By Judith Graham
Kaiser Health News

Doctors assess patients' breathing, heart rate and blood pressure routinely at office visits. Soon, they may be adding body mass index to that list too.

Tracking this measure – an indicator of whether someone is obese or overweight – as if it were a vital sign at medical checkups is among a new set of strategies recommended for battling obesity, a concern that some experts predict will affect 42 percent of adults by 2030.

Although professional medical societies have said for years that physicians should monitor patients' body mass index, most doctors fail to do so. For example, a 2006 survey of family physicians found that fewer than half checked BMIs for children over the age of 2, even though 71 percent knew this has been recommended.

Just over 40 percent of adult patients in commercial HMOs had documented BMI measurements in 2009 and 2010, according to a survey by the National Committee for Quality Assurance, an organization that evaluates health plans. That figure falls to 12 percent for patients in commercial PPOs, a more common type of plan.

The Institute of Medicine last week called for the medical profession and health insurers to become more rigorous in their approach in a report proposing an anti-obesity campaign that would involve every part of society, from individuals and families to schools, communities, workplaces, the food industry and the media.

Pointing to the more than 90 million children, teens and adults counted as obese, well-established links to medical conditions such as diabetes, hypertension, heart disease, and arthritis, and annual healthcare expenses exceeding $190 billion, the report urged comprehensive and sustained action.

For physicians, monitoring body mass index – a ratio of height to weight – is at the top of the list of priorities because it's the best way to identify people who have a weight problem. (Adults are counted as obese if they have a BMI of 30 or higher; children if their BMI is at the 95 percentile or higher for kids of the same age and sex.)

"We need to normalize the process of obesity screening and lifestyle counseling so they're usual and people expect this," said Dr. Sandra Hassink, a member of the panel that prepared the IOM report and director of the Obesity Initiative at Nemours, a pediatric health system in four states.

Medical groups call for change
Groups such as the American Medical Association and the American Academy of Pediatrics have recommended regular BMI checks for years. Several health care systems also have embraced the practice. Kaiser includes BMI as a "vital sign" in electronic medical records for nearly 9 million members, and it is planning to do the same for physical activity, another contributor to the obesity epidemic, said Ray Baxter, the plan's senior vice president for community benefit and health policy.

(Kaiser Health News is not affiliated with Kaiser Permanente.)

So why the problem? Many harried physicians are unprepared to advise people about how to change their behaviors, unconvinced they have time to do so, and therefore look skeptically at screening, said Dr. Robert Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

If doctors are overweight themselves, they're less likely to recognize the issue in their patients, research shows. What's more, doctors aren't trained in medical school to handle weight issues. They also often aren't convinced obesity treatments work, and many believe there aren't good community programs to which they can refer patients.

"The question is, how many programs are out there for primary care doctors to refer to in the community, and answer is – not many," said Dr. Ned Calonge, a Colorado physician who is the immediate past chairman of the U.S. Preventive Services Task Force.

Northwestern is tackling a part of that by weaving instruction in "lifestyle medicine" throughout all four years of a new medical school curriculum being introduced this August.

Another significant problem has been a historic lack of reimbursement from insurers for obesity screening and counseling. That changed last year for seniors, when Medicare said it would cover up to six months of weight loss counseling for obese beneficiaries as part of a package of new preventive services. Nearly 13 million Medicare members are thought to be obese.

Meanwhile, new preventive services guidelines from the government call for all insurance plans to cover obesity screening and counseling without charge to patients.

And insurers are expanding childhood obesity programs following a 2010 recommendation from the U.S. Preventive Services Task Force that endorsed comprehensive weight management programs for youngsters at least 6 years old. Previously, the task force supported BMI screening but not weight loss programs.

Seeking evidence-based programs
For the insurance industry, the challenge now is providing evidence-based programs that can be introduced on a broad scale.

UnitedHealth Group is promoting "Join for Me," a year-long behavioral modification program piloted with the YMCA of Greater Providence, R.I., in which youngsters 6 to 17 years old, accompanied by a parent, learn about healthy eating and exercise in a group led by a coordinator.

"Doctors are in short supply" and it makes sense to conduct intensive behavioral change programs in the community, not in their offices, said Dr. Deneen Vojta, senior vice president of UnitedHealth's Center for Health Reform & Modernization. For overweight and obese adults, the company is looking at offering a version of the Diabetes Prevention Program, a well-studied intensive intervention that has been shown to help people lose weight.

WellPoint has taken a different approach, choosing to work through doctors and with the Alliance for a Healthier Generation, an organization that's trying to convince health plans to offer more comprehensive coverage for obesity counseling and treatment. The alliance asks participating plans to offer four visits with a child's primary care doctor and four visits with a dietitian if the youngster is found to be overweight or obese. So far several plans, including WellPoint, Aetna, Humana and Highmark, Inc., have signed up, and 2.4 million children are covered.

WellPoint recently launched a limited pilot study of this type of benefit in California and is learning what physicians need and members want before deciding whether to roll it out more broadly, said Harvinder Sareen, clinical program director for the insurance company.

Insurance companies and some self-insured employers are also exploring the use of financial incentives -- cash payments or reduced premiums or deductibles – to motivate members to keep their weight in check and to adopt other lifestyle changes. One program at UnitedHealthcare offers members up to $250 for reaching a BMI of 25 or less, and similar incentives for not smoking and lowering cholesterol and blood pressure.

"Is there coverage [for obesity] is yesterday's conversation. Today's conversation is how to design coverage to encourage people to use it and continue using it," said Karen Ignagni, president of America’s Health Insurance Plans, an industry trade group.

Others disagree that coverage for obesity counseling is adequate.

"The problem is there's no real incentive for the insurance industry to pay for better prevention and treatment, because the costs are immediate while the benefits are long-term," said Dr. David Ludwig, director of the new Balance Foundation Obesity Prevention Center at Children's Hospital, Boston. "Although reducing the prevalence of obesity is one of the most profitable investments the healthcare system could make, it doesn't make a lot of sense for individual plans when families change policies every three to five years."

Related:

• Too fat for surgery? Suction cups hold up patients' guts
• Holding steady on U.S. obesity rate could save $550 million
• A modest proposal: To solve health spending crisis, tax cats

Jeff Fitlow / Rice University

A team of Rice University engineering seniors created a device to lift the weight from the abdomens of obese patients undergoing surgery. The R-Aides device uses suction cups hooked to a vacuum to help patients under light sedation breathe.

At first it sounds like the start of one of those offensive “fat” jokes obese people hate so much: “How fat was he? So fat the surgeons need suction cups to lift his belly.”

But this is no joke. A team of Rice University bioengineering students, responding to an urgent request from heart surgeon Mehdi Razavi, has developed a device that can lift the abdomen of an obese patient undergoing surgery so the patient can breathe.

Razavi, an electrophysiologist who specializes in implanting pacemakers and performs heart catheterizations, often places his patients under “conscious sedation,” a light anesthesia, because if the patient were simply knocked out, with a tube down his or her throat, and a machine doing the breathing, there’d be a greater risk of complications. But during one surgery on an obese man, Razavi realized his patient was snoring and having trouble breathing. The man’s oxygen levels were dropping.

That’s because the man was struggling against his own abdominal fat.

“It’s like putting a suitcase on the belly,” Razavi said. “It presses down and the belly has to go somewhere, so it pushes against the lungs, and if you try to take a deep breath, the lungs cannot expand.” The problem could become so severe, the doctor would have to stop the surgery.

The device the students designed uses suction cups hooked to a horizontal beam hovering above the abdomen. The cups are attached to the skin – there is a slight chance of bruising, student Marisa Prevost said – and a vacuum pump. Activating the device slightly raises the abdomen so the fat is out of the way.

When Razavi first approached the students for help, they were incredulous. “When we first heard about it, we were, like, ‘Huh? What?’” Prevost said. “We thought, that’s kind of weird.”

Now though, they’re intimately aware of how America’s obesity crisis is affecting medical practice in dozens of ways.

As of 2010, more than 35 percent of U.S. adults were obese. By 2030, the U.S. obesity rate is projected to rise to 42 percent. Obesity puts people at much greater risk for all sorts of medical problems, so they wind up in doctors’ offices and in hospitals more often than optimal weight people.

Medicine is struggling to make accommodations. Doctors often check blood pressure using cuffs meant for thighs, Razavi said. Surgical tools have to be enlarged in order to reach through layers of fat. Obese patients require higher doses of radiation during imaging tests like CT scans. “And that means if I’m doing the procedure, I am getting higher doses of radiation, too,” Razavi pointed out.

Some patients won’t fit into MRI scanners. Surgical tables have been redesigned to handle patients weighing up to 450 pounds. Needles for injections have made been longer so they can penetrate fat layers and reach muscles. Even lab tests results have to be interpreted differently.

For surgeries, Razavi said, “the ultimate compromise is that if the patient is really obese, you either do it under general anesthesia, or don’t offer it at all. It’s a judgment call,” he said. “When you tailor therapy to each patient, sometimes the risks outweigh the benefits.”

Brian Alexander is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love Sex and the Science of Attraction,"  to be published Sept. 13.

 Related stories

• No end to US obesity epidemic, forecast shows 
• Is healthy weight impossible for many Americans?
• Mothers like chubby toddlers, study suggests
• Report: Schools key to fighting America's obesity

By MyHealthNewsDaily

Parents who let their young children climb into bed with them during the night may decrease their child's risk of obesity, a new study from Denmark suggests.

In the study, children who never entered their parents' bed during the night were three times more likely to be overweight compared with children who got into their parents' bed every night.

The findings are contrary to what might have been expected: obesity is associated with poor sleep quality, and kids who climb into bed with mom and dad are clearly waking up during the night, the researchers said.

However, parents who let their kids enter their beds at night may be giving their children a greater sense of emotional support, which may protect against obesity, the researchers said. In contrast, some children who are not allowed to enter their parents' bed at night may feel rejected, and such negative feelings may increase the risk of obesity, they said.

Dr. Nanna Olsen, of the Institute of Preventive Medicine at Copenhagen University Hospitals, and colleagues analyzed information from 645 children ages 2 to 6 who were predisposed to obesity because they had a high birth weight, their mothers were overweight before pregnancy or their families had a low income.

For about 500 of the children, information was available on whether the child entered the parents' bed at night, and if so, how often. In addition, researchers had information on the children's body mass index (BMI).

The study was presented today (May 9) at the European Congress on Obesity in Lyon, France.

• 11 Surprising Things That Can Make Us Gain Weight
• 10 Ways to Promote Kids' Healthy Eating Habits
• Top 10 Baby Monitors

By Judith Graham
Kaiser Health News 

Cut the growth in rates of obesity by just 1 percent a year over the next two decades, and you’ll slice health care costs by $85 billion.

Keep obesity rates at their current levels – which is well below a 33 percent increase being projected -- and you’ll save nearly $550 billion during the same time frame.

Those are the attention-grabbing conclusions of a new paper being released this morning at the “Weight of the Nation” conference in Washington, D.C., sponsored by the U.S. Centers for Disease Control and Prevention. Researchers from Duke University, RTI International and CDC prepared the study, published in the American Journal of Preventive Medicine.

It’s the latest effort to document medical costs associated with obesity and the severe financial consequence of failing to address this epidemic.

In the new study, researchers estimate that obesity will continue to expand and will affect 42 percent of adults by 2030.  (Obesity represents a body mass index score, a ratio of weight to height, of 30 or higher.  Separate estimates for children aren’t calculated.)

That projection takes account of recent evidence that obesity has leveled off among some groups, and as a result it’s lower than an earlier estimate that just over half of the nation’s adults would be obese by 2030.  It also factors in conditions in the states that can affect the prevalence of obesity, such as unemployment, the availability of fast food, and price differences between healthy and less healthy food items.

But while increases in obesity may have moderated, the trends laid out in this study still point upward – especially for people who are roughly 100 pounds overweight, with body mass index scores of 40 or higher.

That rapidly-growing group of severely obese people, who have the most medical problems and incur the highest health care costs, will rise from about 5 percent of the population in 2010 to 11 percent by 2030, researchers suggest.

The findings are meant to be a call to action as experts gathering at the CDC conference consider intensified strategies to combat obesity, a public health problem that affects about 78 million adults and 12.5 million children and adolescents.  Tuesday morning, the Institute of Medicine, an arm of the National Academies of Science, will release a new report examining ways to accelerate progress against obesity – an objective that has proved elusive to date, with a few, limited exceptions.

Proven interventions are now available. “We know more than ever about the most successful strategies that will help Americans live healthier, more active lives and reduce obesity rates and medical costs,” said Dr. William H. Dietz, director of the CDC’s division of nutrition, physical activity and obesity, in a prepared statement.

But adopting new policies will cost money. The new study from Duke, RTI and CDC suggests even small dents in obesity rates can prove cost efficient.

Still, projections included in the report could prove overly aggressive if effective strategies to lower obesity rates are adopted, researchers note.

Earlier this year, a separate report underscored the enormous cost of obesity by calculating that $190.2 billion, or one in every five dollars spent annually on health care in the U.S., was associated with obesity-related expenditures. That is double the amount previously estimated.

Related:

Obama v. Ryan on Medicare spending cuts

This story was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation, a nonpartisan health care policy research organization which is unaffiliated with Kaiser Permanente

Lots of Americans buy the argument that we should ration health care according to lifestyle. So do many employers who are trying to charge their obese employees more for health insurance.  But if we are going to penalizing the health care sinners amongst us, shouldn’t we target all of those who raise our collective health care bill through poor lifestyle choices? This means you, cat owners.

The costs of a cat-loving America ought to be looked at in the same vein as recent calls to tax fat people. According to a Forbes magazine poll, one in three Americans believe that obese people should pay more in taxes than those who maintain a healthy weight. The same sentiments prevail among doctors in the UK. 

Overweight people cost the system a ton. People seem to think it's fair to ask them to pay more if they choose to munch chips while reclining on the Lazyboy watching Paula Deen on TV. Let's apply the same logic to all lifestyle choices. Cats are costing each one of us a lot of money to treat the allergies, asthma, skin problems and hospitalizations that they cause.

According to the Humane Society of the United States, there are over 86 million owned cats in the USA.  Nearly a third of you own these furry disease vectors. More than half of you cat owners have the gall to own more than one! 

At a recent meeting on immune diseases in Chicago, doctors and scientists who are studying allergies made it clear that cats are a menace. I learned that 17 percent of Americans, or 60 million of us, have allergies to cats.  So that means the odds are high that either you are allergic or someone you have over to your house could be.

Once a cat is in a home it is nearly impossible to get the cat allergens out of the bedding, carpets and furniture. The cost to all of us of treating cat-induced asthma, rhinitis, skin reactions and allergies is big. While there are no specific numbers for paying for the shots and drugs to treat the health problems due to cats, the overall medical cost for treating all allergies in the USA exceeds $7 billion.  And that does not include time lost from work or days out of school due to allergies.

One drug that is now frequently prescribed for kids and adults with chronic asthma due to exposure to cats, omalizumab, costs anywhere from $6,000 to $24,000 a year depending on dose. One in 2,000 of those with cat allergies require a trip to the hospital in any given year due to an acute adverse reaction to shots or drugs!

If we apply the "fat tax" logic, the obvious ethical question is why the heck are we cat-free citizens paying for the health problems associated with tolerating cat ownership? If you choose to own a cat or refuse to get rid of one even after being told to do so by your doctor, then why should I pay for this gross irresponsibility? 

So bring on the fat tax -- but tax all those who choose to make themselves, their kids and visitors sick by lifestyle choices, whether it's eating too much junk food or housing felines. And hey, employers, don’t hire cat owners, or at least make them go to classes where they can learn about the true cost that kittens impose on us all.  

While we are at it, let's impose a fine on those who fail to wear a hat while at the beach, risking melanomas, and a skiing tax for those nutty enough to speed downhill knowing that the orthopedic clinic awaits at the bottom.

Of course, none of this applies to dogs or dog owners such as me. Those who own them should receive a tax break. Pet ownership has a lot of benefits for your health, particularly if the pet is a dog. But cats are a very different matter. Those who insist that personal responsibility ought to drive what everyone pays for health insurance had better let cat owners know what is best for them.

More from Art Caplan:

• For organ donation, Facebook beats the DMV
• Time to think of health costs to IVF babies
• Youth hockey injuries border on child abuse

 By Robert Bazell
Chief Science and Medical Correspondent
NBC News

How hard is shift work on a worker's body? 

Research out Wednesday from Brigham and Women’s Hospital in Boston demonstrates very precisely the way fighting the body's natural sleep patterns can increase the risk of type 2 diabetes, the most common form of the disease.

More than 21 million Americans are “shift workers,” according to U.S. Census figures. That is, they labor during the hours that most of us set aside for rest or sleep, either all or part of the time. That number is increasing 3 percent a year because of the nature of our service economy and the need for ever more people to take whatever work they can.

The sleep research team at Brigham and Women’s, under the direction of Dr. Charles Czeisler, has spent decades documenting how shift work can lead to increased obesity, heart disease, diabetes and many other health problems. In this latest research in their sleep lab they show how one mechanism creates the risk.

Twenty-one healthy volunteers were subjected to varying hours of sleeping and waking, light and dark, all designed to disrupt the body’s natural internal clock (the circadian rhythm.)

Within a few days, when the subjects ate a normal meal, their bodies did not respond in a normal way.

“Glucose levels went much higher and stayed that way for several hours,” said neuroscientist Orfeu Buxton, Ph. D., the study's lead author. “This was because of decreased insulin released from the pancreas. Together these reflect an increased risk of diabetes.”

The stress was so severe that during the three-week experiment three of the healthy volunteers became pre-diabetic. Fortunately, after nine days of normal sleep and waking, all symptoms disappeared.

Still, the experiment clearly demonstrates that shift work can make people diabetic. For people who already have diabetes or are pre-diabetic, it can make the conditions worse.

The advice from the scientists for those who perform shift work -- either out of necessity or choice:

• Try to make your daily clock as normal as possible.
• Get good sleep during the day -- finding, if you can, a quiet, very dark room. 
• Don’t eat big meals at a time when you feel your body clock is out of whack.

Sound advice, experts would agree.  But anyone who works odd hours knows how challenging such simple routines can be in the demands of a normal family and social life. This latest research is further evidence out-of-whack sleep’s harm to our health.

The research is published in Science Translational Medicine.  You can read an abstract here: 

http://stm.sciencemag.org/lookup/doi/10.1126/scitranslmed.3003200

 Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC

More from Robert Bazell:

Dental X-rays linked to brain tumor risk

"False positive" mammogram can signal future cancer

Study: Most early cancer research is wrong

Regular prostate screening can reduce deaths. Now what?

Women who are obese when pregnant may have a higher risk of having a baby with autism, a new study indicates.

Researchers found that the risk of autism increased by nearly 70 percent when moms were obese during their pregnancies, while the risk of a having a baby with some other neurodevelopmental disorder doubled, according to the study published early online Monday in Pediatrics.

Click here to read the study.

Milder versions of autism, such as Asperger's syndrome and related conditions, form a "spectrum" of autism-related disorders. In addition, impairments in any one of the autism-related cognitive skill areas are considered developmental delays.

To take a closer look at the impact of obesity, diabetes and high blood pressure during pregnancy, the researchers compared medical histories of 315 typically developing children to those of 517 children with autism and 172 children with developmental disorders.

Moms with diabetes were slightly more likely to have a baby with autism, but the numbers weren’t large enough for the researchers to be sure that the association wasn’t just by chance. The association between a mom’s diabetes and some other neurodevelopmental disorder was stronger. In fact, diabetic moms were more than twice as likely to have a child later diagnosed with a neurodevelopmental disorder.

Researchers have been looking for preventable factors that contribute to the rise in the number of children with autism,  said Dr. Andrew W. Zimmerman, director of clinical trials at the Lurie Center for Autism at the Massachusetts General Hospital for Children who is also on the faculty of the Johns Hopkins Bloomberg School of Public Health.  “It’s very suggestive that this might be a real factor,” Zimmerman said.

That doesn’t mean that every obese woman is going to have a child with autism, he added. “But it’s one of the many things that goes into increasing the risk.”

Zimmerman would like to see more research on the topic. “Hopefully a larger one yet will be able to show what the effect of gestational diabetes is,” he said. “That’s a bigger question since a lot of women who don’t have any sign of diabetes develop gestational diabetes.”

It's unclear whether diabetes or obesity is actually impacting the growth of the fetus, but it’s always possible that these women have something else in common, said the study’s lead author Paula Krakowiak, a Ph. D. candidate at the University of California, Davis. But, said Krakowiak, “we’re seeing a rise in the rates of obesity and diabetes as well as a rise in autism.”

Krakowiak and her colleagues don’t yet know how obesity and diabetes might impact babies’ brain development, but they have some theories.

A possible culprit is the inflammatory proteins produced by the fat cells of an obese mom. “These same proteins are involved in the normal development of the brain,” Krakowiak said. “When the level of those immunological markers is higher or lower than the normal range it might affect how the brain develops in an adverse way. And at least one type has been shown to be able to cross over the placenta to the fetus.”

It’s also possible that the higher levels of blood glucose in obese and diabetic women could have a negative impact on the developing brain, since glucose can also cross over to the fetus, Krakowiak said. High levels of glucose could cause the baby to produce more insulin and also to grow faster, she added.

“When they’re growing at a faster rate, they require more oxygen and if the mom doesn’t provide enough oxygen then that could also cause some problems with brain development,” Krakowiak said.

Typically, a woman is considered obese when she's about 35 pounds overweight or more, or has a body-mass index of 25, experts say.

Krakowiak and her colleagues didn’t have information on inflammatory markers or insulin resistance in the moms in this study. That’s a subject for future research, she said.

Until researchers know more, obese moms might want to take the new findings as another reason to lose weight,  Krakowiak said.

“That’s the safest message,” she added. “It doesn’t hurt anybody to lose weight and it comes with other benefits to the mom. So losing weight not only will help you, but it also might potentially help your child to be healthier.”

Reuters contributed to this report

More from Vitals:

Outgrowing autism? Study looks at why some kids 'bloom'

Families of kids with autism earn less

Twins with autism: Parents wonder, did it have to happen?

Experts: Wide 'autism spectrum' may explain diagnosis surge

By Joyce Ho and Dr. Nancy Snyderman
NBC News

The nation’s ever-growing obesity epidemic may be far worse than originally thought. New research demonstrates that even people with a healthy Body Mass Index, a commonly used scale to measure body fat, could actually be obese and at risk for a host of complications.

A study published Monday in the journal PloS One found that using BMI as an indicator of obesity actually misclassifies 39 percent of Americans as “overweight” rather than “obese.” And because BMI doesn’t distinguish between fat and muscle, some people with normal BMIs may have dangerously high amounts of fat in their bodies.

Without an accurate measurement of body fat, the researchers say, millions of people don’t know they are at high risk for a number of obesity-related diseases.

“The fat is what causes heart disease, cancer, menstrual problems, depression, anxiety, and a host of medical problems,” said Dr. Eric Braverman, a professor at Weill Cornell Medical School and co-author of the study. “So if you want to save society from a lot of illnesses …  you have to identify how much fat they have.”

More than one in three adults in the U.S. are obese, as defined by a BMI of 30 or higher, according to the Centers for Disease Control. Obesity measurement, however, has been a controversial topic for years, and the widely-used BMI calculation has been called outdated by experts.

BMI is calculated through a simple formula: weight divided by height squared. The ease of calculation made this formula popular, even though it’s nearly 200 years old. In Braverman’s study, researchers compared the BMI with a different measurement, the Dual Energy X-ray Absorptiometry (DXA) scan. DXA scans, commonly done in women to check for osteoporosis, measure percentage of body fat, muscle mass, and bone density.

Of the 1,393 people studied, 26 percent were classified as obese when body fat was measured with BMI, whereas 64 percent of them were considered obese when measured with DXA. The misclassification was observed more often in women and increased with advancing age: 48 percent more women between the ages of 50 to 59 were classified as obese when measured with DXA instead of BMI, and among women ages 70 and above, 59 percent more were considered obese after getting a DXA scan. 

According to the authors, BMI is an inaccurate measure for obesity – but especially in this demographic, because as women age they lose more muscle to fat than men. BMI, which does not distinguish between muscle or fat, does not reflect this bodily change. 

“BMI doesn't tell you how much fat … you have,” said Braverman. “So without knowing how much fat you have, you can't really save people from illness. It is the number one predictor of who's going to live or die.”

Researchers also tracked blood levels of leptin, a hormone produced by fat cells that regulates hunger and energy expenditure. Increased blood leptin levels correlated well with DXA scan results, highlighting the potential for a simple leptin blood test to be a measurement for obesity.

Based on these findings, Braverman and his co-author Dr. Nirav Shah, the current New York state health commissioner, suggest lowering the BMI definition of obesity from 30 to 24 in women and down to 28 in males. Under these suggested guidelines, a woman who is 5’ 6” and 150 pounds would be considered obese. Under the current BMI standards, the same woman would be considered healthy.

“Fat is costing the country a fortune, by not measuring it,” said Braverman. “A dollar blood test and doing our bone density scans with body fat scans at the same time is going to save us an enormous medical cost in the end.”

NBC’s Stacey Naggiar, Chiara Sottile and Joo Lee contributed to this report.

Read more from msnbc.com:

• America’s fattest cities
• Size matters for obese cancer patients’ drug dose
• U.S. advisers back obesity pill

It doesn’t happen often, but sometimes Dr. Jennifer Griggs’ hand trembles a bit when she prescribes “enormous” doses of chemotherapy drugs for obese breast cancer patients.

Those powerful drugs kill not only cancer cells but healthy cells as well. And that makes some doctors nervous, so they order chemotherapy doses based on patients’ ideal weight, not their actual weight.

But Griggs knows that such hesitation carries a high price: Up to 40 percent of obese cancer patients don’t get large enough chemotherapy doses, jeopardizing treatment of individual patients -- and the overall public health.

Now, Griggs and her co-authors, writing in the latest issue of the Journal of Clinical Oncology, have published new guidelines aimed at making sure even the heaviest cancer patients get the full treatment they need.

“It looks like we could save up to 6,000 lives in breast cancer a year,” Griggs says, by giving obese patients the right-sized dose.

The guidelines should help resolve confusion among cancer doctors over the correct doses for patients who weigh in at 250, 300, even 400 pounds.

“I get a lot of emails from people who … want to fully dose, and their colleagues are telling them they can’t,” says Griggs, a University of Michigan breast cancer specialist.

The confusion over how much chemo to give obese patients stems in part from the caps research trials used to put on doses, Griggs and her coauthors write.

Take the drug docetaxel, or Taxotere, used to treat breast and lung cancers. The traditional capped dose is 150 milligrams. But for a 400-pound patient, the size-based dose would be 212 milligrams, a significant difference, says Judith Smith, director of pharmacology research at the University of Texas M.D. Anderson Cancer Center in Houston.

Even at that world-renowned institution, some doctors insist on using outdated caps, says Smith, of the department of gynecologic oncology and reproductive medicine.

“The physicians fight me on it,” says Smith, who was not involved in writing the new guidelines. Still, she says, “I don’t fight that battle on a daily basis anymore.”

The authors of the new guidelines acknowledge a scarcity of studies that randomly assigned obese patients to capped doses or size-based doses of chemotherapy drugs.

But, they write, research suggests that obese cancer patients actually do better, not worse, when treated with doses commensurate with their size. They don’t experience any more toxicity with weight-appropriate doses than do lean patients, and they are more likely to be cured than those who are under-dosed.

“You’re not going to harm your patient if you give them the full dose,” Griggs’ co-chair Dr. Gary Lyman, a professor of medicine at the Duke Cancer Institute, tells msnbc.com. “In fact, just the opposite.”

Under-dosing is probably a “significant” contributor to the higher cancer death rates among overweight and obese patients, Lyman says.

Size-based dosing might most benefit breast cancer patients who are black and/or poor, the authors write. No matter what they weigh, breast cancer patients in those groups are more likely to receive reduced doses of chemotherapy, and their higher rates of obesity only compound the problem.

Correct dosing would be a boon even amid an ongoing shortage of cancer drugs, says Lyman, who calls the situation "a travesty." Appropriate dosing of obese patients should have little or not impact on the shortage situation. In most cases, Lyman says, fully dosing obese patients simply means using all of the vial of a drug instead of throwing away part of it.

There are exceptions to the recommendation of full dosing of chemotherapy drugs for obese patients, according to the guidelines. Fixed doses, prescribed independent of a patient’s weight, are justified for a few, such as carboplatin and bleomycin, because of concerns about nerve tissue damage.

The guidelines note that costs, even insurance co-pays, could be higher with larger doses, although, Griggs says, many chemotherapy drugs are off-patent and relatively inexpensive.

And, Lyman says, the cost of treating recurrent cancer or providing palliative care after the disease has spread “probably far outweighs giving the full dose of chemotherapy.”

Related stories:

Daily aspirin might reduce cancer risk

Can oral sex really give you cancer?

Rethinking how we confront cancer: Bad science and risk reduction

By Michelle Fox
CNBC.com

More than one-third of American adults are obese, according to the Centers for Disease Control and Prevention. The obesity epidemic has been going on for decades, and today health-care costs associated with obesity are estimated at $147 billion a year.

To be considered obese, a person has a body mass index (BMI) of 30 or higher. With the extra weight comes myriad health issues — obesity contributes to heart disease, diabetes, stroke, and some cancers.

Recently, the Gallup-Healthways Well-Being Index ranked the 10 most obese metropolitan areas in the U.S., offering perspective on the cities that are affected by the country’s obesity woes.

The health implications are apparent — of the metro areas with the highest obesity levels, 58 percent of their residents were more likely to report having had a heart attack over the course of their lifetimes, and 34 percent were more likely to report having high blood pressure.  Combined, residents of these cities also pay an estimated $1 billion more in medical costs each year thanks to their high obesity rates.

In 2010, the government announced its goal to lower the prevalence of obesity to 15 percent. In 2011, only three out of the 190 areas surveyed in the Gallup-Healthways Well-Being Index had an obesity rate below that level: Fort-Collins-Loveland, Colo.; Bridgeport-Stamford-Norwalk, Conn.; and Boulder, Colo. Boulder ranked as the least obese city, with an obesity rate of 12.1 percent.

It’s not all bad news, however. According to the CDC, although there was a rise in obesity between 1983 and 2000, the rates actually have stabilized over the past 10 years.

“There has been no change in obesity prevalence in recent years,” CDC scientist Heidi Blanck said. “However, over the last decade there has been a significant increase in obesity prevalence among men and boys, but not among women and girls overall.”

The government is aiming to eventually reduce the rate of obesity. In 2010, the Childhood Obesity Task Force released 70 recommendations to prevent and control childhood obesity.

Look ahead to see the most obese metro areas in the U.S., and how much their citizens are paying in obesity-related health-care costs every year, according to the recent Gallup survey.

10. Reading, Pennsylvania

Obesity rate: 32.7 percent

Annual obesity-related costs: $190.2 million

Located approximately 60 miles northwest of Philadelphia, Reading, Pa., ranks 10th on the Gallup-Healthways Well-Being Index. It’s the most obese city in Pennsylvania, which has a statewide obesity rate of 28.6 percent, according to the CDC .

With 88,000 people residing in the city, more than 28,000 residents are considered obese. In Reading, 10 percent report having diabetes, a chronic disease associated with obesity. Even higher than the obesity rate is the poverty rate: 35 percent of the population in the city lives below the poverty level. According to the nonprofit Food Research and Action Center, women and children in poverty are at the highest risk for obesity.

9. Kennewick-Pasco-Richland, Washington

Obesity rate: 33.2 percent

Annual obesity-related costs: $116.5 million

This metropolitan area in southeastern Washington is called Tri-Cities. It’s also known as “The Heart of Washington Wine Country,” with more than 160 wineries. However, according to Gallup, the region has one of the highest obesity rates in the country — at 33.2 percent — which shows an increase from the 31.5 percent obesity rate a CDC survey found for the area in 2010.

8. Topeka, Kansas

Obesity rate: 33.3 percent

Annual obesity-related costs: $109.8 million

More than 42,000 of the 127,473 residents of Topeka, Kan., suffer from obesity, according to data from Gallup. The good news is the city’s situation appears to be improving: Topeka had an obesity rate of 36 percent in 2010, almost three percentage points above where it is today, according to the CDC survey.

Topeka, the capital of Kansas, was also named as one of the 10 best cities for the next decade by Kiplinger’s Personal Finance Magazine in 2010.

7. Lakeland-Winter Haven, Florida

Obesity rate: 33.5 percent

Annual obesity-related costs: $279.3 million

According to Gallup, the Lakeland-Winter Haven, Fla., metro area has the potential to save more than $154 million in health-care costs if its obesity rate dropped to 15 percent. Instead, 33.5 percent of its residents suffer from obesity, racking up more than $279 million a year in medical bills.

The metropolitan area, which includes the cities of Lakeland and Winter Haven, has more than 75 lakes and is located in central Florida between Orlando and Tampa. In 2010, 37.9 percent of its residents were obese, according to the CDC study.

6. Charleston, West Virginia

Obesity rate: 33.8 percent

Annual obesity-related costs: $146.9 million

Charleston is the capital of West Virginia and is dubbed the cultural, recreational and business capital of the Appalachian Mountains. It’s home to several golf courses and parks, including the Haddad Riverfront Park along the Kanawha River.

There are more than 51,000 people living in the city, as of the 2010 census, and based on the rates from Gallup approximately 17,000 of them are obese. In addition, about 17 percent of the population has also reported having diabetes.

The Gallup-Healthways’ number is up from the CDC survey’s obesity rate of 32.3 percent for the city in 2010. According to the CDC, the state of West Virginia had a 32.5 percent obesity rate in 2010, placing Charleston higher than the state average.

5. Beaumont-Port Arthur, Texas

Obesity rate: 33.8 percent

Annual obesity-related costs: $182.8 million

Located in southeast Texas, this metro area includes the cities of Beaumont and Port Arthur. Oil is big business for the region, with refineries throughout the area. The metro area has been a major player in the oil industry ever since the Lucas Gusher exploded on Spindletop Hill in 1901.

According to the Gallup-Healthways Well-Being Index, the metro area could potentially save $101.6 million in medical costs if its obesity rate dropped to 15 percent, instead of the almost 34 percent it has now. Beaumont-Port Arthur is the second most obese metro area in Texas, which has a statewide obesity rate of 31 percent.

4. Rockford, Illinois

Obesity rate: 35.5 percent

Annual obesity-related costs: $179.4 million

Located in northern Illinois, Rockford calls itself the “City of Gardens” because of the 7,000 acres of parks, trails, tree-lined streets and public gardens within its borders. That’s not the only nickname the city has had — it has also been called “Forest City,” because of its woods and was once known as the “Screw Capital of the World” due to factories that produced screws and bolts. Manufacturing is still the area’s biggest industry.

Rockford also ranks as the fourth fattest city in the country, however, with an obesity rate of 35.5 percent. Of the more than 152,000 people who live in Rockford, nearly 54,000 are considered obese, while 10 percent have diabetes and 23 percent live below the poverty line.

3. Huntington-Ashland, West Virginia-Kentucky-Ohio

Obesity rate: 36 percent

Annual obesity-related costs: $146.9 million

The Huntington-Ashland metropolitan area encompasses three states — West Virginia, Kentucky and Ohio — at the point where they all meet by the Ohio River.

The metro area first gained national attention in 2008 after an Associated Press story called it the nation’s unhealthiest. That led Jami Oliver to bring his ABC reality show, “Jamie Oliver’s Food Revolution” into Huntington, W.Va., to give schools and the town a nutrition make-over. Oliver has called his time there a success. However, the larger metro area still appears to be struggling — 36 percent of its citizens are obese, according to the Gallup-Healthways Well-Being Index, and nearly 20 percent suffer from diabetes.

2. Binghamton, New York

Obesity rate: 37.6 percent

Annual obesity-related costs $131.5 million

In the city of Binghamton, more than 17,000 residents are obese, according to rates from the Gallup-Healthways Well-Being Index. It's surprising then that 54 percent of respondents also said they exercise frequently.

Located at the junction of the Susquehanna and Chenango rivers in southern New York, Binghamton has the highest obesity rate in the state, compared to New York State’s rate of just below 24 percent. Meanwhile, 27.8 percent of Binghamton’s population lives below the poverty level.

1. McAllen-Edinburg-Mission, Texas

Obesity rate: 38.8 percent

Annual obesity-related costs: $410.9 million

Located near the Mexican border in southern Texas, this metro area is the most obese in the nation, according to the Gallup-Healthways Well-Being Index. If the region dropped the rate from 38.8 percent to 15 percent, it could potentially save a whopping $252 million a year in medical costs annually. That’s a big savings, especially considering 50 percent of residents report being uninsured.

In 2010, 33.3 percent of the McAllen-Edinburg-Mission metropolitan area’s population was obese, according to a CDC survey, so the data suggest that the country’s most obese city is also getting worse, bucking the nationwide trend of stabilization in obesity rates.

See the full list: America's fattest cities

 “Fat & Fatter” premieres Thursday, March 29 at 9 p.m. ET, with a re-air Sunday, April 1 at 10 pm ET.

The Gallup-Healthways Well-Being Index results are based on telephone interviews throughout 2011, with a random sampling of 353,492 adults living in the U.S. Health-care costs were based on the National Institute of Health’s estimate of $1,429 per person, per year, in additional health-care costs for people considered obese, compared to those of non-obese individuals.

Related links from CNBC:

Where the 1% live

Best places to live

Top turnaround towns

By Jeanna Bryner
LiveScience

Our nation's cities appear to be fat, according to a new Gallup-Healthways poll, which found that at least 15 percent of residents in 187 of the 190 metro areas surveyed are obese.

Boulder, Colo., came out on top as the skinniest city, with just 12.1 percent of residents considered obese, while the number of obese in the fattest metro area, McAllen-Edinburg-Mission, Texas, soared to 38.8 percent. The state of Colorado snagged the top spot as the skinniest state in Gallup's 2011 survey of U.S. states.

The only three metro areas with obesity rates at or below 15 percent were Boulder,  Bridgeport-Stamford-Norwalk, Conn., and Fort Collins-Loveland, Colo. These would be the only cities meeting the U.S. Centers of Disease Control and Prevention goal of a 15 percent obesity rate in the United States.

The results come from the Gallup-Healthways Well-Being Index and are based on interviews with more than 350,000 American adults between Jan. 2 and Dec. 29, 2011. Participants reported their height and weight, which was used to calculate body mass index, or BMI, a measure of a person's fatness. BMI scores of 30 or greater are considered obese. (For example, a 5-foot-4-inch woman who weighs 174 pounds or more, or a 5-foot-10-inch man who weighs 209 pounds or more would have a BMI of 30.)

The metro areas are based on the U.S. Office of Management and Budget's metropolitan statistical areas, which in many cases include more than one city. For instance, the San Jose, Calif., statistical area also includes the smaller nearby cities of Sunnyvale and Santa Clara.

Top 10 most obese metro areas (with percent of residents considered obese):

• McAllen-Edinburg-Mission, Texas: 38.8 percent
• Binghamton, N.Y.: 37.6
• Huntington-Ashland, W. Va., Ky., Ohio: 36.0
• Rockford, Ill.: 35.5
• Beaumont-Port Arthur, Texas: 33.8
• Charleston, W. Va.: 33.8
• Lakeland-Winter Haven, Fla.: 33.5
• Topeka, Kans.: 33.3
• Kennewick-Pasco-Richland, Wash.: 33.2
• Reading, Penn.: 32.7

(See full list of cities' obesity rates)

10 least obese metro areas:

• Boulder, Colo.: 12.1 percent
• Bridgeport-Stamford-Norwalk, Conn.: 14.5
• Fort Collins-Loveland, Colo.: 14.6
• Barnstable Town, Mass.: 15.9
• Santa Barbara-Santa Maria-Goleta, Calif.: 16.4
• Naples-Marco Island, Fla.: 16.5
• Trenton-Ewing, N.J.: 16.8
• Provo-Orem, Utah: 17.1
• Colorado Springs, Colo.: 17.4
• San Francisco-Oakland-Fremont, Calif.: 17.5

The nation's average obesity rate has held steady at about 26 percent in 2011, while the average for the 10 most obese metro areas was 34.8 percent, compared with an average of 15.9 percent for the least obese metro areas surveyed.

Adult obesity rates were higher than 15 percent in all but three of the 190 metropolitan areas that Gallup and Healthways surveyed in 2011. McAllen-Edinburg-Mission, Texas, residents were the most likely to be obese, at 38.8 percent, while people living in Boulder, Colo., were the least likely, at 12.1 percent.

Supporting an abundance of research linking obesity with a long list of health ailments, those living in the 10 most obese areas were much more likely, compared with the skinniest cities, to report chronic diseases, including diabetes, high blood pressure, high cholesterol and depression, at some point in their lives. For instance, compared with people living in the lowest-obesity cities, residents of the most obese areas were 70 percent more likely to report diabetes, 58 percent more likely to have had a heart attack, 30 percent more likely to report a diagnosis of depression, and 23 percent more likely to report high cholesterol, Gallup noted. [ Infographic: Diabetes & Obesity in US ]

Obesity not only plagues the individual, it can also drain Americans' wallets, with the National Institutes of Health estimating the average incremental health-care cost for an obese person is $1,429 every year. With that number, Gallup estimates that in the 10 metro areas with the highest obesity rates, Americans cumulatively pay about $1 billion more in annual health-care costs than if those states had obesity rates of 15 percent.

For example, the McAllen-Edinburg-Mission metro area pays more than $400 million in unnecessary health-care costs each year because of its high obesity rate. If it reduced the obesity rate to 15 percent, the area could potentially save more than $250 million annually, Gallup estimates.

The bottom line, according to Gallup officials, is a grim one: "Even in metro areas that consistently post among the lowest obesity rates in the nation, such as Boulder and Fort Collins-Loveland, at least one in eight residents are still obese," they write on their website. "The health and economic burden of the chronic conditions resulting from obesity is very real and very significant."

More from LiveScience:

7 Diet Tricks That Really Work

8 Reasons Our Waistlines Are Expanding

9 Myths That Can Make You Fat

Rachel Rettner
MyHealthNewsDaily

We've heard obesity can be "spread" between friends when we copy each other's eating habits, but a new study in mice suggests obesity could actually be infectious.

That's right, infectious. As in, something you can catch.

In the study, mice engineered to have a particular immune deficiency developed fatty liver disease and got fatter when fed a Western-style diet. But strikingly, when these immune-deficient mice were put in the same cage as healthy mice, the healthy mice started to come down with symptoms of liver disease, and also got fatter.

The culprit? Microbes in the stomachs of the mice. Because the mice had their immune systems disturbed, the bacteria in their guts got "out of wack," said study researcher Richard Flavell, a professor of immunobiology at Yale School of Medicine. We normally live in symbiosis with the bacteria in our guts, but in the study, the number of "bad," disease-associated bacteria increased 1,000-fold in mice with immune problems, Flavell said.

And it's these bad bacteria that were transmitted from mouse to mouse, causing the healthy mice to also experience changes in their gut microbes -- and making them fat.

"We could make a mouse fatter just by putting it in the same cage as the other mouse," Flavell said.

The crucial question is: Could this happen in people?

It's possible, but we'll need much more research to find out, Flavell said. The contagiousness of obesity  seen in this study is probably more likely in mice than in people because mice eat each other's poop, a very efficient way to transmit gut bacteria (add this to your list of reasons not to eat poop).

At minimum, the study suggests "this should be very seriously looked at in people," Flavell said. Fatty liver disease is very common among obese people, affecting 75 percent to 100 percent of the obese population, the researchers say. In about 20 percent of these individuals, the disease progresses and becomes severe.

Previously, if two family members living in the same household both developed liver disease or became obese, people would have blamed genetics. But the new study suggests the environment may play a role as well.

If the findings apply to people, they would suggest we need to take approaches to obesity and fatty liver disease that address gut microorganisms — perhaps antibiotics or probiotics — in addition to traditional treatments, Flavell said.

"This is a very thought-provoking study that underlines the role of the bugs that we all carry inside us in determining our susceptibility to liver disease and its complications," said Dr. Jasmohan Bajaj, an associate  professor of gastroenterology, hepatology and nutrition at Virginia Commonwealth University,  who was not involved in the study.  More work is needed in humans, who are much more complex than mice, to understand the role of gut bacteria in liver disease, but "these experiments form a key step forward," Bajaj said.

The study was published online Feb. 1 in the journal Nature.

Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter@RachaelRettner. Find us onFacebook.

• 11 Surprising Things That Can Make Us Gain Weight
• Dieters, Beware: 9 Myths That Can Make You Fat
• Lose Weight Smartly: 7 Little-Known Tricks that Shave Pounds