Heidi Splete

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

WASHINGTON — The health cost of obesity in the United States jumped from $74 billion in 1998 to approximately $147 billion (inflation adjusted) today, based on data from a study conducted by the Centers for Disease Control and Prevention and the Research Triangle Institute. The data were presented last month at the CDC's inaugural Weight of the Nation conference on obesity.

“Obesity affects every body system,” Dr. Thomas R. Frieden, director of the CDC, said during opening remarks at the conference.

Obesity accounted for 6.5% of overall annual medical costs in the United States in 1998, but that proportion increased to 9.1% by 2006, said the study's lead author, Eric Finkelstein, Ph.D., of the independent Research Triangle Institute.

The annual cost of medical care per adult in the United States is 41% less for a normal-weight individual than for an obese individual, Dr. Finkelstein said. In this study, obesity was defined as a body mass index of 30 kg/m

Prescription drugs are among the top contributors to the costs of obesity, Dr. Finkelstein said. In 2006, across all insurance payers, the average annual prescription drug cost for a normal-weight individual was $707, compared with $1,275 for an obese individual. This difference represents an 80% increase in drug costs for the obese, Dr. Finkelstein said. The data were collected from annual Medical Expenditure Panel Surveys, which are nationally representative surveys of medical expenses for the civilian, noninstitutionalized U.S. population. The complete data were published online on July 27 in the journal Health Affairs (doi: 10.1377/hlthaff.28.5.w822).

If the obesity prevalence had remained the same between 1998 and 2006, 2006 medical costs in the United States would have been approximately $40 billion less, Dr. Finkelstein emphasized.

The study results were limited by the reliance on self-reports of body mass index, Dr. Finkelstein noted. The study examined only aggregate health costs and did not look at disease-specific costs, but “diabetes is one of the largest drivers of health care costs,” he said.

At a media briefing, Dr. Frieden said that the most effective strategies to reduce obesity and its associated costs in the United States may involve community intervention rather than clinical intervention. But physicians have a responsibility to promote healthy living in their communities, as well as to encourage patients'weight-loss efforts in a clinical practice setting, he added.

The study was sponsored in part by the CDC.

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the novel influenza A(H1N1) this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health.

“Our goals are straightforward: to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in the volume of cases of the novel H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov, which reinforces ways to prevent spreading the flu. In an effort to engage an Internet-savvy population in public health, the site offers visitors the opportunity to create a 60-second H1N1 video public service announcement. One of the announcements submitted will be chosen by the government for widespread distribution, she said, with a $2,500 prize going to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said. If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She encouraged state and local leaders to host their own local flu preparedness summits.

Because the novel H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the novel H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies. It's possible the H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

'Our goals are straightforward: to reduce illness and death and minimize social disruption.'

Source DR. FRIEDEN

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — Pregnant women's snoring has no apparent negative impact on fetal outcomes, despite some differences in fetal umbilical arterial blood gases, based on data from two studies including more than 600 women.

Previous research has suggested that habitual snoring in pregnant women may be a risk factor for poor fetal outcomes, but the available data were primarily from case studies, said Dr. Alexandra Bullough and Louise O'Brien, Ph.D., of the University of Michigan in Ann Arbor.

As part of a larger study of the impact of sleep-disordered breathing (SDB) on both maternal and fetal outcomes, the researchers recruited 380 women aged 18 years and older in the third trimester of singleton, uncomplicated pregnancies to complete sleep questionnaires. This study is the first known to examine the impact of maternal SDB on fetal outcomes after delivery, based on umbilical blood gas values for arterial pH, partial pressure of carbon dioxide (PCO₂), HCO₃, and base excess.

Overall, 129 women met the criteria for SDB, and they were compared with 251 nonsnoring controls. The women with SDB averaged a significantly higher body mass index than controls both before pregnancy (35 kg/m

In this study, there were no significant differences between the SDB and control groups in average measures of arterial pH (7.3 vs. 7.3), PCO₂ (54.4 mm Hg vs. 57.4 mm Hg), HCO₃ (23.6 mmol/L vs. 24.4 mmol/L), and base excess (−1.82 mmol vs. −1.85 mmol).

These preliminary findings suggest that maternal SDB may not be associated with adverse fetal outcomes. But the study is ongoing, and data that haven't yet been fully analyzed suggest a possible association. “We're not sure how [maternal SDB] might affect fetal outcome,” Dr. Bullough said in a poster presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

Habitual snoring was not significantly associated with low birth weight or Apgar scores, based on a second study of 429 women with uncomplicated singleton pregnancies. In this study, also conducted by Dr. O'Brien and Dr. Bullough, 35% of the women reported habitual snoring (at least 3 nights each week) and 25% were obese (with a BMI of at least 30 kg/m

Overall, habitual snoring was not significantly associated with low birth weight and Apgar scores. These results held after controlling for variables including maternal diabetes, age, and race. Only the gestational age at delivery and the mother's BMI before pregnancy were independent significant predictors of birth weight and 1-minute Apgar scores, and only gestational age at delivery was an independent and significant predictor of 5-minute Apgar scores. Regardless of sleep apnea status, “women with high BMI were going to have bigger babies,” Dr. Bullough said.

These results contrasted with previous studies suggesting that maternal sleep apnea may predict poor infant outcomes, and more research is needed to evaluate the association.

The researchers said they had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — When equal access to epidural anesthesia is available, patient ethnicity is not a factor in choosing whether to have an epidural, according to results of a study of 797 consecutive women with singleton pregnancies at a hospital in Flushing, N.Y.

Although epidural anesthesia is widely available in the United States, previous studies have suggested that ethnic disparities persist in the provision of epidurals, according to Dr. Isaac P. Lowenwirt of the New York Hospital Queens, Flushing.

To describe the use of epidural anesthesia during labor in a multiethnic population, Dr. Lowenwirt and his colleagues conducted a prospective study of 800 consecutive singleton pregnancies at a single hospital.

The average age of the women across all ethnic groups ranged from 27 to 32 years. Women who had multiples, malpresentation, or planned cesarean deliveries were excluded from the study.

Complete data from 797 women were presented in a poster at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The women were offered three options: parenteral fentanyl, patient-controlled anesthesia (bupivacaine), or no medication. The severity of pain was measured with a visual analog scale.

Overall, 82% of the patients chose an epidural.

The average baseline pain scores were higher among the women who chose an epidural, compared with those who did not (8.8 vs. 3.7). But there was no significant difference in epidural use among the ethnic groups, and patients in all groups reported similarly effective pain relief after epidural placement.

The ethnic groups were defined as white (103 patients), black (78 patients), Hispanic (150 patients), Chinese or Korean (338 patients), Indian (67 patients), and other ethnicities (61 patients).

Socioeconomic factors and maternal education were not factors in the use of an epidural, Dr. Lowenwirt reported.

In addition, nulliparous women were four times more likely to choose an epidural than multiparous women, regardless of ethnicity.

On further analysis, Chinese or Korean patients averaged the shortest duration of analgesia, and black patients averaged the longest duration (141 minutes vs. 185 minutes).

And there was a significant difference in average bupivacaine use between the group with the highest use (Hispanic patients) and the lowest use (Chinese or Korean patients).

The Hispanic patients who chose bupivacaine averaged 7.3 mg/hr, compared with an average of 5.5 mg/hr for the Chinese or Korean patients who chose bupivacaine, he said..

The results suggest that when equal access to epidural analgesia is available, women of all ethnic groups choose it in similar proportions, compared with no medication, the researchers wrote in the poster.

Dr. Lowenwirt said he had no financial conflicts to disclose.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

WASHINGTON — Women who were able to bite down on a mouth guard had a significantly shorter second stage of labor, compared with women who didn't use a mouth guard, based on the results of a randomized trial of 64 women with uncomplicated singleton pregnancies.

Developing a way to help women push harder may shorten the second stage of labor and reduce the number of cesarean or instrumental deliveries that are associated with a longer second stage, Dr. Janna Mudd said at the annual meeting of the Society of Obstetric Anesthesia and Perinatology.

“We wanted to come up with a method that would maximize maternal expulsive effort,” she explained.

Previous studies have shown that wearing a mouth guard increases the isometric strength of different muscle groups, and the researchers hypothesized that the device (a plastic mouth guard similar to those used in sports) would encourage women to push harder during the second stage of labor.

To test this theory, Dr. Mudd and her colleagues at the University of Maryland in Baltimore randomized women at a single hospital in Baltimore to wear or not wear a mouth guard during the second stage of labor. The women were nulliparous with uncomplicated singleton term pregnancies, and an average gestational age of 39 weeks. There were no significant obstetrical demographic differences between the two groups, Dr. Mudd commented.

The researchers excluded women with diabetes, preeclampsia, or other comorbidities; those whose babies were large for gestational age; or those who had shoulder dystocia or other potential complications. A total of 38 women (19 in each group) were evaluated during the second stage of labor. Overall, the average duration of the second stage was 19 minutes in the mouth guard group vs. 31 minutes in the control group.

Each of the women in the study had received an epidural, and their pushing was directed by a doctor or midwife. The women were instructed to start pushing when they were deemed fully dilated based on a digital exam.

There were no significant differences in birth weight, head circumference, Apgar scores, umbilical arterial and venous pH, and rate of NICU admission among infants of women who used the mouth guards, compared with those women who did not wear a mouth guard.

“We also were very interested in patient satisfaction,” Dr. Mudd said. “I was surprised how many people seemed very enthusiastic and willing to try anything to avoid an operative deliver,”

Overall, the patients were very satisfied with the device and said they thought that wearing it helped them to focus while pushing, although some women reported discomfort and nausea while using the mouth guard. On average, the women who used the mouth guards rated their satisfaction as 4 on a scale of 1–5.

The researchers considered three possible mechanisms of action for the impact of a mouth guard on the second stage of labor: a direct effect on the muscles, a secondary effect on posture, and increased endurance during isometric muscle activity.

In response to a question from the audience, Dr. Mudd noted that she had no explanation for why the second stage of labor in the study population as a whole was shorter than average for nulliparous women. (The American Pregnancy Association says the second stage lasts anywhere from approximately 20 minutes to 2 hours.)

The study was limited by its small size, and more research is needed to confirm the results, Dr. Mudd said. Factors to consider in future studies include measuring the uterine pressure to identify whether the expulsive effort is greater in women who wear mouth guards during the second stage of labor, she commented.

The researchers had no financial conflicts to disclose related to the study.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

The rate of serious infections in women who had medical abortions decreased by 93% after a protocol change from vaginal to buccal misoprostol combined with routine antibiotics, based on data from more than 200,000 women.

From 2001 through March 2006, Planned Parenthood health centers in the United States managed medical abortions with a combination of oral mifepristone followed by vaginal misoprostol 24–48 hours later, said Mary Fjerstad of Chapel Hill, N.C., a nurse practitioner with Planned Parenthood.

But at the end of March 2006, in response to several deaths from bacterial infections after medical abortions, the organization switched its protocol from vaginal to buccal misoprostol (200 mg mifepristone followed by 800 mcg buccal misoprostol 24–48 hours later), in addition to either routine antibiotics or screening and treatment for chlamydia. In 2007, Planned Parenthood required all its centers to provide antibiotics for all patients undergoing medical abortions (N. Engl. J. Med. 2009;361:145–51).

In this study, Ms. Fjerstad and her colleagues reviewed data from 227,823 women who had medical abortions at 78 Planned Parenthood sites throughout the United States between 2005 and 2008. The data were divided into four time periods based around changes in protocol.

In period 1 (Jan. 1, 2005, through March 31, 2006), the health care centers used vaginal misoprostol and standard antiseptic measures for fetuses through 63 days' gestation.

In period 2 (April 1, 2006, through June 30, 2007), they used buccal misoprostol for fetuses through 56 days' gestation (or, rarely, oral misoprostol through 49 days' gestation); some centers administered doxycycline to all patients, while others screened for sexually transmitted infections and treated them.

In period 3 (July 1, 2007, through Dec. 31, 2007), the health care centers used buccal misoprostol and routine doxycycline for fetuses through 56 days' gestation.

In period 4 (Jan. 1, 2008, through June 30, 2008), the centers used buccal misoprostol and routine doxycycline for fetuses through 63 days' gestation. The doxycycline regimen, when used, was 100 mg orally twice a day for 7 days.

A total of 92 serious infections were reported in the study population. Of these, most occurred in period 1 (67) and period 2 (20). Two serious infections occurred in period 3, and three occurred in period 4. The relative decrease in infections was statistically significant between periods 1 and 4. In addition, the rate of serious infection decreased significantly between periods 1 and 2 and between periods 2 and 3. The change in serious infection rate was not significant between periods 3 and 4.

“Because there was no significant increase in the rate of serious infection from period 3 to period 4, it is unlikely that a decline in the maximum gestational age from 63 days in period 1 to 56 days in period 2 explains the decline over time in the rates of serious infection observed in both groups,” the researchers noted.

The patients also were evaluated in two groups based on whether they received antibiotics only if they tested positive for a sexually transmitted infection (group 1) or received antibiotics as part of the treatment protocol (group 2). The decline in serious infection rates was significantly greater in group 2, compared with group 1 between periods 1 and 2 (93% vs. 61%), the researchers noted.

The results were limited by the retrospective nature of the study and the lack of long-term follow-up data, they said.

One of Ms. Fjerstad's coauthors, Dr. Vanessa Cullins, was also employed by Planned Parenthood at the time of the study. No other conflicts were reported.

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm

BETHESDA, MD. — The most likely scenario involving the influenza A(H1N1) virus this fall is that young people in schools will be disproportionately affected, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

“We might need to offer interventions to people who aren't used to getting even a seasonal influenza vaccine,” Dr. Schuchat said during a breakout session on vaccine preparation and distribution at an H1N1 Influenza Preparedness Summit sponsored by the National Institutes of Health.

[Since the session, children were named one of the target groups for priority H1N1 vaccination by the CDC's Advisory Committee on Immunization Practices (see page 1)].

The CDC's H1N1 Vaccine Task Force developed a guidance document with a best-case planning scenario, so clinicians have some idea what might unfold if the number of H1N1 viral infections surges in the fall.

The document describes likely target populations and presents ideas for where and how the H1N1 vaccines could be administered.

Students and staff associated with schools, children aged 6 months and older, child care center staff, and health care workers would be among those on the high-priority list in the likely event that the vaccine's availability is limited. In a best-case scenario, students would be vaccinated at schools and child care centers, and health care workers would be vaccinated in their work environments.

The goal in any emergency is to “keep our children safe and keep them learning,” Arne Duncan, secretary of the Department of Education, said at the summit's morning session. School closings are a last resort, and more guidance is needed at the local level to help schools make informed decisions about what level of illness merits a closing. However, “most school districts have developed good emergency plans,” he added.

Heath and Human Services Secretary Kathleen Sebelius encouraged everyone—clinicians and the public—to visit www.flu.gov

The presenters had no financial conflicts to disclose.

The guidance document is available at www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

BETHESDA, MD. — President Obama joined other U.S. government and health leaders at a preparedness summit in urging Americans to plan now for a likely surge in cases of the 2009-H1N1 influenza this fall.

“We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation,” President Obama, who was in Italy, said by phone during the summit at the National Institutes of Health in Bethesda, Md.

“Our goals are straightforward; to reduce illness and death and minimize social disruption,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention.

Dr. Frieden, along with Kathleen Sebelius, secretary of the Department of Health and Human Services, Janet Napolitano, secretary of the Department of Homeland Security, and Arne Duncan, secretary of the Department of Education, reviewed the status of the government's efforts to prepare for an anticipated surge in volume of cases of the 2009-H1N1 flu in the fall.

Secretary Sebelius summarized the government's four-pronged strategy of surveillance, community mitigation, vaccination, and communication. She encouraged all Americans to visit the government's flu-specific Web site, flu.gov

Of all the announcements submitted, one will be chosen by the government for widespread distribution, she said. A $2,500 prize will go to the maker of the winning video, according to the site.

In addition, Secretary Sebelius outlined the government's intentions for minimizing the impact of H1N1. The H1N1 vaccine, if it is found to be safe and effective, will be purchased by the federal government, she said, and medical and scientific experts will help prioritize vaccination efforts and “get the shots in the arms of the people who need them most.” A vaccine is currently being evaluated in clinical trials, and safety and effectiveness information should be available this month, she said.

If the vaccine is found to be safe and effective, it should be available in limited amounts in October. Based on current evidence, likely high-risk groups that would be the first candidates for the H1N1 vaccine might include younger adults with comorbid conditions, children, and pregnant women.

Federal grants for state health departments to help with preparedness are available, Secretary Sebelius also announced. She added that $90 million will be available for hospitals to help them prepare for the potential surge in flu-related activity.

The Department of Homeland Security is focusing on the importance of maintaining essential services if widespread illness contributes to widespread absenteeism, Secretary Napolitano said. She stressed the need to “make sure that plans are in place so the functions of government continue,” and encouraged state and local leaders to host their own local flu preparedness summits to be sure that backups for essential services are in place.

Because the 2009-H1N1 virus has disproportionately affected children, it is important to “get clear guidance out early,” to schools, said Secretary Duncan. School-closing decisions should be made at the local level, on a school-by-school basis, and only as a last resort, he said.

Secretary Napolitano said that even if the 2009-H1N1 flu is less severe than expected, the procedures being put in place will improve the public health system for future emergencies.

It's possible that the 2009-H1N1 virus won't be as bad as anticipated, Secretary Sebelius said, but it's wise to prepare for a worst-case scenario.

For the latest information on H1N1 preparedness, visit flu.gov

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Stimulant use was significantly associated with sudden, unexplained deaths in children and adolescents in a study of more than 500 children, but the data are not sufficient to change clinical prescribing practices, Food and Drug Administration officials said in a press briefing.

“It's hard to characterize the results as reassuring, but we didn't find them threatening,” said Dr. Robert Temple, director of the Office of Drug Evaluation I at the agency's Center for Drug Evaluation and Research.

Previous studies suggest that stimulants increase the risk of cardiovascular events, including sudden death, in children who are already at risk for heart problems, Dr. Temple said. But few data exist on the impact of stimulant use in children without known underlying risk factors, he noted.

In this study, Madelyn S. Gould, Ph.D., of Columbia University in New York, and her colleagues compared stimulant use in 564 children aged 7-19 years who died suddenly from no known health problems, with stimulant use in 564 children aged 7-19 years who died as passengers in motor vehicle accidents.

Accident victims were chosen because they provide a control population of children who died suddenly and whose death was not caused by a known health problem. Children with a known history of heart problems were excluded from the study (Am. J. Psychiatry 2009 June 15 [doi: 10.1176/appi.ajp.2009.09040472

The researchers found that 10 (1.8%) children who died suddenly of unexplained causes were taking stimulants, compared with 2 (0.4%) children who died suddenly in car accidents. This difference was statistically significant after controlling for multiple variables, but the study was limited by several key factors, including a lack of complete postmortem blood work on the car accident victims, the researchers wrote.

A case-control study cannot prove causality, Dr. Temple added. “The reason for our cautious interpretation is that everything depends on whether the people who died were or were not taking an amphetamine,” he said, adding that the researchers depended primarily on the memories of people involved with the accident victims.

“We were unable to conclude that the data affect the overall risk and benefit profile of the stimulant medications,” said Dr. Temple.

He advised clinicians who treat children with stimulants to adhere to the current labeling recommendations and to monitor the children closely. “We continue to advise people to look at these children for any evidence of an underlying cardiac disease.”

Two additional studies on the effects of stimulant use and cardiovascular outcomes are in progress, one in children and one in adults, said Dr. Gerald Dal Pan, director of the Office of Surveillance and Epidemiology at the Center for Drug Evaluation and Research.

These studies will evaluate the impact of stimulant use on sudden cardiac death, heart attack, and stroke. Results of the child study are expected in the fall, and results of the adult study are expected early next year, he said.

To view the full study, go to www.ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2009.09040472v

The study was cofunded by the FDA and the National Institute of Mental Health. Dr. Gould had no financial conflicts to disclose.

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org

Not a single state showed signs of a decline in adult obesity rates in the past year, according to the annual obesity report released by the Trust for America's Health and the Robert Wood Johnson Foundation.

The report, “F as in Fat: How Obesity Policies Are Failing in America 2009,” ranks states by obesity rates in adults 18 and older and overweight or obesity rates in children aged 10-17 years.

The data suggest that children may be especially at risk—adult obesity rates in the United States increased in 23 states compared with last year's data, but obesity rates in children aged 10-17 years have tripled since 1980.

The prevalence of obesity in adults and the prevalence of either overweight or obesity in children was highest in Mississippi (33% and 44%) and lowest in Colorado for adults (19%) and Utah and Minnesota for children (tied at 23%).

Overweight was defined as at or above the 85th percentile for height and weight, and obesity was defined as at or above the 95th percentile for height and weight.

Despite the apparent lack of progress, “we are beginning to see early signs of hope,” in efforts to prevent overweight and obesity, especially in policies that are designed to improve children's school environments, Dr. James S. Marks, a pediatrician and the senior vice president of the Robert Wood Johnson Foundation, Princeton, N.J., said at a press conference.

For example, a total of 19 states currently have school nutrition standards that are stricter than the national standards, Dr. Marks said.

But all parts of the community need to work together to create solutions to the obesity problem, he noted.

For doctors, the take-home message is to tell people whether they are overweight or obese. Hearing from their physician is critical in getting people to get serious about the changes they need to make, Dr. Marks said.

In addition, physicians and other practitioners must “be advocates for changes that their community needs,” such as eliminating junk food vending machines in schools, he said. “Their voices will carry a lot of weight.”

Data from the report also suggested that obesity rates in youth increased during the summer months. “That was a surprising finding for us in the field,” Dr. Marks said.

The data suggest that despite the break from sitting at school desks all day, young people “are eating more and exercising or playing less” than expected, he said.

The report also emphasized that programs to reduce obesity should address baby boomers before they reach Medicare age and place additional strain on the health care system.

“Our health care costs have grown along with our waistlines,” Jeff Levi, Ph.D., executive director of the Trust for America's Health, said at the press conference.

Obesity-related health care costs become more significant as people age. Recent data suggest that the baby boomers are more obese than previous generations, and as they reach Medicare age, the percentage of obese seniors could increase significantly over the current obesity rates among seniors.

The report also called for a national strategy to combat obesity that involves federal, state, and local governments and promotes community efforts outside of the doctor's office, stating that economic and neighborhood factors continue to thwart the efforts of youth and adults to eat well and exercise regularly.

The complete report is available at www.healthyamericans.org