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Study: Exposing Infants to Peanuts May Prevent Peanut Allergies

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PBS NewsHour

The extra costs of extra weight for older adults


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JUDY WOODRUFF: Two major trends are on a collision course in the United States: the aging of the U.S. population and a decades-long surge in obesity.

The elderly population is projected to double to 80 million by 2050. And, as that’s happening, obese individuals are far more likely to become sick or disabled as they age.

Special correspondent Sarah Varney has the story from Alabama, produced in collaboration with our partners at Kaiser Health News.

SARAH VARNEY: Bayou La Batre calls itself the seafood capital of Alabama. Residents here depend on fishing and shrimping for their livelihood. And when they sit down to eat, they like most things fried.

Former Surgeon General Dr. Regina Benjamin has been trying to reverse the nation’s obesity epidemic one patient at a time at her Bayou clinic.

REGINA BENJAMIN, Former U.S. Surgeon General: Bake, boil, and broil. Say that again.

GARI QUALLS: Bake, boil, and broil.

REGINA BENJAMIN: So no more fried shrimp.

SARAH VARNEY: Gari Qualls is 69 years old and a retired crab picker. She spent most of her life seriously overweight and was diagnosed with diabetes age 39.

As obesity became commonplace around the U.S., health care providers like Benjamin began seeing the impacts of the disease all around them.

REGINA BENJAMIN: We saw our patient population get heavier. We also saw chronic diseases start to rise, hypertension, strokes, diabetes. We’re now called the Stroke Belt, where we are. So we saw all those things start happening. And if we continued, our entire community would totally be crippled basically based on chronic diseases and chronic illnesses.

SARAH VARNEY: That grim assessment stretches beyond Bayou La Batre.

Here along Alabama’s Gulf Coast and elsewhere in the South, one in three adults is obese and many who have lived for decades with excess weight, diabetes, and heart disease are now heading into their senior years.

Their problem has been deepening everywhere. As you can see, the obesity rate grew in many states from 10 to 15 percent, shown in blue, to more than 30 percent, shown in red. That is going to have profound effects as the country ages.

Dr. Virginia Chang, a demographer at New York University, says lifelong obesity, now common in the U.S., is poised to undermine improvements in disability rates among older adults.

VIRGINIA CHANG, New York University: We’re potentially going to have a larger older population that’s more likely to be obese, surviving longer with cardiovascular disease and other chronic conditions. I think the primary fallout from increasing obesity is probably not going to be some huge hit to mortality, right? It’s going to be disability.

At the University of Alabama at Birmingham, biology Professor Steven Austad is studying the effects of diet and nutrition on aging using mice.

STEVEN AUSTAD, University of Alabama at Birmingham: What aging researchers used to think is that aging was all of these different processes and had your heart age, your brain age, something, feet age.

But now what we realize, there’s a handful of processes that are involved in aging all parts of your body. And it turns out that one of the processes is inflammation.

SARAH VARNEY: Inflammation naturally increases as we age, but that process is exacerbated by belly fat, which secretes chemicals that cause further inflammation around the body.

STEVEN AUSTAD: If you’re obese, then your system-wide levels of inflammation are higher, particularly when you get to be older.

WOMAN: My mother had vascular dementia.

SARAH VARNEY: That’s one reason scientists think men and women who are obese are more likely to develop dementia, Alzheimer’s disease, and certain cancers as they age.

Birmingham resident Bob Parker says his own weight is starting to catch up with him. As a realtor and Democratic Party activist, he often attends meetings at restaurants. He says all those nights dining out make it hard to eat well. Now at age 60, he’s being treated for diabetes, high blood pressure, high cholesterol and sleep apnea. He’s lost 90 pounds twice, and gained it back.

BOB PARKER: There’s no question. I mean, I can just feel it. I get tireder. When I do projects around the house or something like that, I can’t do them as long. And I find myself resting more when I am doing it. I like to do things out in the yard and have a couple of various little projects going on that have stopped for the winter.

And I can’t — I just can’t work on them as much. So that’s pretty galling, to be honest.

SARAH VARNEY: To get help he’s been coming here, to the university’s weight loss clinic to see Dr. Tarnay Solamani.

TARNAY SOLAMANI: Tell me what is making it challenging for you to adhere to the diet plan that we discussed last time.

BOB PARKER: The choices are things, frankly, that I don’t much like.

SARAH VARNEY: Obesity is an expensive diseases, especially for aging seniors. One study found that while obese 70-year-olds live as long as healthy weight 70-year-olds, they will spend $39,000 more on health care.

DAVID ALLISON, University of Alabama at Birmingham: Obese people have higher health care costs than non-obese people. This is true virtually those life.

SARAH VARNEY: David Allison directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham.

DAVID ALLISON: As one gets into the age where health care spending goes up — 25-year-olds don’t spend that much on health care, but as you progress through age, that difference is going to be bigger and bigger and more and more important.

SARAH VARNEY: Two hours from Birmingham, in the northwest corner of the state, Generations of Red Bay is one of the only nursing homes in the region willing to taken to the added expense of caring for heavier patients. Patients come from as far away as Texas.

Surveys show more obese people are heading into nursing homes at younger ages and staying long than non-obese residents.

WOMAN: Are you feeling OK?

WOMAN: Yes, I’m fine.

SARAH VARNEY: Margaret Hill Douglas arrived two years ago at age 47 after she broke her knee. Surgery was considered too risky because of her congestive heart failure, so she languished in the hospital for weeks while a social worker looked for a nursing home that would accept her. Patients like Hill Douglas require additional staff and costly equipment, says Aundrea Fuller, the nursing home’s chief operating officer.

That includes everything from specialized beds and lifts to larger blood pressure cuffs.

AUNDREA FULLER, Generations of Red Bay: There are two certified nursing assistants for eight to 10 residents and that’s about twice the staffing that you would have for the general population of a skilled nursing facility.

SARAH VARNEY: Fuller says most of the people that move in, even the younger ones, will need this type of care for the rest of their lives.

Back at the weight loss clinic in Birmingham, Bernard Rayford, age 55, says he wants to avoid that fate.

BERNARD RAYFORD, Birmingham: I have always prayed, lord, before I be a burden, just take me. So I saw myself being a burden and me being a major problem. So the end was for me not to make it, or me for being — end up being an invalid. And that’s a direction I don’t want to be in.

SARAH VARNEY: Rayford is working hard now on his diet and in the clinic’s gym. He says there is much at stake. He wants to be around to enjoy retirement with his wife and years with his grandson.

For the PBS NewsHour, I’m Sarah Varney in Birmingham, Alabama.


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5 things to know about the Supreme Court case challenging Obamacare

Photo by Paul J. Richards/Getty Images

Photo by Paul J. Richards/Getty Images

The Affordable Care Act is once again before the Supreme Court.

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don’t get it through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1: This case does NOT challenge the constitutionality of the health law.

The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012’s NFIB v. Sebelius.

At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage “through an exchange established by the state.” In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all “is consistent with the language, purpose and structure” of the law as a whole.

Last summer, the U.S. Court of Appeals for the Fourth Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is “ambiguous,” they relied on so-called “Chevron deference,” a legal principle that takes its name from a 1984 Supreme Court ruling that held that courts must defer to a federal agency’s interpretation as long as that interpretation is not unreasonable.

Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. “As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states,” wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in an article in the Health Matrix: Journal of Law-Medicine.

In any case, a ruling in favor of the challengers would affect only the subsidies available in the states using the federal exchange. Those in the 13 states operating their own exchanges would be unaffected. The rest of the health law, including its expansion of Medicaid and requirements for coverage of those with pre-existing conditions, would remain in effect.

2: If the court rules against the Obama administration, millions of people could be forced to give up their insurance.

A study by the Urban Institute found that if subsidies in the federal health exchange are disallowed, 9.3 million people could lose $28.8 billion of federal help paying for their insurance in just the first year. Since many of those people would not be able to afford insurance without government help, the number of uninsured could rise by 8.2 million people.

A separate study from the Urban Institute looked at those in danger of losing their coverage and found that most are low and moderate-income white, working adults who live in the South.

3: A ruling against the Obama administration could have other effects, too.

Experts say disallowing the subsidies in the federal exchange states could destabilize the entire individual insurance market, not just the exchanges in those states. Anticipating that only those most likely to need medical services will hold onto their plans, insurers would likely increase premiums for everyone in the state who buys their own insurance, no matter where they buy it from.

“If subsidies [in the federal exchange] are eliminated, premiums would increase by about 47 percent,” said Christine Eibner of the RAND Corporation, who co-authored a study projecting a 70 percent drop in enrollment.

Eliminating tax subsidies for individuals would also impact the law’s requirement that most larger employers provide health insurance. That’s because the penalty for not providing coverage only kicks in if a worker goes to the state health exchange and receives a subsidy. If there are no subsidies, there are also no employer penalties.

4: Consumers could lose subsidies almost immediately.

Supreme Court decisions generally take effect 25 days after they are issued. That could mean that subsidies would stop flowing as soon as July or August, assuming a decision in late June. Insurers can’t drop people for non-payment of their premiums for 90 days, although they have to continue to pay claims only for the first 30.

Although the law’s requirement that individuals have health insurance would remain in effect, no one is required to purchase coverage if the lowest-priced plan in their area costs more than eight percent of their income. So without the subsidies, and with projected premium increases, many if not most people would become exempt.

5: Congress could make the entire issue go away by passing a one-page bill. But it won’t.

All Congress would have to do to restore the subsidies is pass a bill striking the line about subsidies being available through exchanges “established by the state.” But given how many Republicans oppose the law, leaders have already said they will not act to fix it. Republicans are still working to come up with a contingency plan should the ruling go against the subsidies. Even that will be difficult given their continuing ideological divides over health care.

States could solve the problem by setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. And the Obama administration has no power to step in and fix things either, Health and Human Services Secretary Sylvia Burwell said in a letter to members of Congress.

Kaiser Health News (KHN) is a nonprofit national health policy news service.

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Obama celebrates Black History Month ahead of Selma visit

U.S. President Barack Obama gestures next to First Lady Michelle Obama at a reception celebrating African American History
         Month in the East Room of the White House in Washington February 26, 2015. Photo by Yuri Gripas/Reuters

U.S. President Barack Obama gestures next to First Lady Michelle Obama at a reception celebrating African American History Month in the East Room of the White House in Washington February 26, 2015. Photo by Yuri Gripas/Reuters

WASHINGTON — President Barack Obama is celebrating what he calls “the central role that African Americans have played in every aspect of American life.”

Obama was joined by his wife Michelle as they hosted a White House reception Thursday for Black History Month.

The president said his family, including daughters Sasha and Malia will visit Selma, Alabama next week to honor the 50th anniversary of historic civil rights marches across the state. He said the trip will also note the upcoming 50th anniversary of the signing of the Voting Rights Act.

Obama said the visit is to pay tribute to civil rights legends who participated in the march like Martin Luther King Jr. and John Lewis — now a congressman from Georgia — as well as “countless American heroes whose names aren’t in the history books, that aren’t etched on marble somewhere— ordinary men and women.”

The president said the trip will also remind his daughters of their own obligations “because there are going to be marches for them to march, and struggles for them to fight. And if we’ve done our job, then that next generation is going to be picking up the torch as well.”

The Black History Month celebration fell on the third anniversary of Trayvon Martin’s death. The unarmed 17-year-old was shot and killed by a neighborhood watch volunteer during a 2012 confrontation. Obama thanked Martin’s parents for attending on the difficult day, and said part of all parent’s task is to show their children “every single day that their lives matter.”

Guests at the reception included House Democratic leader Nancy Pelosi, Del. Eleanor Holmes Norton, Rep. Sheila Jackson Lee, D-Texas, and Mattie Atkins, who participated in the violent Selma marches in the 1960s.

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Feeding infants peanuts could reverse dramatic allergy rise, study finds


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GWEN IFILL: For years, doctors had routinely recommended children at risk of food allergies should avoid peanuts until they turn 3. But a new study challenges that medical wisdom, suggesting the opposite, that more infants should be introduced to diets with peanut products as a way of inoculating against allergies later.

Jeffrey Brown has the story.

JEFFREY BROWN: Peanut allergies are one of the most common forms of food allergy among American children. And the last two decades have seen a dramatic rise in the number of cases. It’s estimated that today 2 percent of all children are allergic to peanuts, four times the number as recently as 1997. And it’s the leading cause of death from food allergies.

For parents, of course, a key question, how to avoid the risk to their children. And now comes a new twist. A study published in “The New England Journal of Medicine,” it finds that exposing higher-risk infants to peanut products greatly reduced the risk of developing an allergy later on.

The study was sponsored by the National Institutes of Health.

And Dr. Anthony Fauci, head of the Allergy and Infectious Diseases Institute, joins me now.

Dr. Fauci, what was generally thought up to now, that exposure to peanuts early on was a bad thing, that was wrong?

DR. ANTHONY FAUCI, National Institute of Health: Indeed.

As we have seen from this case, this study that you just mentioned, is that earlier exposure of a child does what we call tolerizing the child, so you can get less of an incident of later-on peanut allergies. So if you’re predetermined to get peanut allergy and you try avoid getting the child to be exposed, you find out the contrary. If you take the child and expose them early on and compare them to people in which you have tried to avoid exposure, there was a highly significant difference, in the sense of less later-on peanut allergies among the children who had the early exposure, as opposed to the avoidance.

JEFFREY BROWN: Tell us about a little bit about this study, briefly. Is it really aimed at infants who already had a predilection or a higher risk for allergies? How is that defined?

DR. ANTHONY FAUCI: Well, what you did is you take children who, for a variety of reasons, either children who have a history of egg allergy, milk allergy, asthma, family history of allergic diathesis, as we call it, namely, a predisposed tendency to develop allergic reactions.

Those are the children who would most likely to develop peanut allergies compared to a control population. And if you take those children and divide them into two groups, children who you’re going to completely avoid peanuts for a certain period of time vs. those that you expose early, and that’s where we got the results.

It’s very interesting because it originated from an observation that, in Israel, where they expose children for nutritional reasons very early on to peanuts, these children have a much, much lower rate of peanut allergy compared to Jewish and Israeli children who actually are living in the U.K. And it turned out that that triggered the thought about doing the experiment in a controlled way to determine if deliberate exposure actually avoids the ultimate allergic reactions that you see later on. And it was a success.

JEFFREY BROWN: Translate this now for parents and for doctors. What should they do now?

DR. ANTHONY FAUCI: Well, right now, since this study was just published literally today, what you need to do is to just wait a bit, because what we at the National Institute of Allergy and Infectious Diseases are going to do is going to convene and be the host of a convening of individual stakeholders, the American Academy of Pediatrics, the various allergy societies, to take a close look at the data and to come up with guidelines or recommendations.

You don’t want parents now, on the basis of this study, to go ahead and be challenging the children early on, because you have got to be careful that you don’t precipitate a reaction in a child who might actually have a reaction immediately. So you have got to be a bit careful about that. We don’t want parents on their own deciding what they’re going to do.

Let’s wait — and it won’t be very long — for some solid guidelines and recommendations.

JEFFREY BROWN: And there’s, in the meantime, still no cure for children who have this allergy? It’s still really all about avoidance?


Well, it’s avoidance if you have the allergy. What this study is all about, Jeff, is getting children to not develop the allergy. And it’s almost paradoxical, because the study says that if you give them early on in life peanuts, you dramatically lessen the likelihood that they will develop an allergy and then will subsequently have to avoid.

So you want to get away from having to avoid by exposing them early on.

JEFFREY BROWN: And very briefly, Dr. Fauci, is there potential application in all of this to other allergies?


The mechanism that allows for this tolerance to peanut very well might actually be applicable to other food allergies. And there are studies that are going to be planned and that are ongoing to see if you can replicate these exact mechanisms and results with other food allergies.

JEFFREY BROWN: All right, Dr. Anthony Fauci, thanks so much.

DR. ANTHONY FAUCI: Good to be with you.


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