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Obesity – Growing epidemic. Center for Disease Control and Prevention 2006. Obesity – Growing epidemic. 65% Americans overweight or obese 30-40% Americans are obese (~100 million) Doubled in past 20 years Tripled in past 30 years. Obesity Trends* Among U.S. Adults BRFSS, 1985.

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Obesity growing epidemic

Obesity – Growing epidemic

Center for Disease Control and Prevention 2006


Obesity growing epidemic1

Obesity – Growing epidemic

  • 65% Americans overweight or obese

  • 30-40% Americans are obese (~100 million)

    • Doubled in past 20 years

    • Tripled in past 30 years


Obesity trends among u s adults brfss 1985

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1986

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1987

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1988

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1989

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1990

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


Obesity trends among u s adults brfss 1991

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1992

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1993

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1994

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1995

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1996

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%


Obesity trends among u s adults brfss 1997

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%


Obesity trends among u s adults brfss 1998

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%


Obesity trends among u s adults brfss 1999

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%


Obesity trends among u s adults brfss 2000

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%


Obesity trends among u s adults brfss 2001

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity growing epidemic

Obesity Trends* Among U.S. AdultsBRFSS, 2002

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity trends among u s adults brfss 2003

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity trends among u s adults brfss 2004

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


Obesity trends among u s adults brfss 2005

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity trends among u s adults brfss 2006

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity trends among u s adults brfss 2007

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity trends among u s adults brfss 2008

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity trends among u s adults brfss 20081

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity trends among u s adults brfss 20082

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Among U.S. Veterans, the

prevalence of obesity may be as high as 75%

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


Obesity growing epidemic

Overweight

United States 65%

Australia59%

Russia54%

United Kingdom51%

Brazil36%

China15%


Obesity growing epidemic

Europe

>50% are overweight

30% BMI>30 kg/m2

10% BMI>40 kg/m2

Rizzello et al., Obes Surg 2010; 20:55


Obesity growing epidemic2

Obesity – Growing epidemic

  • National Health and Nutrition Examination Survey (NHANES)

  • Obesity data 2007-8 compared to data 1999-2006

  • First trend toward plateau:

Flegal KM et.al., JAMA 2010; 303(3)


Obesity growing epidemic3

Obesity – Growing epidemic

  • National Health and Nutrition Examination Survey (NHANES)

  • Obesity data 2007-8 compared to data 1999-2006

  • First trend toward plateau:

GOOD NEWS?!

Flegal KM et.al., JAMA 2010; 303(3)


Obesity health impact

Obesity – Health impact


Obesity health impact1

Obesity – Health impact

  • Comorbid conditions

    • Type 2 diabetes/Insulin resistance

    • Cardiovascular disease

    • Hypercholesterolemia, Hyperlipidemia

    • Hypertension

    • Osteoarthritis

    • Cancer

    • Liver disease (nonalcoholic steatohepatitis)

    • Obstructive sleep apnea


Obesity health impact2

Obesity – Health impact

Type 2 DM

Normal

BMI


Obesity health impact3

Obesity – Health impact

Type 2 DM

CAD

Normal

BMI

BMI


Obesity health impact4

Obesity – Health impact

Type 2 DM

CAD

Normal

BMI

BMI

Hypertension


Obesity health impact5

Obesity – Health impact

Type 2 DM

CAD

Normal

BMI

Osteoarthritis

Hypertension

Must A, et.al., JAMA 1999:1523


Obesity health impact6

Obesity – Health impact

  • Mortality from all causes increases with BMI

Adams KF, et.al., NEJM 2006; 355:763


Obesity health impact7

Obesity – Health impact

Schauer, D. P. et al. Arch Surg 2010;145:57


Obesity health impact8

Obesity – Health impact

Years of Life Lost—BMI and Age

Fontaine KR, JAMA 2003; 289:187

Men

Women


Obesity health impact9

Obesity – Health impact

  • In both men and women, BMI is associated with higher rates of death due to Cancer

    • Esophagus

    • Colon/Rectum

    • Liver

    • Gallbladder

    • Pancreas

    • Kidney

    • Non-Hodgkin’s lymphoma

    • Multiple myeloma

Calle EE et.al., NEJM 2003; 348:1625


Obesity health impact10

Obesity – Health impact

- Risk of mortality from cancer according to BMI (for men)

--Men and women with BMI>40 kg/m2 had

death rates from all cancers that were 52% (men)

and 62% (women) higher than the rates in normal

weight individuals.

Calle EE et.al., NEJM 2003; 348:1625


Obesity health impact11

Obesity – Health impact

--Obesity in early adulthood

greater risk of pancreatic cancer and a younger age of disease onset

Risk of Pancreatic Cancer

Li et.al., JAMA 2009; 301:2553


Obesity economic burden

Obesity – Economic burden


Obesity economic burden1

Obesity – Economic burden

  • Overweight and obesity account for nearly 10% of total U.S. medical expenditures

  • >$100 billion

  • Morbid obesity associated with >$11 billion direct health care costs

Center Disease Control and Prevention 2009


Obesity economic burden2

Obesity – Economic burden

Obesity-attributable direct medical costs, by state Center for Disease Control & Prev

Millions $

State


Obesity economic burden3

Obesity – Economic burden

Obesity-attributable direct medical costs, by stateCenter for Disease Control & Prev

California: $7.7 Billion

Millions $

State


Obesity economic burden4

Obesity – Economic burden

Mean per capita annual health care expenditure

$3,506

$3,058

Women aged 25-34

$2,873

$2,358

$2,127

Dollars

20-24.9

25-29.9

30-34.9

35-39.9

>40

Wee et.al., Am J Public Health 2005

BMI


Surgical treatment of morbid obesity

Surgical Treatment of Morbid Obesity


Surgical treatment of morbid obesity1

Surgical Treatment of Morbid Obesity

  • Rationale:

    • Significant and durable weight loss

    • Improvement/Resolution of co-morbid conditions

    • Decrease mortality

    • Improved quality of life


Significant and durable weight loss

Significant and durable weight loss

  • NIH Consensus Development Conference:

    “Severe obesity is a chronic, intractable disorder…Surgical procedures [Bariatric Operations] are capable of inducing significant weight loss and amelioration of most of the co-morbid conditions that have been studied.”


Significant and durable weight loss1

Significant and durable weight loss

  • Meta-analysis 22,000 patients

  • Variable duration of follow-up

  • Total Percent Excess Weight Loss = 61%

    • 47.5% Adjustable gastric band

    • 61.6% Gastric bypass

    • 70.1% Biliopancreatic diversion

Buchwald H et.al., JAMA 2004;292:1724


Significant and durable weight loss2

Significant and durable weight loss

  • 10-year post-operative

    follow-up:

  • %EWL = 54-67%

    (All bariatric operations)

Sjostrom L et.al., NEJM 2007;357:741

O’Brien et.al., Obes Surg 2006;16:1032


Significant and durable weight loss3

Significant and durable weight loss

  • 10-year post-operative

    follow-up:

  • %EWL = 54-67%

    (All bariatric operations)

Sjostrom L et.al., NEJM 2007;357:741

O’Brien et.al., Obes Surg 2006;16:1032


Significant and durable weight loss4

Significant and durable weight loss

  • Medical Treatment:

  • Prospective, randomized trial

  • 1-year follow-up

Stefanick et.al., NEJM 1998;339:12


Significant and durable weight loss5

Significant and durable weight loss

  • Medical Treatment:

  • Double-blind placebo-controlled trials + >1-yr follow-up

Padwal et.al., Cochrane Database, Issue 4, 2009


Significant and durable weight loss6

Significant and durable weight loss

  • Medical Treatment:

    • There is no reliable, durable medical treatment of morbid obesity.

    • Nearly all patients (95-97%) regain most or all of the weight that was lost within 2-5 years following diet or drug treatment.

    • Average amount of weight loss is relatively small (2-10% of Excess Weight Loss)


Significant and durable weight loss7

Significant and durable weight loss

Bariatric operations performed in the U.S. (1992-2007)

205,000

16,200


Improvement of co morbid conditions

Improvement of Co-morbid Conditions


Improvement of co morbid conditions1

Improvement of Co-morbid Conditions

Effect on Hypertension


Improvement of co morbid conditions2

Improvement of Co-morbid Conditions

Effect on Obstructive Sleep Apnea


Improvement of co morbid conditions3

Improvement of Co-morbid Conditions

Effect on Type 2 Diabetes


Improvement of co morbid conditions4

Improvement of Co-morbid Conditions

  • Meta-analysis -- 135,246 patients

Buchwald H et al., Am J Med 2009;122:248


Bariatric surgery life expectancy

Bariatric Surgery – Life Expectancy


Bariatric surgery life expectancy1

Bariatric Surgery – Life Expectancy

MacDonald et.al., J Gastrointest Surg 1997; 1:213-220

Flum et.al., JACS 2004;199:543

O’Brien et.al., Obes Surg 2006; 16:1032-1040

Sowemimo et.al., Surg Obes Relat Dis 2007; 1:73-77

Sjostrom L et.al., NEJM 2007;357:741

Christou et.al., Ann Surg 2004;240:416

Adams et.al., NEJM 2007; 357:753-761


Bariatric surgery life expectancy2

Bariatric Surgery – Life Expectancy

  • Retrospective study comparing 7,925 patients who had gastric bypass vs. 7,925 patients severely obese controls.

  • Matched for age, sex, BMI

  • Mean f/u = 7.1 years

Adams et.al., NEJM 2007; 357:753-761


Bariatric surgery life expectancy3

Bariatric Surgery – Life Expectancy

Years gained – BMI and Age

1. Every age group benefits, women and men.

2. The greatest benefit is in the younger population.

3. For any age, the greatest benefit is in the heaviest population.

Schauer, D. P. et al. Arch Surg 2010;145:57


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