Archive for July, 2015
July 31st, 2015
Health economist John Cawley and colleagues have published what might be an extremely important contribution to establishing priorities for interventions in the adult obesity population. Their paper, “Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes status,” shows that additional costs associated with increases in body weight are not shared equally but increase exponentially as BMI increases. Likewise, the greatest savings in medical expenditures arise in weight loss among those with the highest BMI, i.e. persons with Class III or severe obesity. They write,”The IV model indicates that obesity raises annual medical care costs by $US3,508 per obese individual per year, or $US315.8 billion for the USA as a whole (both measured in 2010 values). The results of IV models are also used to construct detailed tables of the estimated medical care expenditure savings given specific reductions in BMI from specific starting values of BMI; these tables indicate that the savings from a given percent reduction in BMI is greater the heavier the obese individual, and is greater for those with diabetes than for those without diabetes. These estimates of the change in medical care expenditures resulting from weight loss can be used to more accurately calculate the cost effectiveness of interventions to prevent and treat obesity, and can be used by health insurers, employers, and government agencies to determine the societal savings from, and business case for, interventions that generate a specific amount of weight loss.”
Dr. Arya Sharma observes in his post on this paper, “Thus, for e.g. the annual cost savings with a 5% reduction in body weight for someone with a BMI of 30 kg/m2 amounted to a mere $69 per year.
This figure, however, increased exponentially for people with higher BMIs, increasing to $528, $2,137, and $10,030 in an individual with a BMI of 35, 40, and 45 kg/m2, respectively (these figures were somewhat higher, when the individual also has diabetes).
Thus, while treating obesity to achieve a 5% reduction in body weight in someone with a BMI of 30 kg/m2 may never be “cost-effective”, the same amount of weight loss in someone with more extreme obesity, would likely pay for itself or even lead to significant savings.
Because the impact of obesity on mental and physical health, life-expectancy and quality of life is also greatest at higher levels of BMI, one could also make a strong ethical argument for singling out these individuals for priority treatment in the health care system.”
We could not agree more.
Conflict Alert: I have a great respect for Dr. Cawley’s work on obesity and was pleased to be part of a Point-Counterpoint debate with him on Employer Wellness programs published in 2014 in the Journal of Policy Analysis and Management.
July 31st, 2015
MedPage of July 8, 2015 contains an interesting opinion piece on liraglutide SCALE study by Dr. F. Perry Wilson of the Yale School of Medicine. Dr. Wilson makes some fair points about the study regarding weight loss but seems a bit shocked that, when the drug is discontinued, the weight returns. He also notes that bariatric surgery is probably a better option than taking a drug for life. Perhaps. But there is a group of patients who would rather avoid surgery at all costs, even if more effective. As to seeing the weight return after discontinuation of the drug, we should not be surprised. Most conditions only respond during intervention and return when the intervention stops. It may be more remarkable that the drug continues to be effective against the phenomenon of adaptive thermogenesis.
July 31st, 2015
Dr. Arya Sharma has a very useful post on the transgenerational transmission of metabolic disease, including obesity. As Dr. Sharma points out, if anyone says that obesity is not genetic, they don’t know what they are talking about. The article cited by Dr. Sharma recalls an earlier post on a three-generation transmission of the memory of starvation. Just goes to show that there much to be learned.
July 31st, 2015
Anahad O’Connor, writing in the New York Times, discloses an upsetting picture of the Food and Drug Administration inaction on policing an amphetamine-like substance in dietary supplements. The article describes how the leadership of the FDA division responsible for policing dietary supplements has been and is led by high level executives from the Natural Products Association, the trade association representing dietary supplement makers.
July 30th, 2015
The Food and Drug Administration (FDA) has approved a new medical device for the treatment of obesity. This device, a minimally invasive dual balloon delivered via an endoscope , is designed to make the stomach feel full and, thus, reduce consumption. While hailed by some groups like the American Society for Bariatric and Metabolic Surgery, the importance of this approval may lie not so much in the specific device but in the greater willingness of the FDA medical device regulators to be open to more devices meant to assist in weight management. See here for more information.
July 30th, 2015
The New York Times reported this morning on the passing of Dr. Jules Hirsch, a pioneer in obesity research. Twenty years ago, Dr.Hirsch and colleagues produced a ground-breaking study showing that, weight is lost, metabolism slows down. This causes weight to plateau without even greater reductions in caloric intake. At some point, a patient becomes frustrated with the lack of progress and/or succumbs to the brain’s demand to assuage the sensation of hunger.
Dr. Hirsch provided a wonderful summary of brain and behavior vis a vis obesity in this 2003 publication in Cerebrum, in 2003, from the Dana Foundation, Obesity: Matter Over Mind.
Dr. Hirsch will surely be missed by the generations of researchers and clinicians he trained, by colleagues throughout the world in obesity research ,as well as by family and friends.
For many years, Dr. Hirsch was a member of the Food and Drug Administration’s advisory panel reviewing drugs for the treatment of obesity. As a witness to most of these hearings since 1998, I can say that fear spread across the faces of presenters from the pharmaceutical company when Dr. Hirsch’s time came to ask questions. His approval or disapproval had a wide impact on other panelists. Likewise, one could hear a virtual sigh of relief among pharmaceutical company presenters were there news Dr. Hirsch would be absent. His testament to scientific integrity will be surely missed.