Obesity Info

According to the National Institutes of Health (NIH), more than half of the U.S. population is overweight. But being obese is different from being overweight. An adult male is considered obese when his weight is 20% or more over the maximum desirable for their height; a woman is considered obese at 25% or more than this maximum weight. Anyone more than 100 pounds overweight is considered morbidly obese.

Rates of obesity are climbing. An ominous statistic is that the percentage of children and adolescents who are obese has doubled in the last 20 years.

Obesity increases a person’s risk of illness and death due to diabetes, stroke, coronary artery disease, hypertension, high cholesterol, and kidney and gallbladder disorders. Obesity may increase the risk for some types of cancer. It is also a risk factor for the development of osteoarthritis and sleep apnea.

Genetic factors play some part in the development of obesity — children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

The term morbid obesity refers to patients who are 50 – 100% — or 100 pounds above — their ideal body weight. Alternatively, a BMI (body mass index) value greater than 39 may be used to diagnose morbid obesity.

For these people, bariatric, or weight loss surgery, is often the best choice for long term, permanent weight loss.

Definitions

Bariatric: from the Greek Baros: weight and Iatrikos: medicine

Obesity: An excess of body fat. Obesity develops when energy intake exceeds energy expenditure over a long period.

Body Mass Index(BMI) : Obesity is classified according to body mass index

BMI Calculator

If you want to compare your weight status to others, BMI is a great method of analysis.

Obesity Facts

• World Epidemic of Overweight estimated to encompass 1.7 Billion Individuals
• 2/3 of the U.S. population are overweight and of those, 1/2 are obese
• BMI>25: 130 Million
• BMI>30: 60 Million
• BMI>35 and at least 1 obesity related complication: 15 Million
• BMI>40: 9 Million
• Prevalence of obesity in persons older than 18 years of age increased 5.6% in just one year from 2000 to 2001
• Each year, an estimated 365,000 adults in the U.S. die of obesity-related causes
• Direct cost of obesity: estimated at 9.4% of U.S. health care expenditures($117 Billion per year)
• Nurses’ Health Study:
  • Direct relationship between increasing BMI and relative risk of dying prematurely
  • >100% increase in relative risk as BMI increased from <19 to >32
  • Framingham data:
    Only 1 in 7 obese individuals will reach U.S. life expectancy of 76.9 years
    In the morbidly obese population, the average life expectancy is reduced by:
    9 years in women, 12 years in men
  • An estimated 14% of all cancer deaths in men are due to obesity
  • An estimated 20% of all cancer deaths in women are due to obesity

Medical Implications of Obesity

Impact of Obesity

• Co morbid diseases
• Reduced quality of life
• Social Discrimination
• Disability
• Increased medical costs
• Premature death

References

Dietel Obes Surgery 2003; Flegal Int J Obes Relat Metab Disord 1998; Flegal JAMA 2002; Mokdad JAMA 1999; CDC 2002; Buchwald JAMA 2004
Buchwald J Am Coll Surg 2005; Moore Epidemiology 2000; Huang Ann Intern Med 1998; Hensrud Mayo Clinic Proc 2006; Calle N Engl J Med 2003

Why Obesity Surgery?

Bariatric Surgery: A Systematic Review and Meta-analysis (Buchwald, H. JAMA 2004)

• 22,094 patients: 19% men, 72.6% women
  • Mean age = 39 years
  • Mean percentage excess weight loss = 61.2%
  • Gastric banding: 47.5% EWL
  • Gastric bypass: 61.6% EWL
  • Gastroplasty: 68.2% EWL
  • Biliopancreatic diversion or duodenal switch: 70.1% EWL
  • Operative mortality:
    • 0.1% purely restrictive surgeries
    • 0.5% gastric bypass
    • 1.1% biliopancreatic diversion or duodenal switch
    • Overall
      • Diabetes completely resolved in 76.8% of patients and resolved or improved in 86%
      • Hyperlipidemia improved in 70%
        Hypertension was resolved in 61.7% and resolved or improved in 78.5%
      • Obstructive sleep apnea was resolved in 85.7% and resolved and improved in 83.6%

Meta-Analysis: Surgical Treatment of Obesity (Maggard, M. Ann Intern Med 2005)

• Evidence supporting a benefit of bariatric surgery was strongest in patients with a BMI>40
• For BMIs of 35 to 39, data from case series strongly support superiority of surgery but cannot be considered conclusive
• Gastric bypass procedures result in more weight loss than gastroplasty
• Bariatric procedures currently in use have been performed with an overall mortality of less than 1%
• Adverse events occur in about 20% of cases
• A laparoscopic approach results in fewer wound complications than an open approach

Swedish Obese Subjects Study (Sjostrom, L. N Engl J Med 2004)

• Prospective, nonrandomized, inter
  ventional trial involving 4047 subjects
• Largest trial comparing surgical versus medical treatment of morbid obesity
• 2010 patients underwent surgery (gastric banding, gastroplasty, or gastric bypass)
• 2037 chose medical treatment
• At 2 years, weight had increased by 0.1 percent in the control group and decreased by 23.4 percent in the surgery group
• At 10 years, weight had increased by 1.6 percent in the control group and decreased by 16.1 percent in the surgery group
• Energy intake was lower and the proportion of physically active subjects was higher in the surgery group

• Two and ten-year rates of recovery were better for diabetes, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, hypertension and hyperuricemia were more favorable in the surgery group
• Surgery group had lower two and ten year incidence rates of diabetes, hypertriglceridemia, and hyperuricemia
• Surgically treated patients were significantly less likely to require medications for cardiovascular disease or diabetes at two and six years
• Costs of medications were reduced significantly in the surgically treated group
• Surgically treated patients had dramatic improvement in scores on validated measures of quality of life

Long-Term

Mortality after Gastric Bypass Surgery (Adams NEJM 2007)

• Compared
  7925 Gastric Bypass (GB) patients vs. 7925 severely obese (BMI >35)
• Follow-
  up 7.1 years
• Mortality
  decreased by 40% in GB patients
• Cause-specific
  mortality decreased in GB pt.s
  • Coronary
    artery disease by 56%
  • Diabetes
    by 92%
  • Cancer
    by 60%
• Lives
  saved: 136 per 10,000 Gastric Bypass Surgeries

Treatment of Mild to Moderate Obesity with Laparoscopic Adjustable Gastric Banding

(O’Brien Ann Intern Med 2006)

• Randomized 80 patients with a BMI 30-35
  • At 2 years, Mean weight loss
    Medical – 5.5%
    Surgical – 21.6%

Implications of Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes

(O’Brien JAMA 2008)

• Randomized
  60 patients: BMI 30-40
• Conventional
  diabetes therapy focus on weight loss by lifestyle change vs. LAGB
• 2-year
  follow-up
• Remission
  of type 2 diabetes
  • 73%
    LAGB
  • 13%
    Conventional
• Remission
  related to weight loss

Economics

• Obese adults have 36%-39% higher health care costs than normal-weight persons
• Obesity is associated with increased costs to businesses, partly because of absenteeism and health-related lost production timeSampalis compared long-term direct health care costs in 1035 bariatric surgical patients with 5746 obese controls
• At 3.5 years, the cost of surgery was compensated for by a reduction in total cost
• Medication costs, specifically for antihypertensive and diabetic medications are reduced by as much as 77% after surgery
• Snow found the savings in drug costs was equal to the cost of surgery at 32 months
• Assessments of quality adjusted life years have been conducted and favor bariatric surgery over nonsurgical treatment

• Conservative attempts at lasting weight loss in the morbidly obese have a nearly 100% failure rate in the long term
• Life expectancy increases
• Increase in employability and productivity
• Activities of daily living improve markedly
• Decrease in medical claims and absenteeism
• Even in those over age 60, there is a significant decrease in number and dose of drugs with cost-savings
• References (Hensrud Mayo Clin Proc 2006; Sampalis Obes Surg 2004; Craig Am J Med 2002; Snow Obes Surg 2004; Jensen SOARD 2005; Brethauer Clev Clinic J Med 2006; Mason Obes Surg 1992)