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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 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%


Overweight

United States 65%

Australia 59%

Russia 54%

United Kingdom 51%

Brazil 36%

China 15%


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 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 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 state Center 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 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 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 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