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Yahoo
15-04-2025
- Health
- Yahoo
Hold the fries. Forgo the soda. R.I. kids' menus could get a tad healthier under proposed bill.
A photo illustration of a Happy Meal at McDonald's in San Francisco, California. In 2010, San Francisco became the first city in the nation to pass a law to control giving away free toys with unhealthy meals for children. (Photo by David) Kids' menus may serve up smaller portions, but smaller doesn't always mean healthier. A piece of legislation recently heard in both chambers of the Rhode Island General Assembly would set nutritional standards for restaurants that serve kids' meals by capping calories, sodium, added sugars, and fats. The default drink included with a children's meal would be water, milk or a milk substitute. Sen. Pam Lauria, the bill's sponsor and a Barrington Democrat, told her colleagues at an April 10 hearing of the Senate Committee on Health and Human Services that the Healthy Kids Act isn't meant to limit what businesses can do, but instead aims to improve families' access to more nutritious meals for their kids. 'Parents are very busy,' Lauria said. 'There are sports, there are activities, and frequently they need to feed their children on the fly, and they will frequent a restaurant to help them to do that.' The bill would give parents more 'healthy options,' Lauria said, by specifying each restaurant with a kids' menu serve at least two qualifying meals. A healthy kid's meal per the bill's definition has no more than 550 calories, 700 milligrams of sodium, and 15 grams of added sugars. A maximum 10% of calories would come from saturated fat, and no trans fats would be allowed. Portions would need to include at least two of five food groups, with one of them being a fruit or non-fried vegetable. The remaining kids' meals would not need to follow these standards, and the default beverage choices could also be swapped out at the customer's request. 'What this bill does not do is stop restaurants from serving anything else that they want for children,' Lauria said to the Senate committee. 'Kids can still have a hot dog if it's on the menu, kids can still have chicken nuggets if they're on the menu. Kids can still have a soda if they prefer, if their parents allow. This [bill] just says that we have to acknowledge that we need healthy options available, and that the healthy options should probably be default, particularly when it comes to sugary drinks.' On the House side, the Healthy Kids Act is sponsored by Rep. Susan Donovan, a Bristol Democrat, and has not yet been scheduled for a committee hearing. Lauria said that the bill was spurred by the 'heartbreaking' prevalence of obesity among Rhode Island kids. According to the 2024 Rhode Island KIDS COUNT Factbook, Rhode Island ranks last place in New England for the number of children ages 10 to 17 that are overweight or obese, accounting for 35% of that demographic. Rhode Island ranks 39th on this same metric nationally, according to the factbook. There are also racial disparities in these numbers, the factbook noted: In 2022, 17% of Hispanic children ages 2 to 17 were overweight and 32% were obese, and 16% of non-Hispanic Black children were overweight and 28% were obese. Doctors showed up to support the bill last week in the Senate, including Dr. Amy Nunn, CEO of the Rhode Island Public Health Institute and a professor at Brown University. The proposal is 'just a common sense bill that promotes healthy opportunities for kids,' Nunn said. 'Our obesity rates are nearly on par with states in the Deep South…Our children, our Hispanic children in Rhode Island, fare 49th in terms of lifetime health and education achievements. Those statistics are breathtaking.' Nunn said the bill was about making accessible the kinds of meals 'you would want to put in front of your children. Nobody wants their kids to be eating supersized food.' Dr. Philip Chan, also of the Public Health Institute and a primary care physician with Brown University Health, framed the bill as a preemptive measure to reduce chronic disease rates and health problems seen in Rhode Island's adult population. 'These behaviors start in childhood, right? So we have to start there in terms of addressing them,' Chan told senators. 'You can have the chicken nuggets, you can have the lemonade or soda every once in a while, but have a vegetable, have a fruit. This is the thing that we try to teach our children. A lot of times you can't find veggies or fruit on the menu. You have to order it specially made.' The push to legislate healthier kids' menus is not new. An April 2024 roundup by the Center for Science in the Public Interest found over 30 jurisdictions have laws governing children's meals. The majority of these laws regulate the default beverage to push kids away from soda or other sugary drinks. Nutrition-based laws — ones closer to Rhode Island's current proposal — are largely found in county-level governments, many of them in Maryland. Statewide initiatives in California, Hawaii, Delaware and Illinois have focused on beverages. Before the Senate committee, Nunn referenced these efforts, saying, 'The data and studies around these bills show that they have had demonstrable impacts on improving healthy eating behaviors among kids and among people of color. So the science around all of this is really sound, and it really hasn't had a huge detrimental impact on restaurants.' You can have the chicken nuggets, you can have the lemonade or soda every once in a while, but have a vegetable, have a fruit. – Dr. Philip Chan, Associate Professor in the Department of Medicine at Brown University Industry giants like McDonald's have had enough time to change and accommodate the trend. The fast food juggernaut at first took a subversive approach to regulations, like in 2011 when McDonald's locations in San Francisco started selling Happy Meal toys for 10 cents to get around a municipal law banning toys' inclusion with unhealthy meals. But by 2014, McDonald's had started to retool its menu, and in 2018 announced all of its kids' meals would max out at 600-calories by 2022. Today, a hamburger Happy Meal would satisfy the requirements of Rhode Island's Healthy Kids Act. The cheeseburger Happy Meal, however, would not, as it exceeds pretty much every threshold specified in the bill (as well as McDonald's previously stated goal, as it has 690 calories). As for the enforceability of the proposed law, the Rhode Island Department of Health (RIDOH) would be charged with ensuring compliance. The bill text prescribes the health department to issue relevant rules and regulations, supply multilingual signage and outreach materials for restaurants, and check that restaurants are training staff properly and maintaining documentation about their meals' compliance. But Dr. Jerome 'Jerry' Larkin, the health department's director, wrote in a testimony that those duties are easier said than done. The department 'applauds the intent of the proposed legislation, which is to establish and enforce environmental food changes to address rising childhood obesity and associated chronic disease emergence in Rhode Island,' Larkin wrote. 'However, RIDOH would not be able to implement the provisions outlined in the bill without adequate resources.' The department would need another full-time position to enforce the bill, Larkin wrote — specifically, a 'grade 27' full-time, nutritionist position that would cost $116,544 a year, with that salary expected to increase in future years. Rolling out content like signage, plus tracking and analyzing compliance, would cost about $1,850 in the first year, Larkin wrote. The proposed cost for an extra nutritionist comes at a time when the department is still reconciling the recent loss of $31 million in federal grant money, as well as the potential loss of dozens of existing full-time staff. The Senate committee voted to hold Lauria's bill for further study, the typical procedure for a bill at its first hearing. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Yahoo
19-03-2025
- Health
- Yahoo
Doctor makes case for expanding Nevada Medicaid coverage of anti-obesity drugs
(Photo:) State lawmakers are considering expanding the types of obesity treatments covered by Nevada Medicaid, including approving weight-loss drugs like Ozempic for wider use and bariatric surgery for minors. Steven Shane, a pediatric obesity doctor out of Reno, told lawmakers on the Senate Committee on Health and Human Services last week that, although these types of medicinal and surgical treatments are expensive upfront, covering them would financially benefit the state in the long term by reducing the cost of chronic diseases associated with obesity. That's true, he added, even with potential Medicaid cuts looming. Shane, who runs the Health Lifestyles Clinic at Renown Children's Hospital, told lawmakers that every day he is 'severely limited' in the care he can provide his patients. 'I typically cannot provide the best evidence-based therapies because Medicaid does not cover these options,' he said. 'It is no different than not covering other diseases such as asthma, diabetes or even cancer, which are all associated with obesity.' Senate Bill 244 would require Nevada Medicaid to cover intensive behavioral and lifestyle treatment programs and certain surgical interventions to treat obesity. It would also cover an established national diabetes prevention program. A proposed amendment, which is supported by the bill sponsors, would also require Nevada Medicaid to cover at least one anti-obesity medication approved by the U.S. Food and Drug Administration (FDA). The proposed amendment does not specify that the approved medication be in the class known as GLP-1s, but GLP-1s like Ozempic, Wegovy and Zepbound have received significant media attention and are now in-demand by both practitioners and the public. These drugs mimic a hormone in the intestinal tract to balance the body's blood sugar levels. And while GLP-1 drugs have been around for years to help patients with diabetes, they are growing in popularity to treat patients in need of significant weight loss. That's because the drugs also send the brain a signal that reduces hunger. Nevada Medicaid began covering Wegovy in March 2024, but only for adults with documented cardiovascular disease, such as a heart attack. Similarly, bariatric surgery is only covered for adults over 21 who have severe obesity and medical complications like diabetes. Anti-obesity medicines are approved by the FDA and recommended by the American Academy of Pediatrics (AAP) for people ages 12 and up. The American College of Endocrinology recommends the drugs for adults who are overweight with medical complications and adults with obesity regardless of whether they currently have medical complications. Nevada Medicaid currently covers medical nutritional therapy, but only 4 hours over 12 months. That's far below the amount medical experts say is needed to be effective. The AAP and the U.S. Preventive Services Task Force recommend children receive at least 26 hours or more of behavioral and lifestyle treatment over three to 12 months. Similarly, medical groups recommend adults receive at least 14 visits over 6 months. Nevada's adult obesity prevalence for 2023 is 30.8%, according to the U.S. Centers for Disease Control and Prevention. Shane referenced studies finding that a little over a quarter of 4th, 7th and 10th graders in Washoe County School District were considered obese and another 16% were considered overweight. Data was even worse for Clark County School District, where one-third of students were considered obese and another 17% were considered overweight. State Sen. Fabian Doñate, who chairs the Senate HHS committee and is an administrator for a regional network of healthcare providers, expressed concerns about doctors who might begin recommending GLP-1s or bariatric surgery to every patient rather than attempting less expensive, less severe interventions like a behavioral health program that helps establish better eating and more physical activity. 'How can we ensure there are guardrails up, that the prescriptive treatments are actually medically necessary versus saying that any doctor can just recommend?' he asked. Shane told Doñate the bill as written relies on doctors using best practices 'like we do for a lot of situations,' but he added that lawmakers could consider adding specific criteria or referencing established clinical guidelines into the bill language. Shane noted the AAP currently recommends patients 12 and older participate in an intensive behavioral and lifestyle treatment and be offered anti-obesity medication simultaneously. Doñate opined that the 'sensationalization of obesity medications' is cause for concern,as is the potential for the companies making these drugs to take advantage of mandated coverage. 'If I'm a pharmaceutical company and a state were to pass this requirement, the first thing I would do is send as many representatives that I could,' he said. 'There's nothing stopping me from doubling or tripling the cost of medication because now it's mandated via state law.' GLP-1s range from about $940 to $1,350 a month before insurance, rebates or discounts, according to reporting by Stateline. The Nevada Division of Health Care Financing and Policy, which houses the state's Medicaid program, estimated the proposed expansion would cost $165.4 million over the upcoming biennium. Nearly $64.3 million would come from the Nevada General Fund, with the rest estimated to be covered by the federal government. Shane pointed to data from states that currently cover GLP-1s showing that utilization rates are not as high as people often assume them to be. Minnesota has the highest utilization rate at 3.16%. 'Many people don't take advantage when they're eligible,' he said. Some studies have suggested the majority, if not all, of the upfront cost of GLP-1s are offset by the outcomes, particularly fewer emergency room visits related to cardiovascular diseases. SB 244 is sponsored by three Democratic state senators from Southern Nevada — Roberta Lange, Rochelle Nguyen, and Michelee Cruz-Crawford. Stateline's Shalina Chatlani contributed to this article.
Yahoo
13-02-2025
- Health
- Yahoo
Puberty blockers latest target in Georgia GOP lawmakers' 2025 campaign against transgender care
Sen. Ben Watson presents his transgender health bill in committee. Ross Williams/Georgia Recorder So far this month, the Georgia Senate has passed two bills adding new restrictions on transgender Georgians, and they could be going for a hat trick. On Wednesday, the Senate Committee on Health and Human Services approved a bill that would bar doctors from prescribing puberty blockers to children with gender dysphoria, a feeling of distress that comes from one's gender identity not matching one's body. The bill's author, Sen. Ben Watson, a Savannah Republican and a physician, argued that prescribing puberty blockers breaks the Hippocratic oath doctors take to do no harm. 'Puberty blockers do do harm, and that's the issue,' Watson said. 'It changes the bone structure, it changes so many things, but it's a natural response that youth are going through. They're going through puberty. These are puberty blockers. It is a natural process that they go through.' The bill could head to the full Senate, which has recently passed bills banning transgender girls from school sports and preventing transgender state employees from receiving gender-affirming care on the state health care plan. Neither have passed the House yet. Issues of transgender rights have been attention-getters in Washington as well as in statehouses around the country, but they're also personal for parents like Peter Isbister, founder of the metro Atlanta chapter of TransParent, a support group for parents of transgender kids, and the dad of a transgender child. 'My 11-year-old son will get the health care he needs, I am privileged to say, because I will go to the ends of the earth to make sure that he does. Why? Because I love him, as you love your children,' he told the committee. 'Do you trust yourselves to provide for your children's health care? I would imagine that you do,' he added. 'Do you trust yourself to love your child and teach him and show him or her the love of God as we do at Congregation Bet Haverim, where we believe that we are all in the image of God? I am sure that you do, that you trust yourselves. I am asking you to trust me and to trust us, because we are not different than you.' To treat gender dysphoria in children, doctors may recommend options including social transitioning, which could include adopting a new name or pronouns; hormone therapy, in which patients take estrogen or testosterone; or puberty blocking drugs, which pause the process of puberty. Many transgender people who underwent puberty describe it as an awful experience in which their bodies changed in ways that did not feel natural. According to the Mayo Clinic, puberty blockers can improve mental health for those dealing with gender dysphoria, but use of common puberty blockers can lead to complications, including dealing with bone growth and density as well as fertility, depending on when the medicine is started. Speaking over Zoom at Wednesday's hearing, Dr. Michelle Zeanah, a Statesboro-based pediatrician invited by the committee who specializes in caring for children with autism, said children are legally barred from making life-altering decisions like getting tattoos, and they should not be allowed to make a big decision like starting puberty blockers. 'I encounter young people that can't label their emotions every day,' she said. 'And some of them are very smart students who make excellent grades, qualify for gifted programs, but that doesn't mean that they understand their emotions or that they can convey abstract concepts or understand abstract concepts. They also really often have difficulty understanding the perspective of others, and those deficits really impact their own sexuality and their relationships. So allowing children and adolescents to make decisions that are permanent doesn't really seem in their best interest.' Zeanah said her expertise was relevant because children with autism are more likely to experience gender dysphoria or identify as LGBTQ. Dr. David McKalip, a Cartersville-based neurosurgeon, urged lawmakers to move forward with the ban. 'When you shut down puberty for years, there's no going back. There's no ethical practice of medicine that can support stopping the natural sexual development of kids,' he said. 'The only reversibility comes when you use it for things like precocious puberty for a year or two, but not for when you stop it for years. Kids on puberty blockers for gender dysphoria are more likely to go on to use dangerous cross-sex hormones, the vast majority do, and move on to pursue cross-sex surgeries.' Dr. Jason Schneider, a physician who provides gender-affirming care in metro Atlanta, said the idea that children are altering their gender on a whim is false. 'It's a very small percentage of kids who ultimately identify as transgender,' he said. 'If a parent or a family member brings in a child that they're wondering if they may be transgender, there are social workers, there are psychologists, there are therapists that work with the child over months to years before they get to the point where puberty blockers are even considered.' Schneider said it's true that the drugs may have side effects, but he said that is not abnormal and doctors monitor their patients and limit the time they can take puberty blockers. 'The physicians on the committee know there is no perfect medication,' he said. 'There are risks and benefits with every treatment we offer, and so it's a discussion. Yeah, there is a risk of changes in bone health as you get older, but that's something we can monitor. That's something we can treat. But when you compare that to the high rates of depression and suicidality for kids that have gender dysphoria, the benefits clearly outweigh any long-term risks.' Georgia banned doctors from performing gender-affirming surgeries or prescribing hormone treatments for minors with gender dysphoria in 2023 but left puberty blockers available. At the time, GOP lawmakers, including Watson, described that as a compromise that would allow children and their families more time to undergo mental health treatments and perhaps decide not to seek hormone therapy. The following year – as Watson faced a primary challenge for the first time since 2010 – he offered a puberty blocker ban bill, which passed the Senate but fell short in the House. 'We have debated this bill last year,' Watson said. 'It passed here, passed in the Senate, I look forward to the House doing that. When you look at the accumulation of the data, I think it is the right thing to do, protecting the minors from puberty blockers.' SUPPORT: YOU MAKE OUR WORK POSSIBLE
Yahoo
06-02-2025
- Health
- Yahoo
R.I. Senate introduces health care legislative package
The Rhode Island Senate chamber is seen empty during the legislative recess in summer 2024. (Photo by Alexander Castro/Rhode Island Current) Nine bills arriving soon on the Rhode Island Senate floor aim to make health care more affordable and accessible for Rhode Islanders. The legislative package was announced Wednesday morning by Senate leadership and Sen. Melissa Murray, a Woonsocket Democrat who now chairs the Senate Committee on Health and Human Services. Murray was appointed last month to fill the vacancy left by Sen. Joshua Miller, who decided not to seek re-election last year. 'The bills we are highlighting with this announcement are key parts of the Senate's action on health care, but there is a great deal of other extremely important work being done by many of our colleagues,' Murray said in a statement. 'Solving this crisis cannot be done through a single piece of legislation, or by one collection of bills.' Murray's contribution to the stack of bills would eliminate prior authorization for therapies and medical services ordered by primary care doctors. The bill does include some exceptions that the potential law 'shall not be construed to prohibit prior authorization requirements for brand-name prescription drugs and controlled substances,' according to its text. Services ordered by doctors with documented histories of fraud or abuse could also continue to be subject to prior authorization. Murray said in a statement the bill is designed to expedite care for patients and prevent them from getting caught up in insurance obstacles. 'It is the doctors, not insurers, who know best what care is needed for their patients. And we need our primary care doctors focused on providing care, not haggling with insurance companies,' she stated. Prospect asks federal bankruptcy judge to expedite sale of Roger Williams, Fatima hospitals Senate President Dominick J. Ruggerio pointed to health care issues on his own turf as indicative of the bigger challenges facing Rhode Islanders. He cited the importance of Our Lady of Fatima Hospital in North Providence, which together with Roger Williams Medical Center in Providence, is being sold by cash-strapped Prospect Medical Holdings. The sale of both safety net hospitals to prospective buyer The Centurion Foundation must be approved by a federal bankruptcy judge. 'In my own community of North Providence, the situation surrounding Fatima Hospital's future has exemplified many of the challenges we are working to address, and driven home the very real, very serious consequences for Rhode Island families,' Senate President Dominick J. Ruggerio said in a statement. 'With the bills in this package, and many other pieces of legislation introduced by my colleagues, the Senate remains focused on making health care less costly, and easier to get, for every resident of our state.' Sen. Majority Leader Valarie Lawson's bill would see people over age 65 enrolled in Medicare Parts A and B 'guaranteed' the right to enroll in supplemental coverage to cover services not in their standard plan. The enrollment period would be chosen by the state's Office of the Health Insurance Commissioner. The health care system 'can be a time-consuming headache, for both providers and patients,' especially when it comes to finding care or getting prescriptions, Lawson said in a statement. Also included in the package: Medical debt relief. One bill by Sen. John Burke, a West Warwick Democrat, would cap the interest rate on new medical debt to be between 1.5% and 4% annually. Another led by Sen. Jake Bissaillon, a Providence Democrat, would stop liens being placed on homes because of medical debt. Spread pricing limits. Two bills — one by freshman Sen. Lori Urso, a Pawtucket Democrat, and the other by Sen. Linda Ujifusa, a Portsmouth Democrat — would prohibit spread pricing by health insurers. The practice can be used by pharmacy benefit managers, which often handle prescription drug benefits for health insurance companies, and involves charging payers more for a drug than what it costs at the pharmacy. The benefit managers then keep the difference. Ujifusa's bill specifically targets Medicaid managed plans; Urso's bill focuses on commercial insurers. Financial aid for doctor education. A bill by Sen. Brian Thompson, a newly elected Woosocket Democrat, would use Medicaid funding to support graduate medical education programs in areas such as trauma care, primary care and maternal and mental health. Vaccine delivery. A bill by Sen. Robert Britto, a Rumford Democrat, would clarify state law regarding pharmacist administration of vaccines. Cutting through licensing red tape. A bill by Sen. Peter A. Appollonio Jr., a freshman Warwick Democrat, wants to address medical license backlogs by permitting the Rhode Island Department of Health to evaluate medical licensing applications if the relevant public body which would normally approve it has not been able to meet quorum in the past 30 days. The Rhode Island Department of Health Could approve or deny the license. The bills, once introduced, will go to the Senate Committee on Health and Human Services for initial hearings. SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
