Obesity Prevention and Treatment

A Practical Guide

James M. Rippe, John P. Foreyt, James M. Rippe, John P. Foreyt

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000456622
• Edition: 1
• Topic: Medicina
• Subtopic: Nutrizione, dietetica e bariatria

The World Health Organization estimates that there are 2.1 billion individuals with obesity globally. Nearly three quarters of adults in the United States are overweight or obese. The average individual with obesity cuts ten years off their life expectancy, yet less than 40% of physicians routinely counsel individuals concerning the adverse health consequences of obesity. Obesity Prevention and Treatment: A Practical Guide equips healthcare practitioners to include effective weight management counselling in the daily practice of medicine.

Written by lifestyle medicine pioneer and cardiologist, Dr. James Rippe and obesity expert Dr. John Foreyt, this book provides evidence-based discussions of obesity and its metabolic consequences. A volume in the Lifestyle Medicine Series, it provides evidence-based information about the prevention and treatment of obesity through lifestyle measures, such as regular physical activity and sound nutrition, as well as the use of new medications or bariatric surgery available to assist in weight management.

• Provides a framework and practical strategies to assist practitioners in safe and effective treatments of obesity.
• Contains information explaining the relationship between obesity and increased risk of heart disease, diabetes, cancer, osteoarthritis, and other chronic conditions.
• Chapters begin with bulleted key points and conclude with a list of Clinical Applications.

Written for practitioners at all levels, this user-friendly, evidence-based book on obesity prevention and treatment will be valuable to practitioners in general medicine or subspecialty practices.

Section I

The Modern Management of Obesity

1 Preventing and Managing Obesity

The Scope of the Problem

James M. Rippe, MD

Rippe Lifestyle Institute

University of Massachusetts Medical School

DOI: 10.1201/9781003099116-2

CONTENTS

1. 1.1 Introduction
2. 1.2 The Burden of Overweight and Obesity in the United States
3. 1.3 Health Effects of Obesity
4. 1.4 Searching for Solutions
5. 1.5 Need for Healthcare Professional Involvement
6. 1.6 Summary/Conclusions
   1. 1.6.1 Clinical Applications
7. References

1.1 INTRODUCTION

Obesity is a pandemic which represents one of the most significant public health issues for the world in recent history. It is currently estimated that 2.1 billion people in the world are obese [1]. Furthermore, obesity significantly contributes to both worldwide morbidity and mortality [2]. In 2013, obesity was recognized by the American Medical Association as a disease. Furthermore, research supports that obesity increases the risk for many chronic diseases including cardiovascular disease (CVD), cancer, type 2 diabetes (T2DM), metabolic syndrome (MetS), chronic kidney disease, and many musculoskeletal conditions.

The prevalence of obesity in the United States has been increasing for almost 100 years [3]. Since the 1960s, the National Health and Nutrition Examination Survey (NHANES) has taken an active role in tracking obesity in the United States [4,5]. The prevalence of obesity remained fairly constant between 1960 and 1980. However, according to the NHANES data, in each interval from 1976 to 1980 and 1988 to 1994 the prevalence of adult obesity increased by eight percentage points. Recent data suggest that obesity plateaued with no significant increase in prevalence in the United States in the interval between 2003 and 2010, but increased in the intervals from 2005 to 2006 and 2013 to 2014 [6,7]. The current prevalence of obesity is more than double that of 1970 with 42.5% of the population considered obese and 73.6% considered overweight or obese in the United States

1.2 THE BURDEN OF OVERWEIGHT AND OBESITY IN THE UNITED STATES

Childhood obesity represents a relatively new chronic disease epidemic with significant medical and health implications. The prevalence of children with obesity has increased significantly since the 1980s, paralleling the increase in adults with obesity during this period [8]. The prevalence of obesity among 2–19 year olds in the United States is 18.5% and continues to rise across all age groups. Obesity disproportionately affects black, Hispanic, and other minority youths. Comorbid conditions such as T2DM are projected to increase dramatically as generations of children carry obesity into adulthood.

In addition to the enormous health toll attributable to obesity, the obesity epidemic is also driving enormous costs. It is estimated in the United States, for example, that obesity may cost as much as $147 billion each year [9]. Roughly one-half of this total is paid by the government (i.e. taxpayers), and the other half is paid by private insurers. Thus, taxes and employee premiums (paid by all employees, regardless of weight) finance much of the cost of treating obesity and its related conditions.

It is estimated that an individual with obesity costs a health plan 47% more in healthcare expenditures and an individual who is overweight costs the health plan 16% more annually than healthy weight individuals. For all of these reasons, multiple stakeholders including governments, employers, taxpayers, and employees all have significant motivation to slow down rising rates of obesity, if only for its financial impact.

It is clear that obesity is a complicated, multifactorial problem with numerous external and internal influences which impact obese individuals. There is no question that in the United States, and in most of the Western world, we live in an obesogenic environment (it has even been called a “toxic” environment) for weight gain. There are multiple factors that impact weight gain and obesity including family, culture, community, government, and world food policies. There is also clearly an influence from genetics since some individuals are more likely to gain weight than others and some ethnic groups (e.g. black and Hispanic women) are more affected than others [9,10].

The recognition that obesity is an urgent national imperative has been articulated by multiple evidence-based documents. Perhaps the most prominent of these are the Dietary Guidelines for Americans 2020–2025, which characterize obesity as the leading nutritional health problem in our country [11]. The Physical Activity Guidelines for Americans 2018 (PAGA 2018) comes to similar conclusions. The goal of limiting obesity to no more than 15% of the adult population was articulated in the Healthy People 2020 document [12] and again in the 2030 document [13]. In the 2020 document, this was clearly wishful thinking. The United States is moving away from this goal rather than toward it.

For all these reasons, it is no longer a viable option for healthcare professionals to stay on the sidelines, both as individual practitioners and community leaders, when it comes to the urgent problems of both adults and children with obesity. This is the underlying premise behind the current book.

1.3 HEALTH EFFECTS OF OBESITY

• Role of adipocytes: It used to be thought that adipocytes were primarily storage sites for excess fat. Research over the last two decades, however, has clarified that adipocytes are, in fact, highly complicated inflammatory, endocrine, and metabolic cells [14,15,16,17]. Essentially, adipose tissue thus serves as a complicated endocrine organ and a potent source of inflammatory molecules such as IL-6, Tumor Necrosis Factor alpha (TNFα), and many others [15]. The complex properties of adipocytes appear to underlie the strong relationship between obesity and a variety of chronic medical conditions such as coronary heart disease (CHD), T2DM, and MetS. The complex metabolic and inflammatory properties of adipocytes seem particularly prominent in those located in the abdominal region.
• Health effects in adults: The adverse health consequences of obesity are diverse and profound. As already indicated, obesity is strongly associated with T2DM (see Chapter 13), metabolic syndrome (see Chapter 14), CHD (see Chapter 12), and some cancers (see Chapter 15), as well as arthritis (see Chapter 16). This list of adverse health consequences of obesity is by no means exhaustive. A more complete listing is found in Table 1.1.

TABLE 1.1
Medical Conditions Associated with Obesity

Metabolic Conditions Type 2 diabetes Metabolic syndrome Glucose intolerance Cardiovascular disease CHD Stroke Heart failure Deep venous thrombosis CHD Risk Factors Dyslipidemia Hypertension Inflammation Hypercoagulability Pulmonary Disease Obstructive sleep apnea Hypoventilation syndrome Asthma Cancers Colorectal Esophageal Endometrial Breast (postmenopausal) Kidney Gastrointestinal Diseases Nonalcoholic fatty liver disease Gallstones cholecystitis Gastroesophageal reflux Other Conditions Gout Kidney stones Osteoarthritis Psychological disorders Fertil...