Obesity Presentation - Rethink Obesity

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Obesity is a chronic disease requiring long-term management.1-5 A number of professional associations haverecognized obesity as a global health challenge requiring a “chronic disease management model,”1-5including the World Health Organization, American Medical Association, American Association of ClinicalEndocrinologists, and The Obesity Society.1-4Obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and theenvironment.6,7References1. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHOconsultation. World Health Organ Tech Rep Ser. 2000;894:1-253. 2. American Medical Association. AMAadopts new policies on second day of voting and annual meeting. 3-06-18-new-ama-policies-annual-meeting.page. Accessed December 13, 2014. 3.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):642-648. 4. Allison DB,Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissionedby the Council of the Obesity Society. Obesity. 2008;16(6):1161-1177. 5. Jensen MD, Ryan DH, Apovian CM,et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; ObesitySociety. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report ofthe American College of Cardiology/American Heart Association Task Force on Practice Guidelines and TheObesity Society. J Am Coll Cardiol. 2014;63(25 pt B):2985-3023. 6. Obesity Education Initiative; NationalHeart, 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: TheEvidence Report. Bethesda, MD: National Institutes of Health; 1998. NIH publication 98-4083. 7. Badman MK,Flier JS. The gut and energy balance: visceral allies in the obesity wars. Science. 2005;307(5717):1909-1914.2

Obesity is considered a global pandemic, owing to its increasing prevalence over thelast decades.1 In the United States, more than one-third of the adult population wasaffected by obesity in 2012.2References1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence ofoverweight and obesity in children and adults during 1980-2013: a systematic analysisfor the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766-781. 2.Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity inthe United States, 2011-2012. JAMA. 2014;311(8):806-814.3

No state had a prevalence of obesity less than 20%. Seven states and the District ofColumbia had a prevalence of obesity between 20% and 25%. Twenty-three states hada prevalence of obesity between 25% and 30%. Eighteen states had a prevalence ofobesity between 30% and 35%. Two states (Mississippi and West Virginia) had aprevalence of obesity of 35% or greater.1Higher 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%).1Reference1. Centers for Disease Control and Prevention. Obesity prevalence maps. ml. Accessed September 5, 2014.4

The World Health Organization defines obesity as abnormal or excessive fataccumulation. BMI provides the most useful measure of obesity and can be used toestimate the prevalence of obesity within a population and the risks associated with it.1BMI is a simple index for weight-for-height, and is defined as the weight in kilogramsdivided by the square of the height in meters (kg/m2).1Reference1. World Health Organization. Obesity: preventing and managing the global epidemic.Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.5

Obesity is associated with multiple comorbidities, including sleep apnea, dyslipidemia,cardiovascular disease, osteoarthritis, various cancers, gallbladder disease, and type 2diabetes.1-4References1. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence ofco-morbidities related to obesity and overweight: a systemic review and meta-analysis.BMC Public Health. 2009;9:88. 2. Must A, Spadano J, Coakley EH, Field AE, Colditz G,Dietz WH. The disease burden associated with overweight and obesity. JAMA.1999;282(16):1523-1529. 3. Li C, Ford ES, Zhao G, Croft GB, Balluz LS, Mokdad AH.Prevalence of self-reported clinically diagnosed sleep apnea according to obesitystatus in men and women: National Health and Nutrition Examination Survey,2005-2006. Prev Med. 2010;51(1):18-23. 4. Bhaskaran K, Douglas I, Forbes H, dosSantos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: apopulation-based cohort study of 5.24 million UK adults. Lancet. 2014;384(9945):755-765.6

A report from the Prospective Studies Collaboration (PSC) examined the relevance ofBMI to cause-specific mortality 5 or more years after recruitment, and estimated thelifetime probabilities of surviving from age 35 years for different BMI levels in middleage.1The results of the study suggest that BMI is a strong predictor of overall mortality. Inparticular, for both sexes, median survival was reduced by 0 to 1 year for those whowould, by about age 60 years, reach a BMI of 25–27.5 kg/m2, by 1 to 2 years for thosewho would reach a BMI of 27.5–30 kg/m2, and by 2 to 4 years for those who woulddevelop obesity (BMI of 30–35 kg/m2). Median survival seems to be reduced by about 8to 10 years in those who would develop morbid obesity(40–50 kg/m2, which in the PSC is mainly 40–45 kg/m2).1Reference1. Prospective Studies Collaboration, Whitlock G, Lewington S, et al. Body-mass indexand cause-specific mortality in 900 000 adults: collaborative analyses of 57prospective studies. Lancet. 2009;373(9669):1083-1096.7

A disease-simulation model was used to estimate the risk of mortality in patients withobesity based on data from 3,992 non-Hispanic white participants in the NationalHealth and Nutrition Examination Survey (2003–2010).1The effect of excess weight on years of life lost was greatest for younger individualsand decreased with increasing age. The years of life lost for men with obesity (BMI: 30to 35 kg/m2) ranged from 0.8 years in those aged 60–79 years to 5.9 years in thoseaged 20–39 years. The years of life lost for women with obesity (BMI: 30 to 35 kg/m2)ranged from 1.6 years in those aged 60–79 years to 5.6 years in those aged 20–39years.1Reference1. Grover SA, Kaouache M, Rempel P, et al. Years of life lost and healthy life-years lostfrom diabetes and cardiovascular disease in overweight and obese people: a modellingstudy. Lancet Diabetes Endocrinol. 2015;3:114-122.8

Impaired physical functioning increases with increasing BMI in patients with obesity,1which may result in limitations in mobility activities.2The Canadian Multicentre Osteoporosis Study measured health-related quality of life(HRQoL) in a randomly selected sample of men and women (aged 25 years) from9 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.1Physical functioning domain scores of the Short Form 36 (SF-36), a questionnaire thatmeasures HRQoL, were found to increase with BMI class in patients withobesity for both men and women.1References1. Hopman WM, Berger C, Joseph L, et al. The association between body massindex and health-related quality of life: data from CaMos, a stratified population study.Qual Life Res. 2007;16(10):1595-1603. 2. Syddall HE, Martin HJ, Harwood RH, Cooper C,Sayer AA. The SF-36: a simple, effective measure of mobility-disability forepidemiological studies. J Nutr Health Aging. 2009;13(1):57-62.9

With increased medical spending, obesity can become an economic burden on bothpublic and private payers. The increase in adult per capita medical spendingattributable to obesity between 1998 and 2006 was estimated at 46% for inpatient,27% for non-inpatient, and 80% for prescription drug spending.1Reference1. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributableto obesity: payer- and service-specific estimates. Health Aff (Millwood).2009;28(5):w822-w831.10

Diet and exercise remain cornerstones of weight-loss interventions. However,maintenance of weight loss achieved by diet and exercise is challenging, asdemonstrated by a review of 14 long-term studies.1,2 Study participants’ weight anddiet statuses were assessed at baseline; their weight was then measured at follow-upsfor up to 7 years after the diet ended.1References1. Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare’s searchfor effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-233. 2. 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):7-15.11

Physiologic and metabolic responses to weight loss trigger weight regain.1-6References1. Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonaladaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604. 2. Schwartz A,Doucet É. Relative changes in resting energy expenditure during weight loss: asystematic review. Obes Rev. 2010;11(7):531-547. 3. Sumithran P, Proietto J. Thedefence of body weight: a physiological basis for weight regain after weight loss. ClinSci (Lond). 2013;124(4):231-241. 4. Rosenbaum M, Leibel RL. Adaptive thermogenesisin humans. Int J Obes (Lond). 2010;34(suppl 1):S47-S55. 5. Rosenbaum M, Kissileff HR,Mayer LE, Hirsch J, Leibel RL. Energy intake in weight-reduced humans. Brain Res.2010;1350:95-102. 6. Badman MK, Flier JS. The gut and energy balance: visceral alliesin the obesity wars. Science. 2005;307(5717):1909-1914.12

Studies have documented that a weight loss of 5% to 10% can improve obesity-relatedcomorbidities by reducing the risk of type 2 diabetes and cardiovascular disease, as well asimproving blood lipid profiles, blood pressure, and severity of obstructive sleep apnea.1-5References1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program ResearchGroup. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. NEngl J Med. 2002;346(6):393-403. 2. Wing RR, Lang W, Wadden TA, et al. Benefits of modestweight loss in improving cardiovascular risk factors in overweight and obese individuals withtype 2 diabetes. Diabetes Care. 2011;34(7):1481-1486. 3. Dattilo AM, Kris-Etherton PM. Effectsof weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr.1992;56(2):320-328. 4. Tuomilehto H, Seppa J, Uusitupa M, et al. The impact of weightreduction in the prevention of the progression of obstructive sleep apnea: an explanatoryanalysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3):329-335. 5. Foster GD,Borradaile KE, Sanders MH, et al. A randomized study on the effect of weight loss on obstructivesleep apnea among obese patients with type 2diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169(17):1619-1626.13

Support from health care professionals can help patients achieve clinicallysignificant and maintained weight loss.1 Moreover, physician-initiated discussions canmotivate patients to lose weight and change behavior.1,2References1. Loureiro ML, Nayga RM Jr. Obesity, weight loss, and physician’s advice. Soc Sci Med.2006;62(10):2458-2468. 2. Rueda-Clausen CF, Benterud E, Bond T, Olszowka R, VallisMT, Sharma AM. Effect of implementing the 5As of obesity management framework onprovider patient interactions in primary care. Clin Obes. 2014;4(1):39-44. 3. NationalInstitutes of Health. US Department of Health and Human Services. Medical Care forPatients with Obesity. Bethesda, MD: National Institutes of Health; 2003. Updated2011. NIH publication 03-5335. 4. 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):518-522. 5.Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/AmericanHeart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of theAmerican College of Cardiology/American Heart Association Task Force on PracticeGuidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B):2985-3023.14

Multiple treatment options are needed to help people with obesity lose weight andimprove 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.1The AHA/ACC/TOS guidelines are meant to define practices that meet the needs ofpatients in most circumstances and are not a replacement for clinical judgment.Clinicians can use these recommendations to help reduce the risks of atheroscleroticcardiovascular disease events.1References1. Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/AmericanHeart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of theAmerican College of Cardiology/American Heart Association Task Force on PracticeGuidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B):2985-3023. 2.Ferguson C, David S, Divine L, et al; George Washington University, School of PublicHealth and Health Services, Department of Health Policy. Obesity Drug OutcomeMeasures: A Consensus Report of Considerations Regarding PharmacologicIntervention. es.pdf. AccessedJanuary 8, 2015.15

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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 a!ected by obesity in 2012.2 References 1. Ng M, Fleming T, Robins

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