Naseem S. Miller

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

WASHINGTON – When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine. 

That’s partly why Dr. Keith A. Nichols screens all of his adolescent and adult patients for alcohol use disorders beyond the patient history form in his private family practice in upstate New York. Often, Dr. Nichols’ questions lead to a conversation.

"Do not stop at taking history," Dr. Nichols said. "Delve into and find out if there’s a problem. Don’t take the person’s snap response. People in general aren’t offended if you ask them. In fact, you get a lot of people who are grateful if you help them."

Because of the key role alcohol plays in a variety of problems, diseases, and injuries, early identification is critical, said John P. Allen, Ph.D. Why? "Because the chances of treating problem drinking are likely most favorable before the drinking becomes more ingrained," said Dr. Allen, associate chief consultant for addictive disorders at the Veterans Health Administration’s (VHA’s) Office of Mental Health Services.

The importance of primary care as an entry point for treating these patients is well established. For example, screening and behavioral counseling interventions in primary care settings to reduce alcohol misuse are top recommendations of the U.S. Preventive Services Task Force. At the VHA, more than 96% of the patients are screened for alcohol use disorders. In addition, roughly two-thirds of patients with a diagnosis of substance use disorder at the VHA are treated in primary care or in general mental health services.

Providers at the VHA use a simple screening instrument called the Alcohol Use Disorders Identification Test (AUDIT-C), which includes three questions inquiring about the frequency of drinking, the usual level of alcohol consumption, and the frequency of very heavy alcohol use. 

Despite physicians’ awareness of the importance of screening and probing for alcohol use disorders, one problem that might explain the failure of screening to become routine could be that physicians "aren’t sure what to do once they obtain a history" that suggests a problem, Dr. Nichols said. "I think there might be a concern that it’s not a priority for the patient, and the doctor might not want to go there."

For many physicians faced with 15-minute limits for each patient visit in order to make a viable practice, the biggest challenge is time. And the problem doesn’t end there. "Even if you have enough time to figure out the problem, there’s not enough time to delve into its origins," said Dr. Jose M. Partida Corona, an internist who practices in Las Vegas.

Other barriers also interfere, such as lack of an integrated system or access to specialty care.

Yet, screening advocates stress the importance of taking that first step.

"It’s important for health care providers to ask about drinking, because it plays a huge role in many physical and mental health problems," Dr. Partida Corona said. "And obviously, treatment for them will be very different if alcohol is playing a significant role."

Dr. Nichols, Dr. Allen, and Dr. Partida Corona reported no conflicts of interest.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

A large percentage of young white women use tanning beds or intentionally tan in the sun, despite repeated health warnings, according to a new survey from the American Academy of Dermatology.

"Our survey underscores the importance of educating young women about the very real risks of tanning," noted Dr. Ronald L. Moy, president of the AAD, in a statement.

©Bora Ucak/iStockphoto.com

The online survey of more than 3,800 white, non-Hispanic females aged 14 to 22 years, found that 81% of respondents had tanned outdoors frequently or occasionally in the past year. More than 32% reported using a tanning bed in the past year, while 25% reported using a tanning bed at least weekly.

Meanwhile, 86% of the respondents said that in the past year they never received a spray tan - the safe alternative to UV exposure.

When comparing ages, 18- to 22-year-old women were almost twice as likely (40%) to use indoor tanning beds, compared with 14 to 17 year olds (22%).

"The challenge is that teens have access to indoor tanning salons on almost every corner," noted Dr. Moy in his statement. "A recent survey of 116 U.S. cities found an average of 42 tanning salons per city, which means tanning salons are more prevalent than Starbucks or McDonald's."

Dr. James M. Spencer, of Mount Sinai School of Medicine, New York, was not surprised by the statistics. "It's a fashion," he said. "The media and advertisements make [being] tan desirable," and the media has more impact than physicians.

"We've been trying to get this message out of 20 years … But the public is headed in the wrong direction," said Dr. Spencer.

More than 1 million people in the U.S. tan in salons on an average day. White girls and women, particularly aged 16 to 29 years, make up almost 70% of tanning salon patrons, according to the AAD.

"We are very concerned that this tanning behavior will lead to a continued increase in the incidence of skin cancer in young people and, ultimately, more untimely deaths from this devastating disease," noted Dr. Moy.

Nearly 75% of skin cancer deaths are due to melanoma and rates have been rising over the last 30 years.

More than 30 states either prohibit or require parental consent for minors who want to use indoor tanning devices. The World Health Organization has declared UV radiation from the sun and artificial light sources a known carcinogen and has called for prohibiting minors from indoor tanning.

May has been designated Melanoma/Skin Cancer Detection and Prevention Month.

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. According to administrative claim data for 50,000 children aged 19 years or younger, 8,226 of whom had diabetes, the average annual medical cost in 2007 for the group with diabetes was $9,061, compared with $1,468 for children without diabetes, researchers reported in Diabetes Care. Children who received insulin treatment had medical costs of $9,333 and children with diabetes who were not getting insulin cost their families and private insurance companies $5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

Intensive Education Works

People with diabetes who enrolled in an intensive educational program had significant improvement in long-term blood sugar control, according to researchers at Johns Hopkins University, Baltimore. They said the results are important because much diabetes education has little impact or, if it does, early benefits wear off. “We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change,” Felicia Hill-Briggs, Ph.D., the study's lead author, said in a statement. The nine-session program included lessons on how to manage diabetes and problem-solving skills to help people with the disease understand why they are having problems when they do. In the educational program, “we helped people integrate diabetes care into everything else that was going on in their lives,” Dr. Hill-Briggs said.

A Checklist for Disaster

The American College of Endocrinology and Lilly Diabetes have created a checklist for people with diabetes to help them prepare for natural disasters. Called “Power of Prevention: Diabetes Disaster Plan,” the checklist includes having a written summary of one's illness, a 30-day supply of insulin and other drugs, a cooler, and other supplies and information such as contacts for health care providers. “During the aftermath of a natural disaster or weather emergency, medical care and supplies are often in short supply,” said Dr. Todd Frieze of Biloxi, Miss., in a statement on the college's Web site. “Through the 'Power of Prevention: Diabetes Disaster Plan,' we hope that the millions of people with diabetes in this country will avoid potentially life-threatening disruptions in their diabetes care.”

Public Citizen: Ban Alli, Xenical

The Food and Drug Administration should immediately ban the weight-loss drug orlistat in its prescription (Xenical) and over-the-counter (Alli) formulations because it can damage the liver and cause acute pancreatitis, according to the advocacy group Public Citizen. The group said it had found in the FDA's adverse reaction files 47 cases of acute pancreatitis and 73 cases of kidney stones associated with Alli and Xenical. In addition, three patients taking orlistat developed acute kidney failure – and one died – because calcium salt crystals formed throughout the organs. “These drugs have the potential to cause significant damage to multiple critical organs, yet they provide meager benefits in reducing weight loss in obese and overweight patients,” Dr. Sidney Wolfe, Public Citizen Health Research Group Director, said in a statement.

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. According to administrative claim data for 50,000 children aged 19 years or younger, 8,226 of whom had diabetes, the average annual medical cost in 2007 for the group with diabetes was $9,061, compared with $1,468 for children without diabetes, researchers reported in Diabetes Care. Children who received insulin treatment had medical costs of $9,333 and children with diabetes who were not getting insulin cost their families and private insurance companies $5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

Intensive Education Works

People with diabetes who enrolled in an intensive educational program had significant improvement in long-term blood sugar control, according to researchers at Johns Hopkins University, Baltimore. They said the results are important because much diabetes education has little impact or, if it does, early benefits wear off. “We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change,” Felicia Hill-Briggs, Ph.D., the study's lead author, said in a statement. The nine-session program included lessons on how to manage diabetes and problem-solving skills to help people with the disease understand why they are having problems when they do. In the educational program, “we helped people integrate diabetes care into everything else that was going on in their lives,” Dr. Hill-Briggs said.

A Checklist for Disaster

The American College of Endocrinology and Lilly Diabetes have created a checklist for people with diabetes to help them prepare for natural disasters. Called “Power of Prevention: Diabetes Disaster Plan,” the checklist includes having a written summary of one's illness, a 30-day supply of insulin and other drugs, a cooler, and other supplies and information such as contacts for health care providers. “During the aftermath of a natural disaster or weather emergency, medical care and supplies are often in short supply,” said Dr. Todd Frieze of Biloxi, Miss., in a statement on the college's Web site. “Through the 'Power of Prevention: Diabetes Disaster Plan,' we hope that the millions of people with diabetes in this country will avoid potentially life-threatening disruptions in their diabetes care.”

Public Citizen: Ban Alli, Xenical

The Food and Drug Administration should immediately ban the weight-loss drug orlistat in its prescription (Xenical) and over-the-counter (Alli) formulations because it can damage the liver and cause acute pancreatitis, according to the advocacy group Public Citizen. The group said it had found in the FDA's adverse reaction files 47 cases of acute pancreatitis and 73 cases of kidney stones associated with Alli and Xenical. In addition, three patients taking orlistat developed acute kidney failure – and one died – because calcium salt crystals formed throughout the organs. “These drugs have the potential to cause significant damage to multiple critical organs, yet they provide meager benefits in reducing weight loss in obese and overweight patients,” Dr. Sidney Wolfe, Public Citizen Health Research Group Director, said in a statement.

Kids With Diabetes Cost More

Medical costs for children with diabetes are six times those of other children, according to the Centers for Disease Control and Prevention. According to administrative claim data for 50,000 children aged 19 years or younger, 8,226 of whom had diabetes, the average annual medical cost in 2007 for the group with diabetes was $9,061, compared with $1,468 for children without diabetes, researchers reported in Diabetes Care. Children who received insulin treatment had medical costs of $9,333 and children with diabetes who were not getting insulin cost their families and private insurance companies $5,683. The authors attributed higher costs with diabetes to medication expenses, specialist visits, and supplies.

Intensive Education Works

People with diabetes who enrolled in an intensive educational program had significant improvement in long-term blood sugar control, according to researchers at Johns Hopkins University, Baltimore. They said the results are important because much diabetes education has little impact or, if it does, early benefits wear off. “We know that people need information to manage their disease, but having knowledge of the facts is not enough for behavioral change,” Felicia Hill-Briggs, Ph.D., the study's lead author, said in a statement. The nine-session program included lessons on how to manage diabetes and problem-solving skills to help people with the disease understand why they are having problems when they do. In the educational program, “we helped people integrate diabetes care into everything else that was going on in their lives,” Dr. Hill-Briggs said.

A Checklist for Disaster

The American College of Endocrinology and Lilly Diabetes have created a checklist for people with diabetes to help them prepare for natural disasters. Called “Power of Prevention: Diabetes Disaster Plan,” the checklist includes having a written summary of one's illness, a 30-day supply of insulin and other drugs, a cooler, and other supplies and information such as contacts for health care providers. “During the aftermath of a natural disaster or weather emergency, medical care and supplies are often in short supply,” said Dr. Todd Frieze of Biloxi, Miss., in a statement on the college's Web site. “Through the 'Power of Prevention: Diabetes Disaster Plan,' we hope that the millions of people with diabetes in this country will avoid potentially life-threatening disruptions in their diabetes care.”

Public Citizen: Ban Alli, Xenical

The Food and Drug Administration should immediately ban the weight-loss drug orlistat in its prescription (Xenical) and over-the-counter (Alli) formulations because it can damage the liver and cause acute pancreatitis, according to the advocacy group Public Citizen. The group said it had found in the FDA's adverse reaction files 47 cases of acute pancreatitis and 73 cases of kidney stones associated with Alli and Xenical. In addition, three patients taking orlistat developed acute kidney failure – and one died – because calcium salt crystals formed throughout the organs. “These drugs have the potential to cause significant damage to multiple critical organs, yet they provide meager benefits in reducing weight loss in obese and overweight patients,” Dr. Sidney Wolfe, Public Citizen Health Research Group Director, said in a statement.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the prevalence of obesity was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509-13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states.

In 2009, nearly 50 million – or 22% – of adults in the United States had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461-77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65:519-25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16-21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136-41).

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the prevalence of obesity was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509-13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states.

In 2009, nearly 50 million – or 22% – of adults in the United States had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461-77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65:519-25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16-21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136-41).

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the prevalence of obesity was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509-13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states.

In 2009, nearly 50 million – or 22% – of adults in the United States had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461-77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65:519-25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16-21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136-41).

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

Subacute atopic dermatitis of the vulva has been described for the first time by Dr. Albert Altchek, clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, New York, according to the physician.

Atopic dermatitis is a clinical diagnosis, according to Dr. Altchek. “There's no corresponding biopsy.”

His findings are based on his observations of a large number of the same girls over a long period of time at three separate clinics as well as his continuing private office consultation, which he presented at the 15th Annual Postgraduate CME Course on Pediatric, Adolescent, and Young Adult Gynecology held at New York's Mount Sinai Hospital.

He also has written a chapter on the topic in “Pediatric, Adolescent, & Young Adult Gynecology” (Oxford: Wiley-Blackwell, 2009), edited by Dr. Altchek and Dr. Liane Deligdisch.

The symptoms include recurrent itching, redness, fissures, and vulvar dysuria. Diagnosis of vulvar atopic dermatitis includes gathering a family history of allergies, asthma, hay fever; looking at the past history of the patient; and conducting a physical examination starting from the head, he said.

Atopic dermatitis fissures are symmetrical and narrow, and look as if they were “made by an artist with a scalpel,” he said. The hymen is intact. In early stages, vulvar atopic dermatitis' most pronounced part is bilateral symmetrical fissures between labia minora and majora. Sometimes the fissures are deep and may cause bleeding. In addition, there is a midline sagittal perineal fourchette to the anterior anus at 12 o'clock, where there is usually a papule. The latter is the result of an anterior anal fissure with red inflamed edges. When red and present for a long time, there is severe permanent swelling simulating a hemorrhoid. In more severe cases there is a fissure anterior to clitoris.

In younger girls, the fissures may cause a sudden jump up from sitting because of pain, which is at times misdiagnosed as a neurologic condition.

The condition is sometimes confused with sexual molestation or lichen sclerosis. In sexual molestation cases there may be general signs of trauma and any vulvar fissures are irregular, with lacerations in addition to the history. “Lichen sclerosis of the vulva has coarse, wide irregular fissures in the same areas. With slight trauma the labia and vulva have transient dark blue subcutaneous blood boils,” said Dr. Altchek, also an attending ob.gyn. at Lenox Hill Hospital. Lichen sclerosis has a specific biopsy finding, which vulvar atopic dermatitis does not. Patients with vulvar atopic dermatitis also have the condition on other parts of their body, including behind the ears, in axilla, elbows, or behind the knees, highlighting the importance of whole body exam.

The condition is managed by avoiding things that could irritate the vulva, including wet bathing suits, hot water, perfume, and certain clothing such as leotards and tights. Otherwise, treatment is individualized to reduce irritation and symptoms, Dr. Altchek said. The condition is most common among prepubertal and young pubertal girls, it may or may not disappear at puberty, and it is less common in adults.

Dr. Altchek said he had no relevant financial disclosures.

In this patient with atopic dermatitis of vulva, there is a right interlabial and midline perineal fissure.

Source Pediatric, Adolescent and Young Adult Gynecology, Altchek et al. ©2009 Blackwell Publishing Ltd. Reproduced with permisison of Blackwell

Subacute atopic dermatitis of the vulva has been described for the first time by Dr. Albert Altchek, clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, New York, according to the physician.

Atopic dermatitis is a clinical diagnosis, according to Dr. Altchek. “There's no corresponding biopsy.”

His findings are based on his observations of a large number of the same girls over a long period of time at three separate clinics as well as his continuing private office consultation, which he presented at the 15th Annual Postgraduate CME Course on Pediatric, Adolescent, and Young Adult Gynecology held at New York's Mount Sinai Hospital.

He also has written a chapter on the topic in “Pediatric, Adolescent, & Young Adult Gynecology” (Oxford: Wiley-Blackwell, 2009), edited by Dr. Altchek and Dr. Liane Deligdisch.

The symptoms include recurrent itching, redness, fissures, and vulvar dysuria. Diagnosis of vulvar atopic dermatitis includes gathering a family history of allergies, asthma, hay fever; looking at the past history of the patient; and conducting a physical examination starting from the head, he said.

Atopic dermatitis fissures are symmetrical and narrow, and look as if they were “made by an artist with a scalpel,” he said. The hymen is intact. In early stages, vulvar atopic dermatitis' most pronounced part is bilateral symmetrical fissures between labia minora and majora. Sometimes the fissures are deep and may cause bleeding. In addition, there is a midline sagittal perineal fourchette to the anterior anus at 12 o'clock, where there is usually a papule. The latter is the result of an anterior anal fissure with red inflamed edges. When red and present for a long time, there is severe permanent swelling simulating a hemorrhoid. In more severe cases there is a fissure anterior to clitoris.

In younger girls, the fissures may cause a sudden jump up from sitting because of pain, which is at times misdiagnosed as a neurologic condition.

The condition is sometimes confused with sexual molestation or lichen sclerosis. In sexual molestation cases there may be general signs of trauma and any vulvar fissures are irregular, with lacerations in addition to the history. “Lichen sclerosis of the vulva has coarse, wide irregular fissures in the same areas. With slight trauma the labia and vulva have transient dark blue subcutaneous blood boils,” said Dr. Altchek, also an attending ob.gyn. at Lenox Hill Hospital. Lichen sclerosis has a specific biopsy finding, which vulvar atopic dermatitis does not. Patients with vulvar atopic dermatitis also have the condition on other parts of their body, including behind the ears, in axilla, elbows, or behind the knees, highlighting the importance of whole body exam.

The condition is managed by avoiding things that could irritate the vulva, including wet bathing suits, hot water, perfume, and certain clothing such as leotards and tights. Otherwise, treatment is individualized to reduce irritation and symptoms, Dr. Altchek said. The condition is most common among prepubertal and young pubertal girls, it may or may not disappear at puberty, and it is less common in adults.

Dr. Altchek said he had no relevant financial disclosures.

In this patient with atopic dermatitis of vulva, there is a right interlabial and midline perineal fissure.

Source Pediatric, Adolescent and Young Adult Gynecology, Altchek et al. ©2009 Blackwell Publishing Ltd. Reproduced with permisison of Blackwell

Subacute atopic dermatitis of the vulva has been described for the first time by Dr. Albert Altchek, clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, New York, according to the physician.

Atopic dermatitis is a clinical diagnosis, according to Dr. Altchek. “There's no corresponding biopsy.”

His findings are based on his observations of a large number of the same girls over a long period of time at three separate clinics as well as his continuing private office consultation, which he presented at the 15th Annual Postgraduate CME Course on Pediatric, Adolescent, and Young Adult Gynecology held at New York's Mount Sinai Hospital.

He also has written a chapter on the topic in “Pediatric, Adolescent, & Young Adult Gynecology” (Oxford: Wiley-Blackwell, 2009), edited by Dr. Altchek and Dr. Liane Deligdisch.

The symptoms include recurrent itching, redness, fissures, and vulvar dysuria. Diagnosis of vulvar atopic dermatitis includes gathering a family history of allergies, asthma, hay fever; looking at the past history of the patient; and conducting a physical examination starting from the head, he said.

Atopic dermatitis fissures are symmetrical and narrow, and look as if they were “made by an artist with a scalpel,” he said. The hymen is intact. In early stages, vulvar atopic dermatitis' most pronounced part is bilateral symmetrical fissures between labia minora and majora. Sometimes the fissures are deep and may cause bleeding. In addition, there is a midline sagittal perineal fourchette to the anterior anus at 12 o'clock, where there is usually a papule. The latter is the result of an anterior anal fissure with red inflamed edges. When red and present for a long time, there is severe permanent swelling simulating a hemorrhoid. In more severe cases there is a fissure anterior to clitoris.

In younger girls, the fissures may cause a sudden jump up from sitting because of pain, which is at times misdiagnosed as a neurologic condition.

The condition is sometimes confused with sexual molestation or lichen sclerosis. In sexual molestation cases there may be general signs of trauma and any vulvar fissures are irregular, with lacerations in addition to the history. “Lichen sclerosis of the vulva has coarse, wide irregular fissures in the same areas. With slight trauma the labia and vulva have transient dark blue subcutaneous blood boils,” said Dr. Altchek, also an attending ob.gyn. at Lenox Hill Hospital. Lichen sclerosis has a specific biopsy finding, which vulvar atopic dermatitis does not. Patients with vulvar atopic dermatitis also have the condition on other parts of their body, including behind the ears, in axilla, elbows, or behind the knees, highlighting the importance of whole body exam.

The condition is managed by avoiding things that could irritate the vulva, including wet bathing suits, hot water, perfume, and certain clothing such as leotards and tights. Otherwise, treatment is individualized to reduce irritation and symptoms, Dr. Altchek said. The condition is most common among prepubertal and young pubertal girls, it may or may not disappear at puberty, and it is less common in adults.

Dr. Altchek said he had no relevant financial disclosures.

In this patient with atopic dermatitis of vulva, there is a right interlabial and midline perineal fissure.

Source Pediatric, Adolescent and Young Adult Gynecology, Altchek et al. ©2009 Blackwell Publishing Ltd. Reproduced with permisison of Blackwell

Neurologists Seeking Bonuses Too

The American Academy of Neurology persuaded two senators to introduce legislation to make neurologists eligible for the 10% primary care incentive payments included in the health reform act. The bonuses are for doctors who provide at least 60% of their services to Medicare patients under evaluation and management codes. “The average neurologist meets the 60 percent threshold, but many in Congress either forgot neurology or thought it was a subspecialty of internal medicine!” Mike Amery, the academy's legislative counsel, wrote on the group's Web site. Sen. Amy Klobuchar (D-Minn.) and Susan Collins (R-Maine) introduced the bill (S. 597), and the academy said it will encourage other senators to be cosponsors. Last year, the Congressional Budget Office calculated that adding neurologists to the incentive program would cost the government $300 million over 10 years.

Rep. Giffords Inspires Plea for Care

Members of Congress, led by the office of Rep. Gabrielle Giffords (D-Ariz.), asked the Department of Health and Human Services to include rehabilitation for brain injury among “essential benefits” in health insurance regulations under the health reform act. Rep. Giffords is recovering from a gunshot wound to the head suffered while meeting with constituents. “Congresswoman Giffords was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act,” Lauren Alfred, legislative assistant to Rep. Giffords, said in a statement. “Every American who sustains a traumatic brain injury deserves the exact same treatment.”

Bill Aims to Improve Helmet Safety

Reacting to recent reports of football head injuries, lawmakers have proposed legislation to improve helmet safety and reduce concussions in young players. “We want our children to be active and athletic, but in the safest possible circumstances right down to the helmets they put on their heads,” said Rep. Bill Pascrell Jr. (D-N.J.) in a press conference. “This bill is the logical next step in Congress's effort to protect our young athletes from brain injuries.” The Children's Sports Athletic Equipment Safety Act (H.R. 1127 and S. 601) would give the industry 9 months to improve its safety standards for youth and high school helmets before the Consumer Product Safety Commission would step in with its own requirements. The act also includes penalties on companies that make false safety claims.

Bill Focuses on Medicare Earning

Sen. Ron Wyden (D-Ore.) and Sen. Charles Grassley (R-Iowa) have introduced a bill that would require the government to disclose what physicians earn from Medicare. The Medicare Data Access for Transparency and Accountability Act would keep patient information hidden. “Taxpayers should have a right to see how their hard-earned dollars are being spent,” said Sen. Grassley in a statement on the Senate floor. “Also, if doctors know their billing information is public, it might deter some wasteful practices and overbilling.” Medicare has been prohibited from making the data public since a 1979 court ruling. Physician organizations, most notably the American Medical Association, have also opposed the release of the data, citing doctors' right to privacy.

Medical Boards Fail on Discipline

State medical boards failed to discipline more than half of doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, according to a report from advocacy group Public Citizen. A total of 10,672 physicians were listed in the National Practitioner Data Bank as having restricted or revoked clinical privileges, yet 5,887 (55%) of them did not see any licensing action from their states, the group reported. Of those escaping licensing actions, 1,119 had been otherwise disciplined for incompetence, negligence, or malpractice, and 605 were disciplined for substandard care, the report said. Hospital boards had identified 220 of the otherwise unsanctioned doctors as “an immediate threat to health or safety,” according to Public Citizen.

Neurologists Seeking Bonuses Too

The American Academy of Neurology persuaded two senators to introduce legislation to make neurologists eligible for the 10% primary care incentive payments included in the health reform act. The bonuses are for doctors who provide at least 60% of their services to Medicare patients under evaluation and management codes. “The average neurologist meets the 60 percent threshold, but many in Congress either forgot neurology or thought it was a subspecialty of internal medicine!” Mike Amery, the academy's legislative counsel, wrote on the group's Web site. Sen. Amy Klobuchar (D-Minn.) and Susan Collins (R-Maine) introduced the bill (S. 597), and the academy said it will encourage other senators to be cosponsors. Last year, the Congressional Budget Office calculated that adding neurologists to the incentive program would cost the government $300 million over 10 years.

Rep. Giffords Inspires Plea for Care

Members of Congress, led by the office of Rep. Gabrielle Giffords (D-Ariz.), asked the Department of Health and Human Services to include rehabilitation for brain injury among “essential benefits” in health insurance regulations under the health reform act. Rep. Giffords is recovering from a gunshot wound to the head suffered while meeting with constituents. “Congresswoman Giffords was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act,” Lauren Alfred, legislative assistant to Rep. Giffords, said in a statement. “Every American who sustains a traumatic brain injury deserves the exact same treatment.”

Bill Aims to Improve Helmet Safety

Reacting to recent reports of football head injuries, lawmakers have proposed legislation to improve helmet safety and reduce concussions in young players. “We want our children to be active and athletic, but in the safest possible circumstances right down to the helmets they put on their heads,” said Rep. Bill Pascrell Jr. (D-N.J.) in a press conference. “This bill is the logical next step in Congress's effort to protect our young athletes from brain injuries.” The Children's Sports Athletic Equipment Safety Act (H.R. 1127 and S. 601) would give the industry 9 months to improve its safety standards for youth and high school helmets before the Consumer Product Safety Commission would step in with its own requirements. The act also includes penalties on companies that make false safety claims.

Bill Focuses on Medicare Earning

Sen. Ron Wyden (D-Ore.) and Sen. Charles Grassley (R-Iowa) have introduced a bill that would require the government to disclose what physicians earn from Medicare. The Medicare Data Access for Transparency and Accountability Act would keep patient information hidden. “Taxpayers should have a right to see how their hard-earned dollars are being spent,” said Sen. Grassley in a statement on the Senate floor. “Also, if doctors know their billing information is public, it might deter some wasteful practices and overbilling.” Medicare has been prohibited from making the data public since a 1979 court ruling. Physician organizations, most notably the American Medical Association, have also opposed the release of the data, citing doctors' right to privacy.

Medical Boards Fail on Discipline

State medical boards failed to discipline more than half of doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, according to a report from advocacy group Public Citizen. A total of 10,672 physicians were listed in the National Practitioner Data Bank as having restricted or revoked clinical privileges, yet 5,887 (55%) of them did not see any licensing action from their states, the group reported. Of those escaping licensing actions, 1,119 had been otherwise disciplined for incompetence, negligence, or malpractice, and 605 were disciplined for substandard care, the report said. Hospital boards had identified 220 of the otherwise unsanctioned doctors as “an immediate threat to health or safety,” according to Public Citizen.

Neurologists Seeking Bonuses Too

The American Academy of Neurology persuaded two senators to introduce legislation to make neurologists eligible for the 10% primary care incentive payments included in the health reform act. The bonuses are for doctors who provide at least 60% of their services to Medicare patients under evaluation and management codes. “The average neurologist meets the 60 percent threshold, but many in Congress either forgot neurology or thought it was a subspecialty of internal medicine!” Mike Amery, the academy's legislative counsel, wrote on the group's Web site. Sen. Amy Klobuchar (D-Minn.) and Susan Collins (R-Maine) introduced the bill (S. 597), and the academy said it will encourage other senators to be cosponsors. Last year, the Congressional Budget Office calculated that adding neurologists to the incentive program would cost the government $300 million over 10 years.

Rep. Giffords Inspires Plea for Care

Members of Congress, led by the office of Rep. Gabrielle Giffords (D-Ariz.), asked the Department of Health and Human Services to include rehabilitation for brain injury among “essential benefits” in health insurance regulations under the health reform act. Rep. Giffords is recovering from a gunshot wound to the head suffered while meeting with constituents. “Congresswoman Giffords was injured while she was on the job and her rehabilitation is covered by workers' compensation under the Federal Employees' Compensation Act,” Lauren Alfred, legislative assistant to Rep. Giffords, said in a statement. “Every American who sustains a traumatic brain injury deserves the exact same treatment.”

Bill Aims to Improve Helmet Safety

Reacting to recent reports of football head injuries, lawmakers have proposed legislation to improve helmet safety and reduce concussions in young players. “We want our children to be active and athletic, but in the safest possible circumstances right down to the helmets they put on their heads,” said Rep. Bill Pascrell Jr. (D-N.J.) in a press conference. “This bill is the logical next step in Congress's effort to protect our young athletes from brain injuries.” The Children's Sports Athletic Equipment Safety Act (H.R. 1127 and S. 601) would give the industry 9 months to improve its safety standards for youth and high school helmets before the Consumer Product Safety Commission would step in with its own requirements. The act also includes penalties on companies that make false safety claims.

Bill Focuses on Medicare Earning

Sen. Ron Wyden (D-Ore.) and Sen. Charles Grassley (R-Iowa) have introduced a bill that would require the government to disclose what physicians earn from Medicare. The Medicare Data Access for Transparency and Accountability Act would keep patient information hidden. “Taxpayers should have a right to see how their hard-earned dollars are being spent,” said Sen. Grassley in a statement on the Senate floor. “Also, if doctors know their billing information is public, it might deter some wasteful practices and overbilling.” Medicare has been prohibited from making the data public since a 1979 court ruling. Physician organizations, most notably the American Medical Association, have also opposed the release of the data, citing doctors' right to privacy.

Medical Boards Fail on Discipline

State medical boards failed to discipline more than half of doctors who either lost their clinical privileges or had them restricted by the hospitals where they worked, according to a report from advocacy group Public Citizen. A total of 10,672 physicians were listed in the National Practitioner Data Bank as having restricted or revoked clinical privileges, yet 5,887 (55%) of them did not see any licensing action from their states, the group reported. Of those escaping licensing actions, 1,119 had been otherwise disciplined for incompetence, negligence, or malpractice, and 605 were disciplined for substandard care, the report said. Hospital boards had identified 220 of the otherwise unsanctioned doctors as “an immediate threat to health or safety,” according to Public Citizen.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the obesity prevalence was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509–13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states. From 2003 to 2009, the percent change in the prevalence ranged from 26.2% in Wisconsin, to −19.2% in the District of Columbia, the only area with a sharp decline, and it stayed roughly the same in 35 states.

In 2009, nearly 50 million – or 22% – of U.S. adults had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461–77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65: 519–25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16–21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136–41).

Reflecting on the trends in his practice, Dr. Larry Greenbaum, a rheumatologist in Greenwood, Ind., said that the report's findings “do have a ring of truth to them.” He said that he recommends diet and exercise to his patients, although “it is very difficult to get people to modify their lifestyle.” He added that the 15-minute office visits don't leave much time for him to delve into counseling, “but I do think it's important.”

Dr. Hootman also stressed the importance of counseling patients to lose weight. “People with arthritis and their health care providers should be encouraged to know that even small amounts of weight loss and small increases in physical activity can have important benefits in terms of reducing pain and improving function,” she said.

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

Dr. Greenbaum reported that he has no relevant conflicts of interest.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the obesity prevalence was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509–13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states. From 2003 to 2009, the percent change in the prevalence ranged from 26.2% in Wisconsin, to −19.2% in the District of Columbia, the only area with a sharp decline, and it stayed roughly the same in 35 states.

In 2009, nearly 50 million – or 22% – of U.S. adults had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461–77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65: 519–25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16–21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136–41).

Reflecting on the trends in his practice, Dr. Larry Greenbaum, a rheumatologist in Greenwood, Ind., said that the report's findings “do have a ring of truth to them.” He said that he recommends diet and exercise to his patients, although “it is very difficult to get people to modify their lifestyle.” He added that the 15-minute office visits don't leave much time for him to delve into counseling, “but I do think it's important.”

Dr. Hootman also stressed the importance of counseling patients to lose weight. “People with arthritis and their health care providers should be encouraged to know that even small amounts of weight loss and small increases in physical activity can have important benefits in terms of reducing pain and improving function,” she said.

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

Dr. Greenbaum reported that he has no relevant conflicts of interest.

A disproportionate number of U.S. adults with arthritis are obese, and the prevalence has been growing over the years, according to a report from the Centers for Disease Control and Prevention.

Obesity and arthritis have a complex relationship, the authors note. “Obesity is an independent risk factor for severe pain, reduced physical function, and disability among adults with arthritis, which might be related to both the increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation,” according to the report.

On average, the obesity prevalence was 54% higher in adults with arthritis than in those without the condition (MMWR 2011;60:509–13).

“Efforts are needed to increase access to and availability of effective services and programs to manage both chronic conditions,” the authors wrote.

The report shows that the prevalence of obesity varied widely by state, and 14 states had a significance increase between 2003 and 2009.

There are several reasons for variations among the states, among which is the variation resulting from the underlying obesity rate in the general population of the state, Jennifer M. Hootman, Ph.D., the lead author of the study and an epidemiologist in the arthritis program at the CDC, said in an interview. “States with relatively higher rates of obesity overall tended to also be the higher states among adults with arthritis,” she added.

In 2003, the age-adjusted obesity prevalence in adults with arthritis was greater than or equal to 30% in 37 states and the District of Columbia. Two states had a prevalence of 40% or higher.

Fast-forward to 2009, and the number of states with at least 30% of their arthritic population in the obese bracket had increased to 48, 12 of which had a prevalence of 40% or more. During the same year, the obesity prevalence among U.S. adults without arthritis was 30% or higher in only two states. From 2003 to 2009, the percent change in the prevalence ranged from 26.2% in Wisconsin, to −19.2% in the District of Columbia, the only area with a sharp decline, and it stayed roughly the same in 35 states.

In 2009, nearly 50 million – or 22% – of U.S. adults had arthritis, with an estimated annual medical cost of $128 billion.

Studies have shown that small amounts of weight loss can improve symptoms and function, and can cut the risk of early mortality almost in half (Clin. Geriatr. Med. 2010;26:461–77; J. Gerontol. A Biol. Sci. Med. Sci. 2010;65: 519–25).

Other studies have shown that counseling patients with arthritis who are obese has a strong correlation with their attempt to lose weight (Am. J. Prev. Med. 2004;27:16–21).

“However, provider counseling for weight loss and physical activity for adults with arthritis is below the Healthy People 2010 target, and represents an effective but underused opportunity to improve the health of adults with arthritis,” said the authors (Ann. Fam. Med. 2011;9:136–41).

Reflecting on the trends in his practice, Dr. Larry Greenbaum, a rheumatologist in Greenwood, Ind., said that the report's findings “do have a ring of truth to them.” He said that he recommends diet and exercise to his patients, although “it is very difficult to get people to modify their lifestyle.” He added that the 15-minute office visits don't leave much time for him to delve into counseling, “but I do think it's important.”

Dr. Hootman also stressed the importance of counseling patients to lose weight. “People with arthritis and their health care providers should be encouraged to know that even small amounts of weight loss and small increases in physical activity can have important benefits in terms of reducing pain and improving function,” she said.

The study has several limitations. Because the data are self-reported, they're subject to recall bias; the survey does not include individuals in institutions or households without a landline phone; and the case-finding question in the analysis covered a range of conditions, such as rheumatoid arthritis and gout, which might have different relationships to obesity, according to the authors.

The report is based on the annual Behavioral Risk Factor Surveillance System random-digital-dialed phone survey of adults aged 18 or older in 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. The arthritis and obesity prevalence data are collected in odd-numbered years.

Dr. Greenbaum reported that he has no relevant conflicts of interest.