Health research roundup: home address and obesity unrelated
Interest in COVID-19 vaccine climbs to 84% across the U.S.; "Low-value care" not needed to make patients happy
Where you live affects your waistline — or does it?
Does your address predict your waistline, or is it your paycheck?
A new study says it may be the latter, finding that obesity is higher in less-populated communities, but that the causes do not appear to be due to the increased presence of drive-throughs.
You know, the kind that ask if you want fries with that?
The finding stems from a large new study on health and the so-called "built environment" published recently in the International Journal of Obesity .
For years, health experts have argued there is a connection between where you live and obesity.
According to this work , some communities are more obese than others because they are "obesogenic," which is to say, high in fast food businesses and convenience stores, and low in parks, sidewalks and grocery stores.
These characteristics are said to lead people to drive more, walk less and eat high-calorie fast or grab-and-go food, growing more obese in the process.
This so-called built environment has been linked to higher rates of obesity in rural communities and urban locations alike, earning the designation "food deserts" by offering mostly only convenience stores and fast food to the hungry.
In the United States, "the USDA estimates that 23.5 million people live in urban neighborhoods and rural towns with limited access to fresh, affordable, healthy food," according to a 2019 editorial in the International Journal of Environmental Research and Public Health.
Although people in lower-density communities or locations with less access to grocery stores are more likely to be overweight, so far the data has not been able to say whether these environments cause obesity, or have simply inherited it.
By reviewing anonymous electronic health records, a new study from the University of Washington followed for five years the weight trajectories of over 100,000 insured patients in the Kaiser Permanente Washington health care system.
Seeking associations between where people live and whether they gained weight over the period of study, the data were analyzed in relation to socioeconomic status, population density, counts of area supermarkets, fast food restaurants, and other variables.
The researchers found the patient's built environment predicted whether a person's starting weight was high or low, but that it had no association with whether someone gained weight over time.
In one exception, the researchers found that those who lived in high-density locations had a slightly lower likelihood of gaining weight over time.
In short, "obesogenic" environments did not in fact prove to be obesogenic.
The authors believe factors beyond the configuration of buildings better explained rates of obesity in a given community.
“Whether you can afford to eat a healthy diet or to have the time to exercise," lead author and UW School of Public Health scientist James Buszkiewicz said in a statement, "those factors probably outweigh the things we’re seeing in terms of the built environment effect.”
Over 70% 'definitely' plan to get vaccinated for COVID-19
The U.S. Census Bureau's weekly Household Pulse Survey suggests COVID-19 vaccine reluctance dropped by a large margin between January and the end of March 2021.
The news comes by way of a recent update from the State Health Access Data Assistance Center (SHADAC), a research communications arm of the University of Minnesota.
Between the start of 2020 and the end of March, SHADAC writes , the percentage of American adults surveyed who said they definitely would get the COVID-19 vaccine rose from 54.5% to 71.6%.
Those who said they "probably" would get the shots were halved during this same period, from 23.7% to 12.4%.
That combination adds up to 84% of U.S. adults surveyed who are not opposed to or intent on getting the COVID-19 vaccine, a percentage well within range believed necessary for herd immunity.
Although upward movement among those positive about the vaccines was large, the remaining 16% who were unlikely (8.2% ) or adamantly opposed (7.8%) to getting vaccinated for COVID-19 changed little, however, having dropped just 3.9% and 1.1% over the period studied.
On a state-by-state comparison, between January and late March COVID-19 vaccine hesitancy dropped by 20 points in North and South Dakota and 10 points in Minnesota. All three neighboring states had differing levels of hesitancy at the start of the year, with North Dakota the highest and Minnesota the lowest.
Hesitancy among Black respondents dropped by the largest percentages among demographic groups in 2020 so far, falling 28 points during the first three months of the year. Those opposed remain slightly elevated over proportions of Hispanic and white populations.
"While concerns about potential side effects, safety, priority, and efficacy have been decreasing, distrust of the COVID-19 vaccines and distrust of the government, along with not believing that 'I need a COVID-19 vaccine' have all increased as stated reasons for vaccine hesitancy," said James Campbell of the State Health Access Data Assistance Center in a statement.
"This could be cause for concern, since these reasons for hesitancy may not fade as individuals see more people in their communities getting safely vaccinated."
Offering low-value care does not make patients happier
Here's another reason for physicians to withhold treatments that are available but which have been determined to offer little benefit: Providing low-value care won't leave the patient any more satisfied with the experience.
Some hospitals continue to offer so-called low-value treatments on the grounds that if patients want you to offer one, and a doctor explains it is not proven to be effective, the patient will rate their satisfaction lower, and the hospital will see its quality scores drop.
These tend to be larger, prominent hospitals. A r ecent national ranking of hospitals based on their restraint in the provision of low-value care placed several small community hospitals in Minnesota and the Dakotas at the top, while marquee providers in the state failed to crack the top 50.
In a study published recently in the journal JAMA Internal Medicine, researchers from University of Chicago and Harvard Medical School gleaned patient satisfaction data from a large health care consumer survey, then cross-checked it with Medicare claims for the eight most frequently provided low-value services.
The eight services studied were:
- PSA testing in males older than 75 with no history of prostate cancer;
- Imaging of the carotid artery in asymptomatic adults;
- Cervical cancer screening in females over 65 with no symptoms;
- Two types of thyroid testing;
- Back imaging for first episode of back pain without complications;
- Head imaging for headache without complications and;
- Spinal injection for low back pain.
The researchers found no relationship between the provision of these low value services and patient satisfaction.
"In fact it is not settled whether patients even advocate for low-value services," lead author Prachi Sanghavi, PhD, Assistant Professor of Public Health Sciences at UChicago, said in a statement .
“In short, the concern is overblown,” said study co-investigator Michael McWilliams, MD, PhD , Professor of Health Care Policy at Harvard Medical School and a general internist at Brigham and Women’s Hospital.
“Whether it’s because less wasteful physicians are adept at informing patients why a requested test or procedure is unnecessary, or because most low-value care is due to provider practice patterns and not patient demand, we should be reassured that we can tackle waste in the system without great patient backlash or flunking providers on their ‘scorecards.’”