Why should we care about Obesity or Weight ( and Chronic Diseases) – Part 2
Obesity is preventable !!
Obesity and being Overweight is seen as one of the top 3 risk factors and is associated with a host of NCDs (Diabetes, Hypertension, Heart Disease, Stroke and even Cancers etc.) But Obesity is a risk factor but not an input factor (like Tobacco or Alcohol).
The official line is that Obesity is caused by Diet, physical inactivity (and stress by some).
We will be talking about a lot about these in the next posts but first an overview of Obesity and Overweight.
3.1 Obesity is common, serious and costly (CDC – US)
- More than one-third of U.S. adults (35.7%) are obese
- Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death
- In 2008, medical costs associated with obesity were estimated at $147 billion; the medical costs for people who are obese were $1,429 higher than those of normal weight
3.2 Worldwide (WHO)
- Worldwide obesity has more than doubled since 1980.
- In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese.
- 65% of the world’s population live in countries where overweight and obesity kills more people than underweight.
- More than 40 million children under the age of five were overweight in 2010.
3.3 Definitions – Overweight and obesity?
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health.
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults. It is defined as a person’s weight in kilograms divided by the square of his height in meters (kg/m2).
The WHO definition is:
- a BMI greater than or equal to 25 is overweight
- a BMI greater than or equal to 30 is obesity
BMI provides the most useful population-level measure of overweight and obesity as it is the same for both sexes and for all ages of adults. However, it should be considered a rough guide (crude measure – my words) because it may not correspond to the same degree of fatness in different individuals.
So let us look at a few figures – first prevalence and then some trends
The following charts show the Relative Risk of mortality by BMI (for Men and Women)
Relative Risk (RR) the relative odds of a person (who has the incidence) dying compared to a normal or control adult. If RR is 2 it means the Relative odds of a person dying are 2:1 or 200% of normal or 100% more than normal.
- In developed countries approximately 2 in 3 adults will be either Overweight or Obese
- In developed countries 1 in 3 children are going to be Overweight or Obese
- Both Obesity and Overweight are on an upward trend both in adults and children
- The Relative Risk graphs are for Caucasians. For Asians, my personal feeling is that the graph needs to be shifted to the LEFT by 2 or 3 units because research indicates that the incidence of NCDs occur in Asians at a smaller BMI compared to Caucasians (so a 25 BMI in Whites is comparable to a 22 BMI in Asians)
- Though Obesity and Overweight increase the risk, being Underweight also increases the odds. This has anecdotally been confirmed by a few of my doctor friends who reckon between an underweight and an overweight person, the underweight person is more at risk (relatively) in surgical procedures etc.
4 Costs related to NCDs
I am taking some liberty with the word costs here and the term will be used to cover a number of aspects – economic and social
4.1 Individual Costs
- Chronic diseases introduce restrictions to some extent on mobility and flexibility of the individual (some if not all) who is suffering from them. This meant these people cannot undertake leisure pursuits (Holiday travel, Cinema/Theatre, Visiting friends/family etc.
- They may also have to give up certain job opportunities because of these restrictions. Estimates indicate that some of the individuals may have to forego anywhere between 25 to 50% of their earnings due to Chronic Diseases
- Some NCDs would be associated with some degree of pain and suffering
- NCDs will make it harder for insurance to be obtained (medical and life) or make it more expensive. In countries where Universal healthcare is provided this may not be immediately a problem for the individual and the family but it will cost the society at large quite a bit
- There are costs associated with medical care
- There is an opportunity cost for the time spent in visiting physicians, labs etc.
- Perhaps the most understated of all is the lingering feeling of the “(negatively) perceived health” which may change the outlook on life and change some of the decisions taken or avoid risks (which otherwise may have been taken) – moving jobs, house, country, starting own firm etc.
4.2 Family or Care-Giver Costs
Not so well understood is the impact on family / friends or the caregiver
- The family member or the care giver may have to forego or significantly alter the jobs that they accept and undertake. This translates into potential lost earning (so in effect this may be a double loss of income)
- The mobility and flexibility of the family member or caregiver may be restricted
I quote the following extract from the abstract of a study undertaken in Netherlands (rather academic but I hope it drives home the point)
“A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. The most prevailing consequences, experienced by more than half of the partners, were related to personal life strain and intrinsic rewards. An impact on social relations and financial situation was reported by 20% of the partners. Partners of patients with cancer, musculoskeletal, or digestive disorders are more vulnerable for the consequences of the chronic disease. The impact on female partners is higher for all 4 impact factors. The findings make clear that living with a chronically ill person has an impact on the partner’s life that goes beyond the consequences of caregiving”
4.3 Social Costs
Perhaps the biggest cost of all is the loss of economic output and treatment costs to the society at large.
The following charts from a Milken Institute study show the impact (US)
These numbers are massive!
If we extrapolate across the entire global (given the global population is approx 20-25 times US population) but assuming an average of a fifth of US costs, we are talking about approximately USD 5 trillion.
Assuming an adult population of approx 250 million in the USA in 2015, the avoidable costs are approx USD 1300 per capita.
It has been written in the popular media that as at 2008, General Motors (the car maker in the US) is contributing the equivalent of approximately USD 1,500 for every car manufactured towards healthcare costs for existing employees and retirees.
We may be oblivious to the above numbers but in the end citizens and consumers have to pay for it in terms of higher taxes (to government) or higher prices (for goods) as the spiralling health-care costs will hit every country, every government, every society and every company.
We have a moral and ethical duty to avoid these where we can apart from an individual and family interest.
The incidence of diabetes is on the rise as well as the incidence of pre-diabetes. Though there is a lot of awareness now a days and testing done for diabetes, I believe it is critical to identify the people who are a in a pre-diabetic condition. There are some studies that show that damage to health and internal organs tends to be done many years before a person becomes diabetic.
I also believe strongly that metabolic disorders are one of the main causes for NCDs (including Hypertension, Obesity, Cancers, Heart Disease and Stroke).
Pre-diabetes is also loosely associated to Impaired Fasting Glucose, Impaired Glucose Tolerance, Insulin Resistance etc.
I will write more about this in a later post but want to give some stats around diabetes (from International Diabetes Federation) for now.
As can be seen below, China and India will lead the world (and already leading) in Diabetes
- One in 10 people globally will suffer from the silent killer, Diabetes and one in six will suffer from Diabetes + Pre-Diabetes
- Half of people with Diabetes are undiagnosed
- Number of people with Diabetes is increasing in every Country
We will talk about one last thing before I sign-off for now.
6. Morbidity and Mortality
The following will provide another perspective as to why we need to remain vigilant and healthy and do our bit to manage our health
The first picture shows the trend in life expectancy for some countries which has been on a consistent upward path for a while.
(I read an interesting quote somewhere that says the most significant contributors to increased life expectancy are increased sanitation, food hygiene, better homes, vaccination and emergency response care as opposed to medication and surgical procedures).
But what is not known commonly is the fact that a significant amount of people are spending the last few years with NCDs (and people are starting to acquire this at an younger age now). Thanks to advances in diagnostics, emergency medical care..
So the full human potential is not available in the later years. I wanted to show this graphically but cannot find one so put a loose one together.
What this graph is intended to portray is the fact that the last 10 to 20 years of a lot of people’s lives are being spent currently with reduced ability and perhaps dependent on medication (another interesting anectode is that in US people take anywhere between 6 and 12 pills a day for multiple Chronic Diseases on average in later years).
By living a healthy life we can aim to steepen the green curve so it starts falling at 70 or so and not 50.
I know it has been a rather long post and so thanks for staying with me (assuming you have come this far).
But let me end on a positive note. A lot of the NCDs are modifiable and avoidable and that is what we will discuss in the forthcoming posts.
Thanks and have a good day.
The next post will talk about trends in various social and dietary habits. Pls click here.