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Obesity Fact Sheet
1.
What is
Obesity?
2.
Obesity - A Global Epidemic
3.
Obesity in the U.S.
4.
Obesity in Minority Populations
5.
Women and Obesity
6.
Obesity in Youth
7.
Health Effects of Obesity
8.
Obesity Treatment
9.
Obesity Research
10.
Obesity and Health Insurance
11.
Obesity, Medicaid and Medicare
What is Obesity?
Obesity is a disease that
affects nearly one-third of the adult American population
(approximately 60 million). The number of overweight and obese
Americans has continued to increase since 1960, a trend that is not
slowing down. Today, 64.5 percent of adult Americans (about 127
million) are categorized as being overweight or obese. Each year,
obesity causes at least 300,000 excess deaths in the U.S., and
healthcare costs of American adults with obesity amount to
approximately $100 billion.
Obesity is the second leading cause of unnecessary deaths.
-
Despite its toll taken in
death and disability, obesity does not receive the attention it
deserves from government, the health care profession or the
insurance industry.
-
Research is severely limited
by a shortage of funds.
-
Inadequate insurance
coverage limits access to treatment.
-
Discrimination and
mistreatment of persons with obesity is widespread and often
considered socially acceptable.
Did You Know?
-
Obesity is a chronic disease
with a strong familial component.
-
Obesity increases one's risk
of developing conditions such as high blood pressure, diabetes
(type 2), heart disease, stroke, gallbladder disease and cancer of
the breast, prostate and colon.
-
Health insurance providers
rarely pay for treatment of obesity despite its serious effects on
health.
-
The tendency toward obesity
is fostered by our environment: lack of physical activity combined
with high-calorie, low-cost foods.
-
If maintained, even weight
losses as small as 10 percent of body weight can improve one's
health.
-
The National Institutes of
Health annually spends less than 1.0 percent of its budget on
obesity research.
-
Persons with obesity are
victims of employment and other discrimination, and are penalized
for their condition despite many federal and state laws and
policies.
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Obesity - A Global
Epidemic
The prevalence of overweight
and obesity is increasing worldwide at an alarming rate in both
developing and developed countries. Environmental and behavioral
changes brought about by economic development, modernization, and
urbanization have been linked to the rise in global obesity. Obesity
is increasing in children and adults, and true health consequences
may become fully apparent in the near future.
Social Structure
-
Developed countries have
high obesity rates, food deprivation is unusual, and physical
activity levels have decreased greatly. Lower income households
are reported to feature diets composed of foods that tend to be
high in calories and fat - contributors to overweight and obesity
- since vegetables, fruits and whole grain cereals are more
expensive.
-
Developing countries have
lower obesity rates, particularly in areas of lower SES
populations. People who live in these areas are limited in their
ability to provide enough food, have little access to public
transportation and engage in moderate to heavy manual labor.
General Trends
-
In many developing
countries, obesity co-exists with under-nutrition – a Body Mass
Index (BMI) less than 18.5.
-
In economically advanced
regions of developing countries, prevalence rates of obesity may
be as high as in industrialized countries.
-
Globally, women generally
have higher rates of obesity than men do, although men may have
higher rates of overweight.
-
Prevalence of obesity in
children and adolescents is on the rise in both developed and
developing regions.
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Obesity in the U.S.
Obesity is a complex,
multi-factorial chronic disease involving environmental (social and
cultural), genetic, physiologic, metabolic, behavioral and
psychological components. It is the second leading cause of
preventable death in the U.S.
Overweight and obesity are
part of the U.S. Department of Health and Human Services' health
agenda that have steadily moved away from their established targets
for improvement. Today, public health leaders recognize obesity as a
"neglected public health problem." This fact sheet will demonstrate
the impact of overweight and obesity on millions of Americans of all
ages and both genders.
Overall Prevalence
-
Approximately 127 million
adults in the U.S. are overweight, 60 million obese, and 9 million
severely obese.
-
Body Mass Index (BMI) is a
measurement tool used to determine excess body weight. Overweight
is defined as a BMI of 25 or more, obesity is 30 or more, and
severe obesity is 40 or more.
-
The number of adults who are
overweight or obese has continued to increase. Currently, 64.5
percent of U.S. adults, age 20 years and older, are overweight and
30.5 percent are obese. Severe obesity prevalence is now 4.7
percent, up from 2.9 percent reported in the 1988 - 1994 National
Health and Nutrition Examination Survey (NHANES) by the Centers
for Disease Control and Prevention (CDC).
Health and Social Impact
-
Obesity increases the risk
of illness from about 30 serious medical conditions.
-
Obesity is associated with
increases in deaths from all-causes.
-
Earlier onset of
obesity-related diseases, such as type 2 diabetes, are being
reported in children and adolescents with obesity.
-
Individuals with obesity are
at higher risk for impaired mobility.
-
Overweight or obese
individuals experience social stigmatization and discrimination in
employment and academic situations.
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Obesity in Minority Populations
Overweight and obesity in the
U.S. occur at higher rates in racial / ethnic minority populations
such as African American and Hispanic Americans, compared with White
Americans. Asian-Americans have a relatively low prevalence for
obesity. Women and persons of low socioeconomic status within
minority populations appear to particularly be affected by
overweight and obesity. Cultural factors that influence dietary and
exercise behaviors are reported to play a major role in the
development of excess weight in minority groups.
Prevalence
-
The prevalence of overweight
(Body Mass Index (BMI) of 25 or more) and obesity (BMI of 30 or
more) increased over the last decade across racial / ethnic
groups, as shown in Table 1.
-
Mexican American and black
(non-Hispanic) adults in the U.S. are considerably more overweight
and obese than white (non-Hispanic) adults.
Health Disparities
Many obesity-related diseases
including diabetes, hypertension, cancer and heart disease are found
in higher rates among various members of racial-ethnic minorities
compared with whites.
Diabetes
-
Diabetes has been reported
to occur at a rate of 16 to 26 percent in Hispanic Americans and
black Americans, aged 45 to 74, compared with 12 percent in whites
(non-Hispanic) of the same age.
-
Higher BMI predicts the risk
for type 2 diabetes in Pima Indians. Type 2 diabetes affects about
half of the Pima people.
-
Among 15 American Indian
tribes studied in Oklahoma, 77 percent of adults screened for
diabetes are reported to be obese.
-
Among Mexican Americans,
obesity and type 2 diabetes are both increasing, unlike other risk
factors of cardiovascular disease including smoking and blood
pressure, which are declining.
Cancer
Obesity appears to contribute
to the higher risk of pancreatic cancer among black Americans than
among whites, particularly for women.
Heart Disease
-
Among African Americans, the
high prevalence of obesity and obesity-related conditions such as
hypertension and type 2 diabetes, are factors reported to
contribute to their high death rate from coronary heart disease.
-
In a study of older
Hispanics, with an average age of 80, obesity was found to be a
risk factor for developing coronary artery disease.
Hypertension
The high prevalence of obesity
is reported to be a contributing factor to the high prevalence of
hypertension in minority populations, especially among African
Americans who have an earlier onset and run a more severe course of
hypertension.
Behavioral Risk Factors Diet & Exercise
-
Cultural factors related to
dietary choices, physical activity, and acceptance of excess
weight among African Americans and other racial-ethnic groups,
appear to play a role in interfering with weight loss efforts.
-
Sedentary life style, which
can contribute to the development of obesity, has been reported by
44 to 60 percent of Native American men and 40 to 65 percent of
women.
-
African Americans and whites
report that they exercise less as they get older, however, African
American women of all ages report participating in less regular
exercise than white women.
-
African American men, age 45
and older, report less regular exercise than white women.
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Women and Obesity
Obesity plays a significant
role in causing poor health in women, negatively affecting quality
of life and shortening quantity of life. More than half of adult
U.S. women are overweight, and more than one-third are obese. The
life expectancy of women in the U.S. is approaching 80 years of age,
and more women than ever are expected to turn 65 in the second
decade of the new millennium. Prevention and early treatment of
obesity are crucial to ensuring a healthy population of women of all
ages.
Prevalence
-
For women, ages 20 to 74, 62
percent are overweight (Body Mass Index (BMI) of 25 or more) and
about half of that population (34 percent) is obese (BMI of 30 or
more).
-
Middle-age women are at a
particularly high risk of becoming obese. The prevalence of
obesity among middle-age women (ages 35 to 64) has increased at a
minimum of 2 percentage points per year over a 40-year time period
from 1960 to 2000. Table 4 indicates prevalence changes in obesity
(BMI of 30 or more) between 1960 and 2000 for U.S. women in
various middle-age groups.
-
Low-income women in minority
populations appear most likely to be overweight.
-
Obesity appears to have a
strong inverse relationship with SES (obesity increases as income
level decreases) among women in developed societies such as the
U.S.
-
A direct association has
been found between body weight and deaths from all-causes in
women, ages 30 to 55.
-
Among U.S. adults, black
(non-Hispanic) women have the highest prevalence of overweight (78
percent) and obesity (50.8 percent).
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Obesity in Youth
Diabetes, hypertension and other obesity-related chronic diseases
that are prevalent among adults have now become more common in
youngsters. The percentage of children and adolescents who are
overweight and obese is now higher than ever before. Poor dietary
habits and inactivity are reported to contribute to the increase of
obesity in youth.
Today's youth are considered the most inactive generation in history
caused in part by reductions in school physical education programs
and unavailable or unsafe community recreational facilities. In the
U.S., only the state of Illinois requires daily physical education
for students in grades K to 12.
This fact sheet outlines many
factors related to obesity in youth that make it the major health
care challenge for the 21st century.
Overweight and Obesity Defined
-
Overweight and obesity for
children and adolescents are defined respectively as being at or
above the 85th and 95th percentile of Body Mass Index (BMI).
-
Some researchers refer to
the 95th percentile as overweight and other as obesity. The
Centers for Disease Control and Prevention (CDC), which provides
national statistical data for weight status of American youth,
avoids using the word "obesity," and identifies every child and
adolescent above the 85th percentile as "overweight."
-
Bariatric Surgery Specialists
use the 95th percentile as criteria for obesity because it:
-
corresponds to a BMI of 30
which is obesity in adults. The 85th percentile corresponds to a
BMI of 25, adult overweight.
-
is recommended as a marker
for when children and adolescents should have an in-depth
medical assessment.
-
identifies children that
are very likely to have obesity persist into adulthood.
-
is associated with
elevated blood pressure and lipids in older adolescents, and
increases their risk of diseases.
-
is a criteria for more
aggressive treatment.
-
is a criteria in clinical
trials of childhood obesity treatments.
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Health Effects of Obesity
Persons with obesity are at
risk of developing one or more serious medical conditions, which can
cause poor health and premature death. Obesity is associated with
more than 30 medical conditions, and scientific evidence has
established a strong relationship with at least 15 of those
conditions. Preliminary data also show the impact of obesity on
various other conditions. Weight loss of about 10% of body weight,
for persons with overweight or obesity, can improve some
obesity-related medical conditions including diabetes and
hypertension.
Arthritis, Osteoarthritis
(OA), Rheumatoid Arthritis (RA), Cancers, Breast Cancer, Cancers of
the Esophagus and Gastric Cardia, Colorectal Cancer, Endometrial
Cancer (EC), Renal Cell Cancer, Birth Defects, Cardiovascular
Disease (CVD), Carpal Tunnel Syndrome (CTS), Chronic Venous
Insufficiency (CVI), Daytime Sleepiness, Deep Vein Thrombosis (DVT),
Diabetes (Type 2), End Stage Renal Disease (ESRD), Gallbladder
Disease, Gout, Heat Disorders, Hypertension, Impaired Immune
Response, Impaired Respiratory Function, Infections Following
Wounds, Infertility, Liver Disease, Low Back Pain, Obstetric and
Gynecologic Complications, Pain, Pancreatitis, Sleep Apnea, Stroke,
Surgical Complications, Urinary Stress Incontinence, Other:
Several other obesity-related
conditions have been reported by various researchers including:
-
abdominal hernias,
acanthosis nigricans, endocrine abnormalities, chronic hypoxia and
hypercapnia, dermatological effects, depression, elephantitis,
gastroesophageal reflux, heel spurs, hirsutism, lower extremity
edema, mammegaly (causing considerable problems such as bra strap
pain, skin damage, cervical pain, chronic odors and infections in
the skin folds under the breasts, etc.), large anterior abdominal
wall masses (abdominal paniculitis with frequent panniculitis,
impeding walking, causing frequent infections, odors, clothing
difficulties, low back pain), musculoskeletal disease, prostate
cancer, pseudo tumor cerebri (or benign intracranial
hypertension), and sliding hiatil hernia.
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Obesity Treatment
A statistic frequently used
about obesity treatment is that 95 percent of people who lose weight
gain it all back. That statistic, based on a small study from 1959,
is no longer valid. Much has changed in the way of obesity treatment
since then. Thousands of people have succeeded in losing weight and
keeping it off -- an encouraging fact for many that are discouraged
by outdated information. There are several different types of
effective treatment options to manage weight including: dietary
therapy, physical activity, behavior therapy, drug therapy, combined
therapy and surgery.
Weight loss of about 10
percent of excess body weight is proven to benefit health by
reducing many obesity-related risk factors. Recommendations for
treatment are now focusing on 10 percent weight loss to help
patients with long-term maintenance of weight loss. Health
professionals including physicians, nutritionists, exercise
physiologists, psychologists and bariatric surgeons help persons
with overweight and obesity to determine the most appropriate
treatment.
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Assessment of Weight
-
Dietary Therapy
-
Physical Activity
-
Behavior Therapy
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Drug Therapy
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Combined Therapy
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Surgery
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Obesity Research
In the last four decades of
obesity research, progress has been made in identifying causes and
treatments. Research has provided a greater understanding of obesity
as a chronic disease caused by a complex interaction of genetic,
metabolic, behavioral, psychological and environmental (social and
cultural) factors. Despite the advances in research, however,
children, adolescents and adults are continuing to become overweight
and obese in record high numbers. Due to the complexity of obesity,
more research is needed in a variety of areas particularly in
prevention to control the spread of this epidemic.
Funding Inequities
The National Institutes of
Health (NIH) has a budget of more than $15.6 billion and is the
largest public funder of medical research. In setting the
priorities of its budget, the NIH has virtually neglected obesity
research.
Obesity-related medical
conditions such as diabetes and hypertension, receive far greater
funding than the causative condition itself, as shown in Figure 1.
Poor diet and inactivity, which contribute to obesity, is reported
to be the second leading cause of preventable death in the U.S.
Yet AIDS, another cause of preventable death, receives over 10
times more research funding than obesity.
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Obesity and Health Insurance
Many insurance plans
do not provide reimbursement for weight loss treatment. According to
many practitioners, few private insurance indemnity plans or managed
care organizations appear to cover the costs of obesity treatment
regardless of whether the service is a medically supervised program
of weight reduction or maintenance, nutrition counseling, surgery or
a pharmaceutical product. The countless number of available
insurance plans and ever changing policies have made it difficult to
assess the extent to which obesity treatment and prevention services
are covered by third party insurers. More data and better tracking
is necessary to determine the health needs of persons with obesity.
Insurance Coverage Trends
A typical
employer insurance plan could be similar to that of Wal-Mart.
Benefits listed in their employee benefits booklet (1999) as “not
payable for treatment or services” include charges from:
-
medications
and diet supplements which result from diet programs
-
appetite
control
-
weight control
-
treatment of
obesity or morbid obesity, including gastric bypasses and stapling
procedures even if the participant has other health conditions
which might be helped by the reduction of weight.
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Obesity, Medicaid and Medicare
Medicaid does not cover obesity, and under Medicare, hospital and
physician services for obesity are clearly excluded. Medicaid is a
government program that provides health insurance to qualified
individuals whose income level is below a certain point. Recipients
of Medicaid are primarily women and children who are poor and
members of minority groups. Given the high prevalence of obesity
among those populations, it could be presumed that many Medicaid
recipients are likely to have obesity. Medicare provides health
insurance coverage to elderly citizens and disabled Americans who
qualify by meeting criteria of the Social Security Administration
(SSA) and completing a two-year waiting period.
Medicaid
A State may choose to
exclude or restrict drugs or classes of drugs, or their medical
uses for certain purposes. A State choosing to include
outpatient drugs within its Medicaid program must cover, for their
medically accepted indications, all Food and Drug Administration
(FDA) approved prescription drugs of manufacturers that have
entered into drug rebate agreements, with a few limited
exceptions.
Exceptions include drugs
when used for: anorexia, weight loss or weight gain; to
promote fertility; for cosmetic purposes or hair growth; for the
symptomatic relief of cough and colds; or to promote smoking
cessation.
As a result of OBRA, the
Department of Health and Human Services ordered states to cover
Viagra for the treatment of erectile dysfunction while continuing
to exclude anti-obesity agents.
Nine states cover
anti-obesity pharmaceutical products including Alaska, California,
Kentucky, Montana, North Carolina, Oregon, Rhode Island,
Washington and Wisconsin.
One state, Arizona, covers
products by specific managed health care plan.
In 23 states, there is no
specific language regarding coverage under Medicaid.
In 29 states, anti-obesity
products are specifically excluded in state Medicaid programs.
Medicare
The Medicare Coverage Manual
defines obesity and the justification for certain treatment coverage
by stating that:
Program payment may not be
made for treatment of obesity alone since this treatment is not
reasonable and necessary for the diagnosis or treatment of an
illness or injury.
However, although obesity is not in
itself an illness, it may be caused by illnesses such as
hypothyroidism, Cushing's disease, and hypothalamic lesions. In
addition, obesity can aggravate a number of cardiac and
respiratory diseases as well as diabetes and hypertension.
Therefore, services in connection with the treatment of obesity
are covered when such services are an integral and necessary part
of a course of treatment for one of those illnesses.
Medicare’s limited coverage of obesity is
difficult to understand when considering that it does cover services
such as inpatient and outpatient alcohol detoxification and
rehabilitation, inpatient and outpatient drug rehabilitation, and
services for sexual impotence. It also covers chemical aversion
therapy for the treatment of alcoholism even though the FDA has not
approved the drugs commonly used in chemical aversion therapy for
this application.
Gastric Bypass Surgery
Surgery for the treatment of obesity is covered on a limited basis.
According to the Medicare Coverage Manual:
- gastric bypass surgery, which is a
variation of the gastrojejunostomy, is performed for patients with
extreme obesity. Gastric bypass surgery for extreme obesity is
covered under the program if:
- it is medically appropriate for the
individual to have such surgery.
the surgery is to correct an illness,
which caused the obesity or was aggravated by the obesity.
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