Disease Management Update
Volume V, No. 26
October 23, 2008

Dear Healthcare Intelligence Network Client,

In this fast-paced world, sometimes it feels like we barely have time to sleep and eat. This week's DM Update looks at how these habits affect DM and prevention: One study finds a link between sleep disorders and unhealthy diets, and an interview showcases one organization's health coaching program for binge eaters.

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

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Link Found Between Severe SDB and High-Fat Diets
  2. Disease Management Q&A: Chronic Pain Management
  3. HealthSounds Podcast: Coaching the Binge Eater
  4. Insomnia Linked to Depression and Substance Abuse During Adolescence
  5. Survey of the Month: Depression and DM in 2008
  6. Employer-Sponsored Weight Management Programs — The Business Case

1. Link Found Between Severe SDB and High-Fat Diets

Unrelated to obesity, people with severe sleep-disordered breathing (SDB) consume a more unhealthy diet, which may be a factor contributing to greater cardiovascular morbidity and mortality. These findings were most evident among women. Findings showed that, on average, all participants with extremely severe SDB, or those with respiratory disturbance index (RDI) above 50 disruptions per hour, consumed 88.16 more milligrams of cholesterol per day compared to people who have less severe obstructive sleep apnea. On average, women participants with severe SDB consumed 21.96 more grams of protein, 27.75 more grams of total fat and 9.24 more grams of saturated fatty acids. These results remained significant after controlling for BMI, age and daytime sleepiness.

Results indicated that among the 320 participants, increasing RDI severity was associated with greater consumption of cholesterol, protein and trans-fatty acids. There also was a trend towards greater ingestion of total saturated fatty acids and total fat, but not carbohydrates, sucrose or dietary fiber. It is unlikely that sleep deprivation or obesity explain the results of the study. It has been suggested that fatigue, sleepiness and sleep deprivation influence dietary intake via alterations in neuroendocrine control of feeding behavior; however, controlling for Epworth Sleepiness Scale score did little to affect results and in bivariate analysis, total sleep time was not associated with alterations in dietary intake.

To learn more about this research, please visit:

2. Disease Management Q&A: Identifying Ideal Candidates for Gastric Bypass Surgery

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Robin Foust, population/individual health and productivity management specialist for Zoe Consulting.

Question: Who is paying for gastric bypass surgery? What kind of screening is done to determine if a patient is a good or poor candidate for the surgery? What factors predict patients that do well with the surgery and those that do not do well? What are the profiles of patients that have a good outcome versus a poor outcome?

Answer: (Robin Foust) Right now, who's paying for the surgery depends on where you are in the country and what the state insurance commissions are mandating. At least one major carrier is not providing coverage for the surgery within their fully insured population products. In some states, such as Virginia where MediCorp is located, the law requires coverage. The screening process is defined within the approval policy, which helps improve outcomes. There are more than 20 criteria for approving surgery, including weight restrictions. The patient must be considered morbidly obese. This would include individuals with a Body Mass Index (BMI) of greater than 40, or BMI greater than 35 with one or more co-morbid conditions such as hypertension, Type II diabetes, coronary heart disease, sleep apnea, or degenerative joint disease.

The person must be well motivated. Most of the time, a psychologist evaluates the patient to ensure there is no psychopathology that would jeopardize the patient's informed consent going into surgery. This screening looks at current stressors, depression, mood, sleep, hopelessness, self-esteem, memory, concentration, libido, the availability of social support, anticipated lifestyle changes, reasonable outcome expectations, substance abuse, psychiatric history and so on. They are also evaluated by nutritionists, dieticians, internists, their primary care physicians, and so on.

This is not a quick fix. The patients must understand that there's work to be done going into the surgery as well as after the surgery. Usually with an extreme weight loss, there is a lot of excess skin. Sometimes patients find out that while the initial surgery is covered, the surgery to remove the excess skin (abdominal plasty) is not covered. They must deal with those financial problems post-surgically. Some of the celebrities are speaking to the fact that it's not quite what they thought either, as far as what they could eat after the surgery. They admit to being sick to their stomachs, and sometimes gaining the weight back. Patients need to be psychologically prepared and educated before the surgery.

For more details on weight management, please visit:

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3. HealthSounds Podcast: Coaching the Binge Eater

For HealthMedia, Inc., the notion of health coaching without a coach is proving to be very successful for their patients in many areas. Dr. Richard Bedrosian, Ph.D., HealthMedia director of behavioral health, and Caren Kenney, director of corporate communications, discuss HealthMedia's Binge Eating Disorder (BED) program, a first-of-its-kind solution aimed at addressing binge eating disorder and its impact on healthcare costs in the United States. Dr. Bedrosian and Kenney also talk about what spurred the idea for the program, how it works and the benefits, challenges and drawbacks that go with this innovative new wave of Web-based coaching.

To listen to this complimentary HIN podcast, please visit:

4. Insomnia Linked to Depression and Substance Abuse During Adolescence

Adolescent insomnia symptoms are associated with depression, suicide ideation and attempts, and the use of alcohol, cannabis and other drugs such as cocaine. Findings suggest that the presence of insomnia in adolescents increases the risk of developing mental health problems and also may increase the severity of these problems. Results indicate that adolescents who had symptoms of insomnia were 2.3 times more likely to develop depression in early adulthood than adolescents without symptoms of insomnia. Specifically, at baseline, the insomnia group was more likely to use alcohol, cannabis and non-cannabis drugs, and was more likely to suffer from depression, suicide thoughts and suicide attempts. The insomnia group also had a greater risk of developing new incidences of depression and suicide attempts after excluding participants who suffered from these specific psychopathologies at baseline. Insomnia symptoms were reported by 9.4 percent of the adolescents in the study. Information discovered during this study could potentially provide parents, educators and mentors with a sign of a risk factor for the development of mental health issues. The study involved 4,494 adolescents between 12 and 18 years of age at the beginning of the study, and 3,582 young adults between the ages of 18 and 25 years in a six-to-seven year follow-up. “Previous research in adults has found similar results to this study,” said principal investigator and lead author Brandy M. Roane, M.S., a doctoral student at the University of North Texas. “The current study suggests adolescents with insomnia are more prone to developing mental disorders, specifically depression.”

To learn more about this research, please visit:

5. Survey of the Month: Depression and DM in 2008

Depression affects over 20 million Americans and billions of dollars are spent on treatment, medication and other therapies. Most cases of depression are still unrecognized or treated inappropriately, which leads to immeasurable costs in employee absenteeism, lost productivity and spiraling healthcare costs. Complete HIN's survey of the month on depression in DM programs in 2008 by October 31 and get a FREE executive summary of the compiled results.

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

6. Employer-Sponsored Weight Management Programs — The Business Case

This new white paper details the significant benefits to organizations that invest in proven weight control strategies at work. The paper cites more than a dozen studies highlighting the ROI in terms of health risks, costs and worker productivity and offers employers solutions to the growing cisis.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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