In-depth analyses of racism and greater recruitment of Black practitioners needed to address inequities in mental health treatment for Black Americans

Peer-Reviewed Publication

NYU LANGONE HEALTH / NYU GROSSMAN SCHOOL OF MEDICINE

A series of literature reviews published online December 13 in The Lancet Psychiatry journal highlight the large body of evidence on the role played by racism in mental health disparities experienced by Black people living in the United States. 

Along with an essay from Black Americans that describes their lived experiences, the three new papers in the series include analysis of more than 50 years of literature on the effects of racism. The authors conclude that improving the mental well-being of Black Americans requires a community-centered and culturally informed approach that is inclusive, accessible and promotes empowerment and resilience in Black communities. The papers also highlight the urgent need for Black sociologists, anthropologists, scientists, physicians, clinicians, and citizens to be setting the priorities in mental health care based on lived experiences.

Led by a physician scientist at NYU Grossman School of Medicine, the authors call for a comprehensive analysis of the conditions and systems through which racism produces mental health issues, while highlighting the potential of community-driven action to reduce inequity.

“Our reviews highlight the impact of racism on mental health disparities, and emphasize the need to understand the roots of racial inequity to achieve racial justice in health care,” said series lead author Ayana Jordan, MD, PhD, the Barbara Wilson Associate Professor in the Department of Psychiatry, and co-lead for the community engagement pillar of the Institute for Excellence in Health Equity at NYU Langone Health.

Racism Shapes Black Mental Health

Due to centuries of racism, Black Americans have much greater exposure to risk factors for mental illness, says Dr. Jordan, including lower quality education, impoverished neighborhoods, high rates of homelessness, and exposure to violence with high rates of police brutality. Additionally, the mental health care system as it stands invalidates the experience of Black Americans, dismissing their cultural backgrounds.

Due to inequitable systems that are not culturally informed, Black people are less likely to seek mental health care when compared to White Americans. Further, Black people have historically been excluded from medical research, and Black scientists make up less than 1 % of researchers receiving independent research funding from the US National Institutes of Health.

Centuries of dehumanization have led to underestimation, misdiagnosis, and inadequate treatment of mental illness among Black Americans, says Jordan, who is also an associate professor in the NYU Langone Department of Population Health. The authors argue that the definitions and framing of mental health, mental illness, and the prescriptions for diagnosing, treating, and maintaining wellness have all been grounded in whiteness and myths of white supremacy. They point out that explanations for the differences in rates of mental illness and substance use disorders between racial and ethnic groups have often been incorrectly seen as evidence of biological or cultural distinctions, and are missing explanations of systemic, avoidable, and unjust policies.

To address these challenges, Jordan and colleagues are calling for a comprehensive analysis of the conditions and systems that produce mental illness and compromise mental health. They say this work must go beyond traditional views of individualized mental illness classifications to focus on collective efforts to combat racism and establish equitable systems that promote Black mental health.

Further, the new articles highlight the value of community-based participatory research (CBPR) conducted by Black scientists, Black leaders, and community members to improve the mental well-being of Black Americans. CBPR involves active participation and input from community members throughout the research process, giving communities a voice as they work with researchers toward long-lasting and culturally appropriate solutions.

In addition, the work looks at the effect of racism on epidemiology, the scientific discipline that estimates the burden of mental illness in populations. Effective sampling and minimizing bias are essential, particularly when the estimates are being used to determine policy. Thus, the methods of collecting, using, and analyzing epidemiological data are critical to the ways in which the intersection of race and mental illness is understood.

The researchers point out that explanations for the differences in rates of mental illness and substance use disorders between racial and ethnic groups are missing explanations of the systemic unjust policies underlying the inequities. For example, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which has long been the classification system to understand mental illness, does not fully capture the experience of being racialized as Black, Jordan notes. Instead of understanding the effects of racism, the DSM-5 locates the problems of mental illness in the bodies and behaviors of individuals and categorizes differences by race—perpetuating systemic biases.

The series authors are calling for a large-scale study that identifies publicly available datasets on political districting, economic factors, environmental exposures to racism, and individual-level data related to emotional wellbeing, standardizes them for analysis, and analyzes the data for impact on emotional wellbeing. This could serve as the basis for a risk index that quantifies different exposures to racism and their potential impact on emotional wellbeing.

This integrated analysis can inform policies by capturing the dramatic impact of inequities on Black mental health in terms of civilian deaths from police, the percentage of those where substance use and mental illness were involved in deaths, the lack of access to treatment, the likelihood of incarceration, and the way Black people are portrayed in the media.

Articles for this review were identified through searches of PubMed and Google Scholar for work published from January, 1969 to October, 2023, by use of the terms “racism”, “racial inequalities”, “mental health”, “Black people”, “minority”, and “public policy”.

Along with Dr. Jordan, authors of review series were Mindy Fullilove, MD, of The New School; Ebony Dix, MD, of Yale University School of Medicine; Sidney Hankerson, MD, of the Icahn School of Medicine at Mount Sinai; Jonathan Lassiter, PhD, of Cooper Medical School at Rowan University, Alfiee Breland-Noble, PhD, of the African American Knowledge Optimized for Mindfully-Health Adolescents (AAKOMA) Project, Frederick Streets, DSW, of Yale Divinity School; and Chyrell Bellamy, PhD, Richard Youins, and Kimberly Guy of the Program for Recovery and Community Health at Yale University School of Medicine.

The series was funded by NYU Grossman School of Medicine Department of Psychiatry, the Yale Department of Psychiatry, and the Yale School of Medicine, as well as by grant 5H79TI081358-04 from the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services, grant 5R01AA028778-04 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and grant 1R01DA057651-01 from the National Institute on Drug Abuse (NIDA). NIAAA and NIDA are part of the National Institutes of Health.

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JOURNAL

The Lancet Psychiatry

DOI

10.1016/S2215-0366(23)00361-9 

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Lancet Psychiatry Series on Black mental health in the USA: Nothing for us without us

ARTICLE PUBLICATION DATE

13-Dec-2023

Racial equity in living donor kidney transplant centers

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: The results of this study of data on 57,000 adults who received living donor kidney transplants indicate that additional work is necessary to identify transplant program and center-level strategies to improve racial equity in access to living donor kidney transplant. 

Authors: Lisa M. McElroy, M.D., M.S., of the Duke University School of Medicine in Durham, North Carolina, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.47826)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

#  #  #

Embed this link to provide your readers free access to the full-text article 

 http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.47826?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=121523

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication. 

 

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JOURNAL

JAMA Network Open

Guiding principles to address bias in healthcare algorithms

Peer-Reviewed Publication

UNIVERSITY OF CHICAGO MEDICAL CENTER

A paper published today in JAMA Network Open addresses bias in healthcare algorithms and provides the healthcare community with guiding principles to avoid repeating errors that have tainted the use of algorithms in other sectors.

This work, conducted by a technical expert panel co-chaired by Marshall Chin, MD, MPH, the Richard Parrillo Family Distinguished Service Professor of Healthcare Ethics at the University of Chicago, supports the Biden Administration Executive Order 14091, Further Advancing Racial Equity and Support for Underserved Communities Through The Federal Government, issued on February 16, 2023. President Biden calls for Federal agencies to consider opportunities to prevent and remedy discrimination, including by protecting the public from algorithmic discrimination.

The technical expert panel was supported by the Agency for Healthcare Research and Quality (AHRQ) and the National Institute for Minority Health and Health Disparities at the National Institutes of Health (NIH) in partnership with the HHS Office of Minority Health and the Office of the National Coordinator for Health Information Technology.

“Healthcare algorithms, including those developed by artificial intelligence, have potential for great benefit and great harm. We know that biased algorithms have harmed minoritized communities in other fields such as housing, banking, education, and criminal justice,” Chin said.

The use of algorithms is expanding in many realms of healthcare, from diagnostics and treatments to payer systems and business processes. Every sector of the healthcare system is using these technologies to try to improve patient outcomes and reduce costs.

The panel developed a conceptual framework to apply the following guiding principles across an algorithm’s life cycle to address the problems of structural racism and discrimination, centering on healthcare equity for patients and communities as the overreaching goal:

1. Promote health and healthcare equity during all healthcare algorithm life cycle phases.
2. Ensure healthcare algorithms and their use are transparent and explainable.
3. Authentically engage patients and communities during all healthcare algorithm life cycle phases and earn trustworthiness.
4. Explicitly identify healthcare algorithmic fairness issues and tradeoffs.
5. Establish accountability for equity and fairness in outcomes from healthcare algorithms.

The technical expert panel reviewed evidence, heard from stakeholders, and received community feedback.  Although algorithms are widely used and can offer value in diagnostics and treatments, not all individuals benefit equally from such algorithms, creating inequities. This is due primarily to biases that result in undue harm to disadvantaged populations, which perpetuates healthcare disparities and may violate civil rights protections. To rectify these issues, the healthcare community and the public must understand how using algorithms may lead to unintended biased outcomes, how to identify biases before implementation, and what to do with biases discovered after implementation.

“Algorithmic bias is neither inevitable nor merely a mechanical or technical issue. Conscious decisions by algorithm developers, algorithm users, the healthcare industry, and regulators can mitigate and prevent bias and proactively advance health equity,” Chin said.

 

The paper, Guiding Principles to Address the Impact of Algorithm Bias on Racial and Ethnic Disparities in Health and Health Care, may be found in JAMA Network Open. The journal also links to an accompanying podcast interview of panel co-chairs Marshall Chin, MD, MPH, and Lucila Ohno-Machado, MD, PhD, MBA.

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JOURNAL

JAMA Network Open

U$A

Facility fees charged by hospitals for colonoscopy procedures are about 55 percent higher than those charged by surgical centers

Analysis used national insurer data provided under Transparency in Coverage requirement that went into effect in July 2022

Peer-Reviewed Publication

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

U.S. hospitals charge facility fees for colonoscopy procedures covered by private health insurance that are on average approximately 55 percent higher than facility fees billed by smaller clinics known as ambulatory surgical centers, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health. 

The findings appear in a peer-reviewed research letter to be published online December 15 in JAMA Health Forum.

Colonoscopies are widely used for cancer screening among people who are middle age and older and/or have a family history of colorectal cancer, with current guidelines recommending colonoscopies starting at age 50. The outpatient procedures are routinely performed at hospitals and ambulatory surgical centers.

Under a Transparency in Coverage requirement that went into effect in July 2022, insurers must publish their in-network rates for covered items and services. The analysis, one of the first to use Transparency in Coverage data, found that hospitals billed an average of $1,530 in facility fees for colonoscopies, $1,760 for colonoscopies with biopsy, and $1,761 for colonoscopies with removal of polyps, compared to $989, $1,034, and $1,030 in facility fees at ambulatory surgical centers. 

The researchers determined that colonoscopy facility fees were, respectively, 54, 56, and 61 percent higher for hospitals than ambulatory surgical centers located in the same county and contracting with the same insurer. (The study did not analyze facility fees charged under Medicaid and Medicare insurance.)

“These price differences for the same services are hard to justify,” says study senior author Ge Bai, PhD, CPA, a professor in the Bloomberg School’s Department of Health Policy and Management. “Higher prices mean higher premium payments from patients and higher premium contributions from their employers.”

Bai is also a professor of accounting at Johns Hopkins Carey Business School. The study’s first author was Yang Wang, PhD, assistant research professor in the Bloomberg School’s Department of Health Policy and Management.

Over the past century, health care in the United States has shifted from a simple, individual-based system to a regulated, insurance-based system. That shift has weakened the market forces that, for health care providers, would normally compel price transparency and constrain pricing power. Providers in recent decades have largely not made available their prices to the public, and often charge dramatically different prices for the same service. 

The Transparency in Coverage rule stems from an executive order issued June 2019 by the Trump Administration that went into effect July 1, 2022. The rule is meant to stimulate competition and reduce prices by restoring price transparency; it requires insurers to post prices for covered items and services.

In their study, the researchers analyzed Transparency in Coverage data for 13,287 colonoscopy facility fees charged by 3,582 hospitals and 17,052 ambulatory surgical centers in 50 states and Washington, D.C., as of May 2023. The data came from four major private health insurers: Cigna, Anthem, Healthcare Service Corp., and UnitedHealthcare, and covered three types of colonoscopy procedures: colonoscopy, colonoscopy with biopsy, and colonoscopy with removal of polyps.

Bai notes that while hospitals incur higher costs primarily due to their greater overhead expenses, these pricing differences could be burdensome. The study suggests that patients could benefit from site-neutral payment policies that remove price differences based on the service site for standard services such as colonoscopies. 

The authors note in the research letter that results might not be generalizable to other procedures or non-major insurers. 

“Facility Fees for Colonoscopy Procedures at Hospitals and Ambulatory Surgical Centers” was co-authored by Yang Wang, Yuchen Wang, Elizabeth Plummer, Michael Chernew, Gerard Anderson, and Ge Bai.

Support for the research was provided by Arnold Ventures and PatientRightsAdvocate.org

 U$A

Health insurance coverage, access to care continued to decline for sexual minorities during COVID

A new study found that sexual minority women had worse access to care and sexual minority men were less likely to be able to afford necessary medical care compared to their heterosexual peers during the pandemic

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH

Uninsurance rates among sexual minorities have increased steadily from their low in 2016 in the United States, affecting a population that has historically had fewer opportunities to access comprehensive health services, compared to heterosexual individuals.

These inequities in health insurance coverage and access to care widened even further during the COVID-19 pandemic, according to a new study led by a Boston University School of Public Health (BUSPH) researcher.

Published in the American Journal of Public Health, the study found that sexual minority women were significantly more likely to be uninsured than heterosexual women, and sexual minority men faced greater challenges affording necessary care with health insurance than heterosexual men.

The study builds upon previous research about these disparities, but assesses a much larger study population than past studies—nearly 160,000 US adults.

These findings suggest that insurance status is an important driver of access to care for sexual minority populations, and these populations may disproportionately lose health insurance coverage as state-level eligibility rules continue to change across the country following the expiration of Medicaid continuous enrollment protections earlier this year. Medicaid covers higher rates of sexual minority adults than heterosexual adults.

“This steady rise in uninsurance rates beginning in 2017 likely reflect efforts to undermine the Affordable Care Act during President Donald Trump’s administration,” says study lead and corresponding author Dr. Kevin Nguyen, assistant professor of health law, policy & management. “Our study suggests that sexual minority adults may have been disproportionately impacted by employment loss and health insurance loss during the pandemic.”

For the study, Dr. Nguyen and colleagues from BUSPH, Columbia University School of Social Work, and Vanderbilt University utilized data from the Behavioral Risk Factor Surveillance System data to examine differences in health insurance coverage type and access to care by sex and sexual orientation among 158,722 adults ages 18-64, from January 2021 to February 2022.

Overall, about 1 in 8 nonelderly sexual minority adults in 34 states were uninsured in 2021, compared to 1 in 10 heterosexual adults. Sexual minority men and women were much more likely to not have employer-sponsored health insurance compared to heterosexual adults, and were more likely to have Medicaid insurance than heterosexual men and women. Sexual minority women—particularly those who were uninsured—were less likely to have a personal doctor or a checkup in the last two years. While sexual minority men were more likely to report having health insurance and a doctor, they had greater difficulty paying for this care than their heterosexual peers.

The researchers emphasize that public policies likely play a critical role in reducing health inequities. They found that, for both men and women, living in states with the most inclusive LGBTQ+ policies narrowed the disparities in inability to afford necessary medical care compared to states with negative LGBTQ+ policies.

Expanding Medicaid in the 10 states that have not done so could also reduce inequities in uninsurance for low-income sexual minority adults, the team says. Broader policy changes that support well-being can also help close this gap in access to care.

“Because inequities in health insurance coverage and access to care are, in part, a reflection of discrimination and structural barriers, social policies that codify equality by sexual orientation and/or gender identity—such as passage of the federal Equality Act—could potentially have positive impacts on health, financial security, and access to care,” Dr. Nguyen says.

**

About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.

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JOURNAL

American Journal of Public Health

DOI

10.2105/AJPH.2023.307446 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Health Insurance Coverage and Access to Care by Sexual Orientation During the COVID-19 Pandemic: United States, January 2021–February 2022

ARTICLE PUBLICATION DATE

13-Dec-2023

 

News sites continue to stigmatize people’s weight, study suggests

Peer-Reviewed Publication

TAYLOR & FRANCIS GROUP

The largest US and UK news sites are continuing to stigmatize people’s weight with the images they use, suggests a new peer-reviewed study published in the Journal of Health Communication.

Assessing 445 stories about obesity over the course of a year, researchers from the University of Connecticut and the Rudd Center for Food Policy and Health found that “stigmatizing” images were used 70% of the time when the articles were focused on people of higher weight.

Women were also demonstrated to be “significantly” more likely than men to be featured in images accompanying obesity-focused news.

Calling for “broader systemic efforts” from the news media industry, lead author of the new study Aditi Rao, from the Department of Communication at the University of Connecticut, states the team’s findings highlight that news media need to “be mindful of the images included in obesity and health news”.

“Even if news articles report on societal issues and policies related to health, these stories can inadvertently communicate weight stigma when the accompanying image negatively stereotypes individuals with higher weight,” says Rao, a PhD Student and Graduate Assistant.

“By using appropriate and respectful depictions, news images can be a tool for eliminating negative societal perceptions of persons with larger body sizes.”

The latest research on this topic area, the research assessed articles from CNN; HuffPost US; Fox News; and The New York Times, in the US, and in the UK: the BBC; the Guardian; Sky News; and HuffPost UK.

Across these eight news sites, news articles were searched using the following terms: “overweight,” “obesity,” and “obese”.

An image was classed as “stigmatizing” if it demonstrated one of five features such as “disproportionately emphasizing” the abdomen/lower body of a higher-weight individual, portraying the higher-weight individual without clothes, and showing the individual to be engaged in a stereotypical activity, such as consuming fast food or sitting on a couch watching TV.

The findings show UK news sites were 2.5 times more likely to contain stigmatizing images than U.S. news.
The BBC had the highest number of stigmatizing depictions across all eight news sources, followed by Sky News.

In the US, 54% of people of higher weight were depicted in a stigmatizing manner. This is lower compared to studies conducted a decade ago, which suggests an improvement. However, “the majority of the depictions continue to be negative and stigmatizing,” says co-author Dr. Rebecca Puhl, a professor in the Department of Human Development and Family Sciences and Deputy Director of the Rudd Center for Food Policy and Health, both at the University of Connecticut.

Political leaning of the news source also influenced findings; conservative news sources were “significantly more likely” to depict higher-weight individuals in a stigmatizing manner than liberal news sources.
Further, the prevalence of stigmatizing images was almost twice as high in articles addressing consequences of obesity than in those addressing contributors to obesity.

The issue may relate to stock imagery problems, the authors suggest, with journalists and the stock imagery photographers potentially being “unaware of weight bias or insensitive to respectful representations of persons with higher weight”.

Fellow co-author Dr. Kirstie Farrar, a professor in the Department of Communication, University of Connecticut, adds: “This stigma in news images is still a persistent problem that needs to be addressed."

“While suppliers of stock images offer a variety of creative and vivid visuals produced by professionals, the visuals don’t appear to be screened for weight-stigmatizing content.”

Moving forward, the authors suggest future research should examine visual representations of stigma related to not just obesity, but other sensitive health issues such as mental health as well.

This study has “several limitations” the authors state. One being that it only focused on images. They recommend a visio-textual analysis assessing news articles in its entirety along with the effects of multiple narratives could offer more insights especially with respect to potential effects of the article topic.

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JOURNAL

Journal of Health Communication

DOI

10.1080/10810730.2023.2286512 

ARTICLE TITLE

Weight Stigma in Online News Images: A Visual Content Analysis of Stigma Communication in the Depictions of Individuals with Obesity in U.S. and U.K. News

Being overweight costs society far more than obesity

Far more people are overweight than obese, which means their overall use of the health care system may be far larger than for those who are heavier.

Peer-Reviewed Publication

NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY

“

We often hear that obesity represents a high cost for both individuals and society because it increases the risk of health problems. All in all, however, the costs associated with being overweight are much higher,” says Christina Hansen Edwards, a researcher at the Norwegian University of Science and Technology (NTNU).

Since the 1980s, Norwegians have become increasingly heavier. Over the past 40 years, the percentage of people with obesity, i.e. a body mass index (BMI) of over 30, has increased significantly. It is currently estimated that almost one in four Norwegians is obese, which is comparable to obesity rates throughout Europe.

However, the number of people who are ‘only’ overweight has also increased. During the period 1980 to 2000, the average BMI of the population increased by one point every decade.

“We are seeing a shift in the entire population towards a higher BMI. People with a BMI in the ‘normal range’ have also gained weight,” says Edwards.

The researchers have now looked at the relationship between BMI and costs in the specialist health service.

“Although the individual costs are highest for people who are obese, the total costs for society are highest in relation to people who are overweight, since there are many more people who are overweight than obese," says Gudrun Maria Waaler Bjørnelv, a researcher at NTNU’s Department of Public Health and Nursing.

Population-level measures needed

In other words, although the risk of disease is higher if your BMI is over 30, the overall risk of disease in the entire population will be greater with a BMI of over 25. This is because the vast majority of people find themselves within this range on the scale.

Edwards thinks it is important for politicians to be aware of this when managing health and societal resources.

“People with obesity need good treatment from the health services. However, in order to ease the burden of disease and the costs of overweight and obesity in the entire population, individualized treatment should be combined with effective measures at the population level,” says Edwards.

The study is based on figures from the HUNT Study – a longitudinal population health study in Norway. It shows that 75 per cent of men and 61 per cent of women were overweight or obese.

Of these, 3.7 per cent of men and 6.6 per cent of women had a BMI of over 35, while 22.4 per cent of men had a waist measurement of more than 102 cm, and 23.4 per cent of women had a waist measurement of over 88 cm.

“At the individual level, we saw that an increase in BMI resulted in the greatest increase in expenses for the specialist health services among those who previously had the highest BMI. If one compares a man with a BMI of 37 to a man with a BMI of 38, on average, the latter will result in NOK 2110 (roughly US $210) more in average costs for the specialist health services per year. A similar difference in men with a BMI of 27 and 28 respectively will only result in an increase of NOK 293 (approximately US$ 29)," Edwards said.

 

Should not feel ashamed

Similar comparisons among women show differences of NOK 1306 (US $130)  and NOK 277 (US $28), respectively. However, when the researchers look at the figures for the population as a whole, the picture changes.

“At the societal level, by contrast, we see that the largest increase in costs for the specialist health services was due to changes in BMI in people that were ‘only’ overweight, i.e. they had a BMI of between 25 and 30, as well as in those with mild obesity, i.e. a BMI of between 30 and 35. This was true for both women and men,” says Bjørnelv.

She emphasises that the point of the comparison is not primarily to save the health service money, but that the specialist health service costs reflect the burden of disease, both in individuals and in society.

"People with obesity should not feel ashamed that they cost society money," Bjørnelv said.

“Obesity is often portrayed as expensive for society,” he said, referring to the Norwegian Broadcasting Corporation's series ‘A fat life’.

In this TV series, host Ronny Brede Aase uses himself and his own body to shed light on questions about obesity, lifestyle and health. In the series, Aase says that he is "an expenditure," which Bjørnelv says is not necessarily correct.

“People with obesity should not feel ashamed that they cost society money. Although they are at higher risk of disease, the highest specialist health service costs result from those who are overweight," he said. “We don’t want people who are overweight to feel ashamed because of that, but we need to be reflective in how we shed light on the issue and how we deal with this as a society."

Recent research has shown that people with a high BMI have an increased likelihood of being stigmatized and discriminated against, also in the healthcare system.

"This can cause people with a high BMI to avoid the use of health services, so that they receive poorer health services and the relationship between doctor and patient is damaged. This is a field where there is a clear need for more research, for example on how stigma affects the costs of health services in the longer term," Bjørnelv said.

Consensus on risk

The researchers are also keen to emphasise that BMI as a unit of measurement is primarily important when looking at overweight and obesity in groups, and not in each individual.

“BMI alone is not a suitable measuring unit at an individual level, but at a population level it can give a good picture of obesity and overweight," Edwards said.

She clarifies that the results in the study are average costs for different BMI values, and that there are variations around this average. A single person with a given BMI will therefore not be able to use these results to say anything about own costs.

It is also not a given that being overweight leads to health problems.

"This is where the variation comes in. A person with a BMI of 33 does not necessarily have higher costs for health services than a person with a BMI of 23. But if we look at the average of all people with a BMI of 33 and 23, then people with a BMI of 33 have higher costs for health services than those with BMI of 23," she said.

It would therefore be more appropriate to direct measures to the entire population.

BMI is thus primarily a useful unit of measurement at the population level, and less useful for individuals.

"In our study, we investigated the relationship between BMI and healthcare costs," she said.

Although this relationship can be influenced by many different factors, there is broad agreement among researchers that an increase in BMI increases the risk of a number of diseases, Edwards said.

It would therefore be appropriate to implement measures that target the entire population the researchers concluded.

“The challenge then is finding out which measures work,” says Edwards.

So, what should health policymakers do? Bjørnelv and Edwards believe it is important that studies are conducted on the effectiveness of national public health measures.

"The measures that were introduced as part of the Smoking Act were unpopular when they were introduced, but eventually this turned around completely. Similar measures, such as advertising bans, taxation, and access restrictions on unhealthy food, could have been tested to overcome the obesity pandemic. This requires brave politicians who dare to take controversial decisions," Edwards said.

Reference:
Christina Hansen Edwards, Gudrun Waaler Bjørnelv, Karsten Øvretveit, Kristian Hveem, Johan Håkon Bjørngaard: Healthcare costs associated with overweight and obesity at an individual versus a population level – a HUNT study. The Journal of the Norwegian Medical Association. Published 19 September 2023
doi: 10.4045/timeskr.22.0726

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JOURNAL

Tidsskrift for Den norske legeforening

DOI

10.4045/timeskr.22.0726 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Healthcare costs associated with overweight and obesity at an individual versus a population level – a HUNT study

 

Insights into the metabolism of plastic-eating bacteria

Peer-Reviewed Publication

FORSCHUNGSZENTRUM JUELICH

 

IMAGE: 

IRIDESCENT LAYERS OF HALOPSEUDOMONAS BACTERIA

view more 

CREDIT: COPYRIGHT: IMET

Plastic-eating bacteria could help to curb the global waste problem in the future. But many questions remain unanswered. Researchers at Forschungszentrum Jülich and Heinrich Heine University Düsseldorf have now shown for the first time how bacteria of the genus Halopseudomonas break down common plastic coatings made of polyester urethane. The metabolic pathways and enzymes described underline the relevance of the newly isolated bacterium for the biodegradation of plastics and pave the way for its application.

Plastic materials are indispensable in everyday life. But if they are left lying around, they become a problem. As they do not decompose, they accumulate in the environment, a process that has already led to global pollution. Only recently, a promising candidate was discovered – bacteria of the genus Halopseudomonas. Researchers at Forschungszentrum Jülich and Heinrich Heine University Düsseldorf have now taken a closer look at these bacteria. The results have been published in two joint articles in the journal Microbial Biotechnology.

Halopseudomonas bacteria live in the deep sea in places that are polluted with crude oil or heavy metals. However, they have also been found in compost heaps. Researchers from Jülich and Düsseldorf have now discovered that the bacteria have a particular appetite for so-called polyester polyurethanes. This type of plastic is used to coat textiles, ropes and fishing nets, among other things, which improves their durability but at the same time makes it more difficult to break down or recycle these plastic materials.

One promising solution of this problem lies with the bacterium Halopseudomonas formosensis FZJ, which was isolated from a compost heap. The bacteria can rapidly biodegrade polyester urethane coatings and is particularly tolerant of the high temperatures that typically occur in compost.

Researchers led by Prof. Nick Wierckx from the Institute of Bio- and Geosciences (IBG-1) at Forschungszentrum Jülich have succeeded in elucidating the metabolic pathways underlying this process. In the paper by Jan de Witt et al., they also describe an enzyme involved in the coating degradation.

Pathways to biotechnological application

Researchers at the Institute for Molecular Enzyme Technology at HHU Düsseldorf led by Prof. Karl-Erich Jaeger have investigated further steps towards practical implementation. In the paper by Luzie Kruse et al. they further unlock Halopseudomonas bacteria for biotechnology applications by developing appropriate cultivation strategies and molecular biological methods allowing for genetic modification of these bacteria. It is also shown that these bacteria can utilize dicarboxylic acids, which are components of many plastics.

"These two publications provide detailed insights into the microbial degradation of plastics and underlines the importance of the newly isolated bacterium for future processes enabling plastic biodegradation and bio-upcycling", Nick Wierckx and Karl-Erich Jaeger agree.

This work arose from a fruitful collaboration between the HHU Institute of Molecular Enzyme Technology IMET led by Jaeger and the research group "Microbial Catalysis" led by Wierckx at the Jülich Institute of Bio- and Geosciences IBG-1. The work in the Wierckx group was funded by the EU Horizon 2020 project Glaukos, the work in the Jaeger group by the BMBF projects No-Stress and PlastiSea. The plastic coatings were provided by industry partners I-Coats and Covestro. The close collaboration between the IBG-1 and IMET teams with industry partners thus paves the way for potential applications in biotechnology and bioremediation.

 

"Plastic-eating" Halopseudomonas bacteria.

CREDIT

Copyright: IMET

From left to right: Jan de Witt (Wierckx working group, IBG-1, Forschungszentrum Jülich), Rebecka Molitor and Luzie Kruse (Jaeger working group, IMET, HHU Düsseldorf).

CREDIT

Copyright: HHU Düsseldorf / IMET

JOURNAL

Microbial Biotechnology

DOI

10.1111/1751-7915.14369 

ARTICLE TITLE

Halopseudomonas species: Cultivation and molecular genetic tools

 

Princeton research reveals the secret sites where America’s migrating songbirds stop to rest and refuel

Peer-Reviewed Publication

PRINCETON SCHOOL OF PUBLIC AND INTERNATIONAL AFFAIRS

Every year, billions of birds migrate thousands of miles from their summer breeding ranges to their warmer wintering ranges and back. However, the question of where these birds stop to rest and refuel along the way has long stumped ornithologists. Princeton Ph.D. student Fengyi Guo and her colleagues from Princeton and the University of Delaware address this question in a newly published paper by using weather radar imagery to map the birds’ migratory stopover sites in North America.   

Using weather surveillance radar to compute and compare bird movement patterns across five years of spring and fall migrations, Guo and her team pinpointed over 2.4 million hectares of land as key stopover hotspots for landbirds across the eastern United States.

“Most landbirds migrate at night, and they typically lift off from their stopover site to continue their journeys shortly after sunset. Weather radar actually captures this movement of birds, but it requires a lot of processing of the data ,” explains Guo.  “Each weather radar actively samples the atmosphere every 6-10 minutes and can detect the take-off of birds up to 80 km in radius. Sampling the nightly take-off patterns gives us the spatial details of the daily stopover habitat use of those transient migrants.”

The fast-growing field of radar ornithology provides an invaluable peek at the secret lives of migratory birds at an unprecedented scale. David Wilcove, a C-PREE faculty member and co-author of the paper, explains the importance. 

“Fengyi’s work using weather radar images of migration provides us with the first accurate picture of where the key stopover sites for these birds are across the eastern United States.” Wilcove explains. “This information is incredibly important. Without it, we wouldn’t know which sites to protect to ensure safe passage for the birds.” 

The radar imagery showed that stopover hotspots along the eastern U.S. consist primarily of deciduous forests, including forest fragments in broadly deforested regions. These hotspots serve as crucial pitstops for large numbers of landbirds each year. Protecting these sites helps to ensure the long-term viability of all the bird species that sojourn at these sites.

However, only half of the currently protected hotspots are free from any form of extractive resource use, and two thirds of all identified hotspots lack any formal protection at all.  Guo also found substantial seasonal differences in where hotspots were located.  In other words, the places where birds choose to rest and refuel in the fall often do not overlap with the places they use on their return flights in the spring.  Overall, only 17% of hotspots were shared in both seasons. This suggests that sufficiently safeguarding landbirds along both legs of their thousand-mile journeys will require protection of a large number of sites spread across the eastern half of the country. 

Since 1970, migratory bird populations have plummeted by more than a quarter in the United States, a loss attributable to a host of human-induced factors including habitat loss, overexploitation, and climate change. In their paper, the authors emphasize the importance of protecting key habitats:

“We found generally higher stopover densities in protected areas than in unprotected areas in both seasons,” the report states.  “A well-distributed network of well-protected stopover areas, complementing conservation efforts on the breeding and wintering grounds, is essential to sustaining healthy populations of migratory landbirds in North America.”  
 

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“Seasonal patterns and protection status of stopover hotspots for migratory landbirds in the eastern United States,” was published online in Current Biology on Dec 12, 2023.  The authors are Fengyi Guo, Jeffrey J. Buler, Jaclyn A. Smolinsky, and David S. Wilcove*.  

*C-PREE Affiliates

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JOURNAL

Current Biology

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Seasonal patterns and protection status of stopover hotspots for migratory landbirds in the eastern United States

ARTICLE PUBLICATION DATE

12-Dec-2023

Cockroaches can transmit antimicrobial resistance genes between groups

Peer-Reviewed Publication

AMERICAN SOCIETY FOR MICROBIOLOGY

Washington, D.C.—A new paper describes a study of antimicrobial resistance (AMR) transmission among cockroaches, with implications for AMR transmission in humans. The study was published in mSystems, a journal of the American Society for Microbiology.

AMR represents a serious threat to the health of humans and other animals. With fewer and fewer drugs being effective against some microbial pathogens, infections have become increasingly difficult to treat. Theoretical modeling has been used to explore the spread of AMR through the microbiome of the symbiotic, or nonpathogenic, gut of animals. The present study represents a real-world investigation.

Gregarious insects such as cockroaches permit a simple, easily maintained experimental system to test microbial transmission of AMR. Many cockroach species live in dense groups and have frequent contact, parallel to humans living in urban environments. Researchers added tetracycline to the diet of a population of socially interactive cockroaches. Tetracyclines are a class of antibiotics that treat several kinds of bacterial infections. They observed an increase in abundance of tetracycline resistance genes in their gut microbiomes. 

The researchers at the Technical University of Denmark then allowed an untreated population of cockroaches to mix with the tetracycline-treated ones. After interaction with treated cockroaches, the untreated ones also displayed elevated resistance to tetracycline, as did the soil substrate in the habitat which housed the cockroaches. The levels of tetracycline resistance depended on the extent and the frequency of interaction between treated and untreated cockroach populations.

The results of the study illustrate that the direct overuse of antibiotics may not be the only way in which AMR is transmitted; animals carrying AMR genes in their microbiomes can interact with those that do not, facilitating transmission of AMR genes between them. Complementary research in mammals will be needed to confirm these results and extrapolate the findings to humans.

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The American Society for Microbiology is one of the largest professional societies dedicated to the life sciences and is composed of 36,000 scientists and health practitioners. ASM's mission is to promote and advance the microbial sciences.

ASM advances the microbial sciences through conferences, publications, certifications, educational opportunities and advocacy efforts. It enhances laboratory capacity around the globe through training and resources. It provides a network for scientists in academia, industry and clinical settings. Additionally, ASM promotes a deeper understanding of the microbial sciences to diverse audiences.

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JOURNAL

mSystems