Why Do We Treat Obesity? Epidemiology

Why Do We Treat Obesity? Epidemiology

Epidemiology of Obesity U.S. Epidemic 2

More than Two Thirds of US Adults Are Overweight or Obese 87.5 NHANES Data US Adults Age 2 Years (Crude Estimate) Population (%) 7. 52.5 35. 17.5 3.5 33.9 35.9 35.1 22.5 12.8 14.1 14.5 3.5 32. 31.5 32. 34. 34.4 33.3 33.9 1.7-fold increase in obesity since 1962 BMI 3 BMI 25-29. 1962 1974 198 1994 2 28 21 212 BMI = body mass index (in kg/m 2 ); NHANES = National Health and Nutrition Examination Survey (x-axis lists last year of each survey). Flegal KM, et al. Int J Obes Relat Metab Disord. 1998;22:39-47; Flegal KM, et al. JAMA. 22;288:1723-1727; Flegal KM, et al. JAMA. 21;33:235-241; Flegal KM, et al. JAMA. 212;37:491-497. Ogden CL, et al. JAMA. 214;311:86-814. 3

Obesity Rates Are Increasing Across the United States BFRSS Data 199 2 21 Adults with BMI 3 kg/m 2 No data <1% 1% 14% 15% 19% 2% 24% 25% 29% 3% (21) 3%-34% (211-213) 35% 211* 212* 213* *BFRSS methodology changed in 211 and data from 21 and earlier cannot be compared to data from 211 onward. BRFSS = Behavioral Risk Factor Surveillance System; BMI = body mass index. CDC. Adult obesity facts. Available at: http://www.cdc.gov/obesity/data/trends.html. 4

Prevalence of Obesity Varies With Race, Ethnicity, and Sex 75 NHANES Data US Adults Age 2 Years With BMI 3 6 Population (%) 45 3 15 White men White women Black men Black women Latino men* Latina women* 198 1994 2 28 21 212 *Estimates based on Mexican Americans only for 198-28. BMI = body mass index (in kg/m 2 ); NHANES = National Health and Nutrition Examination Survey (x-axis lists last year of each survey). Flegal KM, et al. Int J Obes Relat Metab Disord. 1998;22:39-47; Flegal KM, et al. JAMA. 22 ;288:1723-1727; Flegal KM, et al. JAMA. 21;33:235-241; Flegal KM, et al. JAMA. 212;37:491-497. Ogden CL, et al. JAMA. 214;311:86-814. 5

Epidemiology of Obesity Worldwide Trends 6

Worldwide Prevalence of Obesity 215 Women, Age 18 Years Men, Age 18 Years BMI 3 kg/m 2 <1.% 1.%-19.9% 2.%-29.9% 3% Data not available Not applicable WHO. Global Health Observatory Map Gallery. Available at: http://gamapserver.who.int/maplibrary/app/searchresults.aspx. 7

Obesity Increase Is Associated with Rising Rates of Diabetes Worldwide Current estimated prevalence: 415 million worldwide By 24, 642 million people worldwide are expected to have diabetes IDF. Diabetes Atlas Update 215. Available at: http://www.idf.org/sites/default/files/atlas7e-poster.pdf. 8

Strong Association Between Weight Gain and Diabetes: Rural India Obesity* Diabetes Population (%) 2 15 1 5 2. 75% increase 8 191% increase 17.1 Population (%) 6 4 2.2 2 6.4 1989 23 1989 23 *BMI 25 kg/m 2. BMI = body mass index. Ramachandran A, et al. Diabetologia. 24;47:86-865. 9

The Increase in Diabetes Parallels the Increase in Obesity in the United States Obesity* Diabetes 45 96% increase 12 43% increase 36 35.1 1 9.3 Population (%) 27 18 17.9 Population (%) 8 6 4 6.5 9 2 1998 212 1998 214 *BMI 3 kg/m 2. BMI = body mass index. CDC. National diabetes statistics report, 214. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, 214. Mokdad AH, et al. JAMA. 1999;282:1519-1522; Mokdad AH, et al. Diabetes Care. 2;23:1278-1283; Ogden CL, et al. JAMA. 214;311:86-814. 1

Epidemiology of Obesity Impact on Clinical Outcomes 11

The Risk of Chronic Conditions Increases With BMI Women Men Type 2 diabetes Hypertension Cholelithiasis Coronary heart disease Relative Risk 6 5 4 3 2 1 <21 22 23 24 25 26 27 28 29 3 BMI (kg/m 2 ) 6 5 4 3 2 1 <21 22 23 24 25 26 27 28 29 3 BMI (kg/m 2 ) Increased abdominal adiposity is highly correlated with insulin resistance and type 2 diabetes BMI = body mass index. Willett WC, et al. N Engl J Med. 1999;341:427-434. Carey VJ, et al. Am J Epidemiol. 1997;145:614-619. 12

Prevalence of Weight-Related Comorbidities in the US NHANES 27-21 US Adults Age 18 Years (N=12,175) Patients (%) 6 5 4 3 2 1 19.8 26.4 35.6 28.6 44.2 49.7 Hypertension Dyslipidemia Diabetes SBP 14 mmhg, DBP 9 mmhg, or using anti-ht drug Normal weight Overweight Obese Non-HDL-C 16 mg/dl or using cholesterol-lowering drug 5.4 8.2 18.5 FPG 126 mg/dl, A1C 6.5%, or DM diagnosis Normal weight = BMI 18 to <25 kg/m 2 ; overweight = BMI 25 to <3 kg/m 2 ; obese = BMI 3 kg/m 2 BMI = body mass index; DM = diabetes mellitus; DBP = diastolic blood pressure; HDL-C = high density lipoprotein cholesterol; HT = hypertension; SBP = systolic blood pressure. Saydah S, et al. Obesity (Silver Spring). 214;22:1888-1895. 13

Mortality Increases with BMI Cancer Prevention Study II (N=1,46,154) Relative risk of death* 3. 2.6 2.2 1.8 1.4 1..6 2.2 1.8 1.4 1..6 Men Women Normal Overweight CVD death risk significantly increased CVD death risk significantly increased Obese Cardiovascular disease Cancer All other causes *Cox proportional hazards model adjusted for age at enrollment, education, physical activity, alcohol use, marital status, aspirin use, fat consumption, vegetable consumption, and use estrogen replacement therapy in women. Calle EE, et al. New Engl J Med. 1999;341:197-115. 14

All-Cause Mortality Increases with BMI National Institutes of Health AARP Cohort Study, 1996-29 (N=19,947 Never-Smokers) Men Women Multivariate hazard ratio* 3 2.5 2 1.5 1 1.28 1.2 P<.5 for linear trend 1.15 1 1 1.2 1.25 1.46 1.7 2.13 2.43 2.59.5 <18.5 18.5-22.4 22.5-24.9 25.-27.4 27.5-29.9 3. (Referent) Body mass index (kg/m 2 ) *Regression analyses adjusted for age, race/ethnicity, education, leisure-time physical activity, and alcohol consumption. Adams KF, et al. Am J Epidemiol. 214;179:135-144. 15

Earlier Weight Gain Increases Total Mortality Risk National Institutes of Health AARP Cohort Study, 1996-29 (N=19,947 Never-Smokers) Multivariate hazard ratio* 2.5 2 1.5 1.5 Men Women 2.4 1.68 1.68 1.26 1.32 1.12.98.96 Study entry 5 35 18 (Age 5-71) Age at which BMI 25 kg/m 2 *Regression analyses adjusted for age, race/ethnicity, education, leisure-time physical activity, and alcohol consumption. Adams KF, et al. Am J Epidemiol. 214;179:135-144. 16

Racial Differences in BMI-Mortality Association National Health Interview Survey, 1997-26 Never Smokers (N=32,975) Ever Smokers (N=38,7) Age-standardized all-cause mortality rates for persons aged 35-75 years without a history of heart disease or cancer at baseline. Bars indicate upper or lower 95% confidence intervals. Jackson CL, et al. Obesity (Silver Spring). 214;22:842-851. 17

Epidemiology of Obesity Economic Impact 18

The Effect of Weight on Healthcare Costs U.S. Adults (N=23,689) Medical expenditures Confidence interval Population distribution Cawley J, Meyerhoefer C. J Health Econ. 212;31:219-23. 19

Obesity-Related Illness Accounts for One-Fifth of U.S. Healthcare Costs Obesity Costs 1 U.S. Adults Age 18 Years Diabetes Costs 2 U.S. Residents, All Ages 1. 14 Health Expenditures (25 US$, billions) 75. 5. 25. Total $923.2 billion Health Expenditures (27 US$, billions) 15 7 35 Total $1,3 billion. Obesity $19.2 billion 2.6% of total costs Diabetes $176 billion 13.5% of total costs 1. Cawley J, Meyerhoefer C. J Health Econ. 212;31:219-23. 2. ADA. Diabetes Care. 213;36:133-146. 2

Medicare Spending Is Rising Significantly Faster in the Overweight Population Annual Increase in Medicare Expenditures 1997-26 35 P=.1 Cost per year (26 US$) 28 21 14 7 $122 P=.1 $23 $271 Normal weight Overweight Obese After adjustment for obesity-related chronic conditions, interactions were no longer significant Alley D, et al. Arch Intern Med. 212;172:277-278. 21

Obesity Significantly Increases Medicare Expenditures 14 Mean Expenditures in 23 Individuals >65 Years of Age Normal (BMI <25) Obese (BMI 3) ** $12,841 Costs (25 US$) 15 7 35 $3,247 $3,888 $982 ** $1,37 ** $2,331 $1,528 $1,443 ** $1,12 $1,654 Inpatient Outpatient Prescription drugshealthcare provider Total* *Includes dental and other costs not shown. **P.1 vs normal weight. BMI = body mass index in kg/m 2. Wilkins TL, et al. Obesity (Silver Spring). 212;2:124-1248. 22

Weight Loss Reduces Lifetime Healthcare Costs Projected Lifetime Healthcare Expenditures Obese Individuals <45 Years of Age Costs (US$) 2813-2813 -5625 + $23 - $357 + $93 - $48 + $17 Cost offsets Prolonged life Improved health -8438 - $81-1125 5% Weight Loss for 2 Years Total Benefit $334 Permanent 5% Weight Loss Total Benefit $315 Permanent 1% Weight Loss Total Benefit $64 Dall TM, et al. Am J Prev Med. 211;4:338-344. 23

Summary Obesity is increasing globally Rates of obesity have risen dramatically in the United States over the past 4 decades The increase in obesity is strongly associated with the increase in diabetes in the U.S. and worldwide Obesity is costly 24