Midlife obesity and dementia: Meta‐analysis and adjusted forecast of dementia prevalence in the united states and china

Objective:

Obesity is a risk factor of dementia. Current forecasts of dementia prevalence fail to take the rising obesity prevalence into account.

Design and Methods:

Embase and Medline were searched for observational studies on the association between overweight (BMI 25‐30 kg/m²) or obesity (BMI > 30 kg/m²) and dementia and pooled the effect sizes by meta‐analysis. The population attributable risk (PAR) was calculated for different time points and adjusted them for confounders. Based on current prevalence rates of dementia and demographic forecasts, patient numbers were calculated and adjusted by the growth rates of PAR.

Results:

Compared to normal weight, midlife obesity increases the risk of dementia later in life (BMI 25‐30: RR = 1.34 [95% CI 1.08, 1.66], BMI > 30: RR = 1.91 [1.4, 2.62]). If obesity is included into forecast models, the prevalence of dementia is estimated to be 7.1 million (6.9, 7.3) and 11.3 million (10.9, 11.7) for the United States in 2030 and 2050, respectively. In China, the estimate is 13.1 million (12.8, 13.3) in 2030 and 26.2 million (25.1, 27.4) in 2050. These figures are 9% and 19% higher for the United States and China, respectively, than forecasts that rely solely on the demographic change.

Conclusion:

The past and ongoing increase in midlife obesity prevalence will contribute significantly to the future prevalence of dementia and public health measures to reduce midlife obesity are simultaneously primary prevention measures to reduce the risk of dementia.     

Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic

We projected future prevalence and BMI distribution based on national survey data (National Health and Nutrition Examination Study) collected between 1970s and 2004. Future obesity-related health-care costs for adults were estimated using projected prevalence, Census population projections, and published national estimates of per capita excess health-care costs of obesity/overweight. The objective was to illustrate potential burden of obesity prevalence and health-care costs of obesity and overweight in the United States that would occur if current trends continue. Overweight and obesity prevalence have increased steadily among all US population groups, but with notable differences between groups in annual increase rates. The increase (percentage points) in obesity and overweight in adults was faster than in children (0.77 vs. 0.46-0.49), and in women than in men (0.91 vs. 0.65). If these trends continue, by 2030, 86.3% adults will be overweight or obese; and 51.1%, obese. Black women (96.9%) and Mexican-American men (91.1%) would be the most affected. By 2048, all American adults would become overweight or obese, while black women will reach that state by 2034. In children, the prevalence of overweight (BMI >/= 95th percentile, 30%) will nearly double by 2030. Total health-care costs attributable to obesity/overweight would double every decade to 860.7-956.9 billion US dollars by 2030, accounting for 16-18% of total US health-care costs. We continue to move away from the Healthy People 2010 objectives. Timely, dramatic, and effective development and implementation of corrective programs/policies are needed to avoid the otherwise inevitable health and societal consequences implied by our projections .     

Population-Attributable Causes of Cancer in Korea: Obesity and Physical Inactivity

Background

Changes in lifestyle including obesity epidemic and reduced physical activity influenced greatly to increase the cancer burden in Korea. The purpose of the current study was to perform a systematic assessment of cancers attributable to obesity and physical inactivity in Korea.

Methodology/Principal Findings

Gender- and cancer site-specific population-attributable fractions (PAF) were estimated using the prevalence of overweight and obesity in 1992–1995 from a large-scale prospective cohort study, the prevalence of low physical activity in 1989 from a Korean National Health Examination Survey, and pooled relative risk estimates from Korean epidemiological studies. The overall PAF was then estimated using 2009 national cancer incidence data from the Korea Central Cancer Registry.Excess body weight was responsible for 1,444 (1.5%) and 2,004 (2.2%) cancer cases among men and women, respectively, in 2009 in Korea. Among men, 6.8% of colorectal, 2.9% of pancreatic, and 16.0% of kidney cancer was attributable to excess body weight. In women, 6.6% of colorectal, 3.9% of pancreatic, 18.7% of kidney, 8.2% of postmenopausal breast, and 32.7% of endometrial cancer was attributable to excess body weight. Low leisure-time physical activity accounted for 8.8% of breast cancer, whereas the PAF for overall cancer was low (0.1% in men, 1.4% in women). Projections suggest that cancers attributable to obesity will increase by 40% in men and 16% in women by 2020.

Conclusions/Significance

With a significantly increasing overweight and physically inactive population, and increasing incidence of breast and colorectal cancers, Korea faces a large cancer burden attributable to these risk factors. Had the obese population of Korea remained stable, a large portion of obesity-related cancers could have been avoided. Efficient cancer prevention programs that aim to reduce obesity- and physical inactivity-related health problems are essential in Korea.     

Current Estimates of the Economic Cost of Obesity in the United States

This study was undertaken to update and revise the estimate of the economic impact of obesity in the United States. A prevalence-based approach to the cost of illness was used to estimate the economic costs in 1995 dollars attributable toobesity for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, gallbladder disease, breast, endometrial and colon cancer, and osteoarthritis. Additionally and independently, excess physician visits, work-lost days, restricted activity, and bed-days attributable to obesity were analyzed cross-sectionally using the 1988 and 1994 National Health Interview Survey (NHIS). Direct (personal health care, hospital care, physician services, allied health services, and medications) and indirect costs (lost output as a result of a reduction or cessation of productivity due to morbidity or mortality) are from published reports and inflated to 1995 dollars using the medical component of the consumer price index (CPI) for direct cost and the all-items CPI for indirect cost. Population-attributable risk percents (PAR%) are estimated from large prospective studies. Excess work-lost days, restricted activity, bed-days, and physician visits are estimated from 88,262 U. S. citizens who participated in the 1988 NHIS and 80,261 who participated in the 1994 NHIS. Sample weights have been incorporated into the NHIS analyses, making these data generalizable to the U. S. population. The total cost attributable to obesity amounted to $99. 2 billion dollars in 1995. Approximately $51. 64 billion of those dollars were direct medical costs. Using the 1994 NHIS data, cost of lost productivity attributed to obesity (BMI≥30) was $3. 9 billion and reflected 39. 2 million days of lost work. In addition, 239 million restricted-activity days, 89. 5 million bed-days, and 62. 6 million physician visits were attributable to obesity in 1994. Compared with 1988 NHIS data, in 1994 the number of restricted-activity days (36%), bed-days (28%), and work-lost days (50%) increased substantially. The number of physician visits attributed to obesity increased 88% from 1988 to 1994. The economic and personal health costs of overweight and obesity are enormous and compromise the health of the United States. The direct costs associated with obesity represent 5. 7% of our National Health Expenditure in the United States .     

The Obesity Epidemic and Its Impact on Urologic Care

Although heart disease and cancer are the number one and two causes of death in the United States, respectively, obesity is gaining speed as a contributing cause to both of those conditions, along with diabetes, arthritis, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. Nearly one-third of the adults in the United States is overweight with a body mass index (BMI) greater than 25 kg/m², and another third of the adult population is obese, with a BMI greater than 30 kg/m². This article reviews the root causes of obesity, the societal implications, and the implications of obesity on various urologic diseases.Key words: Obesity, Morbid obesity, Body mass index, Exercise, Weight loss, Diet, EpidemicMore than 20% of adults in the United States are clinically obese, defined by a body mass index (BMI) of 30 kg/m² or higher, and an additional 30% are overweight, with a BMI between 25 and 30 kg/m².¹ An environment that promotes excessive food intake and discourages physical activity lies at the root of the current obesity epidemic. Although humans have excellent physiologic mechanisms to defend against body weight loss, they have only weak physiologic mechanisms to defend against body weight gain when food is abundant. So much has been discussed about the obesity epidemic that it’s easy to think the issue is being blown out of proportion. After all, people putting on a few pounds may not seem to warrant the proclamation of a national emergency. Although obesity may not attract the degree of attention that heart disease and cancer do, it is a serious public health issue. Experts agree that, as more and more obese children become obese adults, the diseases associated with obesity, such as heart disease, cancer, and particularly diabetes, will surge.The obesity epidemic in the United States is an unintended consequence of the economic, social, and technologic advances realized during the past several decades. The food supply is abundant and low in cost, and palatable foods with high caloric density are readily available in prepackaged forms and at fast-food restaurants. Laborsaving technologies have greatly reduced the amount of physical activity that used to be part of everyday life, and the widespread availability of electronic devices in the home, school, and office has promoted a sedentary lifestyle, particularly among children.A recent study estimated that medical expenditures attributed to overweight and obesity accounted for 9.1% of total US medical expenditures in 1998, and might have reached $78.5 billion dollars.² Today, the healthcare costs attributed to obesity are estimated to be $190 billion—nearly 21% of total US healthcare costs.³ Expenditures will continue to rise, particularly due to increases in the prevalence of obesity and the cost of related healthcare.Total healthcare costs attributable to this obesity epidemic are expected to double every decade, reaching $860.7 to $956.9 billion by 2030, accounting for 16% to 18% of total US healthcare costs, or 1 in every 6 dollars spent on healthcare. ⁴ In addition, obesity is likely to result in a decreased life expectancy for our population. Current US generations may have a shorter life expectancy than their parents if this obesity epidemic cannot be controlled.⁵ Based on nationally representative data and the assumptions of a future of increased obesity rates, along with increased healthcare costs, this paints an alarming picture of the future obesity epidemic. Projections show that if the trends continue, in 15 years, 80% of all American adults will be overweight or obese.⁶     

The Potential Impact of a 20% Tax on Sugar-Sweetened Beverages on Obesity in South African Adults: A Mathematical Model

Background/Objectives

The prevalence of obesity in South Africa has risen sharply, as has the consumption of sugar-sweetened beverages (SSBs). Research shows that consumption of SSBs leads to weight gain in both adults and children, and reducing SSBs will significantly impact the prevalence of obesity and its related diseases. We estimated the effect of a 20% tax on SSBs on the prevalence of and obesity among adults in South Africa.

Methods

A mathematical simulation model was constructed to estimate the effect of a 20% SSB tax on the prevalence of obesity. We used consumption data from the 2012 SA National Health and Nutrition Examination Survey and a previous meta-analysis of studies on own- and cross-price elasticities of SSBs to estimate the shift in daily energy consumption expected of increased prices of SSBs, and energy balance equations to estimate shifts in body mass index. The population distribution of BMI by age and sex was modelled by fitting measured data from the SA National Income Dynamics Survey 2012 to the lognormal distribution and shifting the mean values. Uncertainty was assessed with Monte Carlo simulations.

Results

A 20% tax is predicted to reduce energy intake by about 36kJ per day (95% CI: 9-68kJ). Obesity is projected to reduce by 3.8% (95% CI: 0.6%–7.1%) in men and 2.4% (95% CI: 0.4%–4.4%) in women. The number of obese adults would decrease by over 220 000 (95% CI: 24 197–411 759).

Conclusions

Taxing SSBs could impact the burden of obesity in South Africa particularly in young adults, as one component of a multi-faceted effort to prevent obesity.     

Age at arrival and risk of obesity among US immigrants

Although immigrants are a rapidly growing subgroup, little is known about overweight/obesity among the foreign-born in the United States, especially regarding the effect of age at arrival. This study determined whether overweight/obesity prevalence is associated with age at arrival of immigrants to the United States. We analyzed data on 6,421 adult immigrants from the New Immigrant Survey (NIS), a study that is nationally representative of adult immigrants with newly acquired legal permanent residence (LPR). Multiple regression analyses tested the effects of duration of residence and age at arrival on overweight/obesity, defined by BMI of > or = 25 kg/m(2), and self-reported dietary change score. We found the relationship between duration of residence and overweight/obesity prevalence varied by age at arrival (P < 0.001). Immigrants < or = 20-years old at arrival who had resided in the United States > or = 15 years were 11 times (95% confidence interval: 5.33, 22.56) more likely to be overweight/obese than immigrants < 20-years old at arrival who had resided in the United States < or = 1 year. By comparison, there was no difference in overweight/obesity prevalence by duration among immigrants who arrived at >50 years of age. Higher self-reported dietary change is also associated with overweight/obesity. In conclusion, immigrants younger than 20 at arrival in the United States may be at higher risk of overweight/obesity with increasing duration of residence than those who arrive at later ages. Obesity prevention among young US immigrants should be a priority.     

Prevalence and Covariates of Obesity in Lebanon: Findings from the First Epidemiological Study

Objective: To estimate the prevalence of overweight and obesity and examine associated covariates in the Lebanese population. Research Methods and Procedures: A cross‐sectional survey of a representative sample of 2104 individuals, 3 years of age and older. Anthropometric measurements and dietary assessments were conducted following standard methods and techniques. Overweight and obesity (classes I to III) were defined according to internationally standardized criteria for classification of BMI. Results: For children 3 to 19 years of age, prevalence rates of overweight and obesity were higher overall for boys than girls (22.5% vs. 16.1% and 7.5% vs. 3.2%, respectively). For adult men and women (age ≥ 20 years), the prevalence of overweight was 57.7% and 49.4%, respectively. In contrast, obesity (BMI ≥ 30 kg/m²) was higher overall among women (18.8%) than men (14.3%), a trend that became more evident with increasing obesity class. BMI, percentage of body fat, and waist circumference increased to middle age and declined thereafter. Whereas lack of exercise associated significantly with obesity among children, obesity in older adults was more prevalent among the least educated, nonsmokers, and those reporting a family history of obesity. Discussion: The results from this national population‐based study in Lebanon show high prevalence rates of overweight and obesity comparable with those observed in developed countries such as the United States. While further studies are needed to examine the underlying social and cultural factors associated with lifestyle and nutritional habits, now is the time to institute multicomponent interventions promoting physical activity and weight control nationwide.     

Implications of childhood obesity for adult health: findings from thousand families cohort study

ObjectiveTo determine whether being overweight in childhood increases adult obesity and risk of disease.DesignProspective cohort study.SettingCity of Newcastle upon Tyne.Participants932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50.ResultsBody mass index at age 9 years was significantly correlated with body mass index age 50 (r=0.24, P<0.001) but not with percentage body fat age 50 (r=0.10, P=0.07). After adult body mass index had been adjusted for, body mass index at age 9 showed a significant inverse association with measures of lipid and glucose metabolism in both sexes and with blood pressure in women. However, after adjustment for adult percentage fat instead of body mass index, only the inverse associations with triglycerides (regression coefficient= −0.21, P<0.01) and total cholesterol (−0.17, P<0.05) in women remained significant.ConclusionsLittle tracking from childhood overweight to adulthood obesity was found when using a measure of fatness that was independent of build. Only children who were obese at 13 showed an increased risk of obesity as adults. No excess adult health risk from childhood or teenage overweight was found. Being thin in childhood offered no protection against adult fatness, and the thinnest children tended to have the highest adult risk at every level of adult obesity.

What is already known on this topic

Many studies have found that body mass index in childhood is significantly correlated with body mass index in adulthoodObese children have been found to have higher all cause mortality as adults

What this study adds

No excess health risk from childhood overweight was foundChildhood body mass index was linked to adulthood body mass index but not percentage body fatOnly children who were obese at 13 showed a significant increased risk of obesity as adultsPeople who were thinnest as children and fattest as adults tended to have the highest adult risk     

Familial Aggregation of Morbid Obesity

Recent studies have shown major gene effects for obesity in randomly ascertained families. To investigate the familial aggregation of a specific subset of obesity, which is particularly prone to medical complications, families with morbid obesity were studied. This condition occurs in 1%-2%of the population and is defined as 45.5 kg (100 pounds) or more over ideal weight. First-degree relatives of 221 morbidly obese probands (1560 adults) were identified, and height and weight (current and greatest) were obtained from each family member. Morbid obesity occurred in the family members of the probands 8 times more often than in the general population. Of the morbidly obese probands, 48% had one or more first-degree relatives who were also morbidly obese compared to a 6% population estimate. By the ages of 20–24, 12% of the morbidly obese probands were already 45.5 kg or more overweight, and 45% were 22.7 kg (50 pounds) or more overweight. There was little difference in the prevalence of familial morbid obesity by the gender of the probands: 47% of the male probands and 48% of the female probands had another morbidly obese relative, while 67% and 53% of the early onset (before age 25) male and female probands, respectively, had one or more first-degree relatives who were also morbidly obese. In addition to the extreme degree of familial aggregation, the prevalence of morbid obesity in parent-offspring sets was calculated within the morbidly obese families. Morbidly obese families who have one or two morbidly obese parents have a 2.6 times increased risk (p<0.002) of having one or more morbidly obese adult offspring, compared to families who have neither parent morbidly obese. Evidence for trimodality of the body mass index distribution was found for each gender (p = 0.0006 for male relatives and p = 0.075 for female relatives). The strong familial aggregation of morbid obesity indicates the need for further understanding of the genetic determinants of this extreme clinical disorder and how environmental factors affect the genetic expression of the trait. (OBESITY RESEARCH 1993;1:261–270)     

Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006

Objective: Little is known about the prevalence and patterns of weight discrimination in the United States. This study examined the trends in perceived weight/height discrimination among a nationally representative sample of adults aged 35–74 years, comparing experiences of discrimination based on race, age, and gender. Methods and Procedures: Data were from the two waves of the National Survey of Midlife Developmentin the United States (MIDUS), a survey of community‐based English‐speaking adults initially in 1995–1996 and a follow‐up in 2004– 2006. Reported experiences of weight/height discrimination included a variety of settings in major lifetime events and interpersonal relationships. Results: The prevalence of weight/height discrimination increased from 7% in 1995–1996 to 12% in 2004–2006, affecting all population groups but the elderly. This growth is unlikely to be explained by changes in obesity rates. Discussion: Weight/height discrimination is highly prevalent in American society and increasing at disturbing rates. Its prevalence is relatively close to reported rates of race and age discrimination, but virtually no legal or social sanctions against weight discrimination exist.     

The Case for Medical Management of Obesity: A Call for Increased Physician Involvement

The United States is in the midst of an escalating epidemic of obesity. Over one-third of the adult population in the United States is currently obese and the prevalence of obesity is growing rapidly. By any criteria, obesity represents a chronic disease which is associated with a wide range of comorbidities, including coronary heart disease (CHD), Type 2 diabetes, hypertension and dyslipidemias. The comorbidities of obesity are common, occurring in over 70% of individuals with a BMI of ≥ 27. In addition to obesity itself, excessive accumulation of visceral abdominal fat and significant adult weight gain also represent health risks. Physicians have an important role to play in the treatment of obesity. Unfortunately, the medical community has not been involved actively enough to help stem the major epidemic of obesity occurring in the United States. This article puts forth a proposed model for the treatment of obesity in clinical practice, including obtaining the “vital signs” of obesity, recommending lifestyle measures, and instituting pharmacologic therapy when appropriate. By utilizing a chronic disease treatment model, physicians can join other health care professionals to effectively treat the chronic disease of obesity. Relatively modest weight loss, on the order of 510% of initial body weight can result in significant health improvements for many patients and represent an achievable goal for most obese patients.     

Varying Body Mass Index Cutoff Points to Describe Overweight Prevalence Among U. S. Adults: NHANES III (1988 to 1994)

KUCZMARSKI, ROBERT J, MARGARET D CARROLL, KATHERINE M FLEGAL, RICHARD P TROIANO. Varying body mass index cutoff points to determine overweight prevalence among U. S. adults: NHANES III (1988 to 1994). Body mass index (BMI; kg/m²) distributions are commonly reported in the scientific literature to describe weight for stature. These data are collected for various groups of subjects in local health and body composition studies, and comparisons with national distributions are often desirable. Tabular data for population prevalence estimates from thethird National Health and Nutrition Examination Survey (NHANES III, 1988 to 1994) at selected gender- and age-specific BMI levels ranging from <18. 0 to >45. 0 are presented and compared with various examples of BMI criteria reported in the scientific literature. NHANE HI was a statistically representative national probability sample of the civilian, noninstitutionalized population of the United States in which height and weight were measured as part of a more comprehensive health examination. The implications of varying population prevalence estimates based on varying BMI cutoff points are briefly discussed for selected examples including World Health Organization overweight/obesity criteria and the U. S. Dietary Guidelines for Americans. The median BMI for U. S. adults aged 20 years and older is 25. 5 kg/m². Median stature and weight for men are 175. 5 cm and 80. 0 kg and for women are 161. 6 cm and 65. 6 kg, respectively. The percentage of the population with BMI <19. 0 is 1. 6% for men, 5. 7% for women; BMI 19. 0 to <25. 0 is 39. 0% for men, 43. 6% for women; BMI 25. 0 is 59. 4% for men, 50. 7% for women. An estimated 97. 1 million adults have a BMI 25. 0. Additional prevalence estimates based on other BMI cutoff points and ages are presented.     

Weight perceptions among overweight and obese women: a US-Mexico binational perspective

We examined actual and perceived weight in nationally representative cohorts of adults in Mexico (n = 9,527) and the United States (n = 855) using data from the National Health and Nutrition Examination Survey (waves 2001-2006) and Mexican National Health and Nutrition Survey (2006). Actual weight was assessed by health technicians using BMI and perceived weight was collected through self-report. The prevalence of overweight or obesity (OO) in Mexican women was 72% and in Mexican-American women was 71%. OO Mexican-American women were more likely than OO Mexican women to label themselves as "overweight" (86% vs. 64%, P < 0.001), and this difference was significant while controlling for socio-demographic and weight-related variables. Among OO women from both populations, those who had been told by a health provider that they were OO were much more likely to perceive themselves as such (odds ratio = 5.3; 95% confidence intervals: 3.8-7.3). Significantly fewer OO women in Mexico than in the United States (13% vs. 42%, P < 0.0001) recalled having been screened for obesity by their health care provider. Weight misperceptions were common in both populations but more prevalent in Mexico, and low screening by health providers may be an important contributor to poor weight control in both countries.     

The prevalence of obesity in ethnic admixture adults

Objective: To determine whether the prevalence of obesity in ethnic admixture adults varies systematically from the average of the prevalence estimates for the ethnic groups with whom they share a common ethnicity. Methods and Procedures: The sample included 215,000 adults who reported one or more ethnicities, height, weight, and other characteristics through a mailed survey. Results: The highest age‐adjusted prevalence of overweight (BMI ≥ 25) was in Hawaiian/Latino men (88%; n = 41) and black/Latina women (74.5%; n = 79), and highest obesity (BMI ≥ 30) rates were in Hawaiian/Latino men (53.7%; n = 41) and Hawaiian women (39.2%, n = 1,247). The prevalence estimates for most admixed groups were similar to or higher than the average of the prevalences for the ethnic groups with whom they shared common ethnicities. For instance, the prevalence of overweight/obesity in five ethnic admixtures—Asian/white, Hawaiian/white, Hawaiian/Asian, Latina/white, and Hawaiian/Asian/white ethnic admixtures—was significantly higher (P < 0.0001) than the average of the prevalence estimates for their component ethnic groups. Discussion: The identification of individuals who have a high‐risk ethnic admixture is important not only to the personal health and well‐being of such individuals, but could also be important to future efforts in order to control the epidemic of obesity in the United States.     

Racial/Ethnic Differences in Weight Perception

The objective of this research was to estimate the prevalence of weight misperception among adults using the most recent nationally representative data, according to measured weight category and to assess the relationship between weight misperception and race/ethnicity. Height and weight were measured as part of the 1999–2006 National Health and Nutrition Examination Survey. The study sample consisted of 17,270 adults aged ≥20 years. BMI was categorized as underweight (BMI < 18.5), healthy weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). Subjects reported self‐perception of weight status. Among study subjects, 31.7% of healthy weight adults, 38.1% of overweight adults, and 8.1% of obese adults incorrectly perceived their weight category. Among obese men, the odds of weight misperception were higher for non‐Hispanic blacks (odds ratio (OR) = 3.0; 95% confidence interval (CI) = 2.0–4.5) compared to non‐Hispanic whites and for persons with less than a high school education (OR = 2.1; 95% CI = 1.3–2.1), compared to those with some college education. Among obese women, the odds of weight misperception were higher for non‐Hispanic blacks (OR = 3.4; 95% CI = 1.4, 3.1) and Mexican Americans (OR = 1.9; 95% CI = 1.2, 3.2) compared to non‐Hispanic whites and for persons with less than high school education compared to those with some college education (OR = 5.5; 95% CI = 3.3–9.3). Weight misperception is highly prevalent in the US population, and more frequent in racial/ethnic minorities, males, and in persons with lower educational levels. Addressing the issue of weight misperception may help address the problem of obesity in the United States by increasing awareness of healthy weight levels, which may subsequently have an impact on weight‐related behavior change.     

Direct Healthcare Cost of Obesity in Brazil: An Application of the Cost-of-Illness Method from the Perspective of the Public Health System in 2011

Background

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems.

Objective

To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m²) and morbid obesity (BMI ≥ 40 kg/m²) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011.

Settings

Public hospitals and outpatient care.

Methods

A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web.

Results

Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men.

Conclusion

The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.     

Increasing trends in waist circumference and abdominal obesity among US adults

Objective: Some studies have shown that abdominal obesity may be a better predictor than overall obesity for disease risks and all‐cause mortality. This study sought to examine the recent trends in waist circumference (WC) among adults in the United States. Research Methods and Procedures: Data from the National Health and Nutrition Examination Survey during 1988–1994, 1999–2000, 2001–2002, and 2003–2004 were analyzed to estimate the trends in the mean WC and the prevalence of abdominal obesity. Pooled t tests were used to test the differences in estimates between two time periods. Results: Between the periods of 1988–1994 and 2003–2004, the age‐adjusted mean WC increased from 96.0 cm to 100.4 cm among men (p < 0.001) and from 89.0 cm to 94.0 cm among women (p < 0.001); the age‐adjusted prevalence of abdominal obesity increased from 29.5% to 42.4% among men (p < 0.001) and from 47.0% to 61.3% among women (p < 0.001). Between the periods of 1999–2000 and 2003–2004, a significant increase occurred in mean WC only among men (from 99.0 cm to 100.4 cm; p = 0.03) and in the prevalence of abdominal obesity among both men (from 37.0% to 42.2%; p = 0.03) and women (from 55.3% to 61.3%; p = 0.04). People with a BMI of 25 to 29 kg/m² had a greater relative increase in abdominal obesity. Discussion: The mean WC and the prevalence of abdominal obesity among U.S. adults have increased continuously during the past 15 years. Over one‐half of U.S. adults had abdominal obesity in the period of 2003–2004.     

Out-of-pocket health care expenditures due to excess of body weight in Portugal

The prevalence for excessive weight has also been increasing dramatically in Portugal over the last decades. The consequences for families as well as for the publicly funded Portuguese health care system are a matter of policy interest. This paper uses an econometric model to compute the fraction of the national out-of-pocket health care expenditures attributable to overweight and obesity among Portuguese adults. Given that public health care system pays for a substantial share of the national health care expenditures, the estimated the out-of-pocket expenditures is only a share of the total expenditures. Per-capita expenditures and the burden that obesity and overweight impose on families are also estimated. Two waves of the Portuguese National Health Survey (NHS), namely; 1995/1996 and 1998/1999 are considered. The results suggest that out-of-pocket expenditures due to excess weight have increased sharply during these 3 years. The two-part model estimates suggest that the obese and overweight are more likely to incur out-of-pocket health care expenditures but, in the restricted sample of those that incur expenditures, there is weak or no evidence that the obese or overweight spend, on average, more than those of normal weight. Overall, it is estimated that in 1995/1996, more than 1.8% out-of-pocket health care expenditures were attributable to obesity and 2% to overweight (although not statistically significant). The estimated percentages are over 2.9% for obesity and 4% for overweight in 1998/1999. Combined, the estimated attributable percentage of national out-of-pocket expenditures due to excess weight was 3.8% in 1995/1996 and 6.9% in 1998/1999. Per-capita expenditures due to obesity or overweight are small, on average, in absolute terms, but they can be a significant cost for low income families. With respect to public policy concerns, the results suggest that measures which only slightly increase the out-of-pocket health care expenditures of being obese (overweight) are likely to be inefficient.     

Cirrhosis and Advanced Fibrosis in Hispanics in Texas: The Dominant Contribution of Central Obesity

Liver cirrhosis is a leading cause of death in Hispanics and Hispanics who live in South Texas have the highest incidence of liver cancer in the United States. We aimed at determining the prevalence and associated risk factors of cirrhosis in this population. Clinical and demographic variables were extracted for 2466 participants in the community-based Cameron County Hispanic Cohort in South Texas. Aspartate transaminase to Platelet Ratio Index (APRI) was used to predict cirrhosis in Cameron County Hispanic Cohort. The prevalence of cirrhosis using APRI≥2 was 0.94%, which is nearly 4-fold higher than the national prevalence. Using APRI≥1, the overall prevalence of cirrhosis/advanced fibrosis was 3.54%. In both analyses, highest prevalence was observed in males, specifically in the 25–34 age group. Risk factors independently associated with APRI≥2 and APRI≥1 included hepatitis C, diabetes and central obesity with a remarkable population attributable fraction of 52.5% and 65.3% from central obesity, respectively. Excess alcohol consumption was also independently associated with APRI≥2. The presence of patatin-like phospholipase domain-containing-3 gene variants was independently associated with APRI≥1 in participants >50 years old. Males with both central obesity and excess alcohol consumption presented with cirrhosis/advanced fibrosis at a young age. Alarmingly high prevalence of cirrhosis and advanced fibrosis was identified in Hispanics in South Texas, affecting young males in particular. Central obesity was identified as the major risk factor. Public health efforts are urgently needed to increase awareness and diagnosis of advanced liver fibrosis in Hispanics.