Obesity

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Contents

Introduction

Obesity is a condition in which the natural energy reserve, stored in the fatty tissue, is increased to a point where it is associated with certain health conditions or increased mortality.[1] It is characterized as a state of excess adipose mass with abnormal increase of fat on the subcutaneous connective tissue. Obesity is generally defined as a Body Mass Index (BMI) greater than 30. A high BMI is associated with a higher risk for medical problems.[1] Although obesity is an individual condition, it is increasingly viewed as a serious and growing public health problem: excessive body weight has been shown to predispose to various diseases or co-morbidities, particularly cardiovascular diseases (see Congestive Heart Failure), Diabetes Type 2, Sleep Apnea and Osteoarthritis.[2][3]

International Aspects

More than one-third of U.S. adults -– over 72 million people -- were obese in 2005-2006. This includes 33.3 percent of men and 35.3 percent of women.[4] Adults aged 40-59 had the highest obesity prevalence compared with other age groups. Approximately 40 percent of men in this age group were obese, compared with 28 percent of men aged 20-39, and 32 percent of men aged 60 and older. Among women, 41 percent of those aged 40-59 were obese compared with 30.5 percent of women aged 20-39. Women aged 65 and older had obesity prevalence rates comparable with women in the 20 to 39 age group.[4] There were large race-ethnic disparities in obesity prevalence among women. Approximately 53 percent of non-Hispanic black women and 51 percent of Mexican-American women aged 40-59 were obese compared with about 39 percent of non-Hispanic white women of the same age. Among women 60 and older, 61 percent of non-Hispanic black women were obese compared with 37 percent of Mexican-American women and 32 percent of non-Hispanic white women.[4][5] In Japan, obesity is also on the rise, going from around 2.5% of the population in the 80's and 90's to 3.5% in 2002.[6]

According to a study of national costs attributed to both overweight (BMI 25–29.9) and obesity (BMI greater than 30), medical expenses accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6 billion in 2002 dollars)[5]. Approximately half of these costs were paid by Medicaid and Medicare. The primary data sets used to develop the spending estimates for this study included the 1998 Medical Expenditure Panel Survey (MEPS) and the 1996 and 1997 National Health Interview Surveys (NHIS). The data also included information about each person’s health insurance status and sociodemographic characteristics.[7]


Obesity Forecasts US and EU Source: WHO and OECD Health data 2008

The following are other important facts related to obesity[8]

  • It is predicted and generally agreed across medical and social economic literature that by 2025, over 80% of Americans will be overweight and 50% of people will be obese.
  • In the USA affected individuals will on average die 15 years earlier than non-obese people.
  • In the USA a child born in 2000 will have a 1 in 3 chance of developing diabetes as a result of obesity.
  • In the USA obesity costs exceed $120 billion a year.
  • In the United States, the prevalence of excess weight and obesity in adolescents has nearly tripled in the past two decades
  • Britain is following the USA’s path towards a massive prevalence of obesity, which could affect half the adult population by 2050 and cost the UK health system almost $100 billion a year.
  • The EU has stated that the greatest challenge in to the next decade will be the tackling of obesity and its comorbidities such as diabetes and cardiovascular diseases
  • Weight loss market forecast to hit $61 billion by 2008

Interventions and Challenges

The main treatment for obesity is to reduce body fat by eating fewer calories and exercising more. A beneficial side effect of exercise is to increase muscle, tendon, and ligament strength, which helps to prevent injury from accidents and vigorous activity. Diet and exercise programs produce an average weight loss of approximately 8% of total body mass (excluding program drop-outs). Not all dieters are satisfied with these results, but a loss of as little as 5% of body mass can lead to significant health benefits.[1]

Eighty to ninety-five percent of those who lose 10% or more of their body mass by dieting regain all that weight back within two to five years. The body has systems that maintain its homeostasis at certain set points, including body weight. Therefore, keeping weight off generally requires making exercise and eating right a permanent part of a person's lifestyle. Certain nutrients, such as phenylalanine are natural appetite suppressants which allow resetting of the body's set point for body weight.[1]

Exercise requires energy (calories). Calories are stored in body fat. The body breaks down its fat stores in order to provide energy during prolonged Calories are stored in body fat. The body breaks down its fat stores in order to provide energy during prolonged aerobic exercise. The largest muscles in the body are the leg muscles, and naturally these burn the most calories, which make walking, running, and cycling among the most effective forms of exercise for reducing body fat.

A meta-analysis of randomised controlled trials by the Cochrane Collaboration found that "exercise combined with diet resulted in a greater weight reduction than diet alone".[9]

Certain physical and mental illnesses and particular pharmaceutical substances may predispose to obesity. Apart from the fact that correcting these situations may improve obesity, the presence of increased body weight may complicate the management of others.

Medical illnesses that increase obesity risk include several rare congenital syndromes such as hypothyroidism, Cushing's syndrome, growth hormone deficiency. [8] Smoking cessation is a known cause for moderate weight gain, as nicotine suppresses appetite. Certain medications (e.g. steroids, atypical antipsychotics, some fertility medication) may cause weight gain.

Mental illnesses may also increase obesity risk, specifically some eating disorders such as bulimia nervosa, binge eating disorder, and compulsive overeating (also known as food addiction).


Policies

In a clinical practice guideline by the American College of Physicians, the following five recommendations are made:[10]

  • People with a BMI of over 30 should be counseled on diet, exercise and other relevant behavioral interventions, and set a realistic goal for weight loss.
  • If these goals are not achieved, pharmacotherapy can be offered. The patient needs to be informed of the possibility of side-effects and the unavailability of long-term safety and efficacy data.
  • In patients with BMI > 40 who fail to achieve their weight loss goals (with or without medication) and who develop obesity-related complications, referral for bariatric surgery may be indicated. The patient needs to be aware of the potential complications.
  • Those requiring bariatric surgery should be referred to high-volume referral centers, as the evidence suggests that surgeons who frequently perform these procedures have fewer complications.

Public health and policy responses to obesity seek to understand and correct the environmental factors responsible for shifts in the prevalence of overweight and obesity in a population. Obesity and overweight are, currently, primarily policy problems in the United States. Policy and public health solutions look to change the environmental factors that promote calorie dense, low nutrient food consumption and that inhibit physical activity.[1]

In the United States, policy has focused primarily on controlling childhood obesity which has the most serious long-term public health implication. Efforts have been underway to target schools. There are efforts underway to reform federally-reimbursed meal programs, limit food marketing to children, and ban or limit access to sugar sweetened beverages. In Europe, policy has focused on limiting marketing to children. There has been international focus on food environments that produce overweight and obesity in a population. To confront physical activity, efforts have examined zoning and access parks and safe routes in cities.

In the United Kingdom, a 2004 report by the Royal College of Physicians, the Faculty of Public Health and the Royal College of Paediatrics and Child Health, titled "Storing up Problems"[11] was followed by a report by the British House of Commons Health Select Committee - "the most comprehensive inquiry" ever by that body - on the impact of obesity on health and society in the UK and possible approaches to the problem.[12] In 2006, the National Institute for Health and Clinical Excellence (NICE) issued a guideline on the diagnosis and management of obesity, as well as policy implications for non-healthcare organizations such as local councils.[13] A 2007 report produced by Sir Derek Wanless for the King's Fund warned that unless further action was taken, obesity had the capacity to cripple the National Health Service financially.[14]


Future Vision

Many medical devices exist that measure motor activities. One vision may be to combine monitoring devices with strict daily drug and exercise schedules. Web applications could provide access to the treating physician to the patient’s status. Besides, web applications could be utilized to facilitate access to support groups when craving is experienced by the patient.


Related Interventions in CAPSIL:



Related Enabling Technologies in CAPSIL:



Related CAPSIL Scenarios


References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 WikiDoc – Obesity: http://www.wikidoc.org/index.php/Obesity
  2. ↑ National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. International Medical Publishing, Inc
  3. ↑ Haslam DW, James WP (2005). "Obesity". Lancet 366 (9492): 1197–209.
  4. ↑ 4.0 4.1 4.2 New CDC Study Finds No Increase in Obesity Among Adults: http://www.cdc.gov/nchs/PRESSROOM/07newsreleases/obesity.htm
  5. ↑ 5.0 5.1 Finkelstein, EA, Fiebelkorn, IC, Wang, G. National medical spending attributable to overweight and obesity: How much, and who’s paying? Health Affairs 2003;W3;219–226
  6. ↑ http://www.nissui.co.jp/academy/eating/04/eating_vol04.pdf
  7. ↑ Economic Consequences of Obesity: http://www.cdc.gov/obesity/causes/economics.html
  8. ↑ World Obesity Statistics
  9. ↑ Shaw K, Gennat H, O'Rourke P, Del Mar C (2006). "Exercise for overweight or obesity". Cochrane database of systematic reviews
  10. ↑ Snow V, Barry P, Fitterman N, Qaseem A, Weiss K (2005). "Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians". Ann Intern Med 142 (7): 525-31.
  11. ↑ Storing up problems; the medical case for a slimmer nation
  12. ↑ Great Britain Parliament House of Commons Health Committee (May 2004).
  13. ↑ National Institute for Health and Clinical Excellence. Clinical guideline 43: Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children
  14. ↑ Wanless, Sir Derek; John Appleby, Anthony Harrison, Darshan Patel (2007). Our Future Health Secured? A review of NHS funding and performance

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