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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment. Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania.

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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

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  1. The Obesity/Diabetes Epidemic:Perspectives, Consequences,Prevention, Treatment Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania

  2. Defining Obesity • Body Mass Index • Evaluates weight relative to height (kg/m2) • Correlates highly with body fat, morbidity, and mortality • Categories • Underweight (< 18.5 kg/m2) • Normal weight (18.5-24.9 kg/m2) • Overweight (25.0-29.9 kg/m2) • Class I Obesity (30.0-34.9 kg/m2) • Class II Obesity (35.0-39.9 kg/m2) • Class III Obesity (> 40 kg/m2) NIH National Heart, Lung, and Blood Institute. Obes Res. 1998;6(suppl 2):51S

  3. Cautions • High BMI may be due to excessive lean body mass • use clinical judgement • Elevated BMI without other risk factors may indicate a healthy weight • Eg: only 30-40-% get DM Might explain recent ‘obesity paradox’

  4. Outline • Epidemiology and Economics of obesity/diabetes • Perspectives on Obesity • Consequences of Obesity, Prediabetes, Obesity • Obesity/ Diabetes Risk Factors, • Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. • Medical Benefits to Weight Loss • Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- • Basics, • Next Lecture in Series

  5. Obesity Prevalence: Projected to Double Over the Next 30 Years

  6. Overweight and Obesity Among U.S. Adults Flegal KM et al. JAMA 2002;288:1723-27 Hedley AA et al. JAMA 2004;291:2847-50 Ogden CL et al. JAMA 2006;295:1549-55

  7. Increased Prevalence of Obesity Among Children and Adolescents Prevalence (%) NHES II & III NHANES I NHANES II NHANES III 1963-70 1971-74 1976-80 1988-94

  8. Leads to Diabetes Epidemic

  9. An Expensive Epidemic • 56 million Americans have a BMI of 30-40 • Had healthcare costs 36 percent greater than normal-weight individuals • Had pharmacy costs 77 percent greater than normal-weight individuals • Nearly 10% of annual medical spending was for overweight and obese patients • Total medical cost for obesity in 2003 was $75 billion. • Finkelstein,Jan/2004Obesity Research • Sturm, Ph.D. Archives of Medicine

  10. Healthcare visits Pharmacy Laboratory tests 100 All outpatient services All inpatient services 80 Total healthcare 60 Increase in Cost Compared with Lean Subjects (%) 40 20 0 BMI 30–34.9 kg/m2 BMI 35 kg/m2 Increase in Health Care Costs Among Obese Compared withLean (BMI <25 kg/m2) Patients* *HMO Setting: Northern California Kaiser Permanente. Quesenberry et al. Arch Intern Med 1998;158:466.

  11. Direct Cost* of Chronic Diseases in the United States 60 $53.2 $51.6 50 $38.7 40 30 Direct Cost (Billions $)* $18.4 $18.1 20 10 0 Type 2 Diabetes Hypertension Obesity Stroke Coronary Heart Disease *Adjusted to 1995 dollars. Wolf and Colditz. Obes Res 1998;6:97. Hodgson and Cohen. Med Care 1999;37:994.

  12. Lean Obese* $8,000 $6,822 $1,546 $1,600 $6,000 $4,496 $1,200 $4,000 $683 $800 $2,000 $400 $0 $0 Healthcare Absenteeism Economic Effect of Obesity to Business: 3-Year Costs to First Chicago NBD *BMI >27.8 kg/m2 in men; >27.3 kg/m2 in women. Burton et al. J Occup Environ Med 1998;40:786.

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