1. The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania

2. Body Mass Index –Evaluates weight relative to height (kg/m 2 ) –Correlates highly with body fat, morbidity, and mortalit y Categories –Underweight (< 18.5 kg/m 2) –Normal weight (18.5-24.9 kg/m 2 ) –Overweight (25.0-29.9 kg/m 2 ) –Class I Obesity (30.0-34.9 kg/m 2 ) –Class II Obesity (35.0-39.9 kg/m 2 ) –Class III Obesity (> 40 kg/m 2 ) NIH National Heart, Lung, and Blood Institute. Obes Res. 1998;6(suppl 2):51S Defining Obesity

3. Cautions High BMI may be due to excessive lean body mass –use clinical judgement Elevated BMI without other risk factors may indicate a healthy weight –Eg: only 30-40-% get DM Might explain recent ‘obesity paradox’

4. Outline Epidemiology and Economics of obesity/diabetes Perspectives on Obesity Consequences of Obesity, Prediabetes, Obesity Obesity/ Diabetes Risk Factors, Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. Medical Benefits to Weight Loss Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- –Basics, –Next Lecture in Series

5. Obesity Prevalence: Projected to Double Over the Next 30 Years

6. Overweight and Obesity Among U.S. Adults Flegal KM et al. JAMA 2002;288:1723-27 Hedley AA et al. JAMA 2004;291:2847-50 Ogden CL et al. JAMA 2006;295:1549-55

7. Increased Prevalence of Obesity Among Children and Adolescents Prevalence (%) NHES II & III 1963-70 NHANES I 1971-74 NHANES II 1976-80 NHANES III 1988-94

8. Leads to Diabetes Epidemic

9. An Expensive Epidemic 56 million Americans have a BMI of 30-40 –Had healthcare costs 36 percent greater than normal-weight individuals –Had pharmacy costs 77 percent greater than normal-weight individuals Nearly 10% of annual medical spending was for overweight and obese patients Total medical cost for obesity in 2003 was $75 billion. Finkelstein,Jan/2004Obesity Research Sturm, Ph.D. Archives of Medicine

10. Increase in Health Care Costs Among Obese Compared with Lean (BMI <25 kg/m 2 ) Patients* *HMO Setting: Northern California Kaiser Permanente. Quesenberry et al. Arch Intern Med 1998;158:466. 0 20 40 60 80 100 BMI 30–34.9 kg/m 2 BMI  35 kg/m 2 Increase in Cost Compared with Lean Subjects (%) Healthcare visits Pharmacy Laboratory tests All outpatient services All inpatient services Total healthcare

11. Direct Cost* of Chronic Diseases in the United States *Adjusted to 1995 dollars. Wolf and Colditz. Obes Res 1998;6:97. Hodgson and Cohen. Med Care 1999;37:994. 0 10 20 30 40 50 60 Type 2 Diabetes Obesity Coronary Heart Disease Hypertension Stroke $51.6 Direct Cost (Billions $)* $38.7 $18.4 $18.1 $53.2

12. Economic Effect of Obesity to Business: 3-Year Costs to First Chicago NBD *BMI >27.8 kg/m 2 in men; >27.3 kg/m 2 in women. Burton et al. J Occup Environ Med 1998;40:786. $0 $2,000 $4,000 $6,000 $8,000 Healthcare $0 $400 $800 $1,200 $1,600 Absenteeism $4,496 $6,822 $683 $1,546 Lean Obese*