The Science of Obesity Management: An Endocrine Society Scientific Statement

The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who suffer from the disease. Obesity is associated with and contributes to a shortened life span, type 2 diabetes mellitus, cardiovascular disease, some cancers, kidney disease, obstructive sleep apnea, gout, osteoarthritis, and hepatobiliary disease, among others. Weight loss reduces all of these diseases in a dose-related manner—the more weight lost, the better the outcome. The phenotype of “medically healthy obesity” appears to be a transient state that progresses over time to an unhealthy phenotype, especially in children and adolescents. Weight loss is best achieved by reducing energy intake and increasing energy expenditure. Programs that are effective for weight loss include peer-reviewed and approved lifestyle modification programs, diets, commercial weight-loss programs, exercise programs, medications, and surgery. Over-the-counter herbal preparations that some patients use to treat obesity have limited, if any, data documenting their efficacy or safety, and there are few regulatory requirements. Weight regain is expected in all patients, especially when treatment is discontinued. When making treatment decisions, clinicians should consider body fat distribution and individual health risks in addition to body mass index.

To read the source of this article, click here.

March 7, 2018 Comments are off OCAN

OCAN on the Hill: Advocating for the Treat and Reduce Obesity Act

On Tuesday, February 27, various OCAN leaders joined more than 80 individuals from 24 different states in attending the second annual OCAN Advocacy Day on Capitol Hill in Washington, DC to advocate for the passage of the Treat and Reduce Obesity Act (TROA).

Once again, advocates urged legislators to support and cosponsor this key obesity care legislation which will provide Medicare beneficiaries and their healthcare providers with meaningful tools to treat obesity by:

  • Improving access to weight management counseling;
  • And allowing for coverage of FDA-approved therapeutics for chronic weight management

This year, OCAN leaders and other advocates visited 102 congressional offices and legislators who had never cosponsored the Treat and Reduce Obesity Act in the past. By the end of the day, a number of House members had indicated that they would be signing onto the legislation! The success of the OCAN Advocacy day is a true testament to the level of support gathered for such key obesity legislation, and even more so of the need for expanded access to healthcare that TROA would provide.

The day ended with a reception hosted by the Academy of Nutrition and Dietetics Political Action Committee (AND PAC) and the ASMBS Political Action Committee (ObesityPAC) to honor Representative Eric Paulsen (R-MN) – one of the House sponsors of TROA and the National Obesity Care Week Congressional Resolution.

To continue supporting TROA alongside OCAN leaders, contact your Senators and your House of Representatives member and urge them to support this key legislation by CLICKING HERE.

The Impact of Medicare Coverage for Anti-Obesity Interventions

Obesity is acknowledged as a critical public health concern in the US. The economic burden of the disease is not insignificant. Estimates vary, but a recent study suggested that in the US, the cost of obesity, and obesity-related treatments, was approximately $427.8 billion in 2014, an amount that has undoubtedly escalated in the years that followed owing to the increasing numbers of individuals with obesity. Using a validated and published microsimulation model, we predicted the budget impact to Medicare if the coverage utilization of anti-obesity interventions becomes higher among the elderly.

Over the next 10 years, Medicare is expected to save $19 billion after a modest coverage utilization, and $21 billion after a more aggressive coverage utilization, with the majority of the savings coming from reduction in ambulatory care (Part B) and prescription drug (Part D) expenditures. Even after an aggressive (67.4%) coverage utilization, the evidence shows ≤8% of all Medicare beneficiaries to receive some form of anti-obesity treatment.

Additional Findings

  • On average, lifestyle intervention helps elderly who are eligible lose 7.5% of excessive weight per year, and anti-obesity drug combined with lifestyle intervention can help eligible patients lose about 9.7%. Participants regain 1/3 of initial lost weight within 5 years after discontinuation
  • Each treated beneficiary is expected to incur direct costs to Medicare of ~$1,700 from covered anti-obesity treatment. Those costs will be offset by improvement in their overall health condition, leading to lower expenditures in ER, ambulatory care, inpatient stays, and Rx, resulting in net savings between $6,700 – $7,100 over 10 years per person
  • Across the entire Medicare population suggest medical expense would increase about $120 per beneficiary due to higher coverage utilization. The reduction in the cost of treating obesity complications would be more than enough to offset the increased expense, leading to a net savings of between $300 – $330 per beneficiary over 10 years

Our simulation suggests there are likely to be sizable long-term Medicare budget savings due to higher utilization of anti-obesity interventions (lifestyle interventions and/or anti-obesity medications). Download the whitepaper along with a description of the modeling approach and analysis design.

Click here to read the full article

August 28, 2017 Comments are off OCAN

OCAN to Join Others on Capitol Hill

On September 26 and 27, leaders from the Obesity Care Advocacy Network (OCAN) will join with over 400 employees of Novo Nordisk, Inc, for a two-day advocacy blitz of Capitol Hill to urge Congress to pass S. 830/H.R. 1953- the Treat and Reduce Obesity Act (TROA). The legislation, which has the bipartisan support of over 100 House and Senate co-sponsors, aims to effectively treat and reduce obesity in older Americans by enhancing Medicare beneficiaries’ access to healthcare providers that are best suited to provide intensive behavioral therapy (IBT) and by allowing Medicare Part D to cover FDA-approved obesity drugs.

The upcoming September advocacy days will build on more than 250 OCAN congressional visits this year to grow support for TROA, which continues to be championed by Senators Bill Cassidy (R-LA) and Tom Carper (D-DE) and Representatives Erik Paulsen (R-MN) and Ron Kind (D-WI). This time around, advocates will be armed with a new analysis that highlights how passage of TROA could save the Medicare program between $19-21 billion during the next 10 years.

March 2, 2017 Comments are off OCAN

Economics of Obesity: Implications for Productivity and Competitiveness

OCAN Blankets Capitol Hill – Meeting with over 150 Congressional Offices to support TROA and NOCW

On February 27, 2017, the obesity community joined together for the first Obesity Care Advocacy Network (OCAN) Advocacy Day of 2017 — with 120 attendees visiting more than 150 congressional offices. During their visits, OCAN members educated legislators and congressional staff about both the Treat and Reduce Obesity Act (TROA) and a congressional resolution that would designate the week of October 29 – November 4, 2017 as National Obesity Care Week (NOCW).

Sandwiched in between morning and afternoon Hill visits, attendees paused to join legislative staff for a special congressional lunch briefing sponsored by OCAN and Novo Nordisk, inc. regarding the “Economics of Obesity and its Implications for Productivity and Competitiveness.” The briefing, which featured economists, patient advocates and the former Mayor of Nashville, Tennessee, highlighted how obesity and excess weight is an expanding health problem for more than 60 percent of Americans, and how a new study by Hugh Waters and Ross DeVol finds that it’s a tremendous drain on the U.S. economy as well. The authors of the study discussed how the total cost to treat health conditions related to obesity—ranging from diabetes to Alzheimer’s—plus obesity’s drag on attendance and productivity at work exceeds $1.4 trillion annually.

The day ended with a reception hosted by the Academy of Nutrition and Dietetics Political Action Committee (AND PAC), which featured Senator Tom Carper (D-DE) – one of the Senate sponsors of the Treat and Reduce Obesity Act and the Senate National Obesity Care Week resolution. Over 50 OCAN members attended the AND PAC sponsored reception, including representatives from the American Society for Metabolic and Bariatric Surgery, The Obesity Society, the Obesity Medicine Association and the Obesity Action Coalition.

Weight Shaming Falls as Medical View of Obesity Grows

New research to be presented at ObesityWeek 2016 indicates that weight shaming may be easing a bit. At the same time, the public increasingly understands that obesity is a medical condition. Between 2013 and 2016, public perception of obesity as a “personal problem of bad choices” has dropped from 44% to 34%. On top of that, public agreement that people with obesity need medical help increased significantly over the last year.

trends-in-agreement-with-four-obesity-narrativesThe research included data from more than 100,000 interviews with Americans since 2013. Bias against people with obesity is a daunting problem that discourages people from seeking medical care and can make obesity harder to overcome. In recent years, concerns about “fat shaming” have captured public attention and even sparked controversy in the U.S. campaign for president. Rebecca Puhl, Deputy Director of the Rudd Center for Food Policy and Obesity and Professor at the University of Connecticut, was senior author of the study. She commented on the importance of the research, saying:

We see encouraging signs here that the public may begin to reject some of the bias directed at people with obesity. Weight bias remains a significant source of harm to people living with obesity. It makes prevention and treatment of obesity much harder.

The Obesity Action Coalition (OAC) sponsored the research. President and CEO Joe Nadglowski commented:

Putting an end to fat shaming and bias against people with obesity is one of our most important goals. Shame and blame only makes obesity worse. So these numbers tell us that we’re making progress, but we still have a long way to go.

This research was selected by the Obesity Society as one of the top-scoring studies at the ObesityWeek meeting and singled out for a special presentation on Thursday evening. Lead author Ted Kyle pointed to the growing agreement that people with obesity need medical help for their condition. He said:

For years the public and even healthcare professionals have looked at obesity as a personal failure and not one that should require help from medical professionals. We now see that the 2013 decision by the American Medical Association to classify obesity as a chronic disease was an important milestone. And this year, for the first time, more Americans agree than disagree that obesity is a disease that requires medical help.

This trend is gradual. It’s uneven. But it’s progress.

Click here for a pdf of the poster. If you’re attending ObesityWeek in New Orleans, be sure to come for the Poster Education Theater on Thursday at 7 pm, where co-investigator Diana Thomas will present the study.

To view the original source of this blog, please click here.

Health Plans Often Stand in the Way of Obesity Care

New research from two separate studies presented at ObesityWeek in New Orleans demonstrates that health plans often stand in the way of obesity care. In one study, researchers from Harvard, ConscienHealth, and the Obesity Action Coalition found that most Americans report they don’t have health insurance that will pay for obesity care recommended in evidence-based guidelines. These include dietary counseling, medical obesity treatment, and bariatric surgery.

Even for people with employers that are targeting obesity in their wellness programs, more often than not, people do not believe that their health insurance will even cover dietary counseling by a registered dietitian. Reported coverage for medical obesity treatment (43%), obesity medicines (37%), and bariatric surgery is even lower. Ted Kyle presented the results on Thursday.

Ruchi Doshi presented research from the Bloomberg School of Public Health at Johns Hopkins. She reported that most health professionals (57%) believe that better insurance coverage for weight management services is important for providing better obesity care in clinical practice. Scott Kahan, director of the National Center for Weight and Wellness in Washington, DC, and a spokesman for the Obesity Society commented:

While self-management strategies, such as following a commercial diet or increasing exercise, can help in some individuals, most people with obesity, especially those with severe obesity, can benefit from a comprehensive approach that includes healthcare professional support.

Joe Nadglowski, President and CEO of the Obesity Action Coalition, added:

Our members report heartbreaking struggles to obtain insurance coverage for services like bariatric surgeries and obesity medicines that are necessary to reduce and prevent the obesity from ravaging their health. Sometimes they are outright denied coverage. Sometimes they are presented with absurd hurdles that have the same effect.

Harvard Obesity Medicine Physician Fatima Cody Stanford participated in the coverage gap research and commented on its implications:

Without coverage, many people must go without good medical care for obesity. The irony is that untreated obesity leads to a host of chronic diseases – like diabetes and heart disease – that wind up costing health plans even more. The current situation makes little sense, financially or medically.

Click here for the abstract of the study presented by Kyle and here for the study by Doshi et al. Click here for Kyle’s slides.

To view the original source of this blog, please click here.

October 5, 2016 Comments are off OCAN

AACE Announces the Launch of the Obesity Resource Center

The AACE Obesity Resource Center is a compendium of educational tools to educate AACE members and other health care professionals about the rapidly evolving landscape of obesity science and pharmacotherapy and complications-centric strategies that will result in improved long-term maintenance of weight loss in patients with obesity. The content is divided into three sections, each containing detailed, downloadable slide decks:

  • What is the disease of obesity?
  • Why do we treat obesity?
  • How do we treat obesity?

The Obesity Resource Center joins the successful, highly accessed Diabetes Resource Center, originally launched in 2013. This site is continually updated with new therapy information, downloadable slide decks, and current news items.

New Research Shows Keeping the Weight off is a Lot More than Willpower

Both moderate and dramatic weight loss lower metabolic rate; Less weight loss is still beneficial to health

In a special mini-series in the journal, leading obesity experts weigh in on the two papers through two additional commentaries and an editorial, all of which explain the phenomenon of metabolic adaptation, or the process where weight loss is accompanied by a decline in energy (caloric) expenditure as weight is lost. These studies were conducted on different populations, but reached the same conclusion: weight regain results from complex biological forces. The common accusation that individuals who don’t keep the weight off just lack willpower is incorrect.

“Obesity is a serious disease that cannot be ‘cured’ with weight loss,” says Donna Ryan, MD, FTOS, Associate Editor in Chief of Obesity and spokesperson for The Obesity Society. “Research is showing that once people lose weight and their metabolism slows, they experience an increase in appetite and a decrease in energy expenditure. These studies demonstrate that keeping the weight off long term requires constant vigilance and lifestyle changes to combat the biologic factors that are fighting to regain the weight.”

In the second paper released today, researchers Michael Rosenbaum, MD, and Rudolph L. Leibel, MD, examined 17 individuals with obesity first at their usual weight, again during maintenance of a 10% reduced weight, and a final time during maintenance of a 20% reduced weight. Their goal was to determine whether the reduction in energy expenditure was directly proportional to the amount of weight lost, if it was proportional up to a certain point, or if it was increasingly – or even exponentially – proportional. They found that all three models were effective.

While these authors found that energy expenditure is explained by a combination of the three models, Fothergill et al’s research on The Biggest Loser contestants seems to fall in line with the proportional model, where the more weight is lost the more the energy expenditure will decrease.

“This study reinforces the complexities of obesity, illustrating that dramatic weight loss, such as that experienced by contestants from The Biggest Loser, may not be the best approach for keeping weight off long term,” continued Dr. Ryan. “Efforts to maintain weight loss should focus on establishing sustainable diet and physical activity routines. While they may not lead to the dramatic weight loss experienced by contestant on The Biggest Loser, they can improve overall health and well-being.”

A position statement on the topic issued today by The Obesity Society and supported by the Academy of Nutrition and Dietetics, the Obesity Action Coalition and the Obesity Medicine Association reinforces the message:

“Many people are successful at losing weight and sustaining that loss at levels that may be associated with significant health benefits, even if they do not conform to a societal cosmetic ideal… Numerous studies have demonstrated that people with obesity can lose 5 – 10% of their initial weight and many of them successfully maintain this new, lower body weight. In addition, reductions of this size are associated with improvements in hypertension, sleep apnea, mood, physical mobility and the development of Type 2 Diabetes.”

Study author Dr. Rosenbaum notes that only approximately 15% of individuals are able to lose more than 10% of their weight non-surgically and sustain the weight loss. The position statement reinforces this idea that “approximately 70% of individuals are capable of weight-reduction of at least 5%, and more than half of these individuals are able to sustain weight loss of >5% at the 8-year mark.”

“These two studies show that keeping weight off can be extremely difficult and gets even harder as more weight is lost. It’s  important to remember that moderate weight loss can be beneficial for health and likely won’t come with such a forceful fight by the body to regain the weight,” says The Obesity Society President Penny Gordon-Larsen, PhD, FTOS who led the development of the position statement.A front-page article in The New York Times in May spotlighted a National Institutes of Health study in Obesity that studied 14 former contestants of the reality TV show The Biggest Loser who regained an average of 90 pounds – nearly 70% of what they had lost – six years after the show because of complex factors that affected their metabolism and caused their bodies to regain the weight. Researchers explained that a lowered resting metabolic rate (RMR) was partly to blame. RMR is the rate at which calories are burned at rest, which contributes to total daily energy expenditure (TDEE). This study, which was discussed widely on the Internet following The New York Times story, is now published in the August print edition of Obesity, the scientific journal of The Obesity Society, along with a second, new paper also examining metabolic rates after weight loss.

Obesity Score 3-2 for the Affordable Care Act

Speaking at the 13th Annual Bariatric Summit in Nashville yesterday, Ted Kyle tallied a score of three pluses and two minuses for people living with obesity under the Affordable Care Act (ACA), also known as Obamacare.

uninsured-rateOn the plus side of the ledger, Kyle identified three key gains:

  • More People Have Insurance.
    For the first time in recent history, more than 90% of Americans had health insurance in 2015. The uninsured rate is down by more than four points since the ACA took effect. Previously, many people with obesity were unable to obtain health insurance because of preexisting health conditions. Now, that’s illegal.
  • Better Access to Intensive Behavioral Care.Intensive behavioral care for obesity is well-accepted as an effective preventive health service. Under the ACA, preventive services are mandated for free coverage. Health plans of all kinds are scrambling to deliver various forms of the Diabetes Prevention Program.
  • A Ban on Discriminatory Health Plans. Health plans are barred from designing their benefits in a way that discriminates against people based on any health-related condition. So in theory, plans that keep people with obesity from getting good medical care are operating outside of the law.

Two glaring negatives offset the gains:

  • Essential Health Benefits. The definition of health benefits that every plan must offer under the law is set state by state. More often than not, obesity care is not on the list of mandated benefits. Only 23 states mandate coverage for some weight management services. Usually, that service is bariatric surgery.
  • Persistent Discrimination. Even though discriminatory health plan designs are illegal, discriminatory practices aren’t hard to find. Advocacy groups have begun the tedious work of challenging the bad actors.

The bottom line is that the ACA has brought some significant progress in access to care, but it’s been incremental. Access to evidence-based obesity care has long been extremely limited. Movement is in the right direction, but routine access to obesity care requires much more work.

Click here for Kyle’s presentation and here for more from Morgan Downey and Chris Still regarding the ACA’s impact For people with obesity.

Score 3, photograph © photophilde / flickr

This blog post originally appeared on ConscienHealth. To visit the ConscienHealth Web site, please click here.