What are the Costs Associated with Obesity?

The total cost attributable to obesity amounted to $99.2 billion in 1995. Approximately $51.65 billion of those dollars were direct medical costs. Compared with 1988 data, in 1994 the number of restricted-activity days, bed-days, and work-lost days increased substantially. The number of physician visits attributed to obesity increased 88 % from 1988 to 1984. (Obesity Research 1998; 6(2):97-106)

The cost of obesity to US business in 1994 was estimated to total $12.7 billion. The health-related economic cost of obesity to US business is substantial, representing approximately 5% of total medical care costs. (American Journal of Health Promotion 1998;13(2): 120-127)

Sustained modest weight loss among obese persons would yield substantial health and economic benefits. (American Journal of Public Health 1999;89(10): 1536-42)

We found that as BMI increases, so do the number of sick days, medical claims and health care costs and that the mean annual health care costs for the BMI “at risk” population was $2,274 versus $1,499 for the “not at risk” group. (Statistical Bulletin of the Metropolitan Insurance Co. 1999 Jul-Sep;80)                    Back to Top

Weight loss tips - Obesity is a disease, with serious Health Implications

Obesity has been established as a major risk factor for diabetes, hypertension, cardiovascular disease and some cancers in both men and women. Other linked conditions include sleep apnea, osteoarthritis, infertility, idiopathic intracranial hypertension, lower extremity venous stasis disease, gastro-esophageal reflux and urinary stress incontinence.

Obesity-related medical conditions contribute to 300,000 deaths each year, second only to smoking as a cause of preventable death. (JAMA, 1996;276:1907-1915).

The estimated number of annual deaths attributable to obesity among US adults is approximately 280,000 based on relative hazard ratio from all subjects and 325,000 based on hazard ratio from only non-smokers and never-smokers. (JAMA, 1999;282: 1530-1538).

One-third of all cases of high blood pressure are associated with obesity, and obese individuals are 50% more likely to have elevated blood cholesterol levels. (American Family Physician 1997;55(2): 551-558).

Adult onset diabetes (type II, non-insulin dependent) accounts for nearly 90% of all cases of diabetes. Researchers estimate that 88 to 97% of type II diabetes cases diagnosed in overweight people are a direct result of obesity. (Shape Up America, December 1995).

Excess weight is an established risk factor for high blood pressure, type 2 diabetes (adult-onset), high blood cholesterol level, coronary heart disease and gallbladder disease. (JAMA, 1999;282:1523-1529).                   Back to Top

What should a weight loss program provide?  

According to the ASBP, a comprehensive medical weight loss program should include the following:

1. An initial patient work-up to include medical history, physical examination, appropriate laboratory studies and an electrocardiogram if there is past or present evidence of cardiac disease or if the patient has coronary risk factors.

2. Appropriate counseling on:

• Diet and nutrition, including reduced calorie diets and very low calories diets (VLCD) and dietary supplements when needed.
• Exercise, tailored to the capabilities and limitations of the overweight patient to ensure safe and effective exercise.
• Behavior modification (lifestyle changes), to include discussions of proper eating habits, dealing with stress-related eating, family meal planning changes, healthful snacking, etc.
• Prescription appetite suppressants, if indicated, as an adjunct to a comprehensive medical weight loss program, and other medications.

3. If the use of appetite suppressants or other medications is indicated, the patient should be informed about the potential risks of such medication and the physician and patient should weigh the risks of the medication against the benefits, i.e., do the small risks of the medications outweigh the health risk of the patient remaining obese. (The use of appetite suppressants is not indicated for patients with only a small amount of weight to lose.) Often, the loss of only 5 to 10 percent of a patient’s initial weight can lead to significant improvements in health status.

4. Adequate periodic follow-up and counseling, to include a program to help the patient maintain the weight loss that has been achieved.     Back to Top

What About Medications and Special Diets?

Bariatricians have a wide range of tools to offer their overweight patients, including special diet and nutrition products, individualized exercise programs, suggestions for lifestyle changes and prescription medications, if indicated.

Prescription anti-obesity medications can be a useful adjunct to a medical weight loss program, when used as part of a comprehensive program including diet and nutrition changes, exercise, and lifestyle modification. Medications alone will not lead to successful weight loss and maintenance. These medications are intended for patients who have a great deal of weight to lose, not for someone who wants to lose 5 or 10 pounds or drop a dress size. Many of the appetite suppressants and other medications available today have a long history of safe and successful use. New medications are being researched and will be available after clinical testing and FDA approval.

Just as there are some risks and side effects with almost any medication, including aspirin, acetaminophen and birth control pills, so may there be side effects and risks with anti-obesity medications. For most people, the side effects are minimal and of short duration. Bariatricians are trained to know how to prescribe the drugs properly and monitor patients taking these medications. Obese patients, particularly those with some of the diseases linked to their condition, such as diabetes and cardiovascular disease, may be at greater risk from remaining obese than the risk they might incur by taking the medications. The decision to prescribe anti-obesity medications must be made by the bariatric physician and the patient after carefully weighing the risks of the medications vs. the risks of remaining obese.

Bariatricians frequently prescribe low calorie diets or very low calorie diets (VLCD) along with vitamins and nutritional supplements, together with exercise and lifestyle changes to bring about a relatively rapid loss of weight. The VLCD, especially, should only be used under the careful supervision and monitoring of a physician and other health care personnel trained in its use.                    Back to Top

What are the Different Categories of Diet Medications?

Just as there are side effects of any medications, such as aspirin and penicillin, so are there side effects of taking appetite suppressants. Some common side effects are dryness of the mouth, dizziness, abdominal pain, diarrhea or constipation, nausea, difficulty sleeping, nervousness, increased blood pressure and headache. Most of these drugs affect the body’s nervous system. While they generally suppress appetite, some may also alter the way the body burns calories.

Among the best-known medications:

AMPHETAMINES (amphetamine, dextroamphetamine, methamphetamine) are strong stimulants that are no longer recommended by most authorities for weight control because they are highly addictive. Potential side effects include heart palpitations, elevation of blood pressure, gastrointestinal disturbances and insomnia. Amphetamines are prescribed for other problems than obesity, such as attention deficit disorder (ADD/ADHD) and narcolepsy.

APPETITE SUPPRESSANTS — Phentermine was first approved by the Food and Drug Administration in 1959 as a “short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction.” It is sold under the brand names Ionamin, Adipex, Fastin, Banobese, Obenix and Zantryl. Among other drugs of this type are phendimetrizine, mazindol, and the over-the-counter diet aid phenylpropanolamine (Accutrim, Dexatrim). Sibutramine, which is being marketed as Meridia, the newest prescription appetite suppressant, became available in February 1997.

ORLISTAT, which is being marketed as Xenical, became available in the US in May 1999. Not an appetite suppressant, Orlistat is a lipase inhibitor or “fat blocker” drug. It prevents the absorption of about 30 percent of dietary fat by the digestive tract. It is meant to be used in conjunction with a reduced-calorie diet. Some side effects, which are generally mild and transient, may include oily spotting, flatulence with discharge, fecal urgency, oily evacuation and fecal incontinence. Maintaining a diet of no more than 30 percent of calories from fat may minimize these side effects. The medication also reduces the absorption of fat-soluble vitamins; patients are advised to take a daily supplement that contains vitamins A, D, E and K as well as beta-carotene.

LEPTIN is a form of the human protein made in fat cells. It’s currently in human clinical trials and may help reduce body weight and fat through curbs on metabolism and appetite.                     Back to Top

How Are Overweight and Obesity Defined?

The body mass index (BMI) is the most popular tool for defining what is healthy weight, overweight and obesity today. The BMI is calculated by multiplying weight in pounds by 703 and then dividing by the height in inches squared. This approximates BMI in kg/m2. The 1998 Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, developed by the National Heart, Lung and Blood Institute, recommend the following classifications for BMI:

• Underweight - BMI less than 18.5
  
• Normal weight - BMI 18.5 to 24.9
  
• Overweight - BMI 25 to 29.9
  
• Obesity - BMI 30 to 34.9 (Class 1)
  
• Obesity - BMI 35 to 39.9 (Class 2)
  
• Extreme Obesity - BMI greater than 40 (Class 3)

BMI does not actually measure body fat, but generally correlates well with the degree of obesity. For example, a person who is 5 feet, 7 inches tall and weighs 150 pounds would have a BMI of 23, well out of the range of obesity. A person of the same height and weighing 200 pounds would have a BMI of 31 and would be considered obese. BMI charts are widely available.

To find your BMI, click here.

Often, a 10 to 15% reduction in an obese person’s body weight can bring about a significant reduction in the person’s health risk from obesity. This “healthy” weight loss does not always equate with a person’s “cosmetic” weight loss goals.                    Back to Top

How is Obesity and Health Risk Measured?                   

Currently, several different measures are used to evaluate a patient’s weight status and potential health risk. However, a complete evaluation includes assessments of a person’s age, height and weight, fat composition and distribution, and the presence or absence of other health problems and risk factors.

Height-weight tables indicating “ideal” weight have been in use since 1959 but have their shortcomings. A newer measure of obesity that is gaining in popularity among researchers and clinicians is the body mass index (BMI). BMI is the body weight in kilograms divided by the square of the height in meters ([weight in kg] ÷ [height in meters]2). BMI does not actually measure body fat, but generally correlates well with the degree of obesity. The categories of obesity developed by the World Health Organization are:

• BMI 25 to 29.9 - Grade 1 obesity (moderate overweight)
  
• BMI 30 to 39.9 - Grade 2 obesity (severe overweight)
  
• BMI > 40 - Grade 3 obesity (massive/morbid obesity).

Using a BMI table, a person 5'6" tall weighing 140 pounds would have a BMI of 23, well out of the range of risk. That same 5'6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity.

A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors.                    Back to Top

How Is a Patient's BMI Health Risk Determined?

BMI is defined as body weight (in kg) divided by height (in m2 ). You can easily calculate your BMI by multiplying your weight in pounds by 703, then dividing the result by your height in inches and dividing that result by your height in inches.

In recent years, researchers and clinicians have shifted focus from “ideal” body weights as reflected in the height-weight tables, to helping patients achieve and maintain “healthy” or “healthier” body weights. Studies have shown that losing even modest amounts of weight — just 5 to 10 percent of initial body weight — and maintaining the loss improves health and well-being and decreases the risk for a variety of obesity-related health complications.                    Back to Top

Determining Your BMI-Related Health Risk

BMI Category	Health Risk	With Comorbidities**
<25 25 - <27 27 - <30 30 - <35 35 - <40 >40	Minimal Low Moderate High Very High Extremely High	Low Moderate High Very High Extremely High Extremely High

**Hypertension, cardiovascular disease, dyslipidemia, Type II diabetes, sleep apnea, osteoarthritis, infertility, other conditions.

Back to Top

What Are Some of the Medical Complications of Obesity?

Back to Top

ASBP Position On Online Prescribing:      Click here

Back to Top

Can a virus make you fat?

Although the idea sounds more like the premise of a B movie than scientific theory, two scientists at the University of Wisconsin in Madison believe they've found a virus that causes some people to get fat. Nikhil Dhurandhar and Richard Atkinson reported recently that when they injected a virus known as AD36 into mice and chickens, the animals' body fat increased. Because humans were unlikely to volunteer for such experimentation, the scientists decided to test for the presence of antibodies to the virus. Of 154 people tested, about 15 percent of those who were obese had the antibodies. None of the lean people did.

However, the findings don't necessarily prove that the virus caused obesity in the test group. As several virologists have pointed out, obese people may simply be more susceptible to such a virus. Still, in recent years researchers have been surprised to find that viruses can be linked to so many diseases that had been thought to have other origins. For example, viruses are now implicated in several types of cancer, hardening of the arteries, and even mental disorders such as depression. In addition, five viruses besides AD36 have already been shown to cause obesity in animals. The good news is that the same methods that produce flu shots each year could ultimately be used to create an antiobesity injection.

We provide testing for this virus, at an additional charge ($135 plus  shipping), if you are interested.     Back to Top

Doctor's Weight Solutions | Sheila Patterson, MD | 4701 Creedmoor Road | Suite 101 | Raleigh | North Carolina | 27612 | (919)782-9992