Monday, March 17, 2008

More Background Facts on Obesity.

Yesterday’s posting on obesity prompted the Disease Management Care Blog to take a stroll through the obesity information market. The following factoids made it into the DMCB posting check-out basket. Here you are, in the order in which I pulled them out of the bags when I got home:

Here’s a good book on how U.S became one of the fattest nations in the history of the planet. Check out the economics behind high fructose corn syrup, cheap palm oil, supersized value meals and the demise of school based physical education.

And speaking of economics, it really does cost more to eat healthy.

According to Business Week, the estimate of U.S. obesity prevalence can be thought of as thirds: one third are obese, one third are overweight and one third are normal. Among the obese there is a category with a BMI of 40 or greater known as the extreme obese. This group comprises approximately 5% of the U.S. population. The 2/3 of the U.S that are overweight or obese represents a huge potential market for weight loss drugs, and the race is on to be the first to market with one that is safe and effective.

This report used NHANES data to show that medical expenses in the United States for being overweight (BMI 25–29.9) and obese (BMI greater than 30) added up to $92.6 billion in 2002. Prescription drugs currently are only $200 million.

There is a difference between “central” (where fat storage predominates in the abdomen) and “peripheral” (where fat storage is subcutaneous, often resulting in what has been described as a “pear look”) adiposity. Abdominal obesity is associated with a higher rate of disease burden, which may make measuring waist circumference a better disease-preventing screening tool.

The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline.

Bariatric surgery is a growth industry thanks to a 400% increase from 1997 to 2002. And yet, as of 2002, only 0.6 percent of the 11.5 million eligible persons had bariatric surgery. Partly to promote excellence, partly to protect market share and partly to preempt the creation of managed care networks, bariatric surgery centers can achieve status as centers of excellence.

For the managed care perspective on bariatric surgery, see this link. It comes down to safety and cost, in that order.

Unable to find much good news here, the DMCB is thinking of starting an 501(c)(3) advocacy group, named along the lines of “We Battle Obesity – So Are You.” We pledge to only accept pharmaceutical company sponsorship if its weight loss drug has an acceptable mortality rate. We will accept Bariatric Center of Excellence sponsorship if they agree to remit a portion of their surgical fee to the hapless primary care physicians that are supposed to provide follow-up for all these patients.

The DMCB anticipates a zero budget for the foreseeable future. I'll use some of that budget to review the implications for the disease management industry in an upcoming post.

No comments: