carolina at Chapel Hill, found that children have greatly increased their snacking habits since 1977, adding more than one snack per day along with 168 calories per day to their average daily snack intake.

Children aged 2–6 years had the largest caloric increase—182 calories—which the researchers said suggests they are developing an unhealthy eating pattern early in life.

“Kids still eat three meals a day, but they're also loading up on high-calorie junk food that contains little or no nutritional value during these snacks,” Barry Popkin, Ph.D., professor of nutrition at the university, said in a statement. “Such findings raise concerns that more children in the United States are moving toward a dysfunctional eating pattern, one that can lead to unhealthy weight gain and obesity.”

Researchers incorporated data from four separate food intake surveys conducted over the past 3 decades, and included 31,337 children aged 2–18 years in their analysis (Health Affairs 2010;29:3:1–7[doi:10.13/hltaff.2009.0666]).

In 1977, 74% of children ate snacks, while by 2006, 98% ate snacks, according to the study. Also, in 1977, most children ate fewer than two snacks per day, while in 2006 they ate nearly three snacks per day, Dr. Popkin and his associates reported.

Salty snacks, such as chips and crackers, comprised the largest increase in the types of snacks children ate during the three-decade period, the study found. In addition, children are eating more candy at snack time, which Dr. Popkin pointed out can lead to both weight gain and cavities.

At the same time, children now are less likely to drink milk or eat fruit, instead consuming fruit juice or sweetened beverages such as sports drinks, the study reported.

Dessert consumption at snack time declined from 1977 to 2006, although dessert-type snacks still contribute more daily calories than any other category, the study found.

Additionally, the energy density of snacks remained fairly constant over the course of the study.

“Our findings suggest that children ages 2–18 are experiencing important increases in snacking behavior and are moving toward a consumption pattern of three meals plus three snacks per day,” the investigators concluded. “This raises the question of whether the physiological basis for eating is becoming dysregulated, as our children are moving toward constant eating.”

Financial support for the study was provided by the National Institutes of Health. Dr. Popkin reported no relevant conflicts of interest.

Children snack an average of nearly three times each day, most often consuming desserts and sweetened beverages, and more than 27% of their daily calories are coming from snacks, according to a new study.

The study, conducted by investigators at the University of North Carolina at Chapel Hill, found that children have greatly increased their snacking habits since 1977, adding more than one snack per day along with 168 calories per day to their average daily snack intake.

Children aged 2–6 years had the largest caloric increase—182 calories—which the researchers said suggests they are developing an unhealthy eating pattern early in life.

“Kids still eat three meals a day, but they're also loading up on high-calorie junk food that contains little or no nutritional value during these snacks,” Barry Popkin, Ph.D., professor of nutrition at the university, said in a statement. “Such findings raise concerns that more children in the United States are moving toward a dysfunctional eating pattern, one that can lead to unhealthy weight gain and obesity.”

Researchers incorporated data from four separate food intake surveys conducted over the past 3 decades, and included 31,337 children aged 2–18 years in their analysis (Health Affairs 2010;29:3:1–7[doi:10.13/hltaff.2009.0666]).

In 1977, 74% of children ate snacks, while by 2006, 98% ate snacks, according to the study. Also, in 1977, most children ate fewer than two snacks per day, while in 2006 they ate nearly three snacks per day, Dr. Popkin and his associates reported.

Salty snacks, such as chips and crackers, comprised the largest increase in the types of snacks children ate during the three-decade period, the study found. In addition, children are eating more candy at snack time, which Dr. Popkin pointed out can lead to both weight gain and cavities.

At the same time, children now are less likely to drink milk or eat fruit, instead consuming fruit juice or sweetened beverages such as sports drinks, the study reported.

Dessert consumption at snack time declined from 1977 to 2006, although dessert-type snacks still contribute more daily calories than any other category, the study found.

Additionally, the energy density of snacks remained fairly constant over the course of the study.

“Our findings suggest that children ages 2–18 are experiencing important increases in snacking behavior and are moving toward a consumption pattern of three meals plus three snacks per day,” the investigators concluded. “This raises the question of whether the physiological basis for eating is becoming dysregulated, as our children are moving toward constant eating.”

Financial support for the study was provided by the National Institutes of Health. Dr. Popkin reported no relevant conflicts of interest.

Major Finding: From 2003 to 2007, the number of children with a BMI in the 95th percentile or higher grew from 14.8% to 16.4%.

Data Source: National Survey of Children's Health, 2003 and 2007 data.

Disclosures: Study partially funded by federal grant; investigators reported no relevant conflicts of interest.

The percentage of children aged 10–17 years considered overweight remained stable between 2003 and 2007, but the national prevalence of childhood obesity grew significantly in the same time period, according to a new study showing nearly one in three children is overweight or obese.

The study also found marked disparities between the rates of overweight and obesity associated with socioeconomic status, school outcomes, neighborhoods, health insurance coverage, and quality of care.

“The national prevalence of childhood overweight and obesity is alarming, but does not tell the whole story,” according to study author Christina Bethell, Ph.D., director of the Child and Adolescent Health Measurement Initiative at Oregon Health & Science University in Portland, and her associates.

“Tremendous variation and disparities across and within states and population sub-groups demonstrates why we need both targeted, local interventions and broad statewide and national policies across many sectors, including education, transportation, parks and recreation, and health care,” Dr. Bethell said in a statement.

Dr. Bethell and her colleagues compared 2007 data from the National Survey of Children's Health to data from 2003. They found that the percentage of overweight children, defined as a body mass index (BMI) in the 85th-94th percentiles for age and sex, held at about 15.5% over the 4-year study period. But the number of obese children, defined as a BMI in the 95th percentile or higher, grew from 14.8% to 16.4% over the same period (Health Aff. 2010 [10.1377/hlthaff.2009.0762

State statistics varied widely, the study found. Utah and Minnesota had the lowest rate of overweight and obesity (23%) in 2007; Mississippi had the highest (44%).

In addition, publicly insured children were at higher risk for overweight and obesity. Between 2003 and 2007, the combined overweight-obese rate rose from 39.6% to 43.2% for children who were covered by public insurance programs, while privately insured children saw a much smaller increase, from 26.7% to 27.3%.

Children living in poverty were more likely to be overweight or obese, as were children who lived in unsafe neighborhoods, neighborhoods without a park or recreation center, or poorly kept neighborhoods.

Major Finding: From 2003 to 2007, the number of children with a BMI in the 95th percentile or higher grew from 14.8% to 16.4%.

Data Source: National Survey of Children's Health, 2003 and 2007 data.

Disclosures: Study partially funded by federal grant; investigators reported no relevant conflicts of interest.

The percentage of children aged 10–17 years considered overweight remained stable between 2003 and 2007, but the national prevalence of childhood obesity grew significantly in the same time period, according to a new study showing nearly one in three children is overweight or obese.

The study also found marked disparities between the rates of overweight and obesity associated with socioeconomic status, school outcomes, neighborhoods, health insurance coverage, and quality of care.

“The national prevalence of childhood overweight and obesity is alarming, but does not tell the whole story,” according to study author Christina Bethell, Ph.D., director of the Child and Adolescent Health Measurement Initiative at Oregon Health & Science University in Portland, and her associates.

“Tremendous variation and disparities across and within states and population sub-groups demonstrates why we need both targeted, local interventions and broad statewide and national policies across many sectors, including education, transportation, parks and recreation, and health care,” Dr. Bethell said in a statement.

Dr. Bethell and her colleagues compared 2007 data from the National Survey of Children's Health to data from 2003. They found that the percentage of overweight children, defined as a body mass index (BMI) in the 85th-94th percentiles for age and sex, held at about 15.5% over the 4-year study period. But the number of obese children, defined as a BMI in the 95th percentile or higher, grew from 14.8% to 16.4% over the same period (Health Aff. 2010 [10.1377/hlthaff.2009.0762

State statistics varied widely, the study found. Utah and Minnesota had the lowest rate of overweight and obesity (23%) in 2007; Mississippi had the highest (44%).

In addition, publicly insured children were at higher risk for overweight and obesity. Between 2003 and 2007, the combined overweight-obese rate rose from 39.6% to 43.2% for children who were covered by public insurance programs, while privately insured children saw a much smaller increase, from 26.7% to 27.3%.

Children living in poverty were more likely to be overweight or obese, as were children who lived in unsafe neighborhoods, neighborhoods without a park or recreation center, or poorly kept neighborhoods.

Major Finding: From 2003 to 2007, the number of children with a BMI in the 95th percentile or higher grew from 14.8% to 16.4%.

Data Source: National Survey of Children's Health, 2003 and 2007 data.

Disclosures: Study partially funded by federal grant; investigators reported no relevant conflicts of interest.

The percentage of children aged 10–17 years considered overweight remained stable between 2003 and 2007, but the national prevalence of childhood obesity grew significantly in the same time period, according to a new study showing nearly one in three children is overweight or obese.

The study also found marked disparities between the rates of overweight and obesity associated with socioeconomic status, school outcomes, neighborhoods, health insurance coverage, and quality of care.

“The national prevalence of childhood overweight and obesity is alarming, but does not tell the whole story,” according to study author Christina Bethell, Ph.D., director of the Child and Adolescent Health Measurement Initiative at Oregon Health & Science University in Portland, and her associates.

“Tremendous variation and disparities across and within states and population sub-groups demonstrates why we need both targeted, local interventions and broad statewide and national policies across many sectors, including education, transportation, parks and recreation, and health care,” Dr. Bethell said in a statement.

Dr. Bethell and her colleagues compared 2007 data from the National Survey of Children's Health to data from 2003. They found that the percentage of overweight children, defined as a body mass index (BMI) in the 85th-94th percentiles for age and sex, held at about 15.5% over the 4-year study period. But the number of obese children, defined as a BMI in the 95th percentile or higher, grew from 14.8% to 16.4% over the same period (Health Aff. 2010 [10.1377/hlthaff.2009.0762

State statistics varied widely, the study found. Utah and Minnesota had the lowest rate of overweight and obesity (23%) in 2007; Mississippi had the highest (44%).

In addition, publicly insured children were at higher risk for overweight and obesity. Between 2003 and 2007, the combined overweight-obese rate rose from 39.6% to 43.2% for children who were covered by public insurance programs, while privately insured children saw a much smaller increase, from 26.7% to 27.3%.

Children living in poverty were more likely to be overweight or obese, as were children who lived in unsafe neighborhoods, neighborhoods without a park or recreation center, or poorly kept neighborhoods.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment from Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for extending the funding break through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are over a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality-Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Of practices that got the reports, 60% said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18-64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230-43). The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit. Manufacturers whose drugs are approved this way must conduct further studies to evaluate the drug's clinical benefits.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment from Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for extending the funding break through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are over a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality-Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Of practices that got the reports, 60% said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18-64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230-43). The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit. Manufacturers whose drugs are approved this way must conduct further studies to evaluate the drug's clinical benefits.

HHS Extends Medicaid Relief

The Department of Health and Human Services is giving states a $4.3-billion break on prescription drugs for people who qualify for both Medicare and Medicaid. That's how much less the federal government will charge states through this year for Medicare coverage of drugs for “dual eligibles.” “We believe [this] action will help states as they struggle to maintain Medicaid and other budget priorities in these difficult economic times,” HHS Secretary Kathleen Sebelius said in a statement. The relief comes from last year's American Recovery and Reinvestment Act, which granted a temporary increase in the amount states receive from the federal government for Medicaid. The new action applies the funding adjustment from Oct. 1, 2008, through Dec. 31, 2010. California's estimated savings are the largest in the country, at $675 million, while Wyoming will probably receive the least, at about $4 million. In his proposed budget for 2011, President Obama called for extending the funding break through June 30, 2011.

Healthy Food Financing Proposed

In an effort to bring better foods to communities that are known as “food deserts” because of their lack of healthy options, the Obama administration has proposed targeting $400 million in tax credits, low-rate loans, loan guarantees, and grants. If Congress approves the Healthy Food Financing Initiative as part of the federal budget, the funds will support projects ranging from grocery store construction to smaller interventions such as placing refrigerators stocked with fresh produce in convenience stores. Nationwide, the Department of Agriculture estimates that 23.5 million people, including 6.5 million children, live in low-income food deserts that are over a mile from a supermarket. These areas typically are served by fast-food restaurants and small stores that offer little or no fresh produce.

More Quality-Reporting Woes

Medical practice leaders continued to cite multiple administrative challenges with Medicare's Physician Quality Reporting Initiative, according to a survey from the Medical Group Management Association. Specifically, the 429 medical practices surveyed said that the process for accessing PQRI feedback reports was “unnecessarily arduous” and that the reports themselves were not satisfactory. According to the MGMA, fewer than half of the medical practices that attempted to participate in the 2008 PQRI were able to access their 2008 feedback reports. For those that did get the data, it took an average of 9 hours to download the report. Of practices that got the reports, 60% said that they were dissatisfied or very dissatisfied with the presentation of the information, and two-thirds said they were dissatisfied or very dissatisfied with the report's ability to guide them in improving patient care outcomes. The MGMA urged the Centers for Medicare and Medicaid Services to change the PQRI feedback process.

Many Use Internet for Health Info

More than half (51%) of adults aged 18-64 years use the Internet to look up health information over the course of a year, but only a handful communicate with their providers by e-mail or another Internet route, according to a survey by the National Center for Health Statistics. About 3% of adults reported using online chat groups to learn about health topics. The survey showed women more likely than men to use the Internet to research health issues and to join chat groups. Almost 5% of adults said that they had communicated with a health provider online in the past year, while 6% requested a prescription refill online and 3% made an office appointment online. The analysis included data from 7,192 adults surveyed from January to June 2009.

Supplements Bipartisanship

Sen. John McCain (R-Ariz.) and Sen. Byron Dorgan (D-N.D.) have introduced legislation that would give the Food and Drug Administration authority to issue mandatory recalls of unsafe dietary supplements. The bill also would force supplement manufacturers to register with the FDA and provide the agency with lists of their supplements' ingredients. Currently, the FDA does not have the authority to review dietary supplement makers' advertised claims of safety and effectiveness, even though surveys have shown that most users of the products believe the agency does, Sen. McCain said in a statement.

FDA Oncology Approvals Up

The FDA's Office of Oncology Drug Products approved 53 new indications for oncology and hematology drugs and biologics between July 2005—when the office began reviewing marketing applications—and the end of 2007, according to an agency study. During that time, the oncology products office reviewed 60 applications and took action on 58, investigators reported (J. Natl. Cancer Inst. 2010;102:230-43). The office utilizes an accelerated approval process based on various end points, including indirect measurements of clinical benefit. Manufacturers whose drugs are approved this way must conduct further studies to evaluate the drug's clinical benefits.