- What is obesity?
- Obesity – A Global Epidemic
- Obesity in the USA.
- Obesity in minority populations
- Women and obesity
- Obesity in youth
- Health Effects of Obesity
- Treatment of obesity
- Obesity research
- Obesity and medical insurance
- Obesity, Medicaid and Medicare
What is obesity?
Obesity is a disease that affects almost half of the adult American population (approximately 60 million). The number of overweight and obese Americans has continued to increase since 1960, a trend that does not decline. Today, 64.5 percent of Americans (about 127 million) are classified as obese or overweight. Each year, obesity causes at least 300,000 excess deaths in the US and the costs of caring for obese Americans Totaling approximately $ 100 billion.
Obesity is the second leading cause of unnecessary deaths
- Despite the unfolding it has taken on death and disability, obesity does not receive the attention it deserves from the government, health care professions or the insurance industry.
- Research is severely limited due to lack of funding.
- Inadequate insurance coverage limits access to treatment.
- Discrimination and abuse of people with obesity is extensive and often considered socially acceptable.
Did you know?
- Obesity is a chronic disease with a strong family component.
- Obesity increases the risk of developing conditions such as high blood pressure, diabetes (type 2), heart disease, arrest, gallbladder disease and breast, prostate and colon cancer.
- Health insurance providers rarely pay for the treatment of obesity despite its serious effects on health.
- The trend towards obesity is fostered by our environment: the 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 your health.
- National health institutes annually spend less than 1.0 percent of their budget on obesity research.
- People with obesity are victims of employment and other discrimination and are penalized for their condition despite many federal and state laws and policies.
Obesity – a global epidemic
The prevalence of overweight and obesity is increasing worldwide to an alarming extent in developed and developing countries.
Environmental and behavioral changes caused by economic development, modernization, and urbanization have been linked to the increase in global obesity. Obesity is increasing in both children and adults, and the true health consequences may become quite evident in the near future.
- Developed countries have high numbers of obesity, food deprivation is unusual, and physical activity levels have greatly decreased. Lower incomes cause diets made up of foods that tend to be high in calories and fat – contributors to overweight and obesity – from vegetables, fruits and whole grain cereals are more expensive.
- Developing countries have lower obesity rates, particularly in areas of lower SES populations. People living in these areas are limited in their ability to provide enough food, have little access to public transportation and are tied to moderate heavy manual labor.
- In many developing countries, obesity coexists with low nutrition, a body mass index (BMI) of less than 18.5.
- In economically advanced regions of developing countries, prevalence rates of obesity may be as high as in industrialized countries.
- Overall, women generally have higher rates of obesity than men, although men may have higher rates of overweight.
- The prevalence of obesity in children and adolescents is increasing in developing and developed regions.
Obesity in the US
Obesity is a complex chronic multifactorial disease that involves environmental (social and cultural), genetic, physiological, metabolic, behavioral and psychological components. It is the second leading cause of preventable deaths in the US.
Overweight and obesity are part of the US Department of Health and Human Services’ agenda that has steadily moved away from its established goals 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.
- Approximately 127 million adults in the US are overweight, 60 million obese, and 9 million are seriously obese.
- The Total 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 overweight or obese adults has continued to increase. Currently, 64.5 percent of US adults, between 20 years and older, are overweight and 30.5 percent are obese. The severe prevalence of obesity is now at 4.7 percent, up from 2.9 percent reported in 1988-1994 by (NHANES) and the Centers for Disease Control and Prevention (CDC).
Health and social impact
- Obesity increases the risk of illness of about 30 serious medical conditions.
- Obesity is associated with an increase in deaths from all causes.
- Early onset of obesity-related diseases, such as type 2 diabetes, is being reported in obese children and adolescents.
- Individuals with obesity are at a higher risk of impaired mobility
- Overweight or obese individuals experience social stigma and discrimination in employment and academic situations.
Obesity in minority populations
Overweight and obesity in the US occur in higher numbers in racial / ethnic minority populations such as African Americans and Hispanics, compared to white Americans. Asian-Americans have a relatively low prevalence of obesity. Women and people of low socioeconomic status within minority populations appear to be particularly affected by overweight and obesity. Cultural factors that influence diet and exercise behaviors are reported to play an important role in the development of excess weight in minority groups.
- The prevalence of overweight (total body index (BMI) of 25 or more) and obesity (BMI of 30 or more) increased over the past decade across racial / ethnic groups, as shown in Table 1 .
- Adult Mexican-American and black (non-Hispanic) adults in the US are considerably fatter and obese than white (non-Hispanic) adults,
Many obesity-related diseases including diabetes, hypertension, cancer and heart disease are found in higher numbers among various members of racial-ethnic minorities compared to whites.
- Diabetes has been reported to occur at a rate of 16 to 26 percent in Hispanic Americans and Black Americans, ages 45 to 74, compared with 12 percent in whites (non-Hispanic) of the same age.
- A higher BMI predicts 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 who are eligible for diabetes are reported to be obese.
- Among Mexican Americans, obesity and type 2 diabetes are increasing, in addition to other risk factors for cardiovascular disease including smoking and blood pressure, which are declining.
Obesity seems to contribute to the higher risk of pancreatic cancer among black Americans than among whites, particularly for women.
- Among African Americans, the high prevalence of obesity and obesity-related conditions such as hypertension and type 2 diabetes are reported factors contributing to their high mortality rate since coronary heart disease.
- In a study of older Hispanics, with a mean age of 80, obesity was found as a risk factor for developing coronary artery disease.
The high prevalence of obesity is reported as a contributing factor to the high prevalence of hypertension in minority populations, especially among African Americans who have an early onset and have a more severe course of hypertension.
Risk factors of behavior and diet
- 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 lifestyle, which may contribute to the development of obesity, has been reported in 44 to 60 percent of Native American men and 40 to 65 percent of women.
- African Americans and whites report that they are less exercising as they grow older, however, African American women of all ages reported participating in less regular exercise than white women
- African American men aged 45 and older reported less regular exercise than white women.
Women and obesity
Obesity plays a significant role in causing poor health in women, negatively affecting the quality of life and shortening the amount of life. More than half of US adult women are overweight, and more than one-third are obese. The life expectancy of adult women in the US is approximately 80 years old, and more women than ever expect to reach 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.
- For women aged 20-74, 62 percent are overweight (total body index (BMI) of 25 or more) and about half of that population (34 percent) are obese (BMI of 30 or more).
- Mature women are at particularly high risk of becoming obese. The prevalence of obesity among older women (between 35 and 64) has increased by a minimum of 2 percentage points per year over a 40-year period from 1960 to 2000. Table 4 indicates changes in prevalence in Obesity (BMI of 30 or more) between 1960 and 2000 for US women in various age groups.
- Low-income women in minority populations are likely to be overweight.
- Obesity appears to have a strong inverse relationship with SES (obesity increases as the level of income declines) among women in developed societies such as the US.
- A direct association has been found between body weight and all cause deaths in women, between 30 and 55 years.
- Among US 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 chronic diseases related to obesity predominant in adults are now more common in young people. The percentage of children and adolescents who are overweight now is higher than ever before. Poor dietary habits and inactivity are reported as the causes that contribute to increased obesity in children.
Young people today are considered the most inactive generation in history caused in part by reductions in physical education programs and by unreachable or unsafe community recreational facilities. In the United States, only the state of Illinois requires daily physical education for students in grades K through 12.
This fact sheet conforms many factors related to obesity in youth that are the main challenge of medical care for the 21st century.
Excess weight and obesity defined
- Overweight and obesity for children and adolescents are defined respectively as being at or above 80 and 95 percent of the body mass index (BMI).
- Some researchers report 95 percent as overweight and others as obesity. The Centers for Disease Control and Prevention (CDC), which provide national statistical data for the weight status of American youth, avoid using the word “obesity,” and identify each child and adolescent about 85 percent Like “overweight.”
- Obesity surgery specialists use 95 percent as criteria for obesity because:
- Corresponds to a BMI of 30, which is obesity in adults. The 85 percent corresponds to a BMI of 25, adult excess weight.
- Is recommended as a marker for when children and adolescents should have an in-depth medical assessment.
- Identifies children who are very likely for obesity to persist into adulthood.
- Is associated with elevated blood pressure and lipids in older adolescents, and increases their risk of disease.
- Are the criteria for a more aggressive treatment.
- Are the criteria in clinical trials of childhood obesity treatments.
Health Effects of Obesity
People 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 demonstrate the impact of obesity on other conditions.Weight loss of about 10% of body weight, for people who are overweight or obese, can improve some medical conditions related to obesity including diabetes and hypertension.
Arthritis, osteoarthritis (OA), rheumatoid arthritis (RA), cancers, breast cancer, esophageal and gastric cancers, colorectal cancer, endometrial cancer, renal cell cancer, birth defects, cardiovascular disease (CTS), chronic venous insufficiency (CVI), daytime sleep disorders, deep vein thrombosis (DVT), diabetes (type 2), end stage renal disease (ESRD), gallbladder disease, gout , Heat disorders, hypertension, impaired immune function, impaired respiratory function, infections after injury, infertility, liver disease, low back pain, obstetric and gynecological complications, Pain, Pancreatitis, Sleep Apnea, Movement, Surgical Complications, Urinary Stress Incontinence, Other:
Several other conditions related to obesity have been reported by several researchers including:
- Abdominal hernias, acanthosis nigricans, endocrine abnormalities, chronic hypoxia and hypercapnia, dermatological effects, depression, elephantitis, gastroesophageal reflux, heel stimulations, hirsutism, low extremity edema, mammegaly (causing considerable problems such as bra strap pain , Skin damage, cervical pain, chronic odor and infection in the folds of skin beneath the breasts, etc.), large masses of the abdominal wall (abdominal panniculitis with frequent panniculitis, preventing walking, causing frequent infections, Difficulty with clothing, low back pain), musculoskeletal disease, prostate cancer, pseudo brain tumor (or benign intracranial hypertension), and hiatil sliding hernia?
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Treatment of obesity
One statistic frequently used about the treatment of obesity is that 95 percent of people who lose weight gain it all back. That statistic, based on a small study since 1959, is no longer valid. Much has changed in the form of obesity treatment since then.Thousands of people who have succeeded in weight loss and keeping it that way – a fact that encourages many who are discouraged by outdated information. There are different types of effective treatment options for managing weight including: diet therapy, physical activity, behavioral therapy, drug therapy, combined therapy and surgery.
Weight loss of about 10 percent excess body weight is a proven health benefit by reducing many risk factors related to obesity.Recommendations for treatment are now focusing on 10 percent weight loss to help patients with long-term weight loss maintenance. Health professionals including physicians, nutritionists, exercise physiologists, bariatric psychologists and surgeons help people with excess weight and obesity to determine the most appropriate treatment.
- Weight advice
- Dietetic Therapy
- Physical activity
- Behavioral Therapy
- Drug Therapy
- Combined Therapy
In the last four decades of research for obesity, 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 factors (social and cultural). Despite advances in research, however, children, adolescents and adults continue to become overweight and obese in high registered 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.
- Funds for public research for obesity are alarmingly low given that it is a major public health crisis.
- The National Institutes of Health (NIH) has a budget of more than $ 15.6 billion and is the largest public funding provider of medical research. In setting the priorities of its budget, the NIH has virtually neglected obesity research.
- Medical conditions related to obesity such as diabetes and hypertension, receive funding far greater than the condition that cause itself, as demonstrated in table 1. Poor diets and inactivity, which contribute to obesity, Is reported as the second leading cause of preventable death in the United States. Yet AIDS, another preventable cause of death, receives about 10 times more funding for its research than obesity.
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Obesity and Health Insurance
Many insurance schemes do not provide reimbursement for the treatment of weight loss. According to many physicians, few insurance compensation plans or private organizations for care appear to cover the costs of treating obesity regardless of whether the service is a medically supervised weight loss or maintenance program, nutrition advice, Surgery or a pharmaceutical product. The countless number of available insurance schemes and ever-changing policies have made it difficult to determine the extent to which treatment and obesity prevention services are covered by third-party insurers. More data and better follow-up are needed to determine the health needs of people with obesity.
Insurance Coverage Trends
A typical employer insurance scheme might be similar to Wal-Mart’s.
The benefits listed in your employee benefit book (1999) as non-payable treatment or service include charges such as:
- Drugs and dietary supplements that result from a diet program
- Appetite control
- Weight control
- Treatment of obesity or morbid obesity, including gastric bypass and stapling procedures even if the participant has other health conditions that could be helped by weight reduction.
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.Medicaid recipients are mostly women and children who are poor and members of minorities. Given the high prevalence of obesity among these populations, it could be presumed that many Medicaid recipients are likely to be obese. Medicare provides health insurance coverage to senior citizens and disabled Americans who qualify under Social Security Administration (SSA) criteria and ending a two-year waiting period.
- In 1990, Congress enacted the Omnibus Budget Reconciliation Act (OBRA), which funds state programs to provide pharmaceutical products to Medicaid recipients.
- A state may choose to exclude or restrict drugs or classes of drugs, or their medical applications for certain purposes. A state chooses to include outpatient drugs within its Medicaid program must cover, for its medically accepted indications, all food and drug administration (FDA) to approve prescription drugs from manufacturers who have entered into Drug rebate agreements, with some limited exceptions.
- Exceptions include drugs when they are used for: anorexia, weight loss or weight gain; To promote fertility; For cosmetic purposes or hair growth; For symptomatic relief of coughs 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 agents against theobesity.
- Nine states cover obesity pharmaceuticals 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.
- The Medicare coverage manual defines obesity and the rationale for some treatment coverage by stating this:
- Obesity itself can not be considered a disease. The immediate cause is a caloric intake, which persists higher than the caloric output.
- The payment of the program can not be made for the treatment of obesity alone if this treatment is not reasonable and necessary for the diagnosis or treatment of an illness or injury.
- However, although obesity is not itself a disease, it can be caused by diseases such as hypothyroidism, Cushing’s disease, and hypothalamic lesions. In addition, obesity can aggravate a number of heart 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 diseases.
- Medicare’s limited coverage for obesity is difficult to understand when it is considered to cover services such as alcohol detox and inpatient rehabilitation and inpatient and outpatient drug rehabilitation and sexual impotence service. It also covers chemical aversion therapy for the treatment of alcoholism although the FDA has not approved drugs commonly used in chemical aversion therapy for this use.
Gastric Bypass Surgery
Gastric bypass surgery for the treatment of obesity is covered on a limited basis. According to the Insurance coverage manual:
- Gastric bypass surgery, which is a variation of gastro-jejunostomy, 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.
- Surgery is to correct a disease, which caused obesity or was aggravated by obesity.