Is Still a Nation of Excess
Obesity, Adult Obesity Are Still Big Problems
June 15, 2004 -- A new study provides a snapshot of the nation's obesity
problem -- and it's not a pretty picture. More than half of adults are still overweight or obese, and one-third of children
is at risk for overweight or is overweight.
From 1999 to 2002, the number of overweight Americans continued to increase,
according to the nationwide survey from the CDC. It is published in this week's Journal of the American Medical Association
"There is no indication that ... obesity among adults and overweight
among children is decreasing," writes researcher Allison A. Hedley, PhD, with the CDC. "The high levels ... remain a major
public health concern."
Between 1999-2000 and 2001-2002:
- Americans were still overweight or obese --
66% -- compared with 65% in 1999-2000.
- The number of obese Americans was also unchanged
- The number of extremely obese Americans was
also unchanged -- 5%.
From 1999 to 2002:
- More than 50% of adults were overweight or obese;
this was true in almost every age and racial/ethnic group.
- 28% of men over age 20 were obese across all
racial and ethnic groups.
- 33% of women over age 20 were obese -- but with
significant differences among racial and ethnic groups.
- 49% of all black women were obese, compared
with 38% of Mexican-American and 31% of white women.
- 14% of black women were extremely obese -- the
highest number of any ethnic/racial group, whether male or female.
- 30% were overweight or at risk for being overweight
in 1999-2000 versus 32% in 2001-2002.
- 15% were overweight in 1999-2000; 17% were in
- Black and Mexican-American children were at
a significantly greater risk of becoming overweight, compared with white children.
There is no indication that obesity in adults
and children is decreasing, Hedley concludes.
The Lowdown on Weight-loss Surgery
October 2002. There is no doubt that
stomach-stapling surgery leads to dramatic weight loss. But new research shows
that the procedure might also add years to life.
As the number of obese people in the U.S. has soared, so has the popularity of the
surgery. In fact, East Carolina University researchers estimated that the number
of people undergoing weight-loss surgery increased from 40,000 in 2001 to 86,000 this year and will reach 140,000 next year.
Past research has shown that gastric bypass improves diabetes, high blood pressure,
and other diseases related to excess fat. But the effect on a person's lifespan
has been unknown, until now
To answer that question, researchers at New Hampshire's Dartmouth-Hitchcock Medical
Center first looked at data from previous research that showed how much a weight an average person loses after having the
surgery. Then they looked at the average life expectancies of people at various
heights and weights. In this way, they could estimate how much the change in
weight caused by surgery would affect patients' life span.
The results suggest that most people eligible for the surgery would benefit, says
lead researcher G. Darby Pope, MD, surgery resident at Dartmouth-Hitchcock. "By
undergoing the surgery, they will gain life years," he said. Pope presented the
study this week at a meeting of the American College of Surgeons in San Francisco.
People with a BMI -- a measure of obesity that takes both height and weight into
account -- over 25 are considered overweight. But according to U.S. government
guidelines, patients should have a BMI of at least 40, or a BMI of 35 with a related serious disease, to be eligible for gastric
bypass surgery. Most such patients are more than 100 pounds overweight.
The results varied according to the patients' age, gender, and body mass index (BMI). According to the researchers, a woman with a BMI of 45 at age 40 would gain three
years of life. A man of similar age and size could expect to gain 3.9 years.
These results are better than those obtained by heart disease surgery, Pope said. But he cautioned that no one should interpret these findings literally. The actual effects of the gastric bypass surgery will vary a lot from one individual to another.
Questions about the benefits of gastric bypass surgery will be answered with more
certainty by studies now under way on large groups of patients, Pope says.
The surgery is getting more popular not only because more people are obese, but also
because surgeons have improved their techniques. In earlier weight-loss surgery,
doctors routed the digestive track past much of the intestines, resulting in malnutrition.
In the kind of surgery in the Dartmouth-Hitchcock study, most of the stomach is stapled
shut so that food can only enter a small pouch at the top. A branch of the intestines
is connected to this pouch. (The unused part of the stomach is connected to this
branch downstream in order to drain its fluids.)
Patients vomit if they overeat, but feel full with much less food. Typically, they lose about three-quarters of their excess weight in the first year, then gradually gain
some back. After ten years or more, most carry about half the excess weight they
had before the surgery, says Pope.
Patients must take nutritional supplements for the rest of their lives, and there
is a chance of dying from complications of the surgery. But Pope and his colleagues
took this risk of complications into account in their study and the results suggest that the risk of death from the procedure
are much less than the risk of death from obesity.
By Laird Harrison, MD, Medical News; Reviewed by Michael Smith, MD
Use and Costs of Bariatric
Surgery and Prescription Weight-Loss Medications
E. Encinosa; Didem M. Bernard; Claudia A. Steiner; Chi-Chang Chen
Encinosa ( email@example.com ) is a senior economist in the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality,
in Rockville, Maryland; Claudia Steiner is a senior research physician there. Didem Bernard is a senior economist
in the AHRQ Center for Financing, Access, and Cost Trends. Chi-Chang Chen is a postdoctoral fellow at the University
of Maryland School of Pharmacy in Baltimore.
From Medscape at http://www.medscape.com/viewarticle/508412_4
The extent of use of bariatric surgery and weight-loss medications is unknown. Using the Nationwide Inpatient Sample,
we estimate that the number of bariatric surgeries grew 400 percent between 1998 and 2002; such surgeries were performed on
0.6 percent of the 11.5 million adults clinically eligible in 2002. Hospital costs for bariatric surgery grew sixfold to $948
million in 2002. The inpatient death rate declined 64 percent. Among employers that covered weight-loss drugs in 2002, less
than 2.4 percent of adults clinically eligible for these drugs used them, with average annual spending of $304 per user.
The obesity epidemic has recently been brought to the forefront of the national consciousness.
As a result, much attention is now drawn to two medical treatments for obesity: bariatric surgery and bariatric pharmacotherapy.
Bariatric surgery, one of the fastest-growing surgical procedures in the United States, involves restricting the size of the
stomach and bypassing part of the intestines to reduce the absorption of food. Bariatric pharmacotherapy involves prescription
weight-loss medications that either reduce the absorption of fat or suppress the appetite. Xenical (orlistat), a drug that
blocks about one-third of ingested fat, was the third most heavily advertised drug in 1999: $76 million was spent on advertising
it to consumers.
There are about twenty-two new anti-obesity drug compounds in the pharmaceutical pipeline, with two currently in Phase III
These bariatric treatments have substantial health benefits. A recent meta-analysis found that the percentage of excess
weight loss was 61.6-70.1 percent with gastric bypass, the most common bariatric surgery. As a result, diabetes was completely resolved
in 76.8 percent of patients. Another recent study found that gastric bypass patients had an 89 percent reduced relative risk
Although bariatric surgery is recommended only for morbidly obese persons with a body mass index
(BMI) of 40 or more, bariatric drug therapy is recommended for obese people with a BMI of 30 or more. A recent meta-analysis
found that bariatric medications result in a net weight loss of fewer than ten pounds (over the placebo weight loss) at one
year, but this
amount may still be clinically significant in reducing diabetes and high blood pressure.
There are no national estimates of the use and costs of bariatric surgery and weight-loss prescription
drugs. In this paper we address this data gap using national hospital and insurance claims data.
National hospital costs for bariatric surgeries increased
more than sixfold, from an estimated $157 million in 1998 to $948 million in 2002, in constant 2002 dollars. Mean cost per surgery increased 12.9 percent, from $11,705 in 1998 to $13,215 in 2002. The largest increase in average
costs was for Medicaid-covered surgeries, with an increase of 17.7 percent, despite a decline in length-of-stay from 5.8 days
to 4.9 days (data not shown).
Women were more likely than men to undergo bariatric surgery
in both years. In 2002 women accounted for 84 percent of all surgeries. However, both lengths-of-stay and inpatient death
rates were higher among men. Although the inpatient death rate for men declined greatly between 1998 and 2002, it was still
three times higher than the rate among women.
In 2002 theaverage pricefor asurgical procedure was $19,346. Physician payments accounted for 14 percent ($2,667),
while hospital payments accounted for 86 percent ($16,679) of total payments. On average, patients
paid 3.3 percent of expenditures in the form of copayments or deductibles, and health plans paid the remainder.
Prescription Weight-Loss Medications
As of 2002, eight drugs had
been approved for weight loss. Of these, sibutramine (Meridia) and orlistat (Xenical) are approved for up to two years of
use. The other medications are sympathomimetic amphetamine-like drugs: phentermine, phenylpropanolamine,
benzphetamine, phendimetrazine, diethylpropion, and mazindol. These amphetamine-like drugs are
labeled for short-term use (up to twelve weeks). Orlistat is a lipase inhibitor, which blocks fat absorption, while
the other seven drugs are appetite suppressants.
presents prescription weight-loss medication use and spending
among the 2002 Medstatemployersample. Of the 5.1 million with drug coverage, about 4 million had bar-iatric drug coverage.
Of that 4 million, 21,931 used bariatric prescription drugs. Among the users, 45 percent used orlistat, 30 percent used sibutramine,
and 35 percent used sympathomimetics (10 percent used multiple drugs). Close to 71 percent of the sympathomimetic prescriptions
were for phentermine.
Although orlistat and sibutramine are recommended for long-term
use (up to two years), the average number of days of medication supplied per patient per year was 110 days for orlistat and
102 days for sibutramine. This may suggest that the discomfort of side effects reduces adherence.
The average number of days of medication supplied per patient per year was 111 days for sympathomimetics. The average total
supply of drugs per patient per year was 118 days, which reflects the fact that 10 percent of patients in the data took multiple
Patients spent an average of $304 each for weight-loss
medications each year; patients paid 26 percent of this amount, and health plans, 74 percent. This annual total payment per
person increased with age, from $192 per person for ages 8-17 to $361 for ages 55-64. Although only 22 percent of users were
men, men spent more on average on the drugs than women ($327 versus $297), because men used these drugs longer than women
(122 days versus 117 days per year) and because a greater proportion of men than women used the most costly drug, orlistat
(44 percent versus 36 percent) (data not shown).
Finally, we estimated the prevalence of bar-iatric medicine
use among obese adults with employer coverage for the drugs. From our 2002 MarketScan sample, we estimated that 918,000 non-elderly
adults with bariatric drug coverage were clinically eligible to use bariatric prescription drugs.
However, only 21,797 (2.4 percent) of these adults took bariatric medications.
As bariatric surgeons perform more surgeries and outcomes continue to improve, it is likely that more people will opt
for the surgery. This potential demand may be quite large since the number of bariatric surgeries has grown 400 percent in
just five years. This growth will likely continue, given that only 0.6 percent of the 11.5 million eligible people underwent
the surgery in 2002.