Adult obesity rates remained high overall, increased in six states in the past year, and did not decrease in any, according to "The State of Obesity: Better Policies for a Healthier America," a report from the Trust for America's Health and the Robert Wood Johnson Foundation.

The annual report found that adult obesity rates increased in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming.  Rates of obesity now exceed 35 percent for the first time in two states, are at or above 30 percent in 20 states and are not below 21 percent in any.  Mississippi and West Virginia tied for having the highest adult obesity rate in the United States at 35.1 percent, while Colorado had the lowest at 21.3 percent. 

Findings reveal that significant geographic, income, racial, and ethnic disparities persist, with obesity rates highest in the South and among blacks, Latinos and lower-income, less-educated Americans. The report also found that more than one in 10 children become obese as early as ages 2 to 5.
Other key findings from "The State of Obesity" include:

• Among whites, adult obesity rates topped 30 percent in 10 states.
• Nine out of the 10 states with the highest obesity rates are in the South.
• Baby boomers (45- to 64-year-olds) have the highest obesity rates of any age group — topping 35 percent in 17 states and 30 percent in 41 states.
• More than 33 percent of adults 18 and older who earn less than $15,000 per year are obese, compared with 25.4 percent who earn at least $50,000 per year.
• More than 6 percent of adults are severely obese; the number of severely obese adults has quadrupled in the past 30 years.

As of 2011-2012:
• Nearly one out of three children and teens ages 2 to 19 is overweight or obese, and national obesity rates among this age group have remained stable for 10 years.
• More than 1 in 10 children become obese between the ages of 2 to 5; and 5 percent of 6- to 11-year-olds are severely obese.

Recommendations, which were based on a series of in-depth interviews with public health experts in black and Latino communities around the country, included:

• Expand access to affordable healthy foods and opportunities for physical activity by increasing resources for programs, connecting obesity-prevention initiatives with other ongoing community programs, and other approaches.
• Provide education and addressing cultural differences to both improve people's knowledge about nutrition and physical activity and make initiatives more relevant to their daily lives.
• Make sustainability, community input, involvement and shared leadership top priorities of obesity-prevention initiatives from the outset.


Fear, uncertainty and lack of trust send patients back to ED

Patients who return to the emergency department within a few days of discharge do so principally because they are anxious about their symptoms and have lost trust in other parts of the health care system, according to the results of a study published in Annals of Emergency Medicine. To read "Return Visits to the Emergency Department: The Patient Perspective", visit

"When asked why they did not follow up as an outpatient, patients reported feeling that their symptoms were too severe to wait until their scheduled appointment or being instructed to return to the ER by the outpatient provider they contacted," said lead study author Kristin Rising, M.D., of the department of eemergency medicine at Thomas Jefferson University in Philadelphia. 

The paper goes on to say that patients' "decision to return to the emergency department [was] driven largely by fear and uncertainty regarding their medical conditions as well as a lack of trust in the system to be responsive to their needs."  Other prominent themes related to patients' limited use of outpatient care included problems accessing care because of lack of insurance, dissatisfaction with a primary care physician and lack of trust in their primary physician.

Rising and her team conducted 60 in-person interviews with patients who returned to the emergency department within nine days of discharge. The primary reason given for the return was fear or uncertainty about the medical condition that brought them to the ED in the first place.  Neither discharge instructions from the original visit nor transportation were cited as particular post-discharge problems, though many patients reported that their current illness created problems getting around at home.  Forty percent of the patients who returned were admitted to the hospital at the return visit.  These patients were most likely to be experiencing a deterioration of what was a chronic or pre-existing condition (such as asthma).

The majority (70 percent) had a primary care physician. When asked about seeking follow-up care in an outpatient clinic instead of the ED, patients most often reported that clinics lack the necessary resources to complete the work-up or treatment and to sufficiently address their symptoms. Patients also reported delays in diagnosis associated with outpatient testing and inconvenience related to having multiple appointments on different days as limitations in seeking care in clinics.

"The medical community must learn to meet our patients when and where they need us," said Rising.  "Sometimes, they may just need reassurance, especially when there is no clear explanation for what is causing their symptoms.  Going forward, technology may play a role in facilitating connectedness with care teams to help patients stay healthy."

Rates rise for preventable deaths after common urologic procedures

In recent years, a shift from inpatient to outpatient surgery in the United States for commonly performed urologic procedures has coincided with an increasing number of deaths following complications that were potentially recognizable or preventable. The finding, which comes from a study published in BJU International, indicates the importance of monitoring urologic surgery patients for potential complications.

Over the last two decades, measures to improve health care safety and quality have expanded significantly. In the context of surgical procedures, this has led to a decrease in deaths despite an increase in the number of inpatient admissions after surgery. Jesse Sammon, D.O., of the Henry Ford Health System's Vattikuti Urology Institute in Detroit, and his colleagues found that this has not been true for patients undergoing urologic surgery, however. "Unfortunately, we saw an opposite trend in urology, wherein in-hospital surgery rates fell, mortality overall stayed stable, and failure-to-rescue rates — which refer to deaths following complications that were potentially recognizable or preventable — went up," Sammon said.

For their study, the researchers analyzed the discharge records of patients undergoing urologic surgery in the United States between 1998 and 2010. The team found that an estimated 7,725,736 urologic surgeries requiring hospitalization were performed during that time. Admissions for urologic surgery decreased 0.63 percent per year. Odds of dying after urologic surgery decreased ever so slightly overall, yet the odds of dying following complications that were potentially recognizable or preventable increased 1.5 percent every year. Older, sicker, and minority patients, as well as those with public insurance, were more likely to die as a result of a potentially preventable death.

The researchers also discovered evidence of a major shift in the type of patients being admitted for urologic surgeries. Historically, a much larger proportion of relatively healthy urology patients were admitted for low-risk procedures. As surgeons began doing such procedures as outpatient surgeries, the in-patient population became generally sicker. "Consequently, urological surgeons and ancillary staff members need to recognize that the contemporary cohort of urology inpatients is generally at higher risk of complications and consequently failure to rescue mortality," said Dr. Sammon. Therefore, a heightened awareness of early signs of complications may help reduce mortality rates after urologic surgery.