Daily Aspirin - More Benefit Than Risk?

Many people take a low dose of aspirin every day to lower their risk of a further heart attack or stroke, or if they have a high risk of either. While the anticipated benefit is a lower chance of vascular disease, taking daily aspirin is not without danger: for instance it raises the risk of internal bleeding. Hence the important need to discuss beforehand with the doctor, "In my case, doc, should I be taking daily aspirin?"But this week, the publication of three studies in The Lancet, has added a new benefit to the equation: cancer prevention, and stirred up the pros and cons debate.

In those studies, Professor Peter Rothwell of Oxford University in the UK, a world expert on aspirin, and colleagues, confirm that for people in middle age, a daily dose of aspirin can cut the risk of developing several cancers, with effects starting after only two to three years rather than the ten or so previously thought.

Moreover, they propose that treatment with daily aspirin may also prevent an existing, localized cancer from spreading to other parts of the body, which Rothwell says is just as important to know about, since that's when cancer becomes deadly.If you follow their reasoning, we appear to have reached a crucial point in the debate: on the one hand we have the benefit that aspirin can reduce cancer, stroke and heart attacks, which are much more likely to lead to disability or death, and on the other, we have the risk of internal bleeding, which is less harmful than those diseases.

Such arguments cause more people, even those presently enjoying good health, to ask the question: "Should I be taking aspirin every day?

"But, although Rothwell and colleagues present compelling evidence, despite some limitations, their papers do not necessarily furnish a clear answer to that question.

Nevertheless, the balance of the pros and cons may alter in the light of their evidence, because not only does low dose aspirin therapy appear to increase the pros, it may also reduce the cons, in that the researchers found the risk of internal bleeding reduced with time.Plus, the new studies also raise a thorny public health question, similar to that surrounding cholesterol-busters, should health authorities consider recommending routine use of aspirin for cancer prevention?This was the subject of a commentary published in the same issue of the The Lancet. Here, Andrew T Chan and Nancy R Cook of Brigham and Women's Hospital, Harvard Medical School, Boston, suggest that on balance, we are not ready to recommend aspirin for cancer prevention.

One reason is that the Rothwell studies did not include data from the largest randomized trials in primary prevention, the Women's Health Study (WHS), and the Physicians' Health Study (PHS), where subjects took aspirin every other day.

"Also, despite a convincing case that the vascular and anticancer benefits of aspirin outweigh the harms of major extracranial bleeding, these analyses do not account for less serious adverse effects on quality of life, such as less severe bleeding," they add.However, Chan and Cook acknowledge that as we await results of additional trials, and the longer term follow up of the WHS and PHS, the Rothwell studies do move us a "step closer to broadening recommendations for aspirin use".At the very least, it means future evidence-based guidelines cannot ignore the use of aspirin for prevention of vascular disease in isolation from cancer prevention, they conclude.Other authorities have also been quick to respond to the new studies. In the UK, the NHS's answer to the question "Should I start taking aspirin?" is:

"Overall, aspirin is a highly effective medical treatment when used appropriately, but it is not yet a drug that should be taken unsupervised on a daily basis, even at low doses."

They, like Chan and Cook, say that while the Rothwell studies "provide compelling evidence, taking aspirin is not yet recommended to prevent cancer and people should not start taking it daily as a precautionary measure."For healthy people considering taking daily aspirin, they have this message:

"Given that the potential risks could outweigh any benefits, it is not currently advised that healthy people with no risk factors for cardiovascular disease take aspirin to prevent possible cardiovascular events such as heart attack and stroke."

They also say the evidence for taking aspirin purely to prevent cancer or to treat it is "even less substantial than for blood thinning", and urge "we cannot be sure that the potential benefits are not outweighed by the known risks".

The reason aspirin is prescribed in a small daily dose as a means to lower the risk of heart attack or stroke, is because of the effect it has on the clotting action of platelets in the bloodstream.When we bleed, platelets in the blood build up at the site of the wound, forming a plug that stops further blood loss. But this clotting can also happen inside blood vessels, such as when a fatty deposit in a narrow artery bursts. At the site of the burst, blood platelets clump into a clot that can block the artery and stop blood flow to the brain or heart, resulting in a stroke or heart attack.Aspirin reduces the ability of the platelets to clump, thereby lowering the risk of having a heart attack or stroke.

In the UK, for example, aspirin is prescribed as a blood-thinner to reduce the risk of clots. The treatment comprises a small daily dose, often around 75mg (a typical aspirin painkilling tablet has about 300mg of aspirin).But the downside to this anti-clotting benefit, is that aspirin can also cause serious harm, the best known of these being the small but important increased risk of stomach irritation and bleeding.And, ironically, while daily aspirin can help prevent a clot-related (ischemic) stroke, it may actually increase the risk of a bleeding (hemorrhagic) stroke.

Although aspirin's risk-reduction benefits are different between men and women (and among women, it also depends on age), the risk of bleeding with daily aspirin is about the same in both sexes.The risk of bleeding also tends to be higher in older people, those with a history of stomach ulcers, and people already taking medication or who have conditions that increase the risk of bleeding.Daily aspirin use also increases the risk of developing a stomach ulcer. And, for anyone with a bleeding ulcer, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent, say experts at the Mayo Clinic in the US.

People with asthma can also experience breathing problems with aspirin. Other side effects of taking aspirin include nausea and indigestion, ringing in the ears (tinnitus) and hearing loss. And some people can have an allergic reaction.

Aspirin recommendations

Before you take aspirin, even as a pain reliever, experts generally recommend that you talk to your doctor or pharmacist if you are pregnant, trying to conceive or are breastfeeding.The same goes for people with a blood disorder, a stomach ulcer, who suffer from asthma, have high blood pressure, kidney or liver problems, or have allergic reactions to any drugs.It is also important to tell your doctor what other medications or supplements you are taking. Even if you take aspirin with ibuprofen, it reduces the benefits of the aspirin. And taking aspirin with other anti-clotting agents, such as warfarin, could also greatly increase your risk of bleeding.

If you are on daily aspirin and need surgery or dental work, it is important you tell your surgeon or dentist what dose you are on, so they can minimize the risk of excessive bleeding during the procedure. The US Food and Drug Administration (FDA) also warns those who take aspirin regularly to limit their alcohol intake, because that can have an additional blood-thinning effect, and raises the risk of upset stomach. The Mayo Clinic suggest if you are on daily aspirin, you should limit your alcohol consumption to one drink or less per day if you are a woman, or two drink or less if you are a man.

Another point they make, is that stopping daily aspirin therapy may be unsafe: there is a rebound effect that can trigger a blood clot and cause a heart attack or stroke. It is important to talk with your doctor first before you make any changes or stop your daily dose.Aspirin should not be given to children under 16 because of the risk of triggering a rare but dangerous condition known as Reyes syndrome, which is why in the UK it has been removed as an ingredient from all child and baby medicines.

Many experts would also advise those thinking about taking daily aspirin as a way to cut cancer risk, to consider there are many other, less harmful lifestyle changes that can also make a difference: such as giving up smoking, following a healthy diet, limiting alcohol intake, keeping to a normal weight, and taking regular exercise.

By: Catharine Paddock PhD

Original Article: http://www.medicalnewstoday.com/articles/243265.php

More Physical Health...

Many people take a low dose of aspirin every day to lower their risk of a further heart attack or stroke, or if they have a high risk of either. While the anticipated benefit is a lower chance of vascular disease, taking daily aspirin is not without danger: for instance it raises the risk of internal bleeding. Hence the important need to discuss beforehand with the doctor, "In my case, doc, should I be taking daily aspirin?"But this week, the publication of three studies in The Lancet, has added a new benefit to the equation: cancer prevention, and stirred up the pros and cons debate.

In those studies, Professor Peter Rothwell of Oxford University in the UK, a world expert on aspirin, and colleagues, confirm that for people in middle age, a daily dose of aspirin can cut the risk of developing several cancers, with effects starting after only two to three years rather than the ten or so previously thought.

Moreover, they propose that treatment with daily aspirin may also prevent an existing, localized cancer from spreading to other parts of the body, which Rothwell says is just as important to know about, since that's when cancer becomes deadly.If you follow their reasoning, we appear to have reached a crucial point in the debate: on the one hand we have the benefit that aspirin can reduce cancer, stroke and heart attacks, which are much more likely to lead to disability or death, and on the other, we have the risk of internal bleeding, which is less harmful than those diseases.

Such arguments cause more people, even those presently enjoying good health, to ask the question: "Should I be taking aspirin every day?

"But, although Rothwell and colleagues present compelling evidence, despite some limitations, their papers do not necessarily furnish a clear answer to that question.

Nevertheless, the balance of the pros and cons may alter in the light of their evidence, because not only does low dose aspirin therapy appear to increase the pros, it may also reduce the cons, in that the researchers found the risk of internal bleeding reduced with time.Plus, the new studies also raise a thorny public health question, similar to that surrounding cholesterol-busters, should health authorities consider recommending routine use of aspirin for cancer prevention?This was the subject of a commentary published in the same issue of the The Lancet. Here, Andrew T Chan and Nancy R Cook of Brigham and Women's Hospital, Harvard Medical School, Boston, suggest that on balance, we are not ready to recommend aspirin for cancer prevention.

One reason is that the Rothwell studies did not include data from the largest randomized trials in primary prevention, the Women's Health Study (WHS), and the Physicians' Health Study (PHS), where subjects took aspirin every other day.

"Also, despite a convincing case that the vascular and anticancer benefits of aspirin outweigh the harms of major extracranial bleeding, these analyses do not account for less serious adverse effects on quality of life, such as less severe bleeding," they add.However, Chan and Cook acknowledge that as we await results of additional trials, and the longer term follow up of the WHS and PHS, the Rothwell studies do move us a "step closer to broadening recommendations for aspirin use".At the very least, it means future evidence-based guidelines cannot ignore the use of aspirin for prevention of vascular disease in isolation from cancer prevention, they conclude.Other authorities have also been quick to respond to the new studies. In the UK, the NHS's answer to the question "Should I start taking aspirin?" is:

"Overall, aspirin is a highly effective medical treatment when used appropriately, but it is not yet a drug that should be taken unsupervised on a daily basis, even at low doses."

They, like Chan and Cook, say that while the Rothwell studies "provide compelling evidence, taking aspirin is not yet recommended to prevent cancer and people should not start taking it daily as a precautionary measure."For healthy people considering taking daily aspirin, they have this message:

"Given that the potential risks could outweigh any benefits, it is not currently advised that healthy people with no risk factors for cardiovascular disease take aspirin to prevent possible cardiovascular events such as heart attack and stroke."

They also say the evidence for taking aspirin purely to prevent cancer or to treat it is "even less substantial than for blood thinning", and urge "we cannot be sure that the potential benefits are not outweighed by the known risks".

The reason aspirin is prescribed in a small daily dose as a means to lower the risk of heart attack or stroke, is because of the effect it has on the clotting action of platelets in the bloodstream.When we bleed, platelets in the blood build up at the site of the wound, forming a plug that stops further blood loss. But this clotting can also happen inside blood vessels, such as when a fatty deposit in a narrow artery bursts. At the site of the burst, blood platelets clump into a clot that can block the artery and stop blood flow to the brain or heart, resulting in a stroke or heart attack.Aspirin reduces the ability of the platelets to clump, thereby lowering the risk of having a heart attack or stroke.

In the UK, for example, aspirin is prescribed as a blood-thinner to reduce the risk of clots. The treatment comprises a small daily dose, often around 75mg (a typical aspirin painkilling tablet has about 300mg of aspirin).But the downside to this anti-clotting benefit, is that aspirin can also cause serious harm, the best known of these being the small but important increased risk of stomach irritation and bleeding.And, ironically, while daily aspirin can help prevent a clot-related (ischemic) stroke, it may actually increase the risk of a bleeding (hemorrhagic) stroke.

Although aspirin's risk-reduction benefits are different between men and women (and among women, it also depends on age), the risk of bleeding with daily aspirin is about the same in both sexes.The risk of bleeding also tends to be higher in older people, those with a history of stomach ulcers, and people already taking medication or who have conditions that increase the risk of bleeding.Daily aspirin use also increases the risk of developing a stomach ulcer. And, for anyone with a bleeding ulcer, taking aspirin will cause it to bleed more, perhaps to a life-threatening extent, say experts at the Mayo Clinic in the US.

People with asthma can also experience breathing problems with aspirin. Other side effects of taking aspirin include nausea and indigestion, ringing in the ears (tinnitus) and hearing loss. And some people can have an allergic reaction.

Aspirin recommendations

Before you take aspirin, even as a pain reliever, experts generally recommend that you talk to your doctor or pharmacist if you are pregnant, trying to conceive or are breastfeeding.The same goes for people with a blood disorder, a stomach ulcer, who suffer from asthma, have high blood pressure, kidney or liver problems, or have allergic reactions to any drugs.It is also important to tell your doctor what other medications or supplements you are taking. Even if you take aspirin with ibuprofen, it reduces the benefits of the aspirin. And taking aspirin with other anti-clotting agents, such as warfarin, could also greatly increase your risk of bleeding.

If you are on daily aspirin and need surgery or dental work, it is important you tell your surgeon or dentist what dose you are on, so they can minimize the risk of excessive bleeding during the procedure. The US Food and Drug Administration (FDA) also warns those who take aspirin regularly to limit their alcohol intake, because that can have an additional blood-thinning effect, and raises the risk of upset stomach. The Mayo Clinic suggest if you are on daily aspirin, you should limit your alcohol consumption to one drink or less per day if you are a woman, or two drink or less if you are a man.

Another point they make, is that stopping daily aspirin therapy may be unsafe: there is a rebound effect that can trigger a blood clot and cause a heart attack or stroke. It is important to talk with your doctor first before you make any changes or stop your daily dose.Aspirin should not be given to children under 16 because of the risk of triggering a rare but dangerous condition known as Reyes syndrome, which is why in the UK it has been removed as an ingredient from all child and baby medicines.

Many experts would also advise those thinking about taking daily aspirin as a way to cut cancer risk, to consider there are many other, less harmful lifestyle changes that can also make a difference: such as giving up smoking, following a healthy diet, limiting alcohol intake, keeping to a normal weight, and taking regular exercise.

By: Catharine Paddock PhD

Original Article: http://www.medicalnewstoday.com/articles/243265.php

Health and wellness tips for your work, home and life—brought to you by the insurance specialists at HUB International Midwest

Winter

The winter months often provide some relief for allergy sufferers, as the outdoor air is cool and free of pollen. However, if you have allergies, you need to make sure that the air inside your house is clean as well. Be sure to:

·   Keep firewood outside.

·   Clean heating ducts and air conditioning filters.

·   Bathe house pets regularly if dander is a problem.

·   Keep your face covered when out in the cold. Going from cold outside air to warm indoor air can trigger asthma.

Spring

Mold growth blooms indoors and outdoors with spring rains. As flowers, trees, weeds and grasses begin to blossom, allergies will follow. Spring-cleaning activities can stir up dust mites, so be sure to:

·   Wash your bedding every week in hot water to help keep pollen under control.

·   Wash your hair before going to bed, since pollen can accumulate in your hair.

·   Wear an inexpensive painter’s mask and gloves when cleaning, vacuuming or painting to limit dust and chemical inhalation, and skin exposure.

·   Vacuum twice a week.

·   Limit the number of throw rugs in your home to reduce dust and mold.

·   Make sure the rugs you do have are washable.

·   Change air conditioning and heating air filters often.

Summer

Warm temperatures and high humidity can put a strain on seasonal allergy and asthma sufferers. Summer is the peak time for some types of pollen, smog and even mold:

·   Stay indoors between 5 a.m. and 10 a.m., when outdoor pollen counts tend to be highest.

·   Be careful when going from extreme outdoor heat to air conditioning. The temperature change can trigger an asthma attack.

·   Wear a mask when you mow the lawn or when around freshly-cut grass. Afterward, take a shower, wash your hair and change clothes.

·   Dry laundry inside instead of on an outside clothesline.

·   Check your yard for allergens, as well as other irritants such as oak, birch, cedar and cottonwood trees; weeds such as nettle or ragweed can also trigger allergies.

·   Wear shoes, long pants and long sleeves if allergic to bee stings.

·   Do not wear scented deodorants, hair products or perfumes when outdoors.

Fall

Cooler temperatures are ideal for planting flowers and trees, but be sure to plant those that produce less pollen, such as fir, pine, dogwood, azaleas, tulips, irises and pansies.

·   Wear a mask while raking leaves or when working with mulch or hay.

·   Use a dehumidifier in your basement to deter mold.

·   Clean your dehumidifier frequently.

·  Wash bathroom tiles and shower curtains with mold-killing products.

Did You Know...?

Back-to-school time is a great time to discuss allergies or asthma with your child’s school nurse and teachers. Inform them of your child’s needs, including any inhalers or medications, and what to do in case of an emergency.

By: Hub International

Do you know the greatest threats to men's health? The list is surprisingly short. The top causes of death among adult men in the U.S. are heart disease, stroke, cancer and chronic lower respiratory disease, according to the Centers for Disease Control and Prevention. The good news is that a few lifestyle changes can significantly lower your risk of these common killers.

Start by looking at your lifestyle

Take charge of your health by making healthier lifestyle choices. For example:

  • Don't smoke. If you smoke or use other tobacco products, ask your doctor to help you quit. It's also important to avoid exposure to secondhand smoke, air pollution and exposure to chemicals (such as in the workplace).
  • Eat a healthy diet. Choose vegetables, fruits, whole grains, high-fiber foods and lean sources of protein, such as fish. Limit foods high in saturated fat and sodium.
  • Maintain a healthy weight. Losing excess pounds — and keeping them off — can lower your risk of heart disease as well as various types of cancer.
  • Get moving. Include physical activity in your daily routine. You know exercise can help you control your weight and lower your risk of heart disease and stroke. But did you know that it may also lower your risk of certain types of cancer? Choose sports or other activities you enjoy, from basketball to brisk walking.
  • Limit alcohol. If you choose to drink alcohol, do so only in moderation. For men, that means up to two drinks a day for men age 65 and younger and one drink a day for men older than age 65. The risk of various types of cancer, such as liver cancer, appears to increase with the amount of alcohol you drink and the length of time you've been drinking regularly. Too much alcohol can also raise your blood pressure.
  • Manage stress. If you feel constantly on edge or under assault, your lifestyle habits may suffer — and so might your immune system. Take steps to reduce stress — or learn to deal with stress in healthy ways.

Stop avoiding the doctor

Don't wait to visit the doctor until something is seriously wrong. Your doctor can be your best ally for preventing health problems. Be sure to follow your doctor's treatment recommendations if you have health issues, such as high cholesterol, high blood pressure or diabetes. Also, be sure to ask your doctor about when you should have cancer screenings and other health evaluations.

What else puts you at risk?

Another common cause of death among men are motor vehicle accidents. To stay safe on the road, use common sense. Wear your seat belt. Follow the speed limit. Don't drive under the influence of alcohol or any other substances, and don't drive while sleepy.

Suicide is another leading men's health risk. An important risk factor for suicide among men is depression. If you have signs and symptoms of depression — such as feelings of sadness or unhappiness and loss of interest in normal activities — consult your doctor. Treatment is available. If you're contemplating suicide, call for emergency medical help or go the nearest emergency room.

The bottom line

Understanding health risks is one thing. Taking action to reduce your risks is another. Start with healthy lifestyle choices — eating a healthy diet, staying physically active, quitting smoking and getting recommended health screenings. The impact may be greater than you'll ever know.

By Mayo Clinic Staff

Orginal Article: http://www.mayoclinic.com/health/mens-health/MC00013

(Reuters) - U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960.

The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows.

Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops.

The startling economic costs of obesity, often borne by the non-obese, could become the epidemic's second-hand smoke. Only when scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air did policymakers get serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also spurred action. Now, as economists put a price tag on sky-high body mass indexes (BMIs), policymakers as well as the private sector are mobilizing to find solutions to the obesity epidemic.

"As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, 'what policy knob can I turn to stop this hemorrhage?'" said Michael O'Grady of the National Opinion Research Center, co-author of a new report for the Campaign to End Obesity, which brings together representatives from business, academia and the public health community to work with policymakers on the issue.

The U.S. health care reform law of 2010 allows employers to charge obese workers 30 percent to 50 percent more for health insurance if they decline to participate in a qualified wellness program. The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.

Such measures do not sit well with all obese Americans. Advocacy groups formed to "end size discrimination" argue that it is possible to be healthy "at every size," taking issue with the findings that obesity necessarily comes with added medical costs.

The reason for denominating the costs of obesity in dollars is not to stigmatize plus-size Americans even further. Rather, the goal is to allow public health officials as well as employers to break out their calculators and see whether programs to prevent or reverse obesity are worth it.

LOST PRODUCTIVITY

The percentage of Americans who are obese (with a BMI of 30 or higher) has tripled since 1960, to 34 percent, while the incidence of extreme or "morbid" obesity (BMI above 40) has risen sixfold, to 6 percent. The percentage of overweight Americans (BMI of 25 to 29.9) has held steady: It was 34 percent in 2008 and 32 percent in 1961. What seems to have happened is that for every healthy-weight person who "graduated" into overweight, an overweight person graduated into obesity.

Because obesity raises the risk of a host of medical conditions, from heart disease to chronic pain, the obese are absent from work more often than people of healthy weight. The most obese men take 5.9 more sick days a year; the most obese women, 9.4 days more. Obesity-related absenteeism costs employers as much as $6.4 billion a year, health economists led by Eric Finkelstein of Duke University calculated.

Even when poor health doesn't keep obese workers home, it can cut into productivity, as they grapple with pain or shortness of breath or other obstacles to working all-out. Such obesity-related "presenteeism," said Finkelstein, is also expensive. The very obese lose one month of productive work per year, costing employers an average of $3,792 per very obese male worker and $3,037 per female. Total annual cost of presenteeism due to obesity: $30 billion.

Decreased productivity can reduce wages, as employers penalize less productive workers. Obesity hits workers' pocketbooks indirectly, too: Numerous studies have shown that the obese are less likely to be hired and promoted than their svelte peers are. Women in particular bear the brunt of that, earning about 11 percent less than women of healthy weight, health economist John Cawley of Cornell University found. At the average weekly U.S. wage of $669 in 2010, that's a $76 weekly obesity tax.

MORE DOCTORS, MORE PILLS

The medical costs of obesity have long been the focus of health economists. A just-published analysis finds that it raises those costs more than thought.

Obese men rack up an additional $1,152 a year in medical spending, especially for hospitalizations and prescription drugs, Cawley and Chad Meyerhoefer of Lehigh University reported in January in the Journal of Health Economics. Obese women account for an extra $3,613 a year. Using data from 9,852 men (average BMI: 28) and 13,837 women (average BMI: 27) ages 20 to 64, among whom 28 percent were obese, the researchers found even higher costs among the uninsured: annual medical spending for an obese person was $3,271 compared with $512 for the non-obese.

Nationally, that comes to $190 billion a year in additional medical spending as a result of obesity, calculated Cawley, or 20.6 percent of U.S. health care expenditures.

That is double recent estimates, reflecting more precise methodology. The new analysis corrected for people's tendency to low-ball their weight, for instance, and compared obesity with non-obesity (healthy weight and overweight) rather than just to healthy weight. Because the merely overweight do not incur many additional medical costs, grouping the overweight with the obese underestimates the costs of obesity.

Contrary to the media's idealization of slimness, medical spending for men is about the same for BMIs of 26 to 35. For women, the uptick starts at a BMI of 25. In men more than women, high BMIs can reflect extra muscle as well as fat, so it is possible to be healthy even with an overweight BMI. "A man with a BMI of 28 might be very fit," said Cawley. "Where healthcare costs really take off is in the morbidly obese."

Those extra medical costs are partly born by the non-obese, in the form of higher taxes to support Medicaid and higher health insurance premiums. Obese women raise such "third party" expenditures $3,220 a year each; obese men, $967 a year, Cawley and Meyerhoefer found.

One recent surprise is the discovery that the costs of obesity exceed those of smoking. In a paper published in March, scientists at the Mayo Clinic toted up the exact medical costs of 30,529 Mayo employees, adult dependents, and retirees over several years.

"Smoking added about 20 percent a year to medical costs," said Mayo's James Naessens. "Obesity was similar, but morbid obesity increased those costs by 50 percent a year. There really is an economic justification for employers to offer programs to help the very obese lose weight."

LIVING LARGE, BUT NOT DYING YOUNG

For years researchers suspected that the higher medical costs of obesity might be offset by the possibility that the obese would die young, and thus never rack up spending for nursing homes, Alzheimer's care, and other pricey items.

That's what happens to smokers. While they do incur higher medical costs than nonsmokers in any given year, their lifetime drain on public and private dollars is less because they die sooner. "Smokers die early enough that they save Social Security, private pensions, and Medicare" trillions of dollars, said Duke's Finkelstein. "But mortality isn't that much higher among the obese."

Beta blockers for heart disease, diabetes drugs, and other treatments are keeping the obese alive longer, with the result that they incur astronomically high medical expenses in old age just like their slimmer peers.

Some costs of obesity reflect basic physics. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.

"Growing obesity rates increase fuel consumption," said engineer Sheldon Jacobson of the University of Illinois. How much? An additional 938 million gallons of gasoline each year due to overweight and obesity in the United States, or 0.8 percent, he calculated. That's $4 billion extra.

Not all the changes spurred by the prevalence of obesity come with a price tag. Train cars New Jersey Transit ordered from Bombardier have seats 2.2 inches wider than current cars, at 19.75 inches, said spokesman John Durso, giving everyone a more comfortable commute. (There will also be more seats per car because the new ones are double-deckers.)

The built environment generally is changing to accommodate larger Americans. New York's commuter trains are considering new cars with seats able to hold 400 pounds. Blue Bird is widening the front doors on its school buses so wider kids can fit. And at both the new Yankee Stadium and Citi Field, home of the New York Mets, seats are wider than their predecessors by 1 to 2 inches.

The new performance testing proposed by transit officials for buses, assuming an average passenger weight of 175 instead of 150 pounds, arise from concerns that heavier passengers might pose a safety threat. If too much weight is behind the rear axle, a bus can lose steering. And every additional pound increases a moving vehicle's momentum, requiring more force to stop and thereby putting greater demands on brakes. Manufacturers have told the FTA the proposal will require them to upgrade several components.

Hospitals, too, are adapting to larger patients. The University of Alabama at Birmingham's hospital, the nation's fourth largest, has widened doors, replaced wall-mounted toilets with floor models able to hold 250 pounds or more, and bought plus-size wheelchairs (twice the price of regulars) as well as mini-cranes to hoist obese patients out of bed.

The additional spending due to obesity doesn't fall into a black hole, of course. It contributes to overall economic activity and thus to gross domestic product. But not all spending is created equal.

"Yes, a heart attack will generate economic activity, since the surgeon and hospital get paid, but not in a good way," said Murray Ross, vice president of Kaiser Permanente's Institute for Health Policy. "If we avoided that heart attack we could have put the money to better use, such as in education or investments in clean energy."

The books on obesity remain open. The latest entry: An obese man is 64 percent less likely to be arrested for a crime than a healthy man. Researchers have yet to run the numbers on what that might save.

(Editing by Michele Gershberg and Prudence Crowther)

Originaly article found at: http://www.reuters.com/article/2012/04/30/us-obesity-idUSBRE83T0C820120430