The chamber declined to say if it supported any measures to curb smoking .\nThe chamber , a private nonprofit that has more than three million members and annual revenue of $ 165 million , spends more on lobbying than any other interest group in America . For decades , it has taken positions aimed at bolstering its members ’ fortunes .\nWhile the chamber has local outposts across the United States , it also has more than 100 affiliates around the world . Foreign branches pay dues and typically hew to the U.S. Chamber ’ s strategy , often advancing it on the ground . Members include both American and foreign businesses , a symbiotic relationship that magnifies the chamber ’ s clout .\nFor foreign companies , membership comes with “ access to the U.S. Embassy ” according to the Cambodian branch , and entree to “ the U.S. government , ” according to the Azerbaijan branch . Members in Hanoi get an invitation to an annual trip to “ lobby Congress and the administration ” in Washington .\nSince Mr. Donohue took over in 1997 , he has steered the chamber into positions that have alienated some members . In 2009 , the chamber threatened to sue if the Environmental Protection Agency regulated greenhouse gas emissions , disputing its authority to act on climate change . That led Nike to step down from the chamber ’ s board , and to Apple ’ s departure from the group . In 2013 , the American arm of the Swedish construction giant Skanska resigned , protesting the chamber ’ s support for what Skanska called a “ chemical industry-led initiative ” to lobby against green building codes .\nThe chamber ’ s tobacco lobbying has led to confusion for many countries , Dr. da Costa e Silva said , adding “ there is a misconception that the American chamber of commerce represents the government of the U.S. ” In some places like Estonia , the lines are blurred . The United States ambassador there , Jeffrey Levine , serves as honorary president of the chamber ’ s local affiliate ; the affiliate quoted Philip Morris in a publication outlining its priorities .\nThe tobacco industry has increasingly turned to international courts to challenge antismoking laws that countries have enacted after the passage of the W.H.O . treaty . Early this year , Michael R. Bloomberg and Bill Gates set up an international fund to fight such suits . Matthew L. Myers , president of the Campaign for Tobacco-Free Kids , an advocacy group that administers the fund , called the chamber “ the tobacco industry ’ s most formidable front group , ” adding , “ it pops up everywhere . ”


As America debates drug policy reforms and marijuana legalization , there 's one aspect of the war on drugs that remains perplexingly contradictory : Some of the most dangerous drugs in the US are legal .\nDo n't believe it ? The best available data from the Centers for Disease Control and Prevention ( CDC ) , Drug Enforcement Administration ( DEA ) , and National Institute on Drug Abuse ( NIDA ) shows tobacco , alcohol , and opioid painkillers were responsible for more direct deaths in one year than any other drug . This chart compares those drug deaths with the best available data for cocaine , heroin , and marijuana deaths :\nNow , this chart is n't a perfect comparison across the board . One driver of tobacco and alcohol deaths is that both substances are legal and easily available . Other substances would likely be far deadlier if they were as available as tobacco and alcohol . And federal data excludes some deaths , such as drugged driving deaths , which is why the chart focuses on direct health complications for all drugs .\nDeaths also are n't the only way to compare drugs ' harms . Some drugs , such as alcohol and cocaine , may induce dangerous behavior that makes someone more predisposed to violence or crime . Other drugs , like psychedelics , may trigger underlying mental health problems or psychotic episodes . When evaluating the overall harm caused by drugs , all of these factors should be taken into account .\nBut the high total number of deaths is still a major concern for public health policy . And according to experts and researchers , lawmakers could do more to curb deaths caused by the three deadliest drugs — if only they paid more attention to legal drug policy .\nWhen it comes to deadliness , no single substance comes close to tobacco . To put its risk in perspective , more Americans die from tobacco-caused health problems like lung cancer and heart disease than from reported drug overdoses , car crashes , and homicides combined .\nThe chart at the top of this article actually understates the number of tobacco deaths , since it only considers the most direct causes of deaths and excludes secondhand smoking , perinatal conditions , and residential fires .\nOverall , cigarette smoking is linked to one in five deaths in the US each year , according to CDC estimates for average annual fatalities based on deaths between 2005 and 2009 . Nearly 42,000 of the total 480,000 deaths from smoking are caused by secondhand smoke .\nUS tobacco use has greatly declined in the past several decades , although nearly one in six high school students and adults still smoked cigarettes in 2013 and 2014 . Experts attribute the decline to various factors , including education campaigns , mandatory warning labels , public and workplace smoking bans , and higher taxes on tobacco products . Continuing these efforts , public health officials hope , will continue pushing down the rate of smoking in the US . But states could also take additional steps , like increasing the smoking age .\nAlcohol-induced health problems , such as liver disease , led to more than 33,000 deaths in 2015 . But that actually undercounts the number of deaths caused by alcohol : When including other causes of death like drunk driving and homicides , the toll rises to 88,000 per year . ( This number might be an undercount too , since it 's an estimate for 2006 to 2010 and alcohol-linked deaths have steadily risen over the past several years . )\nThe death toll may understate the more general risk of alcohol . A 2010 analysis , led by British researcher David Nutt and published in The Lancet , took a comprehensive look at 20 of the world 's most popular drugs and the risks they pose in the UK . A conference of drug experts measured all the factors involved — mortality , other physical damage , chance of developing dependence , impairment of mental function , effect on crime , and so on — and assigned each drug a score . They concluded alcohol is by far the most dangerous drug to society as a whole .\nWhat makes alcohol so dangerous ? The health effects of excessive drinking and drunk driving are two obvious problems . But there are other major issues rooted in alcohol-induced aggression and erratic behavior : injuries , economic productivity costs , family adversities , and crime . ( Alcohol is a factor in 40 percent of violent crimes , according to the National Council on Alcoholism and Drug Dependence . )\nStill , The Lancet 's report has come under some major criticisms . Although drug policy experts generally agree that alcohol is dangerous — and definitely more dangerous than marijuana — they argue the report misses some of the nuance behind each drug 's harms . For one , it does n't entirely control for the availability of these drugs , so it 's possible heroin and crack cocaine in particular would be ranked higher if they were as readily available as alcohol . And the findings are based on the UK , so the specific scores would likely differ to some extent for the US — particularly for meth , which is more widely available in the states .\nTo show the Nutt analysis 's flaws , Jon Caulkins , a drug policy expert at Carnegie Mellon University , gave the example of an alien race visiting Earth and asking which land animal is the biggest . If the question is about weight , the African elephant is the biggest land animal . But if it 's about height , the giraffe is the biggest . And if the question is about length , the reticulated python is the biggest .\n`` You can always create some composite , but composites are fraught with problems , '' Caulkins said . `` I think it 's more misleading than useful . ''\nThe blunt measures of drug harms present similar issues . Alcohol , tobacco , and opioid painkillers are likely deadlier than other drugs because they are legal , so comparing their aggregate effects to illegal drugs is difficult . Some drugs are very harmful to individuals , but they 're so rarely used that they may not be a major public health threat . A few drugs pose more short-term than long-term risks through overdose ( heroin ) , while others are more dangerous in the long term due to chronic health problems ( tobacco ) . And looking at deaths or other harms caused by certain drugs does n't always account for substances , such as prescription medications , that are often mixed with others , making them more deadly or harmful than they would be alone .\nStill , experts acknowledge , it 's clear alcohol is dangerous and deadly . To curb the deaths and risks linked to alcohol , they often suggest tighter regulations , higher taxes , more education , and even taking away some people 's right to drink .\nA previous analysis by the RAND Corporation found that states that sold alcohol through tightly regulated , state-run establishments kept prices higher , reduced access for youth , and decreased drinking overall . Studies show that higher alcohol taxes could reduce consumption and , as a result , the problems the drug causes . And the 24/7 Sobriety Program , which effectively revokes people 's right to drink if their drinking gets them in trouble with the law , has been linked to decreases in mortality , DUI arrests , and domestic violence arrests .\nHighly addictive opioid painkillers are now part of a national epidemic of overdose deaths .\nIn the 1990s , drug companies , such as Purdue Pharma , pushed opioid painkillers on doctors and patients through an aggressive , misleading marketing campaign . Doctors , who were under pressure from advocates and government agencies to treat pain as a serious medical issue , prescribed the drugs in huge droves , letting them proliferate — not just to patients , but to the patients ' family and friends and the black market . As a result , opioid painkiller deaths skyrocketed .\nOpioid overdose deaths sometimes involve multiple drugs . Benzodiazepines and alcohol , for instance , can increase the risk of an opioid overdose . But without opioids , these deaths may have been avoided entirely .\nPolicymakers have responded to the rise in deaths by putting tighter restrictions on the distribution of opioid painkillers and cracking down on `` pill mills , '' which are doctors , clinics , and pharmacies that dispense opioid painkillers unscrupulously or for nonmedical reasons .\nIn part as a response to the crackdown , some opioid users turned to other opioids that are more potent and potentially more easily accessible — notably , heroin and fentanyl . For public health officials , this has emphasized the need to increase prevention and treatment programs , particularly medication-assisted treatments such as methadone and Suboxone , to try to get people off opioids for good . After all , unless people overcome their addiction , cuts in the supply are only going to lead people to try to get their fix somewhere else .\nThere 's also concerns that restricting painkillers too much makes it more difficult for people to get the medicine they genuinely need for chronic , debilitating pain . A 2011 report from the Institute of Medicine found that many Americans are undertreated for acute and chronic pain . And multiple reports suggest doctors have avoided working in chronic pain treatment because the legal and regulatory hurdles are so big . ( Still , the evidence on whether opioid painkillers can even treat chronic pain is weak at best , even as it 's clear that prolonged use can result in very bad risks and complications . )\nOne way to fill this need for treatment without resorting to dangerous opioids may be medical marijuana . Several studies have found that states that allow pot for medicinal purposes — particularly states that allow dispensaries , where marijuana is sold — have fewer prescription painkiller deaths than one would otherwise expect . Intuitively , this makes sense : Marijuana is a potent painkiller for some types of pain , so it can potentially substitute deadlier and more addictive opioids in some cases .\nStill , while marijuana may work for some patients , it may not for many others . This leaves opioid painkillers as one of the few medications for some pain patients , which requires doctors and regulators to balance out patients ' needs with the risk these addictive , deadly drugs present .\nThere 's admittedly no good federal mortality data on the less direct and long-term impacts of illicit drug use . But there 's reason to think the scale of overall deadliness in the chart at the top of this article would n't change much with additional data .\nThe deadliness of the harder drugs , like crack and cocaine , is severely limited in part because very few people use such substances , especially in the long term . About 0.1 percent of the US population 12 and older reported using heroin and roughly 0.7 percent reported using cocaine in the previous month , according to a 2015 federal survey . ( This could change if the illicit drugs were legal and more accessible . )\nStill , these harder drugs are dangerous . Cocaine and crack can lead to heart attack and stroke , and they can cause violent behaviors that make someone more prone to crime . And heroin poses a massive risk of deadly overdose — a risk that only gets worse as someone uses heroin more and more .\n`` The main risk of cannabis is losing control of your cannabis intake ''\nMarijuana is more widely used , but it 's never been definitively linked to direct deaths or even other medical conditions . The most thorough review of the research yet , from the National Academies of Sciences , Engineering , and Medicine , found that pot poses a variety of possible downsides — including respiratory problems if smoked , schizophrenia and psychosis , car crashes , general social achievement in life , and potentially babies in the womb .\nBut pot does n't appear to pose a high risk , if any , of deadliness ( outside of car crashes and other accidental deaths ) . The research review found smoking pot does n't even seem to cause some of the major health problems that are typically linked to tobacco , particularly lung cancer and head and neck cancers .\nAnd the studies reviewed also suggest marijuana carries several benefits , particularly for chronic pain , multiple sclerosis , and chemotherapy-induced nausea and vomiting . ( There was n't enough research to gauge if pot is truly good for some of the other ailments people say it 's good for , such as epilepsy and irritable bowel syndrome . )\n`` The main risk of cannabis is losing control of your cannabis intake , '' Mark Kleiman , a drug policy expert at New York University 's Marron Institute , previously told me . `` That 's going to have consequences in terms of the amount of time you spend not fully functional . When that 's hours per day times years , that 's bad . ''\nCaulkins of Carnegie Mellon University put it another way : `` At some level , we know that spending more than half of your waking hours intoxicated for years and years on end is not increasing the likelihood that you 'll win a Pulitzer Prize or discover the cure for cancer . ''\nSo a drug 's deadliness is n't everything we need to know about its harms . But deadliness is still a powerful measure — and it suggests that the public and policymakers should n't assume that a substance is more dangerous to society as a whole just because it 's illegal . In fact , based on the numbers , it 's legal drugs that may require more policy attention .


Houston Police Chief Art Acevedo insists that the narcotics officers who shot and killed a middle-aged couple on January 28 after breaking into their home `` had probable cause to be there , '' even though they were executing a search warrant that was based on a fraudulent affidavit . Acevedo 's position is pretty puzzling , since the sole basis for the no-knock search warrant , which led to a deadly raid that found no evidence of drug dealing , was a `` controlled buy '' of heroin that he says never happened .\nGerald Goines , the veteran narcotics officer who wrote the affidavit seeking a no-knock search warrant for the house at 7815 Harding Street , was recently charged with two counts of felony murder based on the allegation that his lies led to the deaths of the home 's owners , Dennis Tuttle and Rhogena Nicholas . Goines claimed in the affidavit that a confidential informant had bought black-tar heroin at the Harding Street house the day before the raid . After the operation went horribly wrong , setting off a gun battle that injured Goines and three other officers as well as killing Tuttle and Nicholas , he admitted that no such transaction had occurred . Steven Bryant , a narcotics officer who backed up Goines ' story , faces a felony charge of tampering with a government document .\n`` We did n't need to lie , '' Acevedo said on August 23 , the day that Harris County District Attorney Kim Ogg announced the charges against Goines and Bryant . `` We could have done this right….When somebody lies to obtain a search warrant , that 's a problem . '' When KPRC , the NBC station in Houston , asked him about his claim , a few weeks after the raid , that `` we still had a ███ to be at that home , '' Acevedo replied , `` I stand by that . We had probable cause to be there . ''\nIt is hard to see how that can be true . According to Acevedo , Goines ' investigation of alleged drug dealing at the Harding Street house was triggered by a tip from a patrol officer who had responded to a January 8 call in which an unnamed woman reported that her daughter `` was in there doing heroin . '' At a press conference three days after the raid , Acevedo described the call this way : `` The caller wanted to remain anonymous but said that her daughter was inside the residence 'doing drugs , and they have a lot of guns in the residence . ' She stated there was also a female in the house . '' The woman said she had looked through a window , and she saw that `` her daughter was in the house , and there were guns and heroin . ''\nWhen two patrol officers arrived in response to that call , the woman was nowhere to be found . According to Acevedo , they questioned a passer-by and afterward heard her say into her cellphone , `` Hey , the police are at the dope house . '' When the officers called the woman who had made the report , Acevedo said , `` She stated she did not want to give any information because they were drug dealers and they would kill her . She wanted the officers to go into the house and get her daughter . '' The officers explained that they had no authority to enter the house .\nThe tip about that incident seems to have been the only basis for suspecting that Tuttle and Nicholas were selling heroin . In his affidavit , Goines , who supposedly had been investigating them for two weeks , cited no suspicious activity consistent with drug dealing . ( Nor was any noticed by neighbors who spoke to reporters after the raid , notwithstanding Acevedo 's claim that the home was known locally as a `` drug house '' and `` problem location . '' ) Goines apparently had not even bothered to look up the names of the home 's owners ; he described the middle-aged man who supposedly had sold heroin to the nonexistent confidential informant as a `` white male , whose name is unknown . ''\nIf Goines had developed evidence to support a search warrant , as Acevedo suggests , why did he feel a need to invent a transaction by a fictitious confidential informant ? Why was that fantasy the only evidence cited in the affidavit ? Goines ' behavior makes no sense if police had an independent basis for probable cause .\n`` Our government should not have intervened in that home , and two people are dead as a result , '' Ogg told KPRC . `` The probable cause to obtain the search warrant was false . ''\nThe initial tip did not provide probable cause for a search . Neither did the phony controlled buy . But according to Acevedo , police could have obtained a warrant based on other , unspecified evidence that Goines for some mysterious ███ failed to cite .\nThat claim is of a piece with the way Acevedo described the officers who killed Tuttle and Nicholas after starting a gunfight by breaking into the house without warning and using a shotgun to kill the couple 's dog . `` I still think they 're heroes , '' Acevedo said after Goines and Bryant were charged . While those two officers may be bad apples , Acevedo said , their colleagues `` acted in good faith '' and appropriately used deadly force to defend themselves . The first claim is debatable based on what we know so far , and the second is highly dubious given the raid 's recklessness . Acevedo 's assertion of probable cause based on evidence that was never presented to a judge is even harder to believe . It does not inspire confidence in his ability to recognize , let alone correct , the supervisory deficiencies that made this fiasco possible .


WASHINGTON — Attorney General Eric Holder said Tuesday that a national moratorium on lethal injection `` would be appropriate '' until the Supreme Court completes its latest review of the execution process as part of a case initially brought by Oklahoma death row inmates .\nAt the National Press Club , Holder said he was speaking `` personally '' on the issue and not as a member of the administration , though the death penalty is the subject of a review by the Justice Department .\nThe Justice review , directed by President Obama after a botched execution last year in Oklahoma , will probably not be completed before Holder leaves office in the next several weeks . His likely successor , Brooklyn U.S. Attorney Loretta Lynch , awaits a confirmation vote .\n`` There are fundamental questions that we need to ask about the death penalty , '' said Holder , who restated his opposition to capital punishment . `` There is always the possibility that mistakes will be made . ... It is for that reason that I am opposed to the death penalty . ''\nHolder described a scenario in which an innocent person may be wrongly executed as the `` ultimate nightmare . '' He said it is `` inevitable '' that such a case has occurred .\nLast month , the Supreme Court announced it was considering whether a drug protocol used in recent lethal injections violates the Constitution 's prohibition on cruel and unusual punishment .\nThe justices agreed to review the case brought by four death row prisoners , one of whom was put to death after the court refused to block his execution using a three-drug combination that has apparently caused some prisoners pain .\nHolder 's comments on a moratorium do not require any response from states that use lethal injection . And the federal government remains engaged in a lawsuit challenging its lethal injection process , which has not been used in more than a decade .\nBut Richard Dieter , executive director of the Death Penalty Information Center , said Holder 's voice is important to the debate . `` All of this has symbolic impact '' on a landscape where questions also have been raised about defendants ' access to counsel and mounting numbers of wrongful convictions involving death row prisoners .\nHolder 's remarks on the death penalty came in response to questions after a speech related to the administration 's efforts on another pressing criminal justice issue : sentencing changes .\nHe said the rate at which federal prosecutors sought mandatory minimum prison terms for non-violent drug offenders dropped to record lows in 2014 .\nAccording to data released by the U.S . Sentencing Commission , prosecutors sought harsh mandatory-minimum punishments 51 % of the time in 2014 , down from nearly 64 % in the previous year .\nSentencing changes have become the centerpiece of Holder 's criminal justice strategy , part of an effort to reduce the overcrowded federal prison population . About 30 % of the Justice Department budget has been consumed by federal prison operations .\nOverall , the number of drug prosecutions declined by 6 % during the same period .\n`` For years prior to this administration , federal prosecutors were not only encouraged but required to always seek the most severe prison sentence possible for all drug cases , no matter the relative risk they posed to public safety , '' Holder said . `` I have made a break from that philosophy . While old habits are hard to break , these numbers show that a dramatic shift is underway in the mind-set of prosecutors handling non-violent offenses . ''\nIn the last two years of Holder 's tenure , the attorney general has sought to revamp a criminal justice system he described as `` broken . ''


Federal food programs are now feeding more than 100 million Americans . The number of recipients has soared in recent years , thanks in part to Barack Obama ’ s 2008 campaign pledge to abolish childhood hunger by 2015 . The food-aid explosion is worsening the nation ’ s obesity epidemic , though , and making a mockery of Michelle Obama ’ s “ Let ’ s Move ” campaign .\nThe Obama administration is aggressively expanding the largest federal food program , bankrolling food-stamp recruiting drives and swaying states to waive asset and income limits for applicants . The result is a boost in enrollment to almost 48 million .\nNumerous studies going back to the 1970s have linked food stamps to poor eating habits . Baruch College professor Diane Gibson estimated that participation in the food-stamp program for five years boosted the odds of young girls being overweight by 43 percent . Professor Charles Baum , writing in the Southern Economic Journal , estimated that food-stamp recipients are far more likely to be obese than eligible nonrecipients and warned that “ chronic food-stamp receipt may promote lifestyle changes that lead to weight gain . ”\nThe Obama administration portrays food stamps as a nutrition program while blocking reforms to exclude purchases of the worst kinds of junk food . The administration did not support an amendment to the farm bill by Rep. Tom Marino , Pennsylvania Republican , to compel the U.S. Department of Agriculuture to disclose how recipients spend their food stamps . Most food stamps are redeemed at large grocery chains or big-box stores such as Wal-Mart , which could easily provide itemized receipts for all food-stamp purchases . The Obama administration is also fighting a Freedom of Information Act lawsuit from The Argus Leader , a South Dakota newspaper , seeking food-stamp expenditure data . The administration apparently feels entitled to treat such information as a “ state secret . ”\nIn 2010 , President Obama swayed Congress to enact the Healthy , Hunger-Free Kids Act . Thanks to this law , far more free breakfasts and lunches are being given to schoolchildren , regardless of their family ’ s income levels .\nWhile politicians tout such programs to prove their benevolence , school meals have long subverted children ’ s health . The Government Accountability Office ( GAO ) has lambasted the federal school lunch program for 35 years for its high fat and poor nutrient content . A University of Michigan study published in 2010 found that students who regularly eat school lunches are 29 percent more likely to be overweight , and that consumption of school lunches is the strongest single predictor of childhood obesity .\nSchool breakfasts have long been renowned for doughnuts , chocolate milk and other sugar bombs . Parents in Houston , Las Vegas and elsewhere have been outraged that there is no opt-out provision to block schools from giving kids a second breakfast after their child has been fed at home . New York City in 2012 suspended expansion of its Breakfast in the Classrooms after discovering that 20 percent of pupils were eating two breakfasts — one at home and another at school .\nThe most damning evidence comes from Uncle Sam . The Department of Agriculture ’ s 2012 School Nutrition Dietary Assessment Study found that the typical school breakfast included almost the entire maximum recommended daily intake for sugar and fat . The number of calories from solid fats and added sugars in the average elementary-school lunch “ was 15 percent above the maximum recommended for the entire day. ” Any young child who ate both a school breakfast and lunch would likely far exceed the recommended daily thresholds for sugar — even before consuming any snacks or dinner .\nCongress has enacted numerous laws commanding the Agriculture Department and schools to serve healthier meals , most recently in 2010 . As in the past , though , such reforms are policy wonks ’ pipe dreams . The GAO reported in June that the latest federal lunch standards are “ making it difficult for some schools to meet minimum calorie requirements for lunches without adding items , such as gelatin , that generally do not improve the nutritional quality of lunches. ” In almost half the districts the GAO visited , schools added “ pudding to certain high-school menus to bring the menus into compliance with the calorie minimum. ” Such menus help explain why the rate of diabetes and prediabetes has more than doubled among American teenagers since 1999 .\nThe Obama administration may be relying on a headcount measure of benevolence , presuming that the more people the government feeds , the better America becomes . However , this numbers game is having catastrophic public health consequences .\nA commentary last year in the Journal of the American Medical Association noted that “ seven times as many [ low-income ] children are obese as are underweight. ” The National Survey of Children ’ s Health , conducted in 2011-12 , revealed that children in lower-income families were more than twice as likely to be overweight or obese as children from families in higher-income families . In Maine , Georgia , Kentucky , North Dakota , Texas , Arizona , South Carolina , Mississippi and Louisiana , more than half of the children from low-income families are obese . In Vermont and Massachusetts , children from low-income households are more than three times as likely to be obese than kids for higher-income homes , as The Washington Post recently reported .\nMr. Obama certainly has no intent to worsen the obesity epidemic , yet he has championed the expansion of federal programs that undermine tens of millions of Americans ’ diets . Unfortunately , politicians can reap applause for fighting hunger regardless of the collateral damage that food programs inflict . Children may one day recognize those free school breakfasts and lunches as the worst bargain they ever received .\nJames Bovard is author of “ Public Policy Hooligan ” ( Sixth Street Books , 2012 ) .


Diabetes , Cost Of Care Top Health Concerns For U.S. Latinos\nDiabetes , Cost Of Care Top Health Concerns For U.S. Latinos Listen · 5:30 5:30\nLatino immigrants in the U.S. say the quality and affordability of health care is better in the U.S. than in the countries they came from , according to the latest survey by NPR , the Robert Wood Johnson Foundation and the Harvard School of Public Health . But many report having health care problems .\nAbout a third of immigrant respondents ( 31 percent ) said they 'd had a serious problem with being able to pay for health insurance in the past 12 months . And more than 1 in 4 had a serious problem affording doctor and hospital bills and prescription medicines .\nBut the health issue that Latinos said is most concerning for them and their families — whether they were born in the U.S. or immigrated here — is diabetes . Last year , in another poll , Latinos said cancer was the biggest problem facing the country .\nHispanic populations have a high prevalence of Type 2 diabetes . About 10 percent of Latino adults have been diagnosed with it or have `` prediabetes , '' a stage of the disease that often goes undetected .\nOne important factor : Latinos may be genetically predisposed to the disease — a risk that can be aggravated by environment and diet .\nTake the example of East Los Angeles , an area heavily populated by Mexican-Americans .\nLike many of her friends and family members , Rebecca Martinez-Rocha says she struggles with her weight . At one point , she weighed more than 320 pounds .\n`` I do n't think I realized it at the time , whether it was denial or I stopped getting on a scale , '' she says , `` but I was morbidly obese . ''\nAnd , as it turns out , Martinez-Rocha was prediabetic , a diagnosis she received at a local health clinic .\n`` I was n't aware of the fact that I was ill ; I figured that I was relatively young , in my 20s and early 30s , '' she says . `` It was kind of one of those 'aha ' moments in life , where you look at it and put it all together and you think , 'How did I get here ? ' ``\nThe doctor who diagnosed Martinez-Rocha 's condition is Anne Peters , a diabetes specialist and professor at University of Southern California 's Keck School of Medicine . She 's also the director of a diabetes program at Roybal Comprehensive Health Center .\nPeters says Type 2 diabetes is the `` plague '' of the Latino community she treats : `` Individuals here are getting diabetes at rates we 've not seen before . ''\nAbout 12 percent of the Latino population she sees has diabetes . Peters projects that number will climb to nearly 30 percent over the next few decades if nothing changes in the environment or diet of local residents .\nPeters told Martinez-Rocha she was on her way to getting insulin-dependent Type 2 diabetes . Martinez-Rocha says she got very scared and made major changes . She lost 160 pounds .\nBut many patients do n't do that , in large part because prediabetes is often `` silent . '' Unless people go to a doctor and get their blood sugar measured , they 'll never know they have it .\nAnd that 's a shame , Peters says , because prediabetes can be turned around . `` If somebody has prediabetes , they need to lose weight — not a lot of weight , maybe only 10 to 15 pounds , '' she says .\nThey `` do n't have to become skinny '' to benefit , she adds . Studies show that moderate weight loss can reduce diabetes risk by half .\nLosing weight is hard for many people . But Martinez-Rocha says it 's even harder when you live in a neighborhood that offers lots of high-fat , high-salt and high-sugar food .\n`` If you drive around my neighborhood , every corner you 'll see a taco stand , a fast-food restaurant , a sweet-bread store , places selling tamales or fried food , '' Martinez-Rocha says .\nIn NPR 's poll with the Robert Wood Johnson Foundation and Harvard School of Public Health , 1 in 5 Mexican-Americans rated the availability of fresh fruits and vegetables in their neighborhoods as fair or poor .\nAlex Ortega , a public health researcher and professor of public health at UCLA , calls neighborhoods like this , where healthy food is hard to come by , `` food swamps . ''\nWalk into the typical corner market , he says , and the first things you 'll see are signs for liquor and lottery tickets , cigarettes , soda and chips . `` They might sell some fruits and vegetables , but they 're typically in the back of the store and in very poor quality , '' Ortega says .\nOur survey found that Latino immigrants generally do not perceive their diets as less healthy in the U.S. : 38 percent see their diet as healthier in the United States , and about the same number ( 39 percent ) say it 's about as healthy . One in 5 ( 21 percent ) see their diet as less healthy .\nPrevious studies have shown that obesity rates among immigrants increase as their duration of residence in the U.S. increases . They suggest this might be attributable in part to changes in lifestyle , including an unhealthy diet .\nOrtega is committed to turning the Latino diet around . As director of the UCLA-USC Center for Population Health and Health Disparities , Ortega is heading a project to convert corner stores in low-income neighborhoods .\nAbout a month ago , Ortega , along with community activists , local high school students and store owner Maria Avila , transformed the Euclid Market in the Boyle Heights section of East Los Angeles . They added windows and a new paint job , and rearranged and organized shelving . But most importantly , Ortega says , they added healthful foods .\nThe newly converted store opened to the public in December . Today , when you walk in the door , the first things you see are n't cigarettes and junk food — they 're fresh fruits and vegetables .\nThis is the fourth corner store in the area to be converted . Ortega is still collecting data , but anecdotally , he says , store owners tell him they have more customers , they 're selling more fruits and vegetables , and they 're making more money .\nBut the big question is whether the availability of fresh fruits and vegetables will make a difference in the health of the neighborhood and the epidemic of diabetes .\nFor college freshman DeeDee Barba , it has made a difference . She has taken part in the store conversion project for two years . Not only has she learned about marketing and sales , but she 's also learned about nutrition . As a result , she says , her family now eats more healthfully . Part of that includes no dressing on salads .\n`` We now eat our salads with olive oil and lemon , and it 's actually good , '' she says . `` We eat a lot of fish and chicken ; we rarely eat red meat . We eat rice , but we have whole-wheat rice . We do n't drink soda anymore — we drink mostly water . ''\nHigh school senior Steven Cardona , 17 , has worked with the store conversion project for the past year . Learning about nutrition , he says , has changed his family 's diet dramatically .\n`` Before , we would eat lots of fast food , but now we eat mostly steamed vegetables , rice , chicken and lean meats , '' he says . Family members have lost a lot of weight , and everybody reports feeling `` better , '' he says .\nOrtega says that 's exactly what 's hoped for : that the availability of healthy food in low-income neighborhoods like this will make a difference in what residents buy , cook and eat . And that it will mean changing diets and reducing the high rates of obesity and diabetes in the Latino community in East L.A .


A California state senator wants to make his state the first in the nation to require warning labels on soda and other sugary drinks , a proposal called “ misleading ” by beverage industry officials .\nDemocratic Sen. William Monning ’ s bill proposed Thursday would require the warning on the front of all beverage containers with added sweeteners that have 75 or more calories in every 12 ounces . The label would read : `` STATE OF CALIFORNIA SAFETY WARNING : Drinking beverages with added sugar ( s ) contributes to obesity , diabetes , and tooth decay . ''\nMonning says there is overwhelming research showing the link between sugary drinks and those health problems , adding that the wording was developed by a national panel of nutrition and public health experts .\n`` When the science is this conclusive , the state of California has a responsibility to take steps to protect consumers , '' Monning said in a press release . `` As with tobacco and alcohol warnings , this legislation will give Californians essential information they need to make healthier choices . ''\nThe bill has the backing of the California Medical Association and the California Center for Public Health Advocacy . The Latino Coalition for a Healthy California and the California Black Health Network also are sponsoring the legislation , citing the heavy consumption of sugary drinks and associated health problems among minorities .\nA bill similar to Monning 's was introduced last year in Vermont , but it has been held in the Committee on Human Services since April . The Vermont bill would require manufacturers to put warning labels on beverages that contain sugar or other artificial additives .\nCalBev , the California arm of the Washington , D.C.-based American Beverage Association , noted that the industry already posts calorie counts on the front of many beverage containers as part of its `` Clear on Calories '' campaign that began in 2010 . Also , drink bottles already have detailed ingredient lists and nutritional information .\n`` We agree that obesity is a serious and complex issue , '' the group said in a statement , but it called Monning 's bill `` misleading '' because it said just 6 percent of calories in the average American 's diet come from soda , fruit , sports and energy drinks , compared with 11 percent in sweets and deserts . Moreover , it said most calories are consumed in the form of fats , oils and starches in food .\nThe group would not put a price tag on complying with the proposed legislation but said the measure would increase the cost of doing business in California .\nThe medical groups backing Monning 's bill countered with their own data , saying sugary drinks are the largest source of added calories in American 's diet in the last three decades . They also said one soda a day boosts an adult 's chances of being overweight by 27 percent and a child 's by 55 percent , and it can increase the risk of diabetes by 26 percent .\nMonning dismissed suggestions that the labeling would be another example of nanny government .\n`` It is not the responsibility of industry to protect the public health . It is the responsibility of government , '' he told the Associated Press , noting that consumers could still choose to drink the beverages . `` We believe it 's an appropriate role for government to play . ''\nThe warning labels would mesh , he said , with health campaigns and proposed ordinances in several California cities and elsewhere to discourage sugar consumption . San Francisco , for instance , is considering asking voters to approve a tax on soda and other sweetened drinks , while former New York Mayor Michael Bloomberg unsuccessfully pushed proposals to tax soda and ban the sale of large soda containers .\nMonning said warning labels can make a difference in consumers ' choices , particularly when paired with other public health campaigns warning of the dangers of obesity .\n`` We do n't underestimate what we 're up against , '' he said . `` We 're up against $ 100 million advertising campaigns . ''\nHe said the labeling would be consistent with the industry 's own stated goal of providing consumers with the information to make an intelligent choice .


Sugar bashing is all the rage these days , and with good cause . Studies over many years have pointed to sugar as , at the very least , an accomplice , if not the perp , behind many of the health ills of modern civilization . Obesity and diabetes are the obvious candidates caused by over-consumption of the sweet stuff . The obesity epidemic has been written about exhaustively for years , and obesity ’ s good friend , Type 2 diabetes , has increased threefold in the past three decades , coinciding with the explosion of sugary products ( both obvious and hidden ) . However , there are a cornucopia of other illnesses and conditions that have lesser-known connections to sugar . The list is long : high blood pressure , hypoglycemia , depression , acne , headaches , hardening of the arteries , fatigue , violent behavior , hyperactivity , aching extremities , and of course , tooth decay .\nIt seems we pay a heavy price for our sweet tooth . Not only do we eat a lot of sugar and make ourselves ill , but it has no nutritional value at all . No vitamins , no minerals , no enzymes , no fiber . ( Honey and molasses lovers could make a teeny tiny case for their sweeteners , since they do have trace amounts of a few nutrients . )\nSugar tastes good . Humans crave sugar right down to their DNA . `` Sugar is a deep , deep ancient craving , '' Daniel Lieberman , an evolutionary biologist at Harvard University recently told Business Insider . Early humans looked for sweet fruits and vegetables because they contained the natural sugars that give us energy . Of course , cavemen were never tempted by Ring Dings or Snickers bars . How badly do we crave sugar ? Here are ( some of ) the shocking statistics :\n1 . Americans consume , on average , 765 grams of sugar every five days . To put that in perspective , in 1822 we consumed on average 45 grams every five days . That is equal to one can of soda . Now we consume 17 times that , or the equivalent of 17 cans of soda .\n2 . Americans consume 130 pounds of sugar every year . Our 1822 predecessors ate under 10 pounds of sugar a year . 130 pounds a year means about three pounds a week . That equals about 3,550 pounds in an average lifetime—approaching two tons of sugar .\n3 . More on that last one : 130 pounds of sugar equals about 1,767,900 Skittles . Or just fill an industrial a dumpster with Skittles .\n4 . The American Heart Association recommends we consume less than 10 teaspoons of sugar a day . The average adult American misses that mark by a lot . Like about 12 teaspoons . The average American gobbles down on average 22 teaspoons a day . And the average child ? 32 teaspoons . Pretty sure none of us needs that much to make the medicine go down . Mary Poppins , it seems , was an enabler .\n5 . Our sugar consumption is both in plain sight and hidden , ingested from the most unlikely places . Sugar in cookies seems obvious . Sugar in potato chips not so much . And ketchup and TV dinners and soup and crackers and just about every other processed food out there . Who are the biggest baddies ? Soft drinks lead the list at 33 % of our sugar consumption ( drink water instead of coke and you ’ ve already made a huge dent ) . Candy and other obvious sweets , 16 % . Baked goods like cookies and cakes , 13 % . Fruit drinks 10 % . Sweetened yogurt , ice cream and milk almost 9 % .\n6 . One can of Coke , 12 ounces , contains 10 teaspoons of sugary goodness . That ’ s more sugar than two Frosted Pop Tarts with a Twinkie thrown in .\n7 . The average American consumes 53 gallons of soda a year . Let ’ s do the math . 128 ounces in a gallon times 53 . That ’ s 6,784 ounces . Or just to simplify it , that ’ s 565 cans of soda a year .\n8 . If you took away all the sugar in an average American diet , you would subtract 500 calories a day . Of course , since we are not taking it away , that means sugar adds 500 calories a day to our diet ( and waistlines ) . That is like eating 10 strips of bacon a day . Even bacon-loving Americans might stop short of that .\n9 . So , given all the bad stuff : Diseases , bad teeth , expanding waistlines . Zero nutrition . Why do we keep consuming sugar ? Well , there is that DNA connection . Sugar is how we are wired for energy , but evolution never took processed sugar into account . Sweets eaters survived because they ate more energy-efficient fruit and veggie sugar that metabolizes slowly and doesn ’ t kill us .\nSugar is as addictive as cocaine . Brain scans after sugar consumption , are very similar to when we do blow . Dopamine floods the brain and , boy , do we feel good . And of course it is a lot easier on the nostrils…unless you ’ re snorting your sugar… Hello . My name is Larry , and I ’ m a sugar addict .\nSo what does a poor American do ? We can start by being conscious of the sugar we are consuming . The stuff comes in many disguises . It ’ s like the Peter Sellers of ingredients . Sugar , cane juice , cane syrup , high-fructose corn syrup , fruit juice concentrate , honey , molasses , malt syrup . Those are its favorite masks . If we are at least aware of what we are chowing down or chugging , we have a fighting chance . Increase the water intake , decrease the soda intake . Check out the ingredients on the labels . Opt for reduced sugar products . Awareness is a good start . As Daniel Lieberman said : `` We need to realize that our bodies are not adapted to the amount of sugar that we are pouring into them and it 's making us sick . ''


There ’ s a surprisingly big disconnect between how obesity researchers think about the causes of and treatments for obesity and how the American public does .\nResearchers think some people have genetic and hormonal traits that make them more susceptible to obesity . They view obesity as a complex , chronic disease , like cancer , with many causes and subtypes . They ’ re also losing faith in dieting and exercise , neither of which is very helpful for weight loss in the long term .\nThe public , on the other hand , generally believes obesity is caused by a lack of willpower , and that it can be fixed with gym memberships and trendy diets . In one 2016 survey of more than 1,500 Americans , 60 percent of the participants said dieting and exercise were even more effective than surgery for long-term weight loss .\nHere ’ s the thing , though : Weight loss surgery is far and away medicine ’ s best treatment for severe obesity .\nThe medical case for bariatric surgery has grown much stronger in recent years . High quality studies on the long-term health outcomes of people with obesity who got surgery show , on average , that they ’ re able to lose dramatic amounts of weight , and even reverse or prevent their obesity-related health conditions , like diabetes and high cholesterol . A recent study in the New England Journal of Medicine demonstrated this once again . That ’ s why Medicaid now covers the procedure in 46 states , and so do national health systems in countries like Israel , Brazil , and Canada . It ’ s also why the American Academy of Pediatrics is now endorsing the operation as a “ safe and effective ” option for adolescents with severe obesity .\nYet out of the 20 million people who are eligible in the US , fewer than 1 percent get bariatric surgery for weight loss , according to the Obesity Society .\nWhy ? Polling data shows that many Americans still think it ’ s dangerous and ineffective .\nTo be clear , not all weight loss surgeries are created equal : The gastric bypass and gastric sleeve operations are considered superior to the lap band , for example . And surgery isn ’ t for people with a few pounds to lose ; it ’ s reserved for those with severe obesity . Even the best surgeries don ’ t work in some people and can cause disturbing side effects in rare cases . But bariatric surgery ’ s benefits appear to vastly outweigh its harms on average , and it is shaping up to be a genuine help for people struggling through one of the most urgent health crises of our time . It ’ s time we started paying attention .\nWeight loss surgeries work by reducing the size of the stomach and suppressing hormones related to hunger and satiety\nThe obesity crisis in America really began to take off in the 1970s . Centers for Disease Control and Prevention estimates from 2016 show that 40 percent of US adults and 19 percent of youth are obese .\nBut long before that , doctors were searching for ways to alter people ’ s bodies to help them eat less food .\nJaw wiring , which involved literally wiring the jaws shut to stop people from eating , was among the early approaches . In the 1950s , researchers noticed that shortening the small intestines of dogs hampered their ability to absorb calories and caused them to lose weight . By the late 1960s , bariatric surgery was being tried in humans . Surgeons ’ methods were crude at first but have vastly improved over the years . And some kinds of bariatric surgery ( most recently , the lap band approach ) have fallen out of favor .\nNow researchers are generating longer-term data showing some of the current surgical methods that can lead to dramatic and durable weight loss , and , even more remarkably , improvements in people ’ s long-term health outcomes .\nThe majority of bariatric procedures in America today involve the gastric sleeve and the Roux-en-Y gastric bypass . Both of these methods permanently alter the digestive tract to help people lose an average of about 30 percent of their original bodyweight ( and keep most of it off — more on that later ) .\nWith the sleeve , which now makes up more than 50 percent of weight loss surgeries in the US , surgeons staple off and remove about 80 percent of the stomach , transforming the organ from a wide football shape into a slim banana ( or sleeve ) shape . By reducing the size of the stomach , people can ’ t eat as much as they used to , so they consume fewer calories .\nWith the gastric bypass , surgeons use staples to make the stomach smaller by creating a small pouch , which can only hold about an ounce ( or walnut ’ s worth ) of food . Next , they reconnect the small intestine to a hole in the new pouch , so food flows into the pouch , bypassing most of the stomach , and then into the latter part of the small intestine , bypassing the first half of the intestine . Like the sleeve , the surgery also restricts the amount of food people can eat , but because food no longer passes through most of the stomach , people also can ’ t absorb as many calories and nutrients as they used to .\nBut an additional reason both the sleeve and gastric bypass surgeries lead to long-term weight loss is likely because of the changes in hormones that occur after these procedures . The sleeve , and especially the bypass , seems to suppress hormones that affect hunger and satiety , like the “ hunger hormone ” ghrelin — something no diet will ever do .\nAnother interesting possible reason for why the surgery works is that it may readjust the body ’ s metabolic rate , making maintaining weight loss easier .\nIn a 2014 study , published in the journal Obesity , researchers compared participants from the Biggest Loser reality TV show who had gone on crash diets and exercise programs to rapidly lose as much weight as possible to people who had gastric bypass surgery . ( They jumped on the chance to study reality show contestants because it ’ s so rare to see people with severe obesity lose vast amounts of weight in real life . ) The bypass surgery patients saw their metabolisms normalize within a year , to a rate that matched their new body size , while the TV show contestants saw their metabolisms slow down and stay that way — even six years after losing the weight and , on average , regaining much of it back .\nResearchers suspect this is because surgery may reset the “ set point , ” or the body ’ s habit of vigorously defending a certain weight range . Once a person gains weight and keeps that weight on for a period of time , the body gets used to its new , larger size . When a person loses weight , a bunch of subtle changes kick in — to the hormone levels , the brain — increasing appetite and slowing the metabolism , all in a seeming conspiracy to get back up to that set point weight .\nAmazingly , surgery seems to lower the set point , and even weaken the body ’ s desire to defend it . And that seems to make keeping weight off a little easier .\nNot all weight loss surgeries are equally effective . The lap band surgery is not a great weight loss surgery .\nThe third most common weight loss procedure in America is the lap band , though it has dramatically fallen out of favor in recent years and now only makes up about 5 percent of surgeries . The problem is the surgery doesn ’ t work as well for weight loss as the other procedures on offer , and it leads to many complications and more surgery .\nLap banding involves placing an inflatable band around the upper portion of the stomach to create a small pouch . When the lap band operation was first approved by the Food and Drug Administration in 2001 , it seemed like a safe option for weight loss surgery that could be adjusted or removed at the patient ’ s behest . ( Unlike the gastric bypass or sleeve operations , it didn ’ t involve permanently altering the stomach or intestines — and it could be reversed by simply removing the device . )\nBut long-term data suggest lap band patients lose about half the amount of weight as bypass or sleeve patients . To be clear , even losing 10 percent of one ’ s bodyweight ( the average weight loss with lap banding ) can improve health outcomes , but it ’ s a lot less than the other weight loss surgeries . The lap band also turned out to be riskier than it seemed at first , often requiring additional surgeries .\nIn the best study we have on just how problematic lap band surgeries can be , published in JAMA , researchers from the University of Michigan looked at 16 years of Medicare data to see how common “ re-operations ” were after the first lap band procedure . These involved everything from removing the band to replacing it , fixing it , or following the initial procedure with another weight loss operation ( i.e. , the gastric bypass ) . They found 20 percent — or one in five — of the 25,000 lap band patients needed an additional procedure . That ’ s much higher than the 3 to 9 percent re-operation rate for the gastric bypass and gastric sleeve surgeries .\nResearchers think one reason the lap bands can fail is that they only restrict the size of the stomach , without producing the hormone and metabolic changes the sleeve and bypass do .\nPeople who get bypass or sleeve operations lose about a third of their original bodyweight on average — and keep most of it off\nIn the longer-term studies of both teens and adults who got sleeve and bypass surgeries , researchers found that people lose about a third of their original bodyweight on average and keep most of it off . So if someone weighs 300 pounds going into surgery , after a year they ’ ll probably weigh about 200 . But not all surgeries are created equal : The lap band is dramatically less effective than the sleeve or bypass . Let ’ s look at the evidence .\nAccording to a recent study , published in JAMA Surgery , researchers followed more than 1,000 adults for up to seven years and found bypass patients lost 28 percent of their original bodyweight ( including regaining about 4 percent of their weight loss between three and seven years ) . Band patients lost only 15 percent of their original bodyweight after seven years .\nIn another 2016 JAMA study , looking at the four-year weight change in veterans who underwent weight loss surgery , the bypass patients lost 27 percent of their original bodyweight , the gastric sleeve patients lost 17 percent , and again , lap band patients lost 10 percent .\nAnother systematic review from 2015 pooled the results of many studies on different weight loss operations and found the same trend : Band patients fared the worst when it came to weight loss , and gastric bypass patients the best .\nThe data on adolescents who get bariatric surgery looks similar . In a 2016 New England Journal of Medicine study , researchers followed 242 adolescents who got either gastric bypass surgery or the sleeve . After three years , sleeve patients lost 26 percent of their original bodyweight while bypass patients lost 28 percent . For a 2019 paper , also in NEJM , researchers compared the health outcomes of 161 teens and 396 adults for five years after their gastric bypass surgeries . Both groups lost around a third of their original bodyweight .\nAnother 2017 Lancet study followed 58 American teens for eight years who underwent gastric bypass . Again , teens lost an average of 30 percent of their bodyweight . That ’ s a similar finding to a study out of Sweden which tracked 81 teenagers with obesity who had a gastric bypass for five years . They lost about 28 percent of their original bodyweight .\nSo the data we have now suggests the surgery can be both safe and effective on average . But there ’ s still more researchers need to learn about the current surgical methods being used , in particular , their very long-term effects on people after more than a decade or two , and whether surgery continues to mitigate the effects of obesity ’ s toll .\nThere ’ s some variation in how much weight people lose after surgery , and no one knows why\nAs with every health intervention , there are some big caveats with weight loss surgery , too . One is that there ’ s some real variability in how people respond to it , and researchers have no way of predicting who will fare well and who won ’ t .\nThis 2018 JAMA Surgery study is a great example . The average weight loss after bypass was about 30 percent , and the majority of the study participants had lost and kept off between 20 and 30 percent of their bodyweight seven years after a bypass surgery . But there were outliers : 5 percent of the participants in the study lost as little as 10 percent of their original bodyweight , while 13 percent lost as much as 45 percent of their original weight .\nWhile researchers can ’ t tell who will succeed and who will fail before a surgery , they are learning people who do well have a few things in common . In the paper , the researchers found that people who lost more weight tended to be younger when they got the surgery . They also tended to be female and white , and had a higher body mass at the start of the study .\nIn another 2016 paper , looking at the variables that affected weight change after surgery , researchers found that people who adopted healthier eating habits lost the most weight . So it wasn ’ t just the surgery that helped people ; it was changes to their diet , too .\n“ Everyone is quite different in terms of how they lose weight and how much they lose over time , ” said Anita Courcoulas , a bariatric surgeon who was an author on both of these papers .\nShe thinks the reason is that there ’ s variability in the causes and subtypes of obesity among people , and that different people may need to be treated differently to get the best results . “ I think the important next step is figuring out how to understand the different subtypes of obesity , ” she said , “ instead of treating people like they ’ re one homogenous group. ” But we ’ re not there yet .\nThe other health benefits of surgery can be dramatic , including driving Type 2 diabetes into remission\nAside from the weight loss , the reason doctors get excited about bariatric surgery is that it seems to reduce the risk of a bunch of obesity-related diseases .\nCompared to obese adults who don ’ t get the surgery , bariatric patients live longer , have a lower risk of cancer , have less high blood pressure , have lower rates of Type 2 diabetes , and weigh significantly less .\nThe JAMA Surgery study offers some of the best evidence that these effects are durable over time . The study came out of LABS , the Longitudinal Assessment of Bariatric Surgery , a rigorous , multi-center study of bariatric patients that ’ s funded by the National Institutes of Health . Many bariatric studies have issues with people dropping out over time , which may bias the results . But the LABS researchers were able to follow up with more than 80 percent of the participants over seven years , which is rare in clinical medicine .\nAnd they found that all of the patients ’ health conditions — diabetes , high blood pressure , high cholesterol — were less prevalent seven years after surgery than they were before surgery . Sixty percent of the patients with Type 2 diabetes going in were still in remission seven years later . ( The same wasn ’ t true for the group that got the lap band . )\nThe newest NEJM study suggests teens may see these benefits even more : They were much more likely to experience remission of their diabetes and high blood pressure than adults .\nSurgery can cause complications and carry rare but disturbing side effects\nToday ’ s weight loss surgical techniques are a lot safer than they used to be — there ’ s a low rate of complications that ’ s similar to other abdominal operations , like gallbladder surgery . But the operations still carry a 0.3 percent mortality risk and other potential harms .\nThe most common long-term issue bariatric surgery patients face is nutritional deficiencies . Surgeries can hamper the body ’ s ability to absorb nutrients , so many of the people go on to develop iron , B12 , calcium , folate , and thiamine deficiencies . That ’ s why bariatric patients need to be closely monitored for the rest of their lives , to make sure they ’ re getting the vitamins they need and that they ’ re not developing any other health issues as a result .\nMany patients also need additional surgeries for surgical complications , or “ revision ” operations to address problems with their original surgeries . For example , patients who got the lap band may go back for a bypass after finding out the lap band didn ’ t work . And between 6 and 20 percent of bypass patients need to get treatment for stomal stenosis , which is when the new connection between the small stomach pouch and the intestine narrows and doctors have to go back in a stretch it out .\nThe sleeve is a simpler procedure and there tend to be fewer complications requiring surgery , but they can still happen . Up to 5 percent of sleeve patients experience gastric leaks , or a hole along the staple line of the newly created stomach , which allows stomach juices to leak into the abdominal cavity . Up to 17 percent of adults who have undergone a sleeve operation are later diagnosed with Barrett 's esophagus , a complication of acid reflux disease that can lead to cancer .\nFinally , some patients may opt for plastic surgery for loose , hanging skin — extra procedures that often aren ’ t covered by insurance .\nThen there are the rare but disturbing psychological effects that have surfaced in adults after bariatric surgery , including a slightly elevated post-surgical risk of self-harm , suicide , and drug and alcohol use disorders .\nResearchers still don ’ t understand why this happens , but they have some ideas they ’ re exploring . Because of the changes in the gut after bypass and sleeve operations , patients are more sensitive to the effects of drugs and alcohol .\n“ Any drug that peaks more quickly is more prone to abuse , ” said James Mitchell , a psychiatrist who studies bariatric surgery at the University of North Dakota School of Medicine and Health Sciences . So it ’ s possible that bariatric surgery may make alcohol and other drugs more addicting for some people .\nJunaid Bhatti , a Toronto-based researcher who has studied the link between suicide and bariatric surgery , said researchers are exploring whether this increased risk is caused by stress after surgery — the pressure to lose weight , the disappointment if you don ’ t . “ There is a subgroup of patients that may not be able to adjust well to the restrictions that come after surgery and if they have any previous mental health issue that may be provoked because of that stress following surgery , ” he explained . Or maybe there ’ s some other yet-to-be-discovered physiological change after surgery that explains it .\nThese two effects — the drug abuse and mental health issues — may work together in dangerous ways , Mitchell added . “ When people are intoxicated , they are disinhibited . If they are depressed and thinking about suicide , that ’ s not an uncommon time for them to act . So those two things may converge in a bad way that needs to be looked at in more detail . ”\nThere ’ s another nonmedical — but important — side effect of going under the knife for weight loss surgery : experiencing a change in relationship status . A study out of Sweden , published in JAMA Surgery , found people with spouses or live-in partners were more likely to separate or divorce after surgery compared to control groups who didn ’ t get surgery , while single patients were more likely to get into a relationship .\nThe new NEJM paper found these serious complications — nutrient deficiencies , self-harm , additional operations — may be more common in teens than adults . So there ’ s an urgent need to understand them .\nThen there are the important cost considerations . Without insurance , bariatric surgery can cost more than $ 20,000 . And that doesn ’ t include the cost of additional operations and follow-up care . So bariatric surgery isn ’ t necessarily going to make a big dent in America ’ s obesity-related costs , which add up to about $ 210 billion per year .\n“ The expectation is bariatric erases these obesity-associated costs , ” said David Arterburn , an obesity expert at Kaiser Permanente Washington Health Research Institute , “ but because of the small complication rate and because complications are expensive — requiring hospitalization , reoperation — my take on the literature is that there ’ s no cost savings that happens from bariatric surgery . ”\nThe average patient with severe obesity uses between $ 5,000 and $ 10,000 in medical care per year , he said . Out of those total costs , about a third are associated with their obesity . The rest is related to other problems , like arthritis or high blood pressure that ’ s brought on by aging . Bariatric surgery can help cut the obesity-related costs , but not necessarily these other costs or the follow-up .\nEven so , bariatric surgery is considered “ cost-effective , ” meaning it ’ s as effective or better than similarly expensive interventions .\n“ Cost-effective treatments are considered somewhere between less than $ 50,000 to $ 100,000 per quality-adjusted life year saved [ QALY ] , ” explained Scott Kahan , director of the National Center for Weight and Wellness and a professor at George Washington University . “ Bariatric surgery is in the range of $ 50,000 per QALY. ” By comparison , annual Pap smear screenings are estimated at $ 800,000 per QALY , kidney dialysis $ 50,000 to $ 100,000 per QALY , and spinal fusion $ 250,000 per QALY .\n“ This is right in that sweet spot of we are spending a reasonable amount of money and getting a reasonable return , ” Kahan added .\nResearchers think the surgery could be even more cost-effective in adolescents — not only because they ’ ll likely experience greater health gains than adults ( since they ’ re young and many of their health problems are more reversible ) , but also because they ’ ll be better positioned to contribute to the economy if they ’ re unencumbered by severe obesity .\nPeople who want surgeries aren ’ t always able to get them\nAgain , fewer than 1 percent of people get bariatric surgery for weight loss . And researchers and obesity experts think there are several reasons for that .\nA lack of understanding about obesity and obesity-related stigma may hold both doctors and patients back from considering surgery . “ There ’ s an attitude that people are at fault for their obesity , that it ’ s failure or personal responsibility , ” said Joe Nadglowski of the Obesity Action Coalition , a membership organization for people with obesity . “ Not only is having obesity something you ’ re stigmatized for but if you need a medical intervention , there ’ s a stigma around needing help to deal with it. ” So doctors may think patients can exercise their way out of the problem , and patients may feel they should be able to , too .\nIn a seminal 1991 study , researchers asked patients who had lost about 100 pounds after surgery to choose between regaining their weight or maintaining their new body size at the cost of living with another disability . The patients opted for deafness , blindness , heart disease , even losing a limb , instead of returning to their morbid obesity .\nInsurance coverage is “ all over the place , ” Kahan said . Though many providers cover the surgery , copays can be high , and insurers often don ’ t pay for follow-up operations or plastic surgeries that are needed later . “ Even when there is coverage , it ’ s quasi-coverage , ” he added . “ Copays can range from hundreds of dollars to over $ 10,000 in some policies . For some patients , surgeries are exempt from out-of-pocket maximums . ”\nMany doctors still don ’ t know the basic requirements for bariatric surgery recommendation and may not be referring patients who could benefit from surgery , he added . In a 2007 survey of nearly 500 doctors , 91 percent referred their severely obese patients to exercise , with diet following closely behind . The least recommended weight loss treatment was bariatric surgery , prescribed for only 15 of the doctors ’ morbidly obese patients .\nWe can ’ t cut our way out of the obesity epidemic\nAlmost all the researchers I spoke to for this story said they hoped to one day find a pill that could do for obesity what surgery does . But until then , surgery is the best thing we have for the treatment of obesity . That doesn ’ t mean it ’ s the answer to the obesity epidemic , however .\n“ The obesity epidemic did not occur because we don ’ t have enough surgery , ” said National Institutes of Health obesity researcher Kevin Hall . “ The obesity epidemic occurred because the food environment has changed remarkably . ”\nThere ’ s no question that our food landscape has increased the opportunities for obesity-related genes and traits to express themselves . Preventing future obesity cases will require making it easier for people to eat healthfully and be more active . But there ’ s still the problem about what to do for the people who are struggling with severe obesity right now .\n“ [ Surgery ] is an incredibly valuable tool right now for treating adults with [ severe ] obesity , ” Hall added , “ but we ’ re not going to cut our way out of the obesity epidemic . ”


The United Nations is calling for a united effort among member countries to tackle the “ largest humanitarian crisis ” in more than 70 years .\nStephen O ’ Brien , the UN undersecretary-general for humanitarian affairs , said on Friday that more than 20 million people in Yemen , Somalia , South Sudan , and Nigeria are facing the threat of starvation and famine . Urging more financial support from member countries , Mr. O ’ Brien said $ 4.4 billion is needed by July to avert this disaster .\n`` We stand at a critical point in history , '' O'Brien told the Security Council on Friday . “ Already at the beginning of the year we are facing the largest humanitarian crisis since the creation of the United Nations . ''\n“ Collective and coordinated global efforts ” are crucial to save those in need , O'Brien said . With the ongoing conflicts in the region , 12 million people in Yemen , 7.5 million in South Sudan , 6.2 million in Somalia , and 10.7 million in Nigeria need immediate assistance , with most of them facing severe food insecurity and a real risk of starving to death .\n“ Children stunted and out of school . Livelihoods , futures and hope will be lost . Communities ’ resilience rapidly wilting away . Development gains reversed , ” he said in his appeal to the president and members of the Security Council . “ Many will be displaced and will continue to move in search for survival , creating ever more instability across entire regions . ”\nAnd despite pledges of help , only six percent of the promised funds have been received so far . While 14 donors pledged a total of $ 672 million for Nigeria and the Lake Chad region , including $ 458 million for humanitarian action , it is still far from the $ 1.5 billion the region requires , he said .\nCiting the dire situation in these countries , he pleaded for donations .\n`` To be precise , '' he said , `` We need $ 4.4 billion by July , and that ’ s a detailed cost , not a negotiating number . ''\nUN Secretary General Antonio Guterres made similar appeals last month , saying that the UN had only received $ 90 million so far in 2017 .\nO'Brien proposed three additional actions for the international community to prevent widespread starvation : Restore the normal access to food in these countries , guarantee unimpeded humanitarian access to people in need , and come up with a political solution to end the fighting that has displaced millions and very often led to food deprivation of the public .\n“ All four countries have one thing in common : conflict , ” he said . “ This means we – you – have the possibility to prevent , and end , further misery and suffering . ”\nThe Humanitarian Affairs Office is not the first one to point out this humanitarian crisis . The United Nations International Children 's Fund on Feb. 21 announced that nearly 1.4 million African children are “ at imminent risk ” of death due to famine in these four countries , as The ███ reported .\n`` Time is running out for more than a million children , '' UNICEF executive director Anthony Lake said at the time .\nGet the Monitor Stories you care about delivered to your inbox . By signing up , you agree to our Privacy Policy\nOn Friday , O ’ Brien said the UN and its humanitarian partners have the coordination and personnel to confront this challenge , but without `` sufficient and timely financial support , '' it is difficult to expand their work .\n`` The situation for people in each country is dire , and without a major international response , the situation will get worse , '' he said in conclusion . `` The UN and its partners are ready to scale up . But we need the access and the funds to do more . It is all preventable . It is possible to avert this crisis , to avert these famines , to avert these looming human catastrophes . ''