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

Is your new year’s resolution not working out the way you planned? Don’t get down on yourself! More than likely you set a goal that might be too big to reach right away. Don’t fret!

At Access Health, we have the tools and steps that you need to start working towards these bigger goals. There is one key to make this possible… small changes! Step by step you can develop the tools you need to make real changes.

When it comes to getting to your healthy weight, start a fun exercise program to keep you motivated. It always helps to have a goal in mind! Whether it be to manage a health condition, improve stamina, or reduce stress. Once you start an exercise program you will see improvements in sleep, fitness, confidence, and better control of appetite.

You can start by small steps:

  • Take a 10-minute walk just twice a week
  • Find an exercise that works for you: dance, yoga, or karate
  • Talk to your health care provider if you have any past health issues
  • Take the stairs at work instead of the elevator
  • Add a walk into your lunch time
  • Park far from the store while running errands
  • Move around with everyday house chores

Once you start making the small changes then…

  • Aim to exercise around 2.5 hours a week
  • Exercise does not need to happen all at once
  • Break it up into shorter time periods during the day

So don’t give up on that new year’s resolution, just make the small changes to lead to lasting results!

Learn more about steps to have a healthier life, and visit the http://www.nytimes.com/health/guides/specialtopic/physical-activity/overview.html

 

 

 

Improve Your Chances for Good Health

“A health risk is the chance or likelihood that something will harm or otherwise affect your health risk.” People tend to understand that there are health risks around them all the time, but what they don’t understand is that there are things they can do to prevent or lessen the likelihood of health risks.

Health risk factors include: age, gender, family, health history, lifestyle and more. Health risks that are genetically or ethnically connected to a person are more difficult to avoid and/or improve. Other health risks can be improved through control over one’s diet, physical activity, and taking persuasions such as wearing a seatbelt while driving.

Dr. William Elmwood, a psychologist and behavioral scientist at NIH, says that, “Understanding health risks is key to making your own health care decisions.” This is true, the more you know and understand about your body and surrounding factors the better health choices you can make for yourself.  

Read more to further understand the importance of being able to recognize health risks and how to prevent them from happening as well as improve your chances of having good health: https://newsinhealth.nih.gov/issue/oct2016/feature1

 

 

 

 

 

(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