The Medical Risks of Obesity
January 27, 2011
Caroline M. Apovian, MD
Excess adipose tissue has been linked to higher risk of developing many diseases including type 2 diabetes and cardiovascular disease. In a review of published literature between 1995 and 2008, Dr. Pi-Sunyer considers the link between obesity and certain cancers, disabilities, pulmonary and gastrointestinal tract complications, as well as depression and socioeconomic factorsI. A selection of the key findings reported in the article confirms the increased risk of these medical conditions for obese men and women:
- Diabetes: The Nurses’ Health Study indicated that body weight was a major risk factor of diabetes for women. The study followed 114,281 women over 14 years, and found that women who gain 5.0- to 7.9-kg almost double their risk of diabetes; those who gain 8.0- to 10.9-kg are almost three times more likely.
- Cardiovascular disease (CVD): The Framingham Heart Study found the lifetime risk of CVD in obese men and women with diabetes was 86.9% and 78.8%, respectively.
- Common cancers: Several studies have shown an association between obesity and cancer, including correlations between increasing BMI and 10 of the 17 most common cancers, including prostate cancer, breast cancer, and colon cancer.
- Osteoarthritis: Obesity also has been found to be strongly associated with osteoarthritis of the knee and moderately associated with osteoarthritis of the hip.
Furthermore, obesity has been shown to be associated with gallbladder disease, acute pancreatitis, non-alcoholic fatty liver disease, pulmonary complications, and depression. Considering these data in light of the 32.2% of adults in the United States that are classified as obese, it seems that obesity should be considered among the first priorities for preventive and treatment efforts in the public health arena.
Although many would argue that, indeed the management of obesity is a priority, from my vantage point there are a number of areas where efforts could be stronger. The treatment of obesity in 2010 involves lifestyle modification, pharmacotherapy, and as a last resort, bariatric surgery. However, much of the lifestyle management strategies that are used in clinical practice are not reimbursable by most third-party payors. In addition, the FDA-approved weight-loss medications that are so often used in obesity management are also usually rejected for reimbursement; thus, weight management as a focus is difficult to practice by many MDs and RDs in this country.
This reluctance to reimburse obesity medications comes despite the known increase in medical spending associated with obesity and its related illnesses. According to a September 2010 issue brief from the Congressional Budget Office, per capita health care spending for obese adults was $1,530 higher in 2007 than that of adults of normal weight, with spending on obesity-related illnesses accounting for 60% of the differenceII. Better access to pharmacotherapy could help delay these comorbidities or prevent them altogether.
Conversely, although bariatric surgery is usually covered by third-party payors, many individuals who are eligible for the procedure do not wish to be considered because of fear of surgery. Additionally, very often they believe that they should be able to lose weight on their own. This belief, no doubt, stems from the idea that obesity is still a matter of willpower and is not really a disease.
It is time to be rid of the notion that individuals who are obese somehow got there on their own and it is their own fault. We have much evidence from neuroendocrine research that obesity is, indeed, a disease. Because it is a disease, third-party payors should cover treatment—lifestyle modification, pharmacotherapy, bariatric surgery—without question. It is not that the patient has failed the diet, it is that the diet has failed the patient.
This review highlights why obesity is a disease and how it should be prioritized—as a target for preventive efforts—so that our children can maintain the health that our industrialized society has achieved in the past millennium.
Caroline M. Apovian, MD is Associate Professor of Medicine and Pediatrics, Section of Endocrinology, Diabetes, and Nutrition at Boston University School of Medicine and Director of the Center for Nutrition and Weight Management at Boston Medical Center.
I Pi-Sunyer X. The medical risks of obesity. Postgrad Med. 2009;121(6):21-33.
II Congressional Budget Office. (2010). How Does Obesity in Adults Affect Spending on Health Care?: A CBO Economic and Budget Issue Brief. Washington, DC: U.S. Government Printing Office. Retrieved from http://www.cbo.gov/ftpdocs/118xx/doc11810/09-08-Obesity_brief.pdf.
For more related articles, click Obesity Perspectives.