The Who (Causes), What (Complications) and Where (Epidemiology) of Obesity.

Transcription

1 The Who (Causes), What (Complications) and Where (Epidemiology) of Obesity. Gabriel I. Uwaifo, MD FACE, FACP Senior Clinical Research Scientist and Endocrinologist, Ochsner Diabetes and Weight Management Clinical Research Section, Frank Riddick Diabetes Institute, Department of Endocrinology, Diabetes and Metabolism, Ochsner Clinic Foundation Presentation Objectives Discuss the definition and classification of obesity Discuss the national and regional epidemiology of obesity Discuss the causes of obesity Discuss the complications, comorbidities and associations of obesity 1

2 What is Obesity? Obesity is a chronic clinical syndrome of multiple potential etiologies characterized by the presence of excess adipose tissue. Obesity is thus not one disease but a common final pathway for many different diseases and thus no two obese subjects are exactly the same making individualized, nuanced evaluation and management key to therapeutic success. For Record keeping and public health stats purposes we generally use the definition of BMI >/= 30kg/m2. PROS Is Obesity a Disease? Obesity is a complex, multifactorial disease that develops from the interaction between genotype and the environment. Our understanding of how and why obesity occurs is incomplete; however, it involves the integration of social, behavioral, cultural, and physiological, metabolic, and genetic factors National Heart, Lung, and Blood Institute (NHLBI) Overweight and obesity are chronic diseases with behavioral origins that can be traced back to childhood American Academy of Family Physicians CONS If obesity is truly a disease, then over 78 million adults and 12 million children in America just got classified as sick...everyone has friends and acquintances who now qualify as diseased. Yet many sensible people, from physicians to philosophers, know that declaring obesity a disease is a mistake. Simply put, obesity is not a disease. To be sure, it is a risk factor for some diseases. But it would be false to say that everyone who is obese is sick as to say that every normal weight person is well Richard B. Gunderman, MD, PhD 2

3 Obesity is increasingly Becoming Officially Recognized as a Disease a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences obesity is a serious chronic disease with extensive and well-defined pathologies, including illness and death. Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans 2 Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults 3 Mechanick JI et al. Endocr Pract. 2012;18: AMA position statement. At: Accessed Oct WHO. Obesity and overweight. At: Accessed Oct US Food and Drug Administration. Federal Register. 2000;65(4): How do we identify it? 3

4 Body Composition Criteria for Obesity in Males and Females Body fat % Category Male Female Asthenia/Wasting states <12% <20% Normal 12-20% 20-30% Borderline 21-25% 31-33% Obesity >25% >33% Class IV: >50 (super-obese) Class V: >60 (super-super obese)) Beware of limitations and caveats Who is the obese one here? BMI; 26 BMI; 32 4

5 Risk stratification Risk stratification Edmonton Obesity Staging System Stage 0: No obesity-related risk factors Stage 1: Pre-clinical risk factors borderline HTN or DM, minor aches or psychopathology Stage 2: Established obesity-related disease HTN, DM, PCOS, moderate limitations ADL Stage 3: Established organ damage MI, CHF, DM comp, significant limitations of ADL Stage 4: Severe disabilities end stage and limitations like wheelchair use Sharma AM and Kushner RF. Int J Obes. 2009;33:

6 Risk stratification Edmonton Staging System Can Predict Mortality Better than BMI Padwal R et al. CMAJ Padwal R, Sharma AM et al. CMAJ 2011 Epidemiology; the where of obesity 6

7 Epidemiology; the where of obesity It is now a global problem and is getting worse with so called 2 nd and 3 rd world countries fast catching up with the developed western countries. Epidemiology; the where of obesity 7

8 Epidemiology; the where of obesity Prevalence of Obesity Among U.S. Adults Ages Prevalence of obesity in the U.S among children In For children and adolescents aged 2-19 years 1 : The prevalence of obesity has remained fairly stable at about 17% and affects about 12.7 million children and adolescents. The prevalence of obesity was higher among Hispanics (21.9%) and non-hispanic blacks (19.5%) than among non-hispanic whites (14.7%). The prevalence of obesity was lowest in non-hispanic Asian youth (8.6%) The prevalence of obesity was 8.9% among 2- to 5-year-olds compared with 17.5% of 6- to 11-year-olds and 20.5% of 12- to 19-year-olds. 1 Read CDC National Center for Health Statistics (NCHS) data brief Epidemiology; the where of obesity Yet, Obesity Remains Underdiagnosed in the U.S. Proportion of actual diagnosis of obesity by BMI (Body Mass Index) Obesity diagnosis, % BMI <23% of individuals with a BMI between kg/m 2 are diagnosed with obesity 43% of patients with BMI 50 kg/m 2 are not diagnosed Crawford AG et al. Popul Health Manag. 2010;13: Data from the GE Centricity System/EMR data of 6 millions records in the US 8

9 The Economic toll, cost and burden of Obesity in the U.S. Direct medical spending due to obesity and its comorbidities is estimated to $210-$316 billion annually: 21-28% of total U.S. healthcare spending When also accounting for the indirect, non-medical costs of obesity, the overall annual cost is estimated to be $450-$556 billion Directmedical costs (U.S. healthcare spending) 21% Indirect, non-medical costs (food, clothing, employer costs: absenteeism, lost productivity) Overall cost of obesity: $ billion/year Some economic prediction models suggest that unless the current trajectories of obesity prevalence and associated comorbidities change they could singlehandedly bankrupt the U.S. entire health care system by ~ 2040 when adult prevalence rates are projected to exceed 40% Brill. The Long-Term Returns of Obesity Prevention Policies (2013). Available at: ; Cawley et al. PharmacoEconomics 2014: Nov 9. Epidemiology; the costs of obesity Cost of Living Changes with Weight Loss Reduces medication Reduces accident proneness Reduces co-pays Reduces risk for cancer Reduces time off work and lost wages Reduces hospitalizations Reduces food costs Reduces doctor visits Change in the Cost of Living after Weight Loss Can Be Dramatic: ITEMS Estimated Annual Costs Mean medical/drug costs (BMI 35) 1 $ 7,337 Out-of-pocket healthcare expenses 2 $ 2,684 Employment inactivity costs 3 $ 1,017 Commercial weight loss program fees 4 $ 678 Prescription co-pays (5 meds at $10) $ 738 Grocery and dining costs 5 $ 6,012 TOTAL $18, Health Management Research Center, University of Michigan, 2001; 2. U.S. Bureau of Labor Statistics, Consumer Expenditures in 2006; 3. Source: Colditz, GA. Economic costs of obesity and inactivity, Med Science Sports Exercise, 1999; 4. Marketdata Enterprises, Inc., 10/02; 5. U.S. Bureau of Labor Statistics, Consumer Expenditures in

10 Epidemiology; the costs of obesity The Good News? Modest Weight Loss Can Reduce Disease Risk Potential impact of 5% average BMI reduction in the U.S. by 2020: 3.5 million cases hypertension avoided 0.3 million cases cancer avoided 2.9 million cases heart disease and stroke avoided 3.6 million cases diabetes avoided 1.9 million cases arthritis avoided Despite this there is still a huge Obesity treatment gap between patients with the condition and those receiving any treatment for it as well as between how much we know about obesity etiology and pathophysiology as opposed to translating that into effective treatments for individual patients and communities. Levi et al. F as in fat: how obesity threatens America s future, Available at: The Who (Causes) of Obesity Concepts of etiology, predisposition and contributory factors. The concept of multiplicity of etiologies, predispositions and contributors The concept of nature vs nuture; genetics vs environment and the epigenetic bridge between them The impact for the clinician; one size does not fit all. 10

11 The Who (Causes) of Obesity The Who (Causes) of Obesity 11

12 The Who (Causes) of Obesity; Root Cause Analysis The What; The complications of obesity Concepts of direct etiologic Complications vs Consequences, Comorbidities and Associations The commonality of obesity prevention ameliorating or preventing these conditions. The commonality of effective obesity treatment ameliorating, preventing and/or reversing these conditions. 12

13 The What; complications and consequences of obesity Blackburn, et al. Medscape Internal Medicine; 2007 Consequences of Obesity: The 4 Ms Obesity Reviews. Vol.11 Issue 11; a 13

14 The What; complications and consequences of obesity Associated increased cancer mortality risk estimated; 52% higher in men and 62% higher in women Concluding Remarks Obesity is a chronic complex multifactorial syndrome cluster that includes very many different diseases with the commonality of excess adiposity and attendant health consequences. It is very prevalent in the U.S and worldwide with increasing incidence especially among minorities and underserved populations. It has a myriad of underlying causes, predispositions and contributors to its etiology. It has myriad complications, comorbidities and associations that escalate the difficulty of its management and its cost burden on the health care system. 14

15 Bibliography and References Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, JAMA 2002; 288: Ljungvall A, Zimmerman FJ. Bigger bodies: long-term trends and disparities in obesity and body-mass index among U.S. adults, Soc Sci Med 2012; 75:109. International Association for the Study of Obesity (Accessed on February 06, 2014). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res 1998; 6 Suppl 2:51S. Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 1998; 22:1164. THANK YOU VERY MUCH FOR YOUR KIND ATTENTION Questions???, Comments??? 15