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July 30, 2009 Volume VI, No. 11

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Just this week the CDC announced that medical costs for treating obesity-related conditions in 2008 reached $147 billion — nearly twice as much as the estimated $74 billion just a decade ago. But healthcare costs are not the only factors affected by the obesity epidemic; this week's Disease Management Update looks at a possible connection between obesity and the swine flu and a common OTC drug can reduce obesity.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Role of Obesity in H1N1
  2. Common Drug Reduces Obesity, Diabetes
  3. Reducing Hospital Admissions
  4. Becoming Eating-Competent
  5. Healthcare Trends & Studies
  6. Osteoporosis Drug May Save Lives
  7. Health Coaching in '09

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Role of Obesity in Severe H1N1 Infections

A report from the University of Michigan Health System (U-M) documents severe lung problems among patients infected with the H1N1 or swine flu virus and suggests that obesity may be emerging as a new risk factor in the pandemic. A high proportion of patients with swine flu and pneumonia or acute respiratory distress syndrome (ARDS) who were cared for in the U-M surgical ICU were obese or extremely obese, according to the U-M report. Out of a series of 10 patients, nine of them were obese, with a BMI over 30. Seven of those were extremely obese, with a BMI over 40. Clinicians should be aware of the potential for severe complications of H1NI, particularly in extremely obese patients, say the authors.

“What we found — patients with severe ARDS, associated pulmonary emboli and high prevalence of obesity — suggests a new focus for community hospitals, which are the first line providers in caring for potential H1N1 flu patients,” said lead author Lena Napolitano, M.D., chief of the division of acute care surgery, director of surgical critical care and associate chair for critical care in the U-M department of surgery. “When doctors see obese patients with acutely worsening upper respiratory infection symptoms, they should consider the possibility of H1N1 viral pneumonia and initiate early appropriate empiric antiviral medications.”

The report from U-M raises questions about what role obesity — a growing societal concern, with one-third of Americans weighing too much — may play in the lingering worldwide H1N1 flu pandemic. Obesity is a risk factor for cardiovascular diseases, type 2 diabetes, some cancers and sleep problems. While this preliminary report could not draw definitive conclusions about the connection between obesity and complications from H1N1 flu, additional research will be required to address this important issue. Health officials are continuing to remind the public about the importance of handwashing and good hygiene to prevent H1N1 flu, which are also good prevention measures for seasonal flu, and hospitals everywhere are preparing for a likely surge in H1N1 cases during the regular flu season beginning in October.

To learn more about this research, please visit:

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Common Allergy Drug Reduces Obesity and Diabetes in Mice

Researchers at Brigham and Women’s Hospital (BWH) have found that two common over-the-counter allergy medications may reduce both obesity and type 2 diabetes in mice. The medications — Zaditor and cromolyn — stabilize a population of inflammatory immune cells called mast cells. Mast cells are immune cells that facilitate healing in wounded tissue, primarily by increasing blood flow to the site. However, in certain conditions, mast cells build up to levels far beyond what the body needs. As a result, these cells become unstable and eventually, like punctured trash bags, leak molecular “garbage” into the tissue. This can result in chronic inflammation that causes asthma and certain allergies.

Mast cells were far more abundant in fat tissue from obese and diabetic humans and mice than they were in normal weight fat tissue. This led to an obvious question: By regulating mast cells, could we then control the symptoms? To find out, researchers took a group of obese and diabetic mice and, for two months, treated them with either ketotifen fumarate (also called Zaditor) or cromolyn, both over-the-counter allergy drugs. The mice were divided into four groups. The first was the control group; the second group was simply switched to a healthy diet; the third was given cromolyn or ketotifen fumarate; and the fourth was both given the drug and switched to a healthy diet. While symptoms of the second group improved moderately, the third group demonstrated dramatic improvements in both body weight and diabetes. The fourth group exhibited nearly 100 percent recovery in all areas.

To bolster these findings, researchers then took a group of mice whose ability to produce mast cells was genetically impaired. Despite three months of a diet rich in sugar and fat, these mice neither became obese nor developed diabetes.

“The best thing about these drugs is that we know it’s safe for people,” said Guo-Ping Shi, a biochemist from the Department of Medicine at BWH. “The remaining question now is: Will this also work for people?” Shi now intends to test cromolyn and ketotifen fumarate on obese and diabetic non-human primates.

To learn more about this research, please visit:

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Constructing Care Transitions to Reduce Hospital Admissions

Geisinger Health Plan's successful Transitions of Care program is the health plan's response to rising rehospitalization rates among Medicare patients, a major concern of both CMS and private payors. Geisinger Health Plan's Doreen Salek defines the transition teams' key area of focus when providing a "clean and clear handoff" of a patient from one care site to another, with the goal of avoiding readmission to the hospital. The health plan's director of business operations of health services also defines the plan's ideal home health partner, its blueprint for a universal plan of care to improve care coordination and its expectations of patients and their families and caregivers.

To listen to this complimentary HIN podcast, please visit:

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Becoming Eating-Competent

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Peggy Crum, registered dietitian and nutrition consultant in Michigan State University’s (MSU) health promotion program.

Question: How do you encourage overweight or obese patients to become eating-competent?

Response: Eating competency emcompasses feeling positive about eating, being reliable about feeding yourself, eating foods you enjoy, eating enough to feel satisfied and leting your body weigh what it will in accordance with lifestyle and genetic endowment. If you put the pressure to lose weight on people, they cannot become eating-competent. These are two opposite ends of the spectrum. They become too focused on external regulation and cannot become internally regulated. You have to say, "Let’s put weight aside at least for a while and take that pressure off of you. Let’s focus on helping you get out of that mode of diet thinking." Dieting works in the short term for some people. There are plenty of options out there for those who decide to take that route; I don’t have to be the one teaching it. No practitioner can predict who will lose weight; who will gain it back; who will end up at a higher weight; and who will become eating disordered.

For more actionable information on obesity and weight management, please visit:

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Managing Care Transitions

When transitioning patients from one healthcare setting to another, it’s not uncommon to encounter gaps in care that have the potential to negatively impact their health. To remedy this problem and reduce associated costs, organizations are taking steps to better plan for a patient’s care transitions and close these gaps in care. These simple strategies can have a significant effect on health outcomes, likelihood of readmission and ER visits, cost to patients, providers and insurers and the burden on caregivers and family members. This white paper from HIN is based on HIN’s April 2009 e-survey in which respondents were asked to share their organization’s experiences with care transitions.

To download this complimentary white paper, please visit:

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Osteoporosis Drug May Save Lives by Strengthening Immune System

An osteoporosis drug proven to save lives after hip fractures may do so by strengthening the body's immune system, according to geriatrics researchers at Duke University Medical Center. In 2007, Duke researchers reported a 28 percent reduction in death among patients who received zoledronic acid (Reclast) within 90 days of surgery for a hip fracture. Zoledronic acid is a yearly intravenous injection of bisphosphonate that inhibits the progression of bone loss. The researchers also reported that the 2,111 people who participated in the study were 35 percent less likely to suffer another fracture.

"The findings marked the first time an osteoporosis medication was shown to have an effect on mortality, but they didn't tell us why the mortality rate was lower," says Cathleen Colon-Emeric, M.D., an associate professor of medicine at Duke. "People assumed it was due to a reduction in secondary fractures. We wanted to know if that was the reason or were other conditions being affected by the medication."

Dr. Colon-Emeric and her colleagues report that the reduction in additional broken bones accounts for only 8 percent of the mortality benefit. "Even after adjusting for secondary fractures and other risk factors, we found the risk of mortality was still 23 percent lower in the zoledronic acid-treated participants. That suggests the drug must work in other ways."

The link between osteoporosis and an increased risk of death has been observed for some time. Up to 25 percent of the 345,000 Americans hospitalized annually with hip fractures die within a year of their fracture. Typically, most patients die from cardiovascular problems like heart attacks, arrhythmias and strokes, infections such as pneumonia, and cancer.

"People who received the drug experienced common complications at the same rate as those who didn't," said Dr. Colon-Emeric. But the people in the zoledronic acid group were better able to survive these events. "In particular, people with certain cardiac problems such as arrhythmias and pneumonias were much less likely to die from those conditions." Patients who lived in a nursing home before their broken hip, or who had high levels of cognitive impairment did not receive a mortality benefit from the drug.

To learn more about this research, please visit:

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Health Coaching Trends in 2009

The health coaching field is evolving, as it is becoming more widely accepted as a means of helping patients better manage their health conditions. HIN's Survey of the Month revisits this field to find out how and to what extent healthcare organizations are implementing health coaching into their organizations. Only two days remain to join more than 150 healthcare organizations that have already responded and complete HIN's Survey of the Month on Health Coaching in 2009. You will receive a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

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