Obesity rates in the US continue to rise. It is well established that not only is obesity intricately linked to the risk of tie 2 diabetes and the metabolic syndrome, but is also powerful risk factor for kidney disease. Dr. Youssef MK Farag writes here about a recent paper published in the US.
Dr. Farag is a
research fellow in the renal division at Brigham and Women’s Hospital, a
teaching affiliate of Harvard Medical School. He is currently pursuing a master
in public health in Johns Hopkins Bloomberg School of Public Health. His
Harvard Catalyst profile is available here.
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| Dr. Farag |
A predictive analysis model has been constructed to estimate
the percentage of Americans who will be obese by 2030. This model was published
in the June
2012 issue of the American Journal of Preventive Medicine by a group
of investigators (Finkelstein et al) from Duke
University and the Center for Disease Control
and Prevention (CDC).
Finkelstein et al used the data of the Behavioral Risk Factor Surveillance System
(BRFSS), conducted by the CDC, from 1990 to 2008. The sample size in this
study is ~3.5 million adults aged ≥18 years, with equal representation of both
genders.
The study shows a double increase of the self-reported
prevalence of obesity and severe obesity during this 19-year period
(1990-2008), increasing from 11.1% to 26.8%, and from 0.9% to 3.5%,
respectively. The study predicts an obesity prevalence (BMI≥30 kg/m2) (Fig.1) of 42% in 2030, which approximately a 33% increase over the next 20 years. The
study reported also predictions for the prevalence of severe obesity (BMI≥40
kg/m2) (Fig.2). It estimates a prevalence of 11%, which is 2.2 times greater
than the 2010prevalence of 5%.
About two years ago, I wrote an editorial in Nephrology
Dialysis Transplantation, discussing the rising epidemic of diabeisty
in the world. Diabesity is a new term describing the diabetes in the context of
obesity. The editorial illustrated the rising prevalence of diabetes around the
world.
Here is an excerpt from the editorial:
“Between 2010 and 2030, there
will be a net increase in the prevalence of diabetes among adults, as reflected
by the 73% increase in adult diabetes numbers in developing countries, compared
to 20% increase in developed countries”
I cited an article
published in the Journal of American Medical Association (JAMA)
which estimated the prevalence of obesity, in 2007-2008, to be 32.2% among
adult men and 35.5% among adult women.
Although there has been previous forecast reports for the
future prevalence and economic cost of obesity, but these reports didn’t factor
the slower progression of obesity as presented in the JAMA
paper.
As the authors of the new report mention, this predictive analysis
incorporated two improvements over the previous reports. They state “First,
consistent with the recent data showing slower obesity growth, the assumption
of linear trajectories in the future rise of obesity prevalence is relaxed.
Second, rather than relying solely on historical obesity levels, the
relationship between obesity and exogenous, state-level variables thought to
influence obesity, is estimated”.
The authors state several limitations of their study. The
most important is the reliance on self-reported height and weight (which
they adjusted for self-reporting error). Also, the data source (BRFSS)
excluded people who don’t have landlines telephones. The authors believe, and I
do too, that these limitations may not change the shape of the forecasts or the
estimated medical savings resulting from successful obesity prevention efforts.
However, I believe that the most important information in
this article is estimating the potential savings in medical expenditures from
obesity treatment and prevention. The study estimates an annual reduction in
the obesity-attributable annual medical expenditures of ~$3-$4 billion per
year, for each 1 percentage point decrease from the predicted trend the
investigators proposed. This means that 2.6
million fewer obese adults in 2020 and 2.9 million fewer obese adults in 2030.
The cumulative dollar savings by 2030 is estimated to be a total of ~$85
billion (over the next 20 years).
The economic cost to combat obesity is overloading the
governments worldwide. Four months ago, February 9-10, 2012 in Brussels,
Belgium, Professor Paul Zimmet spoke at a Eurpean Commission-sponsored
conference titled “DIABESITY - A World-Wide Challenge”. Professor Zimmet ended his presentation
saying that by 2020, diabesity is set to bankrupt the economies of many nations
unless action is taken. Finkelstein et al study demonstrates that we are
not doing what we should do to stop, or at least lessen, the development of
obesity.
Brief biography about Professor Zimmet is available here
(page 35)
