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Tuesday, November 24, 2009 

Category: News and Politics

Save This Date - NAAFA 2010 Convention is Coming

to San Francisco August 5 – 9, 2010!

FOR IMMEDIATE RELEASE

November 24, 2009

Oakland, CA – NAAFA is pleased to announce that we will be returning to the San Francisco bay area for our 2010 fund-raising convention.  Make plans now to join us at the Westin San Francisco Airport Hotel. Room rates are $89 per night and can be booked for August 5 – 9, 2010!   The Westin is prepared to receive your NAAFA convention reservations today at: 
http://www.starwoodmeeting.com/StarGroupsWeb/booking/reservation?id=0910129898&key=524C4
   
We have worked hard to keep the cost of this convention down and to move quickly in making our convention package available early this year.  NAAFA is introducing a three tiered convention registration fee.  Our $199.00 SUPER EARLY BIRD SPECIAL starts now and is available until January 31, 2010.  The Early Bird Special price is $225.00 from February 1 through May 31, 2010.   Beginning June 1, 2010, full convention price will be $265.00. 

The 2010 NAAFA Convention Package would make a great holiday gift for you, your family and all your friends!
 
We have made it easy for you to register for the convention as well as the hotel through our website at www.naafa.org.  We encourage you to register for the NAAFA convention package today and to fully participate in this life-changing event.  Watch our website for more exciting details as they become available.

Founded in 1969, NAAFA is a non-profit human rights organization dedicated to improving the quality of life for fat people.  NAAFA works to eliminate discrimination based on body size and provide fat people with the tools for self-empowerment through public education, advocacy, and member support.

On the web:  http://www.naafa.org


For more information contact:

Peggy Howell, Public Relations Director, NAAFA

e-mail:  naafa_pr@yahoo.com  
11:47 PM 
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Wednesday, November 11, 2009 

Category: News and Politics
SOURCE:  etruth.com

It wouldn't kill you to lose a few pounds -- or would it?

Wednesday, November 11, 2009
BY JENNIFER LARUE HUGET
Special to The Washington Post

These days it seems our entire way of life is predicated on the belief that being overweight is terrible for you. We're waging war against the obesity epidemic, which public health experts call one of the great threats to our society. Countless diet books and programs promise to help us get thin because our lives depend on it.

The government joins in, too. In July, the Centers for Disease Control and Prevention launched a Web site designed to help small and medium-sized employers devise strategies for helping workers manage their weight. In August, the CDC convened its first "Weight of the Nation" conference in Washington to discuss obesity prevention and control.

But what if it turns out being fat's not so bad after all?
The journal Obesity recently published two studies that showed overweight and obese people can expect to live at least as long as people of "normal" weight, while underweight folks are at increased risk of premature death.

In one, a survey over 11 years of nearly 27,000 Japanese men and women ages 61 to 79, underweight people and those at the low end of the normal weight range had a greater risk of death than those squarely in the normal range, while neither overweight nor obesity was found to elevate risk of death.

In the other, a Canadian study involving more than 11,000 people ages 25 and older that aimed to pin down the relationship between overweight and mortality, underweight people were at far greater risk of dying during the 12-year study period than those of normal weight, while those who were overweight and obese were at far less risk of dying. Only the very most obese were at increased risk of death.

Though these findings might sound surprising, they are in keeping with those of earlier research, including studies published in the Journal of the American Medical Association in 2005 and 2007.

So why is it so hard to believe, even in the face of such evidence, that being fat's not exactly a death sentence?

Morgan Downey, policy director for the Stop Obesity Alliance, a nonprofit headquartered at George Washington University, also notes that obesity research is complicated by an array of confounding circumstances such as age, ethnicity, sex and lifestyle, which make it hard to establish clear cause-and-effect relationships between poundage and health. Researchers are even scrutinizing the body-mass index, or BMI, the commonly accepted base for defining weight categories, from underweight to morbidly obese.

The BMI, developed in 19th-century Europe and based on a mostly Caucasian population, may not be a reliable indicator of body-fat levels for blacks and Hispanics, for one thing.

For another, scientists analyzing data don't always agree as to the exact point at which weight becomes tied to mortality.

Downey points out that, paradoxically, obesity/mortality study results might be skewed by the medical community's focus on treating conditions associated with overweight: For example, he'd be interested in seeing a study in which no participants were on statins (cholesterol-reducing drugs).

And he, like other experts, is certain that obesity contributes to poor health, even if it doesn't kill you.

"The pathway seems clear," he says. "Excess adipose tissue leads to impaired glucose tolerance, which leads to insulin resistance." That sets the stage for metabolic syndrome, he says, which is associated with both cardiovascular disease and Type 2 diabetes.

"A lot of people want to think that (obesity's) not as serious as health officials believe," he says, "and they flock to studies that show overweight is moderately protective. I think there's a little denial going on there."

But Linda Bacon, author of "Health at Every Size," thinks the denial's all on the other side. "It is certainly true that people who are heavier are prone to certain diseases, including Type 2 diabetes," she says. "But just because that's true doesn't mean the fat's to blame."

Perhaps, Bacon notes, a lack of exercise among heavy people, not the extra pounds they carry, is what leads to diabetes. Or perhaps it's something about the food they eat or the way they eat it. "There are so many confounding factors," she says.

That may sound like splitting hairs. But Bacon insists that parsing out these relationships is essential. "The reason this issue is so important is that when we address it as a weight-loss issue, we can't tackle the problem. We don't know any method that really helps people lose weight. And weight loss doesn't get rid of the symptoms (of disease)," she adds. "Changed behaviors are what help reverse disease."

Bacon suggests society should help ensure that people be as healthy as they can by encouraging healthful eating and physical activity habits that don't have weight loss as a goal. Bacon believes that "the body will take care of itself"
if people learn to eat when hungry and stop when they're full, to enjoy their foods with gusto, and to engage in physical activity for its own sake.

I like Bacon's approach. In my lifelong struggle to fit into my jeans, I've noticed that I've done best when I've paid least attention to losing pounds. Getting caught up in a work project, preparing for a special vacation or just concentrating on enjoying life takes my mind off dieting and puts food in proper perspective. Maybe if we as a society could shift our focus away from fighting fat and toward healthier behaviors for their own sake, we'd all be better off.

But I don't see that shift happening any time soon.
11:14 PM 
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Saturday, November 07, 2009 

Category: News and Politics
SOURCE: New York Times
November 8, 2009

Overweight Americans Push Back on Health Debate
By SUSAN SAULNY

Marilyn Wann is an author and weight diversity speaker in Northern California who has a message for anyone making judgments about her health based on her large physique.

“The only thing anyone can accurately diagnose by looking at a fat person is their own level of stereotype and prejudice about fat,” said Ms. Wann, a 43-year-old San Franciscan whose motto in life is also the title of her book: “Fat? So!”

Hers has been an oft-repeated message this summer and fall by members of the “fat pride” community, given that the nation is in the midst of a debate about health care. That debate has, sometimes awkwardly, focused its attention on the growing population of overweight and obese Americans with unambiguous overtones: fat people should lose weight, for the good of us all.

Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be healthy at any size.

Extra weight brings with it an increased risk of chronic disease, medical experts say, and heavier people tend to have medical costs that are substantially higher than their leaner counterparts. As a result, Congress is considering proposals in the effort to overhaul health care that would make it easier for employers to use financial rewards or penalties to promote healthy behavior by employees, like weight loss.

Other less-scientific arguments have also gained traction on blogs, chat shows and editorial pages since talk of the overhaul began in earnest, with the overweight cast as lazy or gluttonous liabilities and therefore not entitled to universal health coverage because of poor personal decision-making. As that thinking goes, a healthful eater should not have to pay for the consequences of someone else’s greasy burger binges.

Either way, heavy people — characterized as over-consumers of health care or as those who should miss out on discounts because of their size — say they have been maligned throughout the debate.

“I thought, ‘Health reform? Yay!’ ” said Lynn McAfee, the director of medical advocacy for the Council on Size and Weight Discrimination, an advocacy group for heavy people. But Ms. McAfee said it was not long before her sentiment changed to the more sober, “Oh no, we’re being scapegoated again.”

It is an uphill battle. But the health care debate has, unexpectedly, also provided an opportunity for new expressions of what Ms. Wann calls “fat pride,” the notion that weight diversity is a good thing and that size discrimination is as offensive as any other kind.

“The stigma is so heavy a burden that it took our community 40 years before it could go to Capitol Hill and lobby for ourselves,” said Ms. Wann, a member of the National Association to Advance Fat Acceptance, an advocacy group that organized a lobbying trip to Washington for its members this spring. “We’re kind of a popular punching bag. You can do incredibly discriminating, hurtful, hateful things to fat people in public and not only get away with it but be seen as some kind of superhero.”

On Capitol Hill, the association asked legislators for a public option from which fat people could not be excluded because of weight and for coverage that did not consider excess weight a pre-existing condition.

“Basically,” Ms. Wann continued, “we want to be treated with respect the same as everyone else.”

Americans are more overweight and obese than they were 10 years ago, or even one year ago, according to the Robert Wood Johnson Foundation and the Trust for America’s Health, which published a state-by-state study in June. It showed that the trend is up sharply. Two-thirds of all Americans are overweight or obese. In four states — Alabama, Mississippi, Tennessee and West Virginia — more than 30 percent of adults are obese. In 1991, in contrast, no state had an obesity rate over 20 percent.

And, according to the American Obesity Association, a research organization, poor minority women have the greatest likelihood of being overweight.

Weight is an incendiary issue, experts said, and that may be why it had such staying power as a hot topic of conversation through the health care debate.

“All national health insurance systems are built on the idea that we’re all part of a community, we all get sick and die, so we’re going to take care of one another,” said James Morone, a professor of political science and urban studies at Brown University. “The best philosophical way to stop national health insurance is to say we’re not a community, it’s ‘us vs. them.’ ”

But what has been different about this particular issue, this year, is that “people are pushing back,” Professor Morone said.

Peggy Howell, the public relations director for the National Association to Advance Fat Acceptance, said she had been on the phone delivering her group’s message and answering more news media calls this year than ever before.

The message is simple, she said: “We believe that fat people can eat healthy food and add movement to their lives and be healthy. And healthy should be the goal, not thin.”

That idea is gaining strength and popularity among a segment of the overweight population that feels as though traditional dieting to lose weight does more harm than good, ultimately benefiting the $30 billion weight loss industry, not the public.

“I get so angry when I feel people pushing a weight-loss agenda,” said Linda Bacon, a nutrition professor at City College of San Francisco and author of “Health at Every Size,” a book published last year whose title has become the rallying cry of the fat pride community. “What we’re doing in public health care policy is harmful. We give a direct and clear message that there’s something wrong with being fat.”

A federally financed study by Ms. Bacon, published in the book, found that there were many people who could be healthy in fat bodies.

Ms. Wann used some of Ms. Bacon’s findings as her talking points when she visited legislators with other lobbyists for “fat acceptance” in May.

She said she felt encouraged that the health care bill the House Democratic leaders unveiled on Thursday does not allow changes in insurance pricing based on obesity. But there is still a long way to go before any bill becomes law.

“For me, the takeaway point that was heartening and historic and exhilarating is that it was the first time we started lobbying for a humane health-enhancing system,” said Ms. Wann, who is self-employed and, in her own words, fat and uninsurable.

“We’re all in this life raft together,” she said.
9:56 PM 
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Thursday, November 05, 2009 

Category: Life
SOURCE: BostonHerald.com - The Inside Track

Joe Ligotti chews the fat in Don Imus war

By Gayle Fee and Laura Raposa  
Thursday, November 5, 2009

Joe Ligotti, aka The Guy From Boston, thinks radio yakker Don Imus is a big, fat idiot!

While on air, the notoriously insensitive Imus called the 400-plus-pound Ligotti “fat and stupid” and “a moose” after he saw The Guy From Boston on Neil Cavuto’s show.

Ligotti and Howard Berg, aka the Guiness Book of World Records’ fastest reader, were on the Fox Business channel chatfest reading the Dems’ whopping 1,990-page health-care bill in an effort to demonstrate the ridiculousness of the magnum opus.

“The irony is lost on all of them,” Imus railed. “They’re discussing a health care bill and this moose weighs 600 pounds!”

Ligotti fired back that Imus - who was famously fired by CBS radio after he called the Rutgers women’s basketball team “nappy-headed hos” - “crossed the line.”

“He didn’t just insult a group of basketball players this time,” he said. “He went after 70 percent of the American public who are struggling with their weight.”

Imus claimed not to know who Ligotti was, although the two met when radio station WTKK - which airs Imus’ show in the mornings and Ligotti’s show on the weekends - hosted the annual “Kiss Me, I’m Imus” broadcast in March.

But when the I-blowhard was told that The Guy From Boston had a show on ’TKK, he really teed off.

“He’s fat and he’s stupid! He’s not funny,” Imus ranted. “There was nothing funny on Cavuto last night with this guy. He’s fat and stupid is what he is.”

Geez, do you think it had anything to do with the fact that WTKK recently cut Imus’ show back from four hours to two in favor of local hosts Margery Eagan and Jim Braude????

As for Ligotti, he said he’s aware of his weight issue, but he’d rather be fat than cranky.

“I know I’m a heavy guy and I know every time a camera goes on me, I look larger,” he said. “But Don Imus is just a nasty old man who died five years ago and no one told him. I can’t help it that you’re old, Don, I just hope that when I get old, I’ll be happy with what I did with my life and not just be old and crotchety.”

http://...com/y8e7uow
10:12 PM 
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Wednesday, November 04, 2009 

Category: News and Politics

Weight Acceptance Prevents Weight Gain?

This may sound counterintuitive, but it appears that one way to manage your weight and not continue packing on more pounds year after year may be to simply accept your body weight for what it is and, instead of trying to lose weight, to simply focus on healthy behaviours.

As readers of these pages are probably well aware, the long-term results of restrictive weight-loss interventions is indeed rather disappointing. Thus, the advice to simply eat less, although associated with weight loss in the short term, is rarely sustainable and inadvertently leads to weight regain in the vast majority of patients.

Possible reasons why restrictive dieting often fails is because dieting can increase appetite and promote obsessive thoughts about food and eating as well as increase the risk of depression and overeating in response to negative emotions and stress.

In contrast to this restrictive “weight-centred” approach, a more “health-centered” approach, commonly referred to as “Health-At-Every-Size” (HAES), is based on the notion that health is related to behaviours independently of body weight. Thus, rather than considering weight loss the primary goal, the HAES approach focuses on promoting overall health benefits of behavior changes related to dietary habits and physical activity, with an emphasis on size acceptance and nondieting.

But does this approach provide a viable alternative to weight management?

This question was now addressed in a study by Veronique Provencher and colleagues from Laval University, Quebec, published in the Journal of the American Dietetic Association.

In this study, 144 premenopausal overweight/obese women were randomly assigned to either a HAES group, a social support group, or a control group. The HAES intervention consisted of 13 weekly 3 hour sessions and one intensive 1-day session conducted in small groups led by a registered dietitian and a clinical psychologist. The focus was on well-being and a positive healthy lifestyle as well as to impart awareness and knowledge about biological, psychological, and sociocultural aspects of body weight. In the HAES group, the interveners were active leaders, providing specific information and structured activities to participants.

In contrast, the social support group, which met as often and discussed the same topics as the HAES group, was not specifically directed by the facilitators in terms of content or direction of the discussion. The main function of this group was to mimic the social support and network provided by the HAES group.

The control group consisted of a “waiting list” group, which was not offered any specific intervention at all.

Over the 16 month observation period, situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both the HAES and social support groups, but this difference appeared to be more sustained in the HAES group.

Although, women in the HAES group were not expected to restrict caloric intake, 63.4% of these women had a modestly reduced body weight at 16 months. In contrast, lower body weights were noted in at 16 months in 57.6% of women in the SS group and 43.7% of women in the control group. Significant associations were observed between eating behaviors changes and body weight changes only in the HAES group.

Thus, this study shows that a HAES approach may have long-term beneficial effects in terms of disinhibition and hunger, important behavioural components of healthy ingestive behaviour. Whether or not this approach will translate into better outcomes and long-term prevention of weight gain remains to be seen. It certainly seems to provide a viable alternative to anyone tired of endless weight cycling.

AMS
Edmonton, Alberta
9:05 PM 
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Wednesday, November 04, 2009 

Category: Life
A study is being conducted in the Department of Psychology at the University of Hawai’i-Manoa to examine the impact of experiences and attitudes on our health and quality of life.

Your participation in this study will further our understanding of things which effect our physical and mental health.

Please feel free to forward this email to any adults (people over 18) whom you think may be interested in participating.

Any questions or comments relating to this study should be directed to Laura Durso at ldurso@hawaii.edu.  Thank you.

Please follow the link below to access this online survey:

3:16 AM 
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Tuesday, November 03, 2009 

Current mood:  pissed off
Category: News and Politics
SOURCE: SLATE.COM
The Fat Premium
Congress toys with a silly plan to make Americans lose weight.

By Daniel Engber
Oct. 29, 2009, at 4:14 PM ET

Safeway CEO Steven A. Burd thinks he's solved the nation's health care crisis. The California-based grocery chain has kept its insurance costs stable for the last four years, he says, while its competitors have watched their bills rise by an average of 38 percent. That's because Safeway encourages its workers to pursue a healthy lifestyle: If you're thin and you don't smoke, you can get a significant discount on your premiums. Otherwise, you've got two choices: Pay more for your insurance or mend your wicked ways.

Burd has spent the last several months making supersized claims about this incentive-based approach to health care. In June, he told the Senate that if the government had adopted a Safeway-style program in 2004, we'd have saved $600 billion by now. That makes a federal soda tax look like peanuts.

It would be nice if these flashy numbers were verified by someone not wearing a Safeway management shirt. (The CEO variously describes them as coming from "my calculations" and "our calculations.") Nevertheless, lawmakers from both parties, as well as President Obama, are getting onboard with a Burd-inspired plan to help employer-sponsored insurance plans penalize fat people and smokers with higher premiums. The "Safeway Amendment," which was added to the Senate's health care bill earlier this month and has been proposed in the House, may soon end up as federal law.

There's only one problem: Insurance plans that discriminate according to body size are idiotic, unfair, and possibly illegal.

I'll explain why in a minute, but let's start with a short lesson on how these Safeway-style "wellness programs" came to be. Back in 1996, Congress passed the Health Insurance Portability and Accountability Act, which forbade discrimination among members of group health plans according to their health status. That meant CEOs like Burd couldn't deny coverage or apply higher premiums to people who happened to be sickly or accident-prone; there could be no higher rates for those who had congenital heart defects, or enjoyed skydiving, or happened to be morbidly obese. But the law left open the question of whether insurance plans could lower costs by encouraging healthy lifestyles through more exercise and better diets. In 2006, the federal government got around to clarifying the rules on "wellness programs." In the first place, there would be no limits on rewarding good behavior so long as everyone had equal access to the program. An insurance plan might reimburse members for joining a gym, for example, or entering a program to quit smoking. If participation were the only criterion for getting the reward, everything was legit.

The 2006 clarification also created a second, fuzzier category of wellness programs, in which a plan member's health status could indeed be used against him. Under certain conditions, the government said, a company could set up a system of payouts contingent on an employee's achieving specific health goals. The plan might lower your premium if you joined a gym and lost weight, or entered a program to quit smoking and actually succeeded. That's the kind of program Steven Burd has in place at Safeway: Instead of paying workers to exercise, Safeway pays them to lose weight or stay thin. (In terms of insurance premiums, that's the same as charging them extra money for being fat.) According to the federal regulations, such outcome-based rewards carry their own restrictions: They must be offered to members at least once per year, for example, and they can't exceed 20 percent of the cost of coverage. (The body-size discounts on Burd's plan max out at about $300.)

These rules didn't go into effect until the summer of 2007, and so far very few employers have experimented with premium discounts. But if the Safeway Amendment becomes law, two things would change: First, the regulations governing wellness programs would be codified as federal law; second, the limits on incentives would be increased to 50 percent. Burd already charges the fattest workers in his health plan extra for their coverage; under the new regime, that penalty could be more than doubled.

We're not talking about a radical change in policy so much as an expansion of what is already on the books. But if Burd gets his way, the loophole in the HIPAA nondiscrimination rules would get bigger, and more employers might adopt the kind of wellness programs used by Safeway.

OK, what's so bad about penalizing workers for being fat?

The most egregious flaw in the Safeway program is the way it treats body size as a risk factor in and of itself. Yes, obesity is correlated with higher rates of cardiovascular disease, diabetes, and other ailments—but that doesn't mean that everyone who's fat is going to get sick. A 2008 study from the Archives of Internal Medicine found that a full one-third of all obese patients were "metabolically healthy" in terms of their blood pressure, cholesterol levels, and other measures. Meanwhile, one-fourth of the patients whose BMI was in the normal range showed abnormal metabolic signs. So a policy that varies its premiums as a function of body size is guaranteed to punish a bunch of people who are perfectly healthy and reward a bunch of people who are at risk. (According to the study, these backward incentives would affect about 18 percent of the population.)

Safeway's body-size threshold also ensures that some discounts would be doled out on the basis of trivial differences in body composition. If someone with a BMI of 30.1 trims down to 29.8, has he really reduced his risk of disease? (For someone who's 6 feet tall, that means losing two pounds.) The body mass index was never meant to be used for diagnosing individuals: It's a notoriously sloppy measure that can't distinguish between lean and fatty tissue. Those with athletic builds are often misclassified as being overweight or obese, and some researchers have found that exercise actually leads people to put on weight. Perversely, the Safeway plan could incentivize some of its members to stop exercising. Indeed, by making premium discounts contingent on weight loss rather than healthy behavior, Burd's program may encourage fat people to trim down at any cost. A sensible diet with lots of fruits and vegetables may be less effective than voluntary starvation—or even gastric bypass surgery, which carries its own grave risks and side effects.

The fact that significant weight loss is nearly impossible to maintain poses yet another problem for outcome-based wellness plans. It's a safe bet that any obese person who manages to score the Safeway discount in a given year will be back in the penalty a few years later. That means plan members are incentivized to enter a cycle of yo-yo dieting, which may actually increase their risks of cardiovascular disease (although not all researchers agree on the dangers of weight cycling).

Even if the Safeway incentives did encourage healthy behavior, their implementation would almost certainly be unfair. Much of the criticism of Burd's amendment—and there's been plenty—has focused on the ways in which the program might single out people who are already impoverished. As I've said before, being poor can make you fat, and being fat can make you poor. Rates of obesity and poverty are closely linked across the country, and—among women, at least—the more money you have, the thinner you'll be.

In other words, the workers most likely to run afoul of Safeway's BMI threshold are those most burdened by the process of losing weight. Members of the skinny elite can treat themselves to pricey gym memberships, luxe organic produce, or a piece of the $60 billion diet industry. What about the folks who can't afford to pay for Gyrotonic? Sorry, higher premiums. If you're fat because you're poor, the Safeway penalty makes you poorer still—and that in turn makes it harder to lose weight. This Catch-22 may end up pricing the neediest members out of the system—and it could explain Burd's alleged success at cutting health care costs.

On top of all of this, Safeway-style wellness programs must be carefully designed to accommodate federal and state laws. Last year, a pair of public health experts from Harvard, Michelle Mello and Meredith Rosenthal, reviewed the legal limits of lifestyle discrimination in a paper for the New England Journal of Medicine. They considered all the ways that a program might be against the law, even if it meets the criteria set out in the HIPAA regulations. Charging fat people higher premiums might violate the Americans With Disabilities Act, for example, which protects the health benefits of anyone with an "impairment" caused by a "physiological condition." (So far, there's no clear precedent on whether obesity qualifies as such.) A Safeway-style program could also be challenged on civil rights grounds: Obesity rates are higher among blacks than whites, yet blacks tend to have less visceral fat given the same BMI. And then there's the fact that most states in the union prohibit employment discrimination on the basis of certain behaviors—like smoking—that are conducted outside of working hours.
(Michigan specifically bans weight-based discrimination.) Given these concerns, and several others, Mello and Rosenthal concluded their analysis with "an overarching litmus test of program legality: health plan sponsors of wellness programs cannot 'pay for performance'—they can pay only for participation."

Nothing about the Safeway Amendment makes sense. When the Senate finance committee approved its version of the health reform package earlier this month, Chairman Max Baucus announced that his bill would extend coverage to almost every American, and that it "would prohibit insurance companies from discriminating on the basis of gender or health status." If Congress really wants equal access to medical care, why are we fattening a loophole for discrimination?
9:19 PM 
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Thursday, October 29, 2009 

Category: News and Politics
SOURCE:  NYTimes.com

Weight Gain Associated With Antipsychotic Drugs
By DUFF WILSON

Young children and adolescents who take the newest generation of antipsychotic medications risk rapid weight gain and metabolic changes that could lead to diabetes, hypertension and other illnesses, according to the biggest study yet of first-time users of the drugs.

The study, to be published Wednesday in The Journal of the American Medical Association, found that 257 young children and adolescents in New York City and on Long Island added 8 to 15 percent to their weight after taking the pills for less than 12 weeks.

The patients, ages 4 to 19, added an average of one to one-and-a-half pounds a week.

“The degree of weight gain is alarming,” said Dr. Wayne K. Goodman, head of a Food and Drug Administration advisory panel on the drugs last summer and chairman of psychiatry at Mount Sinai School of Medicine in Manhattan. “The magnitude is stunning,” he said.

Although the drugs’ influence on weight and metabolism had been previously detected, Dr. Goodman, who was not involved in the study, said the speed and magnitude of the effects found in the study were greater than previously reported — findings he said were made possible by looking exclusively at new patients.

The four drugs in the study, the most popular antipsychotic medications, are industry blockbusters, with combined sales of $12.7 billion last year. And while all four caused weight gain, there were differences in the extent of the side effects. Among them, Zyprexa, made by Eli Lilly & Company, showed the most severe effects on weight and metabolism.

The study’s authors, and an accompanying JAMA editorial, called for closer monitoring of patients taking the drugs, as well as additional long-term studies.

The drugs are prescribed for schizophrenia, bipolar disorder and a broad range of less serious psychological conditions.

Their use by children and teenagers has been rising steadily. A 2008 study found that patients under 19 years old accounted for 15 percent of antipsychotic drug use in 2005, compared with 7 percent in 1996.

The study, financed by federal grants, is the largest yet published on childhood use of the drugs. And because it is also the largest study of first-time users of the drugs, whether children or adults, it provided an opportunity to analyze the cause and severity of near-term side effects.

As a result, the study goes further than previous research in distinguishing varying metabolic effects among the four drugs, according to Dr. Judith L. Rapoport, another expert who was not involved in the research.

“It’s by far the best documentation of not just weight gain and metabolic changes but also suggesting there might be differences among the drugs,” Dr. Rapoport, chief of the child psychiatry branch at the National Institute of Mental Health, said in an interview.

The lead researcher, Dr. Christoph U. Correll of Zucker Hillside Hospital in Queens and the Feinstein Institute for Medical Research in Manhasset, N.Y., said researchers had saved their blood work for future study of the molecular basis of the different drugs’ metabolic effects.

“People should think twice before they actually prescribe the medications,” Dr. Correll said in a phone interview. The drugs studied are in a class known as atypical antipsychotics, which are second-generation psychiatric drugs that in some cases regulate the receptors in the brain that interact with the mood-altering hormones serotonin and dopamine.

Abilify and Risperdal are the only two of the four drugs approved as pediatric treatments, for the severe mental conditions schizophrenia and bipolar disorder — and in Risperdal’s case, for some children with autism. More than 70 percent of atypical antipsychotics’ use in young children and teenagers has been off-label prescriptions for nonpsychotic conditions like attention deficit hyperactivity disorder, according to Stephen Crystal, a Rutgers University professor who studies the drugs.

Dr. Rapoport said Lilly’s Zyprexa drug, introduced in 1996, had been so heavily marketed that it was in widespread use before physicians began to recognize the severity of its side effects a few years ago. Zyprexa has continued selling in the range of nearly $3 billion a year in the United States even as concerns emerged about its tendency to cause patients to gain weight.

Abilify, from Bristol-Myers Squibb, showed the least metabolic effects among the four drugs in the study. “It’s considered a very good but weaker drug,” Dr. Rapoport said.

The other two drugs in the study, whose weight-related side effects fell between Zyprexa and Abilify, were Risperdal and Seroquel. Seroquel, from AstraZeneca, had United States sales of $2.2 billion in the first six months of this year, according to IMS Health, a research company. Abilify had sales of $1.9 billion during that period; Zyprexa, $1.5 billion; and Risperdal, from Johnson & Johnson, $660 million.

A Lilly spokesman, Jamaison R. Schuler, said the new research echoed Lilly’s own findings and previous studies about weight gain and metabolic changes that led to a label warning being placed on Zyprexa in October 2007. But in an interview, he said the drug was still essential to sparing children a lifetime of psychological suffering.

“It’s important to recognize that severe mental illnesses, including schizophrenia and bipolar 1 disorder, often strike during adolescence and are devastating,” Mr. Schuler said.

In an editorial accompanying the study in the journal, Dr. Christopher K. Varley and Dr. Jon McClellan, child psychiatrists at Seattle Children’s Hospital and the University of Washington school of medicine, wrote that “ominous long-term health implications” arise from weight gain and changes in blood fat levels early in life. “These results challenge the widespread use of atypical antipsychotic medications in youth,” they wrote.

Dr. Varley said in a phone interview Monday that doctors had been loath to use the older antipsychotic medicines, like Thorazine and Haldol, because of neurological side effects. But he said the new data indicated that the newer ones should be prescribed more cautiously.

“In the course of less than 12 weeks, the weight gains are startling,” he said. “If you look at Zyprexa, the kids are gaining a pound and a half a week. Even with the drug Abilify, which is one that was not so prone to weight gain, kids still gained a pound a week. In addition, they had evidence in a very short period of time of other metabolic problems.”

The study covered 272 patients visiting clinics in Brooklyn, Queens and Long Island from 2001 to 2007. Fifteen patients who stopped taking their medicine were used as a control group. Their weight stayed level. The 257 patients who stayed on their drugs took detailed tests, including a fasting blood test to check for high glucose levels.

Their mean weight at the start of the study period was 118 pounds. But after about 11 weeks, those who took Zyprexa had gained 18.7 pounds; Seroquel, 13.4 pounds; Risperdal, 11.7 pounds; and Abilify, 9.7 pounds.

Their waists typically expanded three inches with Zyprexa, and two inches with the others.

All but Abilify showed rapid and significant increases in one or more metabolic markers, which can presage adult obesity, hypertension and Type 2 diabetes. The metabolic markers included glucose, insulin, triglycerides and cholesterol.

The authors noted that the study had limitations. Patients were not randomly assigned, so the baseline starting weights differed. Clinicians, given the choice, started heavier patients on Seroquel and those with the lowest fat mass on Zyprexa, who then gained the most, the data show. Also, the study did not control for dosing or other medications, which can affect outcome.

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Tuesday, October 27, 2009 

Category: News and Politics
SOURCE: USA Today

Smaller jets squeeze big and tall fliers

By Roger Yu, USA TODAY

Lisa Tealer can't use seat-back trays when she's flying because she's "fat," she says.

So the diversity executive of a biotech company in the San Francisco Bay Area uses her laptop as her tray. She uses candor about her weight to defuse awkward situations during boarding. "If I have to sit in the middle, I tell people, 'Hopefully, it won't be too uncomfortable for you.' "

Mark Diamond, a 6-foot-4 CEO of a technology firm in California, is an avid student of aircraft types so he can avoid the seat he most dreads — a bulkhead seat that keeps him from slipping his legs under the seat in front of him. "It's a lot of work. I hear guys who are 5-6 complain about how difficult flying is, and I'm like, 'You have no idea,' " he says.

Flying — an act that entails sitting still, often for hours, in a cramped space — has never been easy for those who carry more of themselves on board than others. But travelers who are heavy or tall are feeling the effects of airlines' penny-pinching moves more acutely than others.

The average legroom in coach is getting smaller. The seat width remains unchanged in decades even as Americans get bigger. Airlines are increasingly using small regional planes to serve less-popular destinations. To combat slow demand, they've eliminated capacity, resulting in fuller planes and stiffer competition for upgrades. And airlines' rules requiring obese passengers to pay for an extra seat are being enforced more strictly.

Seats and girths don't match

The controversy over paying for a second seat resurfaced earlier this year when United Airlines said it would follow other carriers in requiring overweight passengers in coach to buy a second ticket if two open seats aren't available.

Passengers who can't lower their armrest and require more than one seat-belt extender must buy a second ticket at the price of the original ticket. United spokeswoman Robin Urbanski says it adopted the policy after receiving more than 700 complaints in 2008 from passengers who complained of an overweight seatmate encroaching on their space.

Other U.S. carriers have a similar policy. Southwest is aggressive about enforcing it, says Brandon Macsata, executive director of the Association for Airline Passenger Rights.

Southwest requires passengers who are deemed "customers of size" to buy a second seat at a discounted or child's fare at boarding. If the flight has unsold seats, customers will be issued a refund. The policy is "about safety," Southwest spokeswoman Brandy King says.

Macsata says airlines' "fat tax" overlooks the fact that seat size hasn't kept up with increasing girth. From 1960 to 2002, Americans have become on average of about 25 pounds heavier. The typical seat width — at 17 inches to 18.5 inches — hasn't changed since 1958, he says.

Tealer says she has never been asked to buy another ticket but says coach seats can be painful. "Your hips are pressing against the armrest. I've had bruises, muscle pain."

The armrest test to determine who should buy a second ticket also is discriminatory against women, says Tealer, who's a board member of the National Association to Advance Fat Acceptance, which is battling the second-ticket rule. "Women carry weight more in the hip area. People of color tend to be bigger."

The federal Air Carrier Access Act prohibits discrimination on the basis of disability in air travel but doesn't cover size. But obesity can result from debilitating or chronic medical conditions, Macsata says.

He has called for airlines to retrofit at least the first economy-cabin row with wider seats for heavy passengers who mostly wouldn't mind paying "a bit more."

Tealer has simple strategies for air travel: book as early as possible; fly during less-busy hours, such as early in the morning or overnight; and avoid exit and emergency rows where armrests don't go up.

She prefers aisle seats because she can lean over the aisle for more room. She tries to use the airport restroom before boarding so that she doesn't have to bother seatmates and avoids cramped aircraft restrooms.

'Aspirin and codeine' after trips

A shortage of legroom is a common complaint. But it's a particularly, and literally, sore topic for tall travelers, many of whom have become dedicated students of aircraft interiors in hopes of securing a few more inches.

Domestic economy cabins provide on average of about 32 inches of legroom, or seat pitch. But several airlines, such as AirTran, Allegiant and Spirit, have introduced a 30-inch pitch in recent years, says Matt Daimler of the website SeatGuru.

Robert Kleeman, a 6-foot-5 business valuation specialist from Denver, selects flights based on aircraft types because he can't tolerate the coach seats in Boeing 737 and regional jets made by Embraer or Canadair. "It'll hit my knees even without the seat (in front) reclining," he says.

He prefers Boeing 777s and 767s. But he has seen an uncomfortable surge in smaller planes to many of his destinations. "Even on a Denver-Chicago trip recently, the only option was a regional jet," he says.

SeatGuru's Daimler says legroom in regional jets isn't less on average than on mainline aircraft. But the ceiling is lower, and the aisle is narrower. "There is a feeling of being tighter overall. For those sitting in window seats, the wall curves earlier."

Diamond, the tech executive, says legroom is so important that he prefers a regular reclining seat in coach over a bulkhead seat in first class. "Bulkhead seats are the enemy of tall travelers. They're hard to recline. Your feet are cramped."

Mike Nicholes, 70, an auto-parts-industry consultant from Portland, Ore., who is 6-2 and weighs 275 pounds, flies almost weekly to see clients in small cities on what he calls "Barbie jets."

"If I have an eight-hour flight back home from the East Coast, I'm on aspirin and codeine the next morning," he says.

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Monday, October 26, 2009 

Category: News and Politics
Nightclubs for the plus-size begin to weigh in
By JOHN ROGERS Associated Press Writer
Updated: 10/26/2009

LONG BEACH, Calif — Move over, it's Saturday night at Club Bounce and people are bouncing onto the dance floor in a big, big way.

These are big, big people, all dressed to the nines and many tipping the scales at 250, maybe 300 pounds.

That's because this expansive nightclub a couple blocks from the Pacific Ocean, with its flashing lights, friendly atmosphere and wall-rattling hip-hop sounds, caters specifically to fat people.

That's right, fat people. Not just any fat people, either, but fat people who are proud to call themselves fat people. People who joke that they are part of the new Fat is Phat movement.

"Self-conscious? No! Not at all," laughs Monique Lopez, a curvaceous woman of 23 as she arrives in a tight, black dress and heels. "I was like, 'I'm going to Club Bounce tonight. I'm going to wear my shortest skirt.'" (Which she did.)

The movement for equal rights for plus-sized people is nothing new of course. The National Association to Advance Fat Acceptance, with chapters around the country, was founded 40 years ago. A nonprofit group, it advocates that everyone be treated equally regardless of size, arguing that we don't live in a one-size-fits-all world.

But what has been slower coming, fat advocates say, are places like Club Bounce, where people who might have some trouble getting past the velvet ropes at other night spots because of their size are made to feel like they fit right in.

"When you're not what they consider ideal, you know, and you're out there trying to get your dance on at those other places, you get the looks, the stares. But not here. Everything's accepted here," says Vanessa Gray of Long Beach, an attractive 30-something woman who acknowledges jovially that after giving birth to three children, "I've got a little more meat on my bones."

Such clubs are still a relatively new phenomenon, however, with a handful scattered across California, mainly in coastal cities from San Diego to San Francisco.

"The whole thing really started on the Internet, with clubhouse parties organized online," says Kathleen Divine, who runs another Southern California plus-size club, the Butterfly Lounge. "Now you see a lot more large people out in public, not hiding behind their keyboards anymore."

A Web site for "big beautiful women" (bbwnetwork.com ) sponsors an annual "Vegas Bash," for example, and there are similar gatherings in cities like Atlanta and Seattle.

But veteran fat activist Lynn McAfe of the Council On Size and Weight Discrimination would like to see more clubs.

"It's nice to have a place to go where you can do a little flirting and maybe bring your thin sister or somebody from work who isn't fat, and they'll be in your world for awhile," says McAfe, a pioneer of the fat advocacy movement.


"That's an amazing experience for a lot of people who aren't fat, to spend a day or night in a world of fat people."
Not that every large person prefers to be called fat, especially by someone who isn't.

Lisa Marie Garbo, who opened Club Bounce five years ago, says she prefers plus-sized or larger-framed.

"But I don't think fat is a bad word anymore," she adds. "I think a lot of people embrace it now."


Garbo, a vivacious, 40-year-old blonde partial to flamboyant outfits of tight-fitting pants and low-cut tops, said she opened the club for herself and others who were tired of being "the only fat girl at the local nightclub."

The club, with a capacity of 400, attracts relatively equal numbers of men and women, although Garbo says about three-quarters of the women tend to be heavy, while only about a quarter of the men are.

Some club-goers, like Chad Koyanagi, started out big, then slimmed down. Others, like Garbo herself, have seen their weight go up and down over the years. Still others say they're happy the way they are.

Like a lot of heavy people, Koyanagi says he started dropping by the club after a friend he met on a social networking site kept after him to get out of the house.

Painfully shy at first, the 30-year-old eventually began to fit in and ended up shedding 50 pounds. Although he's no longer hefty enough to fit the club's BHM profile (Big Handsome Man), he says he's made too many friends to
stop coming.

But while not all club-goers are overweight, the very nature of such venues has led some to question whether they are encouraging people to remain fat in a society where, according to the Centers for Disease Control and Prevention, one-third of adults are already obese.

"I'm not a gain-weight advocate or anything like that," says Garbo, who adds she has struggled with her own weight since doctors put her on steroids as a child to treat her asthma. "My message to people is live your life no matter what size you are."

Although obesity remains a serious problem, with links to diabetes, heart disease and other health issues, says sociologist Karen Sternheimer, creating a place where people can feel good about themselves can build self-esteem, which in turn can prompt people to do something about their weight.

"As the country gets heavier and ultimately unhealthier, in many instances the problem is people feeling bad about themselves, and feeling bad about themselves doesn't motivate people to lose weight," says Sternheimer, author of "Connecting Social Problems and Popular Culture."

What does motivate people, she said, is starting with a positive outlook of accepting who you are, then working from there to change your appearance in whatever way you want.

"Anything that helps people feel better about themselves," she said, "there's something positive to that."
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