Monday, September 27, 2010

Health Care Reform to Require Obesity Counseling Insurer Coverage

A number of rules associated with The US Health Care Reform, or the Patient Protection and Affordable Care Act, went into effect on September 23, 2010. One of the rules requires that services, associated with some of the preventive service guidelines established by the US Preventive Services Task Force, be covered by most insurers. And the insurers are to not require co-pays, co-insurance, or deductibles for the preventive services. One of the services is obesity counseling for adults, and another is obesity counseling for children over six years of age.

Physicians, however, may be reluctant to provide counseling for obesity. According to a report from the Penn State College of Medicine, physicians don't necessarily believe that offering weight-loss advice and counseling is a worthwhile activity in clinical practice. So even though insurers may cover the counseling intervention, many physicians might not do the counseling.

However, a study described in a June 2010 article of the "Annals of Family Medicine" may help change physicians’ opinions about weight-loss counseling. The article details a counseling study where urban preschool children were subjected to a counseling process that may help the researchers design "effective primary care based interventions." The counseling process focuses on the family and uses the "Five A’s" counseling approach derived from a counseling approach created by the National Cancer Institute. The five A's, in the approach, are "assess," "advise," "agree," "assist," and "arrange."

As part of the study, the urban childrens’ families were asked to fill out a lifestyle questionnaire, called FLAIR (Family Lifestyle Assessment of Initial Risk). And physicians associated with the study were trained to provide specific counseling "about the behavior selected for change," based on the questionnaire. Learning to provide more precise counseling, while including the family in the process, may enable medical practitioners to better counsel overweight and obese patients.

The study's researchers found that the families in the study responded positively to the counseling intervention -- parents and families being receptive to the intervention. Primary care practitioners and bariatric physicians should view the families’ response as positive. With expected insurer coverage, and promising counseling methods, counseling intervention could become a more important tool for physicians who need to help patients lose weight.

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Friday, September 17, 2010

Lorcaserin Failed to Get FDA Advisory Panel Recommendation

Ipsos Vantis, a pharmaceutical market researcher, estimates that "between one-half and two-thirds of primary care physicians would likely prescribe" any one of the three weight loss drugs currently in the pipeline. The three drugs are qnexa, manufactured by Vivus, lorcaserin produced by Arena, and contrave manufactured by Orexigen. However, as we reported recently, an FDA advisory panel rejected qnexa. And on Thursday of this week, an FDA panel failed to recommend lorcaserin.

One concern the panel had was whether persons taking lorcaserin might be "more likely to develop valvular heart disease." Lorcaserin suppresses the appetite in a way similar to the way the drug fenfluramine suppresses the appetite. And the FDA requested that fenfluramine be taken off the market in the 90s.

The drug was the "fen" part of the combination weight loss drug, fen-phen, which caused severe side effects in patients. However, even though lorcaserin has some things in common with fenfluramine, lorcaserin is said to have fewer and less severe side effects than fenfluramine.

The "phen" part of fen-phen was phentermine. Phentermine is one of the two drugs that comprises Qnexa, another weight loss drug an FDA panel recently rejected. And phentermine is still being prescribed for weight loss and weight management.

Although Qnexa was effective in weight loss, the panel had concerns about the drug when taken in high doses. And participants in qnexa-usage studies experienced thoughts of suicide, anxiety, palpitations, and problems concentrating.

If the FDA does eventually decide to approve lorcaserin or qnexa or contrave, it will be welcomed by the weight loss market. According to Ipsos Vantis, 'U.S. retail sales for any of these three drugs [could] exceed $400 million on an annual basis within 3-5 years of launch.'

And Indeed, if one of the three weight loss drugs gains FDA approval, the use of the drug in combination with exercise, diet, and counseling, could lead to long term weight loss for many patients. And this would be a good thing for both patients and medical weight loss practitioners.

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Friday, September 3, 2010

Using Dance as an Adolescent Weight Loss Tool

Bariatric surgery continues to gain popularity as a way to fight morbid obesity. The complication rate for the surgery is decreasing and the surgery appears to lessen the symptoms of diabetes in some obese persons. And as the obesity rate rises among adolescents, the surgery could be seen as a way to fight adolescent obesity. However, less drastic approaches to adolescent obesity should be improved and employed before resorting to bariatric surgery. Perhaps, culturally specific dance could be a more viable intervention than bariatric surgery.

In Mumbai, India, more and more adolescents are having bariatric surgery done as the obesity rates rise. Although bariatric surgery is probably the most effective form of weight loss, the surgery does have some drawbacks — especially forms of gastric bypass surgery. For example, an adolescent who has had gastric bypass surgery will never be able to eat normal meals without experiencing problems, the operation is not viewed as reversible, and without a good diet, weight might be regained.

Because adolescent obesity is increasing, bariatric surgery as an approach to childhood obesity could spread to other countries. However, adolescents have always been seduced by dance, so why not refine the dance intervention weight loss approach by making it pertinent to specific adolescent groups to maintain participant interest long term. That way, dance could possibly be effective in weight loss.

For example, a study done by C.J. Murrock and others at Case Western Reserve University indicated that culturally specific dance can be useful in weight loss. A community based partnership was formed with two churches within the African American community, a community hit hard by obesity. The participants danced to Gospel music. So the dance intervention was culturally specific, using an element that the participants were accustomed to. And dance, as an intervention, was effective in enabling the participants to use weight.

Dance, as a way to lose weight, is already an accepted weight loss method. And making the dance culturally specific could improve the effectiveness of the dance intervention. Bariatric practitioners could work with community groups to organize programs that encourage regular dance among adolescents.

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