Let's Go RD Community - Get Coverage for Obesity Services!

Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act would allow for qualified health care professionals, typically Registered Dietitians, to bill directly for their Medical Nutrition Therapy and Intensive Behavioral Therapy services.  Increasing access to qualified healthcare professionals helps to reduce the cost of treatment and increase access for obesity treatment provided to Older Americans.  This is a clinically appropriate and cost-effective piece to the puzzle in tring to increase preventive care in our health care system.  I think it is important to ensure that Medicare patients have access to the best possible care at a fraction of the cost.

Medical Nutrition Therapy

The Preventive Services Task Force found that intensive behavioral therapy carried out for obese patients by Registered Dietitians led to clinically significant weight loss, greater weight loss and increase in exercise.  With the obesity epidemic costing our nation $210 billion annually, this is an immensely important issue.  

Go to Grassroots Manager now to write to Congress!

Advocating for our services from the platform of public policy is what will shape the landscape for nutrition services decades from now.  I urge my fellow RDs to log in and help support this bill, as coverage issued by the Centers for Medicare and Medicaid often trickle down to becoming standards of care within the industry.

How Ethical is Marketing Food to Children?

In keeping with my recent favor of wanting to understand the obesity epidemic as it relates to the world of children, I decided to watch this TED talk by Anna Lappe.  With food companies spending $2 billion annually on marketing food to children, it is frightening to hear about the breadth and depth of messaging that the food industry is able to exert.

The obesity epidemic continues to grow here in the US, and public policy is slowly catching up to this world of food marketing.  As a huge proponent of educated decision-making and utilizing policy to minimize our obesogenic environment, I found this talk quite interesting.  What do you think about Anna's message?  What is your response to the marketing of food to children?

[To the food industry] My children, all of our children, are none of your business. - Anna Lappe

Alliance for a Healthier Generation

In 2005 the American Heart Association and the Clinton Foundation teamed up to develop an alliance against childhood obesity.  What resulted is a fantastic initiative that systematically looks at our environment and incentivizes preventive services and healthier surroundings.  

Alliance for a Healthier Generation

RD Coverage: The Alliance has worked with the American Academy of Pediatrics and the Academy of Nutrition and Dietetics to offer comprehensive health benefits to children and families for preventive and treatment services surrounding childhood obesity.  Eligible children have access to four visits with an RD for nutrition services.  [Fellow RDs, learn about how to become a provider here!]

Image from Healthier Generation site.

Image from Healthier Generation site.

Added Sugar in the Diet

Role of High Fructose Corn Syrup in our Sugar-Obsessed World

It is important to stay mindful of the calories that come from added sugars and sweeteners as they are a significant contibuter to the obesity epidemic.  With the addition of high fructose corn syrup (HFCS) to our food supply 30+ years ago, we learned that something sweet and seemingly indulgent could come at a fraction of the cost of harvesting sugar cane (thanks in large part to government subsidies of the corn and soy industry, but that's a blog for another day).  And so HFCS began to sneak into hundreds of products in the marketplace.

The business of agriculture now produces approximately 17.5 billion (!) pounds of HFCS annually.  In fact the use of HFCS has become so insidious in food production you'll be hard pressed to find a loaf of bread or box of cereal without it listed as an ingredient.  While the message is getting out to the masses regarding sugar-sweetened beverages and sodas, I challenge you to begin to look at other sources of added sugar in the diet.  


The American Heart Association recommends no more than 6 teaspoons (27 grams) of added sugar daily for women and no more than 9 teaspoons (41 grams) of added sugar daily for men.  For the sake of comparison, the average American consumes 23 teaspoons (104 grams) of added sugar.  Check out this fantastic infographic from CSPI on added sugars!

Chronic Sleep Deprivation tied to Overwight and Obesity

A recent review of the literature on sleep deprivation, energy balance, and weight regulation reveals that chronic sleep deprivation is linked with obesity.  Over 35 percent of American adults are obese and more than 28 percent sleep less than six hours a night. While weight loss strategies generally focus on diet and exercise, modifying total lifestyle and routine, including sleep behaviors, is integral to helping to manage weight.

Sleep deprivation can impacts a person in several capacities hormonally: reduced insulin sensitivity, increases in circulating ghrelin, and decreases in circulating leptin.  The two latter are the hormones that regulate appetite and our hunger/satiety cues.  This shows that on a hormal level this lack of sleep plays a role in increased appetite.  Researchers are pursuing as to how this impacts fat adiposity as well.

Make developing good sleeping habits a focus of your new year.  It will help with weight control and stress management.  ...Not bad for a New Year's resolution that focuses on adding something for better health and not taking away.

Please know: research from Journal of the American Academy of Nutrition and Dietetics November 2012 Issue

Menu Labeling Broadening Healthy Options

Posting Calories, Fat, and Sodium

Well it looks like taking an enviornmental approach to the obesity epidemic - which cost the American economy an estimated $117 billion in 2010 - is starting to impact retail and restaurant options.  In a recent study done in Kings County, Washington, consumers are increasing demand for healthier options in response to knowing what it is that they're eating.

“We did find evidence of a decrease in energy, saturated fat, and sodium content after the implementation of menu regulations for items that were on the menu at both time periods,” reports Dr. Bruemmer. “We also saw a trend for healthier alternatives across all entrées over time, but only in the sit-down restaurants.”

Given the reach of the obesity epidemic here in the US, I'm a big believer in the total approach.  I think it is important for us to make the environment in which we live less obesogenic and for consumers to make informed decisions.


[Sidenote: I had no good images for this particular blog on hand, so this Rubiks cube of pork and cheese is a small shoutout to my belovedly left-brained brother who turned 22 today.  Happy birthday Derek!]

Response to Centers for Medicaid and Medicare Service

Background Info

For those readers that aren't in the profession, here's a little background information on what's been going on and why it's important in this country's fight against the obesity epidemic:  The Centers for Medicare and Medicaid Service recently announced that it would reimburse specific health professions (MDs, psychiatrists) for billing for Intensive Behavioral Therapy for Obesity in the primary care setting but that it would not reimburse dietitians for this.  The reason that we as a profession are fighting for our rights to bill for this code is because Registered Dietitians are the premiere health care professional trained in counseling for obesity and overweight. 

How it Impacts Healthcare

RDs are the most effective at tailoring a nutrition care plan to each individual and helping them to reduce their weight.  With this memorandum, obese persons with Medicare and Medicaid will have very limited access to dietitians until they have Diabetes (which RDs can currently bill for, along with Chronic Kidney Disease Stage IV and V).  It saddens me that a potentially live-saving preventive service is not going to be able to be offered by myself and other RDs, as we are a group of providers that have been able to produce the best results.  On top of that it is a very needed among those utilizing Medicare and Medicaid.

While I am personally disappointed in this I am and will continue to help in the fight for improved billing for our profession.  Thank you to everyone who aided in signing the White House Petition.  If you're a fellow RD and haven't done so already, please go to the the Grassroots Manager on eatright.org and send your legislators your thoughts on the matter.

And while there's a lot more to delve into on the topic it's too complicated to make into a blog post... feel free to comment and we'll continue the conversation.



Have Obesity Rates Stabilized?

The Latest Data

The government and public health agencies work in conjunction with one another to collect and quantify data from all over the country in countless areas.  This is what allows us to see trends over the long term in everything from bicycle and motor vehicle safety to drinking behaviors to nutrition and growth.  The subset of this effort for the nutrition and public health policy world is called the National Health and Nutrition Examination Survey (NHANES).

The most recent NHANES data is telling us that the rates of obesity in US adults may be stabilizing.  That may be a slight overstatement as the rates are increasing at a slower rate, but I hope that with public health concerns rising and public awareness of the health consequences of overweight/obesity seeping in we can in fact see this giant ship turn around.  It's fascinating to think that the multi-pronged efforts that are going on may be helping to change the social and physical environments and that those changes are driving changes at an individual level.

Rising Health Care Costs

This comes at a particularly important time as the health care debate continues in the beltway.  The Congressional Budget Office released a report just this week regarding how the weight of Americans has affected health care costs in the US.  From 1987-2007, per capita spending has grown by 65% and 61% for normal weight range and overweight adults, respectively.  In the same time period, per capita health care spending has grown by 111% for obese adults.  These statistics were calculated using the body mass index categories.  

Apps for Healthy Kids - Voting Time!

Let's Move!

One part of Michelle Obama's Let's Move! initiative is to fuse the ever-changing face of technology with health.  The Apps for Healthy Kids challenge was created to encourage innovative, fun and engaging technology to help children and families make healthier and more active decisions day in and day out.  With about $60,000 total in prizes being awarded, I encourage you to take a look through the applications that have been created and vote on your favorites today!

Voting will be open until August 14th.  Vote here now!

Let's Move

Let's Move Campaign

I watched the press conference live from the White House today announcing the Let's Move Campaign that Michelle Obama has initiated to combat the rising rates of Childhood Obesity.  Kudos Michelle!  With the partnership of athletes, schools, and both private and public organizations to bring together resources and momentum.  

I believe in this mission so wholeheartedly I can't wait to see where this goes right as I enter the field!

Check it out!


Don't Buy Into the Headlines, Exercise IS Healthy

Insert Racy Title Here

Thank you TIME, for making one of the latest headlines on your site "Exercise Won't Make You Thin".  Traditionally, provocative headlines sell papers (or in this digital age get clicked on, tweeted and dugg), but unfortunately that also means a reduction of thorough research to mere words.  Just Sunday this headline broke, and while the accompanying four page article was a good read, I saw this headline on both TIME and CNN's websites as a main feature.  

Photo courtesy of the Spondylitis Association

More often than not people read just the headlines (or maybe a few paragraphs... congrats on making it this far in the blog) and if that were so in this case you would leave your computer unimpressed with the prospect of exercising.  The article doesn't ignore the health benefits of exercising, but it certainly doesn't get to them until page three.

I encourage you to challenge your sources of information.  Check out the peer-reviewed literature (those super scientific journals that the newspapers get their health information from) from time to time, or reflect on the perspective of the author/journalist.  Becoming hyper-aware of the information you're getting will help you weed out those "Coffee Twice Daily Will Add 15 Years of Life" headlines from the true gems in health information.  

Should Weight Management be on Maslow's Hierarchy of Needs?

Now about the article itself.  TIME truly pulled at the heartstrings of Americans - through weight loss.  Notice that the headline uses the word "thin", a reference so often used to indicate total health today.  While maintaining a healthy weight is very important to overall health, it's not the be-all end-all of the nutrition game.  Next time you're thinking about your own health, don't reduce it to the number on the scale, instead think about the big picture and whether that is in balance.  Balancing family, friends, work, sleep, schoolwork, food, creativity, exercise, and your mental alertness are all integral to your health.  Having even one category out of balance can begin to affect other areas of your life.  

As for exercise... The article discussed the "Compensation Effect".  That is, when after exercising the individual working out has a very large meal, or treats themselves to something calorically dense for working out.  Well this phenomena is tied into the sense of accomplishment exercising brings to the table, but unfortunately yields little or no results in the weight loss department.  The article then goes on to discuss self-control, and the fact that regular, smaller bursts of energy can be just as effective as one workout session daily in weight management.  The bottom line is that any form of exercise is extremely important to your overall health and benefits the body in such tremendous ways, ways that go beyond the "thinness" of your body.  

Falsified Calorie Information?

The Calorie-Menu Debate

New York City instituted a law that requires restaurants to put the calorie content of their foods on the menu.  Since its inception almost a dozen other cities have done the same, and legislation is being considered in the Senate to create national policies instead of leaving it up to local governments.  NYC decided to place calorie content prominently on their menus in an attempt to inform customers, and hopefully eventually slow down the growing rates of obesity, heart disease, and diabetes.  


A recent study by Scripps Research Institute brought many of those NYC menu items to independent labs to determine the calorie content of random items.  Each item was tested twice by different labs.  The study found that the calorie counts being reported on the menus did not reflect the numbers found by the laboratories.  Instead, the menus often showed a number lower than those found.  This has been highlighted by an article in the Wall Street Journal.  How are we supposed to make informed decisions if the restaurants aren't meeting us halfway with honesty?  

According to NPD Group, one in five meals or snacks consumed in the U.S. are produced by restaurants, and 59% of restaurant traffic is at chains.  - WSJ Article

With dining out the norm and not the exception, I think it is very important that people have access to the caloric information.  I don't think that means it needs to be displayed on the menu that is handed to you in the restaurant.  However, having the ability to look that up can help people manage any current diseases or conditions, deal with food allergies and intolerances, and possibly stave off unwanted caloric intake.  

 Photo courtesy of Taylor Umlauf with the Wall Street Journal

What Do You Think?

Setting this law into stone nationally is not the answer to the trend of our growing waistlines in this country, but do you think it is a step in the right direction?  Where would you like to see this information displayed?  And do you think it affects your choices in selecting foods to eat at restaurants?