The Obesity Epidemic The Obesity Epidemic John Ganser, MD, FACS John Ganser, MD, FACS www.westernbariatricinstitute.com The Obesity Epidemic - Outline The Obesity Epidemic - Outline Statistics of the Epidemic Magnitude of the problem Mechanisms of Obesity Metabolic Disease Comorbid conditions associated and their effect on mortality Effect of weight loss on comorbid conditions and mortality 1
What Is Morbid Obesity? What Is Morbid Obesity? A chronic, life-threatening disease. Recognized as a disease by AMA in 2013 Excessive body fat accumulation resulting in a negative effect on health BMI > 30 kg/m 2 Risk factor for 30+ medical conditions. Medical, psychological, social, physical and economic impact. Health Risks of Obesity Health Risks of Obesity Obesity is measured by a formula called body mass index (BMI) weight in kg/height m2. A healthy BMI is about 18-25. A BMI of 30 or more signals obesity. A BMI of 35 or more reflects severe (morbid) obesity. 2
Body Mass Index and Body Fat Body Mass Index and Body Fat Body Mass Index (BMI) Height (ft/in) 4 ’ 9 ” 4 ’ 11 5 ’ 1 ” 5 ’ 3 ” 5 ’ 5 ” 5 ’ 7 ” 5 ’ 9 5 ’ 11 6 ’ 1 6 ’ 3 ” ” ” ” ” • Measures obesity 154 33 31 29 27 26 24 23 22 20 19 based on weight 165 36 33 31 29 28 26 24 23 22 21 176 38 36 33 31 29 28 26 25 23 22 and height 187 40 38 35 33 31 29 28 26 25 24 198 43 40 37 35 33 31 29 28 26 25 Weight (lbs) 209 45 42 40 37 35 33 31 29 28 26 220 48 44 42 39 37 35 33 31 29 28 231 50 47 44 41 39 36 34 32 31 29 BMI (kg/m 2 ) 243 52 49 46 43 40 38 36 34 32 30 Weight Category 254 55 51 48 45 42 40 38 35 34 32 Healthy Weight 18.5-24.9 265 57 53 50 47 44 42 39 37 35 33 Overweight 25-29.9 276 59 56 52 49 46 43 41 39 37 35 Obese 30-34.9 287 62 58 54 51 48 45 42 40 38 36 298 64 60 56 53 50 47 44 42 39 37 Severely Obese 35-39.9 309 67 62 58 55 51 48 46 43 41 39 Morbidly Obese ≥ 40 320 69 64 60 57 53 50 47 45 42 40 • Please note BMI does not distinguish between fat and muscle. A heavily muscled person could have a BMI in excess of 25 without having any increased health risks. Classification of Obesity Classification of Obesity Clinical Terms Used to Describe Various Levels of Body Fat Obese Extremely Obese Normal Weight Overweight Obese (BMI* 18.5 to 24.9) (BMI 25 to 29.9) (Class II) (Class III) (Class I) (BMI 35 to 39.9 ) (BMI 40 or more) (BMI 30 to 34.9) * BMI (Body Mass Index): A measurement of an individual ’ s weight in relation to height (kg/m 2 ). 1. National Institutes of Health/National Heart, Lung and Blood Institute Clinical Guidelines Evidence Report. NIH Publication 98-4083, September 1998. AS1 3
Slide 6 AS1 BMI defined with unit of measurement Amy.Sauer, 10/1/2007
The Obesity Epidemic – U.S. The Obesity Epidemic – U.S. More than 69% of adults are overweight or obese 34.9% of U.S. adults are obese (BMI > 30) 78.6 million people 6.4% of adults are morbidly obese (BMI>40) 32% of children are overweight or obese (2-19) 17% are obese 365,000 obesity-related deaths occur annually NHANES National Health and Nutrition Examination Survey 2011-2012 The obesity Epidemic -Worldwide 1980-2013 Global Burden of Disease Study 3.4 million deaths worldwide Worldwide increase 28.8% to 36.9% in men BMI>30 Worldwide increase 29.8% to 38.0% in women BMI >30 Prevalence in children 23.8% boys, 22.6% girls No nation has reported success in reducing the prevalence of obesity in 33 years The Lancet, Volume 384, issue 9945, P766-781, 30 Aug 2014 4
The Obesity Epidemic – Economic Impact The Obesity Epidemic – Economic Impact Total medical cost for obesity $168 billion (1998 $78.5 billion) 9.1% of annual spending on medical care Individual annual medical cost $1,429 higher than normal weight (42% Increase) 80% higher prescription drug costs than for normal weight individuals Health Conditions Related “Comorbidities” Health Conditions Related “Comorbidities” Heart Disease Dyslipidemia Type 2 Diabetes Mellitus Gallbladder disease Hypertension Sleep apnea Strokes Asthma Certain types of Cancer Reduced fertility – Endometrial Osteoarthritis – Breast – Prostate – Colon 5
“Comorbidities” (continued) “Comorbidities” (continued) Low-back and disk Urinary-stress disease incontinence Pulmonary emboli Gastroesophageal reflux disease Obesity hypoventilation Liver and biliary Pulmonary gallstones hypertension Soft tissue Gout infections Depression Early death Obesity Impacts Nearly Every Organ System Obesity Impacts Nearly Every Organ System Depression Pulmonary disease abnormal PFTs Stroke obstructive sleep apnea GERD hypoventilation syndrome Cardio/Metabolic Syndrome diabetes (80% type 2) Non-alcoholic fatty liver disease dyslipidemia steatosis hypertension steatohepatitis metabolic syndrome cirrhosis Gall bladder disease Severe pancreatitis Gynecologic abnormalities Cancer (42% Breast/Colon) abnormal menses breast, uterus, cervix infertility colon, esophagus, pancreas polycystic ovarian syndrome kidney, prostate stress incontinence Phlebitis Osteoarthritis venous stasis Skin Reference 5 Premature Death Gout 6
Fact Fact An adult with a BMI of 35 or more has a 33% chance of living to age 65 as that of a normal weight person. Relationship between BMI and Health Risk Relationship between BMI and Health Risk • Diabetes • Hypertension • Sleep apnea • Depression • Joint pain • Infertility • Cancer • GERD • Asthma Calle EE, Michael MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of US adults. N Eng J Med . 1999;341(15):1097-105. 7
Relative Risk of Obesity Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. (December 2010). "Body-mass index and mortality among 1.46 million white adults". N. Engl. J. Med. 363 (23): 2211–9. Relative Risk of Obesity Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. (December 2010). "Body-mass index and mortality among 1.46 million white adults". N. Engl. J. Med. 363 (23): 2211–9. 8
Prevalence of Self-Reported Obesity Am ong Prevalence of Self-Reported Obesity Am ong U.S. Adults by State and Territory U.S. Adults by State and Territory The data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, telephone interview survey conducted by state health departments with assistance from CDC. Obesity: Body Mass Index (BMI) of 30 or higher. 1985 Obesity* Trends Among U.S. Adults 1985 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% Source: BRFSS, CDC 9
1991 Obesity* Trends Among U.S. Adults 1991 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% Source: BRFSS, CDC 1993 Obesity* Trends Among U.S. Adults 1993 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% Source: BRFSS, CDC 10
1996 Obesity* Trends Among U.S. Adults 1996 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% Source: BRFSS, CDC 1999 Obesity* Trends Among U.S. Adults 1999 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% ≥ 20 Source: BRFSS, CDC 11
2002 Obesity* Trends Among U.S. Adults 2002 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% 20%–24% ≥ 25% Source: BRFSS, CDC 2004 Obesity* Trends Among U.S. Adults 2004 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% 20%–24% ≥ 25% Source: BRFSS, CDC 12
2007 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% Source: BRFSS, CDC 2010 Obesity* Trends Among U.S. Adults 2010 Obesity* Trends Among U.S. Adults *BMI > 30 or ~ 30 lbs overweight for 5’4” person *BMI > 30 or ~ 30 lbs overweight for 5’4” person 13
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