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Suzan Fisher
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2 Obesity is a chronic disease requiring long-term management. 1-5 A number of professional associations have recognized obesity as a global health challenge requiring a chronic disease management model, 1-5 including the World Health Organization, American Medical Association, American Association of Clinical Endocrinologists, and The Obesity Society. 1-4 Obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and the environment. 6,7 References 1. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894: American Medical Association. AMA adopts new policies on second day of voting and annual meeting. news/news/2013/ new-ama-policies-annual-meeting.page. Accessed December 13, Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American Association of Clinical Endocrinologists position statement on obesity and obesity medicine. Endocr Pract. 2012;18(5): Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society. Obesity. 2008;16(6): Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B): Obesity Education Initiative; National Heart, Lung, and Blood Institute; National Institutes of Health; US Department of Health and Human Services. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Institutes of Health; NIH publication Badman MK, Flier JS. The gut and energy balance: visceral allies in the obesity wars. Science. 2005;307(5717):

Obesity is considered a global pandemic, owing to its increasing prevalence over the last decades. 1 In the United States, more than one-third of the adult population was affected by obesity in 2012.

3 Obesity is considered a global pandemic, owing to its increasing prevalence over the last decades. 1 In the United States, more than one-third of the adult population was affected by obesity in References 1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during : a systematic analysis for the Global Burden of Disease Study Lancet. 2014;384(9945): Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, JAMA. 2014;311(8):

4 No state had a prevalence of obesity less than 20%. Seven states and the District of Columbia had a prevalence of obesity between 20% and <25%. Twenty-three states had a prevalence of obesity between 25% and <30%. Eighteen states had a prevalence of obesity between 30% and <35%. Two states (Mississippi and West Virginia) had a prevalence of obesity of 35% or greater. 1 Higher prevalence of adult obesity was found in the South (30.2%) and the Midwest (30.1%). Lower prevalence was observed in the Northeast (26.5%) and the West (24.9%). 1 Reference 1. Centers for Disease Control and Prevention. Obesity prevalence maps. Accessed September 5,

5 The World Health Organization defines obesity as abnormal or excessive fat accumulation. BMI provides the most useful measure of obesity and can be used to estimate the prevalence of obesity within a population and the risks associated with it. 1 BMI is a simple index for weight-for-height, and is defined as the weight in kilograms divided by the square of the height in meters (kg/m 2 ). 1 Reference 1. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:

Obesity is associated with multiple comorbidities, including sleep apnea, dyslipidemia, cardiovascular disease, osteoarthritis, various cancers, gallbladder disease, and type 2 diabetes.

6 Obesity is associated with multiple comorbidities, including sleep apnea, dyslipidemia, cardiovascular disease, osteoarthritis, various cancers, gallbladder disease, and type 2 diabetes. 1-4 References 1. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systemic review and meta-analysis. BMC Public Health. 2009;9: Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282(16): Li C, Ford ES, Zhao G, Croft GB, Balluz LS, Mokdad AH. Prevalence of self-reported clinically diagnosed sleep apnea according to obesity status in men and women: National Health and Nutrition Examination Survey, Prev Med. 2010;51(1): Bhaskaran K, Douglas I, Forbes H, dos- Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet. 2014;384(9945):

A report from the Prospective Studies Collaboration (PSC) examined the relevance of BMI to cause-specific mortality 5 or more years after recruitment, and estimated the lifetime probabilities of

7 A report from the Prospective Studies Collaboration (PSC) examined the relevance of BMI to cause-specific mortality 5 or more years after recruitment, and estimated the lifetime probabilities of surviving from age 35 years for different BMI levels in middle age. 1 The results of the study suggest that BMI is a strong predictor of overall mortality. In particular, for both sexes, median survival was reduced by 0 to 1 year for those who would, by about age 60 years, reach a BMI of kg/m 2, by 1 to 2 years for those who would reach a BMI of kg/m 2, and by 2 to 4 years for those who would develop obesity (BMI of kg/m 2 ). Median survival seems to be reduced by about 8 to 10 years in those who would develop morbid obesity (40 50 kg/m 2, which in the PSC is mainly kg/m 2 ). 1 Reference 1. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):

A disease-simulation model was used to estimate the risk of mortality in patients with obesity based on data from 3,992 non-hispanic white participants in the National Health and Nutrition

8 A disease-simulation model was used to estimate the risk of mortality in patients with obesity based on data from 3,992 non-hispanic white participants in the National Health and Nutrition Examination Survey ( ). 1 The effect of excess weight on years of life lost was greatest for younger individuals and decreased with increasing age. The years of life lost for men with obesity (BMI: 30 to <35 kg/m 2 ) ranged from 0.8 years in those aged years to 5.9 years in those aged years. The years of life lost for women with obesity (BMI: 30 to <35 kg/m 2 ) ranged from 1.6 years in those aged years to 5.6 years in those aged years. 1 Reference 1. Grover SA, Kaouache M, Rempel P, et al. Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. Lancet Diabetes Endocrinol. 2015;3:

Impaired physical functioning increases with increasing BMI in patients with obesity, 1 which may result in limitations in mobility activities.

9 Impaired physical functioning increases with increasing BMI in patients with obesity, 1 which may result in limitations in mobility activities. 2 The Canadian Multicentre Osteoporosis Study measured health-related quality of life (HRQoL) in a randomly selected sample of men and women (aged >25 years) from 9 centers across Canada. The sample included 6,302 (96.4%) women and 2,792 (96.8%) men after excluding those with missing BMI or HRQoL data. 1 Physical functioning domain scores of the Short Form 36 (SF-36), a questionnaire that measures HRQoL, were found to increase with BMI class in patients with obesity for both men and women. 1 References 1. Hopman WM, Berger C, Joseph L, et al. The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Qual Life Res. 2007;16(10): Syddall HE, Martin HJ, Harwood RH, Cooper C, Sayer AA. The SF-36: a simple, effective measure of mobility-disability for epidemiological studies. J Nutr Health Aging. 2009;13(1):

10 With increased medical spending, obesity can become an economic burden on both public and private payers. The increase in adult per capita medical spending attributable to obesity between 1998 and 2006 was estimated at 46% for inpatient, 27% for non-inpatient, and 80% for prescription drug spending. 1 Reference 1. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-w

11 Diet and exercise remain cornerstones of weight-loss interventions. However, maintenance of weight loss achieved by diet and exercise is challenging, as demonstrated by a review of 14 long-term studies. 1,2 Study participants weight and diet statuses were assessed at baseline; their weight was then measured at follow-ups for up to 7 years after the diet ended. 1 References 1. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3): MacLean PS, Wing RR, Davidson T, et al. NIH working group report: innovative research to improve maintenance of weight loss. Obesity (Silver Spring). 2015;23(1):

12 Physiologic and metabolic responses to weight loss trigger weight regain. 1-6 References 1. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17): Schwartz A, Doucet É. Relative changes in resting energy expenditure during weight loss: a systematic review. Obes Rev. 2010;11(7): Sumithran P, Proietto J. The defence of body weight: a physiological basis for weight regain after weight loss. Clin Sci (Lond). 2013;124(4): Rosenbaum M, Leibel RL. Adaptive thermogenesis in humans. Int J Obes (Lond). 2010;34(suppl 1):S47-S Rosenbaum M, Kissileff HR, Mayer LE, Hirsch J, Leibel RL. Energy intake in weight-reduced humans. Brain Res. 2010;1350: Badman MK, Flier JS. The gut and energy balance: visceral allies in the obesity wars. Science. 2005;307(5717):

Studies have documented that a weight loss of 5% to 10% can improve obesity-related comorbidities by reducing the risk of type 2 diabetes and cardiovascular disease, as well as improving blood lipid

13 Studies have documented that a weight loss of 5% to 10% can improve obesity-related comorbidities by reducing the risk of type 2 diabetes and cardiovascular disease, as well as improving blood lipid profiles, blood pressure, and severity of obstructive sleep apnea. 1-5 References 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6): Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7): Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992;56(2): Tuomilehto H, Seppa J, Uusitupa M, et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3): Foster GD, Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):

14 Support from health care professionals can help patients achieve clinically significant and maintained weight loss. 1 Moreover, physician-initiated discussions can motivate patients to lose weight and change behavior. 1,2 References 1. Loureiro ML, Nayga RM Jr. Obesity, weight loss, and physician s advice. Soc Sci Med. 2006;62(10): Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, Vallis MT, Sharma AM. Effect of implementing the 5As of obesity management framework on provider patient interactions in primary care. Clin Obes. 2014;4(1): National Institutes of Health. US Department of Health and Human Services. Medical Care for Patients with Obesity. Bethesda, MD: National Institutes of Health; Updated NIH publication Ruelaz AR, Diefenbach P, Simon B, Lanto A, Arterburn D, Shekelle PG. Perceived barriers to weight management in primary care perspectives of patients and providers. J Gen Intern Med. 2007;22(4): Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society AHA/ACC/ TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B):

15 Multiple treatment options are needed to help people with obesity lose weight and improve their health. 1,2 Healthy eating and physical activity must be part of any weightloss intervention, but are not always sufficient to maintain weight loss. 1 The AHA/ACC/TOS guidelines are meant to define practices that meet the needs of patients in most circumstances and are not a replacement for clinical judgment. Clinicians can use these recommendations to help reduce the risks of atherosclerotic cardiovascular disease events. 1 References 1. Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society AHA/ACC/ TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B): Ferguson C, David S, Divine L, et al; George Washington University, School of Public Health and Health Services, Department of Health Policy. Obesity Drug Outcome Measures: A Consensus Report of Considerations Regarding Pharmacologic Intervention. Accessed January 8,

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Dr. Shahebina Walji MD. Clinical Lecturer, University of Calgary Medical Director, Calgary Weight Management Centre

Dr. Shahebina Walji MD. Clinical Lecturer, University of Calgary Medical Director, Calgary Weight Management Centre Dr. Shahebina Walji MD Clinical Lecturer, University of Calgary Medical Director, Calgary Weight Management Centre info@cwmc.ca 403.272.2962 Impact of obesity on Canadians Obesity as a chronic medical