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Medical Weight Management Fact Sheet

Medical Weight Management Fact Sheet

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Fact 1 – Overweight and the disease of obesity are widespread, deadly and expensive:

  • Two thirds, or 68%, of Americans are affected by excess weight (overweight) and more than one third is affected by obesity (34.9%).1,2
  • Excess weight significantly increases the development (or occurrence) of multiple chronic diseases including type 2 diabetes, hypertension, gallstones, heart disease, stroke, and colon cancer among others. This risk continues to rise when individuals progress to obesity, with the risk of diabetes doubling.3
  • Approximately 75% of individuals with severe obesity have at least one health-related condition (diabetes, hypertension, sleep apnea, etc.), which significantly increases the risk of premature death.4
  • Life expectancy for a 20-year-old male with severe obesity is 13 years shorter than a healthy weight male of the same age.5
  • In 2008, annual direct medical expenditures attributable to obesity were $147 billion.6

Fact 2 – Obesity disproportionately affects minorities.

  • Non-Hispanic blacks have the highest age-adjusted rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%).7 Non-Hispanic black women are particularly at risk with 54% suffering from obesity.30

Fact 3 – There are several treatment options available for individuals affected by obesity/overweight who are candidates for medical weight management. These medical weight management options have been proven to help achieve a modest to moderate degree of weight-loss.

  • Intensive lifestyle interventions generally result in a weight-loss of 5-10%.8
  • Structured and comprehensive lifestyle interventions need to target diet, physical activity, and behavior to succeed and sometimes use adjunctive medications for chronic weight management.8
  • Adjunctive medication for chronic weight management has proven to be effective when combined with lifestyle interventions.9,10,11,12,13,14
  • Some of the medications for chronic weight management have been able to achieve weight-loss of 5 to 20%.13 The highest percentages approach the results of some bariatric surgical procedures.15
  • Results of the use of medication for the treatment of obesity may vary.

Fact 4 – Medical weight-loss reduces the prevalence of chronic diseases:

  • 31.9% of U.S. adults have hypertension.16 Modest weight-loss from intensive lifestyle interventions improves hypertension significantly, as shown in the PREMIER trial.17, 18, 19
  • 8.3% of the U.S. population has diabetes.20 As shown in the landmark DPP study, the progression of pre-diabetes to diabetes is reduced by 59% when lifestyle interventions are introduced.21
  • Sleep apnea has been linked to chronic diseases such as diabetes22 and cardiovascular diseases.23 Medical weight management has been shown to improve sleep apnea.24 Moreover, the results are comparable to bariatric surgery.25
  • Medical weight-loss decreases inflammatory markers, which are predictors of chronic disease.26

Fact 5 – Medical weight management provided by an obesity medicine physician is a resource for patients affected by excess weight or obesity.

  • Bariatric surgery is a proven tool for obesity treatment but is reserved for populations that are moderately or severely impacted by obesity and meet selection criteria. Hence, this solution is not available to patients with excess weight or mild obesity.27
  • An obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change and pharmacotherapy.28
  • An obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as dietitians, exercise physiologists, psychologists and bariatric surgeons as indicated to achieve optimal results.28
  • According to the recent guidelines for the management of overweight and obesity:
  • Medical weight management should consist of comprehensive multidisciplinary medical treatment, including diet, exercise and behavior modifications.27
  • Medical weight management recommendations for patients with overweight/obesity are intensive lifestyle interventions and, in appropriate situations, chronic weight management medications.27

Fact 6 – Insurance coverage of medical weight management is currently inadequate, and thus, many individuals affected by excess weight or obesity do not have access to this specialized care. This places a significant economic burden on the healthcare system as these individuals are likely to have progression of weight related medical conditions.

  • The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars6; the medical costs for people with obesity were $1,429 higher than those of normal weight.29
  • Offering covered medical treatment for obesity makes economic sense as this population is at increased risk of developing additional chronic diseases, which will be much more costly to treat.3

References:

  1. Flegal KM1, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010 JAMA. 2012 Feb 1;307(5):491-7.
  2. Cynthia L. Ogden, PhD1; Margaret D. Carroll, MSPH1; et al. Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 014;311(8):806-814.
  3. Alison F. Field, ScD; Eugenie H. Coakley; Aviva Must, PhD; Jennifer L. Spadano, MA; et al. Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period. Arch Intern Med. 2001;161:1581-1586.
  4. Must A, Spadano J, Coakley EH, Field E, et al. The Disease Burden Associated with Overweight and Obesity. JAMA, 1999;282:1523-1529.
  5. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003 Jan 8;289(2):187-93.
  6. Finkelstein EA, Fiebelkorn, IC, Wang G. State-Level Estimates of Annual Medical Expenditures Attributable to Obesity. Obesity Research 2004 Jan;12(1):18-24.
  7. CDC.GOV – Centers for disease control and prevention. Division of Nutrition, Physical activity and Obesity. National Center for chronic disease prevention and health promotion. Adult Obesity facts. 2014.
  8. Marion J. Franz, MS, RD; Jeffrey J. VanWormer, MS, A. et al. Weight-Loss Outcomes: A Systematic Review and Meta-Analysis of Weight-Loss Clinical Trials with a Minimum 1-YearFollow-Up. Journal of the American Dietetic Association, Volume 107, Issue 10, October 2007, Pages 1755–1767.
  9. Steven R. Smith, MD; Neil J. Weissman, MD; Christen M. Anderson, MD, PhD; Matilde Sanchez, PhD; et al; and the Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM) Study Group. New England Journal of Medicine, 363;3. July 15, 2010
  10. Meredith C. Fidler; Matilde Sanchez; Brian Raether; Neil J. Weissman, MD; et al; for the BLOSSOM Clinical Trial Group. A One-Year Randomized Trial of Lorcaserin for Weight Loss in Obese and Overweight Adults: The BLOSSOM Trial. The Journal of Clinical Endocrinology & Metabolism, Volume 96 Issue 10 | October 1, 2011
  11. Patrick M. O’Neil, Steven R. Smith, MD; Neil J. Weissman, MD; Meredith C. Fidler, et al Randomized Placebo-Controlled Clinical Trial of Lorcaserin for Weight Loss in Type 2 Diabetes Mellitus: The BLOOM-DM Study. Obesity (2012) 20, 1426–1436. doi:10.1038/oby.2012.66.
  12. Gadde KM, Allison DB, Ryan DH, Peterson CA, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults(CONQUER): a randomised, placebo-controlled, phase 3 trial.Lancet. 2011 Apr 16;377(9774):1341-52. 2011 Apr 8.
  13. W Timothy Garvey, Donna H Ryan, Michelle Look, Kishore M Gadde, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study 1–3. Am J Clin Nutr 2012;95:297-308.
  14. David B. Allison, Kishore M. Gadde, William Timothy Garvey, Craig A. Peterson, et al. Controlled-Release Phentermine/Topiramate in Severely Obese Adults: A Randomized Controlled Trial (EQUIP). Obesity (2011) 20, 330–342. doi:10.1038/oby.2011.330.
  15. A D Miras and C W le Roux. Can medical therapy mimic the clinical efficacy or Physiological effects of bariatric surgery? International Journal of Obesity (2014) 38, 325–333.
  16. CDC.GOV Vital signs: awareness and treatment of uncontrolled hypertension among adults—United States, 2003–2010. MMWR. 2012;61:703–9.
  17. Writing group of the PREMIER collaborative research group. Effects of Comprehensive Lifestyle Modification on Blood Pressure Control – Main Results of the PREMIER Clinical Trial. JAMA. 2003;289:2083-2093
  18. Patricia J. Elmer, PhD; Eva Obarzanek, PhD; William M. Vollmer, PhD; Denise Simons-Morton, MD, et al,for the PREMIER Collaborative Research Group. Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial. Ann Intern Med. 2006;144:485-495.
  19. Lillian F. Lien; Ann J. Brown; Jamy D. Ard.; Catherine Loria; et al. Effects of PREMIER Lifestyle Modifications on Participants With and Without the Metabolic Syndrome. Hypertension. 2007;50:609-616.
  20. CDC.GOV – Centers for disease control and prevention. Diabetes public Health resource. 2011 National Diabetes fact sheet.
  21. Diabetes Prevention Program Research group. Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. The New England Journal of Medicine. 2002, Vol. 346, No. 6.
  22. Knutson KL, Ryden AM, Mander VA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 2006;166:1768–1764.
  23. Kasasbeh E, Chi DS, Krishnaswamy G. Inflammatory aspects of sleep apnea and their cardiovascular consequences. South Med J 2006;99:58–67.
  24. Samuel T. Kuna, MD; David M. Reboussin, PhD; Kelley E. Borradale, PhD; Mark H. Sanders, MD; et al, Sleep AHEAD Research Group of the Look AHEAD Research Group. Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes. SLEEP 2013;36(5):641-649.
  25. John B. Dixon, MBBS, PhD, FRACGP, Linda M. Schachter, MBBS, PhD, Paul E. O’Brien, MD,FRACS, Kay Jones, MT&D, PhD, et al. Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea A Randomized Controlled Trial. JAMA, September 19, 2012—Vol 308, No. 11.
  26. Katherine Esposito, MD, Alessandro Pontillo, MD, Carmen Di Palo, Giovanni Giugliano, MD, et al. Effect of weight loss and lifestyle changes on inflammatory markers in obese women. A randomized trial. JAMA, April 9, 2003, Vol. 289, No. 14.
  27. Michael D. Jensen, MD; Donna H. Ryan, MD; Caroline M. Apovian, MD, FACP; Catherine M. Loria, PhD, FAHA; et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2013;():. doi:10.1016/j.jacc.2013.11.004.
  28. Home – American Board of Obesity Medicine.” American Board of Obesity Medicine. Web. 28 Apr. 2014.
  29. https://cdc.gov/obesity/data/adult.html
  30. https://minorityhealth.hhs.gov/templates/content.aspx?ID=6456