Posts Tagged ‘morbid obesity’

Morbid Obesity Continues to Increase

October 3rd, 2012

Severe or morbid obesity (BMI >40) continues to grow. A new analysis estimates, after adjusting for self-report biases, that, in 2010,  15.5 million adult Americans or 6.6% of the population had an actual BMI >40 kg m−2. The prevalence of clinically severe obesity continues to be increasing, although less rapidly in more recent years than prior to 2005.   PubMed: Morbid Obesity Continues to Rise in the US. To put this number in perspective, 15.5 million is the in-between the population of the 4th and 5th largest states by population, Florida and Illinois. Or, it is roughly equal to the populations of Nebraska, Idaho, Hawaii, Maine, New Hampshire, Rhode Island, Montana, Delaware, South Dakota, Alaska, North Dakota, Vermont, Washington, DC, and Wyoming, combined. It is also about equal to the total US population that use Twitter and the total Asian-American population.

Eric Finkelstein et al have projected that morbid obesity will increase 130% over the next 2 decades. PubMed: Obesity and Severe Obesity Forecasts through 2030

What is significant, to my mind, is that unlike any other chronic disease I can think of, we have an effective treatment for the most severe cases…bariatric surgery. We could (and should) employ a strategy to bring this intervention to this population which we know can benefit from it. This is the same population which has the highest mortality, morbidity and health care costs and health care utilization. What am I missing?


It’s Flu Season…Be Careful Out There

September 9th, 2010

It’s flu season. Have you had your shot? If you are obese you better get one.

You wouldn’t necessarily know it from the health authorities but obesity is an important risk for serious complications from the flu, specifically the H1N1 or swine flu.

Obesity was present in 25% of hospitalized H1N1 patients in northwestern Italy (Bassetti M, et al Risk factos for severe complications of the novel influenza A (H1N1): analysis of patients hospitalized in Italy Clin Microbiol Infect 2010 June 1; epub); 21% of hospitalized patient critically ill with confirmed or probably H1N1 in Mexico (Guillermo DC et al Critically Ill Patients with 2009 Influenza A (H1N1) in Mexico JAMA Nov. 4,2009;302(17):1880-1887); obesity was one of the most common cormorbidities at 33% in Canada. (Kumar A, Critically Ill Patients with 2009 Influenza A(H1N1) infection in Canada, JAMA 2009;302(17): 1872-1879).

A study in California found, “A large portion of our adult cases had other comorbidities that are not established risk factors for severe influenza, including hypertension and obesity. Of adults with BMI data available, more than half were obese and one-quarter were morbidly obese. As a point of reference, the percentage of adults who are morbidly obese in the United States is 4.8%. Almost one-third of obese cases did not have other established risk factors fro severe influenza, although 27% had other comorbidities (eg. Hypertension). Others have reported this novel association in pandemic 2009 influenza A (H1N1): diabetes and obesity were the most frequently identified underlying conditions in fatal cases older than 20 years worldwide, and anecdotal observations of high prevalence of obesity in severe and fatal have been reported from Chile, Manitoba and Mexico. (Louie JK, Factors Associated with Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) infection in California, JAMA,2009;302(17):1896-1902)

Just When We Thought We Were Making Progress

September 27th, 2009

July 30, 2009 :: By Morgan Downey

A couple of weeks ago the New Jersey Department of Health (so-called) decided to stop reimbursement of drugs for obesity and impotency from a program for the elderly designed to supplement the Medicare drug coverage program (Known as Medicare Part D, it excludes drugs for treating obesity.)

An article in N.J. to cease coverage of impotency drugs for seniors enrolled in state prescription plan – quotes the Department of Health spokesperson stating that “cosmetic drugs” that treat obesity, hair loss or minor skin conditions as well as vitamins and cold medicines will no longer be covered saving the cash-strapped state $3.3 million. Amazingly, the state AARP chair said it shouldn’t result in significant hardships for vulnerable adults. Doug Johnson said the state, “could have easily slashed vital health care programs and services that vulnerable adults depend on, but they did not.” (Some advocate for the elderly, eh?)

Weight loss in the elderly is important and achievable. The Diabetes Prevention Program found that older participants actually had greater weight loss and higher levels of physical activity than younger participants. The influence of age on the effects of lifestyle m…[J Gerontol A Biol Sci Med Sci. 2006] – PubMed Result. It may be that younger older persons from 65 years of age to 74 years have reduced stress from their careers, children may be grown, and they may see friends and family struggling with health problems. These may all motivate them to improve their health and it clearly benefits the Medicare program if diabetes or cardiovascular diseases related to obesity can be postponed or avoided.

We thought the old canard that obesity is a trivial, cosmetic problem was put to rest years ago. Even as the Center for Disease Control and Prevention is conducting a three day conference on obesity and even as Congress and the Administration, employers and insurers are grappling with approaches to prevention and treatment of obesity, we see two leading health care institutions throwing up the ‘cosmetic’ view of obesity. This comes, of course, on the heels of the American Medical Association declaring that persons with morbid obesity who cannot work should not be eligible for disability payments. We might expect such attitudes from people or institutions who did not know better but these are respected health organizations who are taking us backward not forward. If supposedly science-based organizations dedicated to improving individual and public health take these attitudes how can we expect the public to take the obesity problem seriously?

Treatments in low-income patients

September 27th, 2009

Obesity – Treatment of Morbid Obesity in Low-income Adolescents: Effects of Parental Self-monitoring[ast][ast]

Weight-Wise: A weight loss program for low-income women in the North Carolina WISEWOMAN program

Dietary Risk Assessment in the WIC Program

Downey Fact Sheet 1 – About Obesity

September 27th, 2009

pdficon_small Printable PDF

Obesity is a global epidemic and a major health concern because of its premature mortality and extensive comorbidities. Obesity is a common, complex, multifactorial disease with a high degree of heritability. Between 25 and 40% of person with obesity have a parent who is obese. There are several significant facts to bear in mind when discussing obesity:

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

Every individual inherits a certain number of fat cells or adipose tissue. Obesity requires (a) a large number of fat cells or (b) a large volume in each fat cell or (c) both. Adipose tissue continues throughout the lifespan. Weight loss, including surgically-induced weight loss, does not remove fat cells. This is why weight regain is so common. Individuals with obesity have significantly more fat cells than the non-obese, 23-65 billion compared to 37-237 billion for persons with obesity . Early onset obesity is associated with increase adipose cell number while adult obesity is associated with normal cell number. There are two phases of life in which growth of adipose cells are likely to develop: very early, within the first few years of life and between the ages of 9-13 years of age. Those who become very obese early in life are the ones who have nearly normal cell size but have the greatest increase in cell number; whereas those with onset of obesity between 9-13 have more change in cell size than cell number. Salans LB, Cushman SW, Weisman RE, Studies of human adipose tissue. Adipose cell size and number in non0bese and obese patients. J. Clin Invest. 1973 Apr’ 52(4): 929-41)

Extremely obese individuals may have four times the number of fat cells as lean counterparts.

Human food intake and energy expenditure are controlled by complex, redundant and distributed neural systems that reflect fundamental biological reaction to food supply and energy balance. The hypothalamus and caudal brainstem play a critical role. The limbic system is important for processing information regarding previous experience with food, reward and emotion. The predisposition to store considerable amounts of energy as fat for later use is now a major health risk. Brain, appetite and obesity – PubMed Results

Extensive research over the past 10 years has shown that appetite is regulated by a complex system of central and peripheral signals which interact in order to modulate the individual response to nutrient ingestion. Satiety signals include cholecystokinin, glucagon-like peptide and peptide YY which originate from the gastrointestinal tract during a meal and through the vagus nerve reach the caudal brainstem. Here the signals move to the arcuate nucleus where satiety signals are integrated with adiposity signals, namely leptin and insulin, and with several other inputs create a neural circuit which controls the individual’s response to a meal, i.e. keep eating or stop. Neuro-hormonal control of food intake: basic mecha…[J Physiol Pharmacol. 2005] – PubMed Result

Adipose tissue, rather than some inert, jello-like, substance is an active hormonal tissue, secreting many hormones which are involved in creating signals from the gut to the brain, indicating hunger or satiety. These hormones include insulin, leptin, ghrelin, PYY-33-6, adiponctin, resistin and visfatin as well as cytokines and chemokines, such as tumor necrosis factor-alpha, interleukin-6 and others. These can lead to a chronic sub-inflammatory state which plays a critical role in the development of insulin resistance, type 2 diabetes, increased risk of cardiovascular disease associated with obesity. Adipokines: the missing link between insulin resis…[Diabetes Metab. 2008] – PubMed Result

Downey Fact Sheet 6 – Morbid Obesity

September 27th, 2009

pdficon_smallPrintable PDF

Fact Sheet Morbid Obesity

Over two-thirds of Americans are overweight or obese; one-third are obese. But the obesity crisis in the United States is really the crisis of morbid obesity. It is this group – persons with morbid obesity – who have the most comorbid conditions, the highest health care costs and the greatest likelihood of death.

Morbid obesity is defined as a Body Mass Index (BMI) of 40 or more (roughly 100 pounds over ideal weight). (The Body Mass Index is a formula in which the weight in kilograms is divided by height in meters squared. A BMI of 30 to 39.9 is regarded as obese; 25-29.9 overweight and 20-24.9 normal weight; a BMI below 20 is considered unhealthy.) The number of Americans with morbid or severe obesity, defined as 100 pounds or more overweight or a BMI of 40, is growing twice as fast as the number of Americans who are overweight or obese.

The prevalence of Americans with a BMI over 50 has increased by 75 percent from 2000 to 2005. This statistic confirms that the heaviest BMI groups have been increasing at the fastest rates for 20 years. (Increases in morbid obesity in the USA: 2000-2005. [Public Health. 2007] – PubMed Result)

  • The prevalence of morbid obesity is now 1 in 20 Americans. The prevalence is greater among women than men and among African-Americans than among non-Hispanic whites or Hispanics. The mortality due to morbid or extreme obesity is greater among the young than the older adults, greater for men than for women and greater among whites than blacks. Extreme obesity: a new medical crisis in the Unite…[Mayo Clin Proc. 2006] – PubMed Result.
  • Unfortunately, it appears this trend will only grow worse. In a recently published paper, researchers noted the tendency for the heavier to become more heavy, especially among the young and minority groups. Gender-ethnic disparity in BMI and waist circumfer…[Obesity (Silver Spring). 2009] – PubMed Result
  • While this population is only about 5 percent of the total U.S. population or 15 million people, it is greater than the entire population of Illinois and is roughly 3 times as large as the population with Alzheimer’s disease.
  • The prevalence of morbid obesity is now 1 in 20 Americans. The prevalence is greater among women than men and among African-Americans than among non-Hispanic whites or Hispanics. The mortality due to morbid or extreme obesity is greater among the young than the older adults, greater for men than for women and greater among whites than blacks.7 7 Extreme obesity: a new medical crisis in the Unite…[Mayo Clin Proc. 2006] – PubMed Result
  • A recent study found of thousands of employees found that those with morbid obesity have a significantly higher prevalence of more than 102 diseases and conditions out of 131 eligible diseases and conditions than other employees and had a lower prevalence in only 3 categories: normal delivery, placenta previa and liveborn. 8 The impact of morbid obesity and bariatric surgery…[J Occup Environ Med. 2009] – PubMed Result This study also revealed several conditions which were not noted in previous studies including intervertebral disc disorders, malaise and fatigue, anemia, other upper respiratory disease, abdominal pain, nonspecific chest pain.
  • Higher BMI is associated with lower than expected life duration. Excess BMI is responsible for an estimated 95 million years-of-life-lost; white females account for more than 2/3 of the years-of-life-lost. Individual and Aggregate Years-of-life-lost Associ…[Obesity (Silver Spring). 2009] – PubMed Result