1 / 47

THE IMPACT OF LIFE STYLE ON HEALTH AND HEALTH CARE COSTS

THE IMPACT OF LIFE STYLE ON HEALTH AND HEALTH CARE COSTS. WILLIAM J. KLISH M.D. Professor Emeritus of Pediatrics Baylor College of Medicine Houston, Texas. THE LIFESTLYE THAT WE ADOPT NOT ONLY DECIDES OUR DESTINY BUT AFFECTS THE HEALTH AND WELFARE OF OUR ENTIRE NATION.

tadeo
Download Presentation

THE IMPACT OF LIFE STYLE ON HEALTH AND HEALTH CARE COSTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. THE IMPACT OF LIFE STYLE ON HEALTH AND HEALTH CARE COSTS WILLIAM J. KLISH M.D. Professor Emeritus of Pediatrics Baylor College of Medicine Houston, Texas

  2. THE LIFESTLYE THAT WE ADOPT NOT ONLY DECIDES OUR DESTINY BUT AFFECTS THE HEALTH AND WELFARE OF OUR ENTIRE NATION.

  3. DISEASES INITIATED BY LIFE STYLE Many serious diseases are either caused or made worse by the way we live, including: Many types of cancer Cardiovascular disease Lung disease Liver disease Allergy AIDS and other STD’s Obesity This lecture will focus on obesity

  4. THE OBESITY EPIDEMIC “The Most Serious Public Health Problem Today”

  5. GOALS AND OBJECTIVES • Discuss the present obesity epidemic • Describe health issues associated with obesity that have become major public health problems • Define how these issues impact health care costs.

  6. Global Burden of Disease World Health Organization Statistics Percent of death due to: populationheart diseasecancertobacco use*overweight* World 7 billion 31 13 20 34 Ethiopia 83 million 15 4 2 7 India 1.2 billion 24 6 14 11 Russia 143 million 61 13 41 60 U K 62 million 34 27 17 64 U S 310 million 34 23 16 71 *Percent of all deaths

  7. BODY MASS INDEX Body Weight in Kg ÷ (Height in Meters)² or Body Weight in Pounds ÷ (Height in Inches) x 703 Adult Standards Normal: 18 – 25 Overweight: 25-30 Obese: >30

  8. OBESITY TRENDS Trust For America’s Health, Robert Wood Johnson Foundation. 2012 • Estimates are that by 2030, 39 states will have an obesity rate of over 50%. • All states will be above 44% • Wisconsin will be at 56%

  9. Obesity in Adulthood is Related to Obesity in Childhood Whitaker et al. NEJM:1997;337:869-873

  10. Prevalence of Obesity in Children and Adolescents Overweight or obese (BMI ≥85 percentile) 26.7 percent of preschool children (2 to 5 years) 32.6 percent of school-aged children (6 to 11 years) 33.6 percent of adolescents (12 to 19 years) Obese (BMI ≥95 percentile) 12.1 percent of preschool children 18.0 percent of school-aged children 18.4 percent of adolescents Severe obesity (defined as a BMI ≥97 percentile) 9.7 percent of preschool children 13.0 percent of school-aged children 13.0 percent of adolescents

  11. Obesity = (BMI) > 95th percentile for age, based on Centers for Disease Control and Prevention (CDC) 2000 growth charts.

  12. Prevalence of Obesity - Texas Children 1999-2002

  13. Health Care Costs of Obesity • USA:240 billion dollars in 2008 and could increase to ~1 trillion dollars by 2030 (Wang et al. Obesity (Silver Spring). 2008 Oct; 16(10):2323-30) • Medical costs will grow at a rate of $48-66 billion per year (Trust For America’s Health, Robert Wood Johnson Foundation. 2012) • Western Europe: 10.4 billion euros in 2008 (Muller-Reimenschneider et al. Eur J Epidemiol 2008;23(8):499-509.) • China: 21.11 billion Yuan ($2.74 billion) in 2003 (Zhao W et al. Obes Rev. 2008 Mar;9 Suppl 1:62-7) • Does NOT include decreased productivity, lost work days, obesity treatment etc. • Medical costs are also underestimated because diagnosis of obesity is frequently not coded.

  14. Health Care Costs of Obesity Obesity (BMI>30) adds about $2,800 to a person’s annual medical bills ¹ Those with a BMI>40 pay $5,530 more for health care than a normal weight person ² 1. National Bureau of Economic Research, 2010 2. Mayo Clinic Employee Health Study, 2012

  15. OBESITY The Cause of The Problem

  16. MOLECULAR GENETICS OF OBESITY • The first obesity gene was mapped in the mouse in 1994 (Ob or Leptin gene) • Now the number of candidate obesity genes identified is greater than 200 • We all probably have at least one obesity gene

  17. EXPLANATION FOR INCREASING RATE OF OBESITY • Obesity genes offer survival advantage so they were favorably selected • They increase the amount of available calories stored as fat when food was lacking • When food is plentiful (and physical activity limited), these genes express themselves as obesity

  18. Therefore the “Cause” of the Present Obesity Epidemic is Obvious OUR LIFESTYLE CHANGED We Decreased Physical Activity The Availability of Calorie Dense Foods Increased We Lack Concern About the Consequences of Obesity

  19. OBESITY IS NOT A COSMETIC ISSUE! OBESITY IS A DISEASE!

  20. Health Problems Associated with Obesity • Psychological • Lack of self esteem • Depression • Pulmonary • Sleep apnea • Respiratory insufficiency • Pickwickian syndrome • Skeletal • Slipped femoral capital epiphysis • Varus or Valgus deformities of knees (Blounts Disease) • Osteoarthritis • Foot pain • Liver • Steatohepatitis • Biliary Disease, Gall Stones • Metabolic • Diabetes • Hyperlipidemia • Cardiovascular • Hypertension • Atherosclerosis • CNS • Pseudotumor cerebri • Cancer • Breast, etc.

  21. Type II Diabetes“adult onset”

  22. DIABETES According to the International Diabetes Federation, in 2011, one person is dying from diabetes every seven seconds.

  23. Pima Girls 16 Texas Children’s Hospital 30 60 12 1967 -1976 50 1976 -1986 % 20 1987 - 1996 40 8 30 Yr of Age 10 20 0 4 10 1995 1999 2001 0 % 5 -9 10 -14 15 - 19 0 82 83 87 88 89 90 91 92 93 94 Year Prevalence of Type 2 Diabetes in Children Cincinnati, Ohio

  24. Co-Morbidities of ObesityGlucose Intolerance Current projections by the CDC include scenarios in which up to one third of the children born today will develop type 2 diabetes mellitus during their lifetime, a percentage that rises to 50% for Hispanics and Blacks. Narayan, K.M., et al., JAMA 2003.

  25. Prevalence of Type II Diabetes: Houston Metropolitan area: (pop. 5.5 million) 21% or 1,155,000 are children 5-17 years of age 0 • 19.2% or 221,760 Houston children are obese (BMI>95th) • 25% of obese children have evidence of impaired glucose tolerance (Sinha et al, NEJM 2002; 346) • Then 4.8% or 55,440 Houston children either have or are developing type II diabetes • (Estimated from U.S. 2006 census)

  26. Health Care Costs of Diabetes • Estimated world wide cost in 2011 is $465 billion • Estimated cost in 2007 for the USA is $174 billion • 1 in 10 health care dollars is attributed to diabetes • Yearly cost per individual diagnosis is $6,649 • Lost productivity is $26.9 billion • Does not include social costs such as unpaid caretakers etc. Am. Diabetes Assoc. Diabetes Care, 2008 Mar;31(3):596-615 International Diabetes Federation, Sept. 2011

  27. Co-Morbidities of ObesityNAFLD (Non-alcoholic Fatty Liver Disease) • A spectrum of disease • Fatty infiltration of the liver(up to 40% of obese children by ultrasound) (Styne, Pediatr Clin North Am, 2000) • Hepatic inflammation(~15% of obese and 40-50% of super obese children have elevated ALT’s) (Dietz, Pediatrics, 1998) • Fibrosis and cirrhosis • If inflammation present it is called Steatohepatitis or "NASH" (nonalcoholic steatohepatitis) • Weight loss is the only treatment • Estimated 25% of US adults have this disease Krasnoff et al Hepatology 47;4 2008 http://www.uic.edu/com/dom/hepatology/fatty.liver.disease.html

  28. Co-Morbidities of ObesityNAFLD ~ 20% of adult patients with this disorder eventually develop cirrhosis, and can progress to liver failure which can only be treated with liver transplant (Roberts, Curr Gastroenterol Rep, 2003)

  29. NASH Accounts for 10.3% of all Liver Transplantation at the Cleveland Clinic in 2006 33.1% 12.8% 10.3% www.clevelandclinic.org

  30. Co-Morbidities of Obesity Steatohepatitis • We studied 332 obese children (BMI>95th%tile) • Aminotransferases were elevated (>1.5 times normal) in 52 children (15.7%) • ALT elevated in 100%, AST in 49% & GGT in 80% • 40 of these children had liver biopsy • Mean age 10.9 ± 2.4 years (range: 6-16y) Ruben Quiros, et al

  31. Co-Morbidities of ObesitySteatohepatitis • HEPATIC FIBROSIS • Of the 40 children who were biopsied • 35 children (87.5%) demonstrated some degree of fibrosis • 26 children (65%) had stage II fibrosis or greater • 2 children (5%) had early cirrhosis Ruben Quiros, et al

  32. Prevalence of Obesity-Associated Steatohepatitis Houston Metropolitan area: (pop. 5.5 million)21% or 1,155,000are children 5-17 years of age 0 • 221,760 or 19.2% are obese (BMI >95th) • 33,264 or ~ 15%will have elevated transaminases • 21,621 or ~ 65%will have significant (>stage 2) fibrosis or cirrhosis in their liver bx. • At least 4,324 or 20% will develop hepatic failure and be candidates for liver transplantation as young adults (Estimated from U.S. 2006 census)

  33. Average cost of a liver transplant today is over $150,000

  34. Co-Morbidities of Obesity Cardiac Risk Factors • Hypertension • Hyperlipidemia • Sleep apnea • Insulin resistance • 50% of overweight adolescents have one risk factor for developing cardiovascular disease • 20% have two factors

  35. Adjusted Hazard Ratio: Risk offatal CHD event in adults relative to rise of 1 BMI z score in children FATAL EVENT age girls boys Baker JL et al. NEJM 357;23 Dec 6.2007

  36. HypertensionCDC Health Statistics • Prevalence of Hypertension in the US • 30% of all adults • 58% of obese adults • Prevalence of Hypertension in Children • 1.5-2.5% of all children (HISD screening 2.2%) • 15-21% ofobese children

  37. Future economic burden of current adolescent obesity related to coronary heart disease $254 billion Lightwood et al. Am J Public Health. Oct 15, 2009

  38. Co-Morbidities of ObesitySleep Disorders • Up to 37% of obese children have an abnormal polysomnogram when studied. (Wing, Arch Dis Child, 2003) • True sleep apnea occurs in ~7% of obese children. (Dietz, Pediatrics, 1998)

  39. Health care costs of associated with sleep apnea Up to $300 per day per patient Banno et al, Sleep. 2009 Feb 1;32(2):247-52

  40. Co-Morbidities of ObesityPsychosocial Complications • Higher risk for poor self-esteem, withdrawal from social interactions, anxiety and depression.(Deckelbaum, Obes Res, 2001) • More likely to remain unmarried, have lower incomes and to live in poverty(Gortmaker, N Engl J Med, 1993) • Less likely to be accepted into college(Must, Int J Obes Relat Metab Disord, 1999 • Cannot be quantified in a monetary sense • These perhaps are the most significant "costs" this disorder inflicts on society

  41. OBESITY • Why should you care? • Whose fault is it? • Individuals? • Food Industry? • Society?

  42. There are solutions to this problem but you need to ask to get the rest of the story

  43. Thank You Any Questions?

More Related