How can we best tackle obesity before it takes a staggering personal and economic toll on society?

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How can we best tackle obesity before it takes a staggering personal and economic toll on society?

Despite many of the problems developing around the world, America continually ranks among the top – the most obese, the most chronic disease with some of the most costly healthcare. By the year 2030, nearly half of America’s elderly population will be obese. Clearly it is time to treat obesity as the national health crisis that it is. 

First Lady Michelle Obama has done great work teaching children the value of exercise and healthy nutritional choices, and ideally this effort will positively impact generations to come in the way of prevention. But there is so much more that needs to be done. In Oklahoma City, for example, city officials decided they would no longer accept being labeled, as one magazine did, as “the fattest city in America,” and launched a community-wide effort to successfully lose over a million cumulative pounds and become one of the fittest cities in America. Surely subsequent studies will show that Oklahoma City’s diabetes and heart disease rates, and its healthcare costs, declined as well. It is efforts like this that can and should certainly be replicated. 

Further, public policy leadership with a willingness to embrace new ideas that work will be imperative. Two-thirds of Medicare beneficiaries have multiple chronic diseases – many obesity-related. Medicare, however, has established very narrow parameters in the therapies it will cover to help people achieve a healthier weight. There is coverage for bariatric surgery if certain thresholds are met.  There is also coverage for one year of intensive behavioral therapy, but only if the patient shows significant progress in the first six months of treatment. There is, however, no provision in the Medicare Part D prescription drug program for pharmacotherapy for obese individuals. Similarly, there is no Medicare coverage for a variety of lifestyle-focused programs that have proven to be successful in having people live and eat healthier. 

Soaring rates of obesity mean far too many people are living in preventable physical misery and facing shorter lifespans. It also means Medicare facing a solvency crisis sooner than it should. A moderate investment in obesity treatment and prevention now could have a tremendous effect in changing the course of Medicare beneficiaries’ lives and the fiscal health our nation. We can beat this crisis, a strong start being if policymakers would allow Medicare to deploy all of the tools necessary to do so.  

This is a huge gap that needs to be corrected. Addressing the obesity epidemic is no doubt an incredible challenge but by putting together a series of strategies aimed at fighting chronic diseases like obesity, better health at lower costs can be achieved.

Kenneth Thorpe, Ph.D.
Chairman, PFCD

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Kenneth Thorpe, Ph.D.
Chairman, PFCD

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Kenneth Thorpe, Ph.D., is Chairman of the Partnership to Fight Chronic Disease (PFCD) and a Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management in the Rollins School of Public Health at Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality. 

Dr. Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. In this capacity, he coordinated all financial estimates and program impacts of President Clinton’s health care reform proposals for the White House. He also directed the administration’s estimation efforts in dealing with Congressional health care reform proposals during the 103rd and 104th sessions of Congress.

As an academic, he has testified before several committees in the U.S. Senate and House on health care reform and insurance issues. In 1991, Dr. Thorpe was awarded the Young Investigator Award presented to the most promising health services researcher in the country under age 40 by the Association for Health Services Research. He also received the Hettleman Award for academic and scholarly research at the University of North Carolina and was provided an “Up and Comers” award by Modern Healthcare. 

Dr. Thorpe has authored and co-authored over 85 articles, book chapters and books and is a frequent national presenter on issues of health care financing, insurance and health care reform at health care conferences, television and the media. He has worked with several groups (including the American College of Physicians, American Hospital Association, National Coalition on Health Care, Blue Cross and Blue Shield Association, Service Employees International Union, and the United Hospital Fund) and policymakers (including Senators Wellstone, Corzine, Bingaman, Snowe, Clinton, Obama and Kennedy) to develop and evaluate alternative approaches for providing health insurance to the uninsured. He serves as a reviewer on several health care journals. 

Dr. Thorpe is a frequent commenter on health care issues in the print media and television. He has appeared on Nightline with Ted Koppel, NBC News with Tom Brokow, ABC World News Tonight with Peter Jennings, CNN, CNBC and Newshour with Jim Lehrer. Dr. Thorpe received his Ph.D. from the Rand Graduate School, an M.A. from Duke University and his B.A. from the University of Michigan.

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How can we best tackle obesity before it takes a staggering personal and economic toll on society?

Obesity is already taking a toll on our society, both on personal and economic levels. More than one-third (about 35.7%) of American adults are affected by obesity, a serious disease that is tied to more than 30 other health conditions, including heart disease and cancer. Many of these comorbid conditions require regular doctor’s visits, multiple medications for treatment, and hospitalizations, contributing approximately $190 billion per year to healthcare costs in the United States. This includes direct costs like preventive health care, diagnostic tests and treatment services, as well as indirect costs that affect employers, like absenteeism and lack of productivity.

The high costs related to obesity continue to increase. In a 2010 report, the Congressional Budget Office estimated that nearly 20 percent of the increase in U.S. health care spending from 1987 to 2007 was due to obesity. And, according to a Harvard University study, if the trend continues, obesity-related medical costs in the U.S. could increase by between $43 billion and $66 billion per year through 2030. This is an unsustainable upward trend in medical expenses related to a treatable, and sometimes preventable disease. Action is desperately needed to prevent a continued increase in spending on comorbid conditions by treating obesity first, as advocated in the new pharmacological guideline for obesity treatment.

Today, healthcare providers have very few tools for obesity treatment, particularly when compared with treatment options for other chronic diseases. Current efforts to prevent or reverse the obesity epidemic focus primarily on diet and exercise. However, weight loss and maintenance solely by altering lifestyle changes, while effective for some, are often difficult to accomplish for others. For a relatively limited number of individuals, FDA approved anti-obesity medications or bariatric surgical procedures are used with some success. 

The Obesity Society (TOS) urges continued research into developing new treatment options for obesity that are effective in producing meaningful and sustained weight loss for the majority. During the past two years we have seen progress toward improving novel treatment options for the disease with the addition of four FDA-approved anti-obesity drugs and a newly approved medical device. These efforts illustrate how additional choices can help healthcare providers treat the many individuals with obesity who have found little success with diet and exercise alone.

TOS calls for continued momentum by our community, public and private sector partners toward developing a full spectrum of obesity treatment tools. Further, the Society urges all healthcare practitioners to treat obesity seriously and start discussing the disease and its health effects with patients. Finally, we encourage policymakers to provide better access to these novel treatments for the disease by taking the first step to expand health insurance coverage through Medicare and state health insurance exchanges.

Nikhil V. Dhurandhar, PhD
President, The Obesity Society

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Nikhil V. Dhurandhar, PhD
President, The Obesity Society

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As a physician in India, I treated over 10,000 cases of obesity. I obtained an MS degree in Nutrition from North Dakota State University, and a PhD in Biochemistry from the University of Bombay. I received post-doctoral training at The University of Wisconsin Medical School. Subsequently, I held the “William Hardy Endowed Chair in Obesity Research” at Wayne State University(WSU), MI. Currently, I am a professor and the chief of the Infections and Obesity Laboratory at the Pennington Biomedical Research Center(PBRC), LA.

I was fortunate to be able to stimulate a new field of study termed “Infectobesity” –obesity of infectious origin. Over twenty years ago, when in India, we identified an adenovirus that caused obesity in animals and showed an association with human obesity. Contributions from collaborators and others have now developed this field considerably (Dhurandhar NV.Lancet Inf Disease. 2011, 11:963-69). Recently, we uncovered novel anti-diabetic properties of adenoviral proteins, which may be harnessed for therapeutic use. Furthermore, I have been involved in pharmacological and nutritional interventions for clinical weight management. My graduate students were selected as Young Investigator Award finalists for the annual meetings of TOS, and International Congress on Obesity in 2002, 2004 and 2006, and won the award in Sydney, Australia.

I have served on study sections for many organizations, including the NIH and the American Diabetes Association. I was elected to the faculty councils of WSU and PBRC. I am an associate editor of the International Journal of Obesity and on the editorial board of “Obesity” and “The Open Obesity Journal”.

Nominations committee (2010 and 2002), Scientific review committee (2011-2013), Council (2006-2009). Scientific program committee (2007-2010), Clinical committee (2007-2009; Chair-2008-2009), Chair, taskforce to create code of conduct (2008), Publications committee (1999-2003), Editor, NAASO newsletter (1999-2002). As a council member, I participated in key activities for TOS, including strategic planning and development of the mission statement. I made a concerted effort to initiate and develop the Clinical/Professional Practice track for the TOS annual meeting. It is gratifying to see the popularity of this track.

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How can we best tackle obesity before it takes a staggering personal and economic toll on society?

To reduce the already staggering impact of obesity, we must set aside simplistic biases about this complex, chronic disease and aggressively pursue innovative, evidence-based approaches for both treatment and prevention of obesity.

For decades, NIH and leading experts in obesity have recognized that obesity is a disease governed by complex physiology, genetic, environmental, and behavioral factors. Research tells us that obesity is chronic because our bodies have powerful hormonal and metabolic mechanisms to protect us from losing weight. These mechanisms worked great when starvation was the biggest threat to survival. Hunger becomes more acute, prodding us to hunt down some food. The calories you burn to keep your body working drops. That drop cancels out the extra calories you might burn with exercise.

The part of your brain -- the hypothalamus -- that regulates your weight, metabolism, and hunger is very patient and persistent. Through sheer force of will, people can beat it for a while and lose a lot of weight throughout a period of six months. But then the weight-loss almost invariably plateaus and most people gain some or all of the weight back. The deeper parts of your brain tend to win and "protect" you from starvation.

Finally, in 2013, the American Medical Association came to the same conclusion that NIH reached years ago -- that obesity is a complex, chronic disease. 

However, pervasive bias gets in the way of treating obesity as we would any other disease. Research has shown that this bias leads to discrimination in education, healthcare, employment, and social interactions. Public policies to address obesity have historically placed an implicitly low value on the unmet needs of people with obesity. Resources were instead disproportionately directed into prevention efforts. Until recently, options and resources for clinical care of people with obesity have been limited. Regulatory authorities set unreasonably high bars for innovative treatments that stifled innovation for almost a decade.  

More recently we have seen some progress. Innovative research has led to ever-improving surgical treatment options for people with severe obesity. In the last three years, four new drug treatments for obesity have been approved by the FDA. For the first time in more than a decade, a new medical device for obesity treatment was also approved. Research programs for new obesity treatments are gaining momentum. 

Access to evidence-based treatment options in health plans is slowly, but surely improving. We see signs of recognition that weight bias, expressed as fat shaming, is reprehensible. 

As encouraging as this progress is, it is only a start. The most effective treatment option for obesity, surgery, is unacceptable to most people with obesity for whom it would be medically indicated. And the efficacy of existing behavioral and drug treatments for obesity, while helpful, is far from perfect. In short, we have no cures for obesity.  

To make progress, we need innovative research to deliver both treatment and prevention tools that will change the course of the disease and the epidemic. We need to set aside bias and the destructive effects of shame and blame that interfere with progress.  

Early progress toward more evidence-based options for obesity treatment options are indeed encouraging. We still have a long way to go.

Ted Kyle, RPh, MBA
Chairman of the Board, Obesity Action Coalition

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Ted Kyle, RPh, MBA
Chairman of the Board, Obesity Action Coalition

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Ted is a pharmacist who chairs the Board of Directors of the Obesity Action Coalition.

In his professional work, Ted collaborates with leading health and obesity experts for sound policy and innovation to address the obesity epidemic in North America. Ted is also an accomplished healthcare marketing and innovation professional.

In 2009, Ted founded ConscienHealth to help experts and organizations work for evidence-based approaches to health and obesity. Ted devotes much of his work to nonprofit advocacy, chairing The Obesity Society's Advocacy Committee for the last five years, serving on the Steering Committee for the STOP Obesity Alliance, and serving on the Board of Directors for the Obesity Action Coalition. Ted was elected to Chair the OAC, beginning in January, 2014. At their respective annual meetings in 2012, both OAC and TOS presented Ted with their top awards for public service and advocacy.

Ted completed a 26-year career with GlaxoSmithKline in 2008. Ted holds two degrees from the University of North Carolina at Chapel Hill: a BS in Pharmacy and an MBA.

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How can we best tackle obesity before it takes a staggering personal and economic toll on society?

The obesity rates in America have risen steadily over the past 30 years. The time to tackle the problem of obesity before it takes a staggering personal and economic toll on society has already passed. Obesity currently takes an enormous personal and economic toll on our society. Research from Scott Kahan for The Fiscal Times indicates that obesity in America costs over 30 billion dollars per year. With over 30 percent of the adult population being obese, the economic, medical, and emotional well-being of individuals and society is already negatively impacted.

The obesity problem must be addressed from the ground up rather than from the government down. Government may be able to legislate soda sizes, school lunch nutrition, and provide medical support for individuals who struggle with obesity, but until the crisis is addressed from the individual level up, little progress will be made. Personal choices cannot be legislated.

Tackling the obesity problem on an individual level has two components – education and access. There is a basic lack of knowledge concerning the role nutrition plays in weight for the average individual. Many individuals do not have a clear understanding of their caloric and nutritional needs and make the false assumption they are overweight due to genes, bad luck, or poverty.  Easy access to healthy foods is limited in certain parts of the country and people living in lower income areas often have more fast food restaurants in close proximity than grocery stores.

Education programs designed to teach adults, teens, and children the fundamentals of nutrition can engage the population in a discussion of what proper nutrition is and how food choices impact individual health.  This should be done without legislation but instead with the intent to teach children, teens, and adults how to eat better, why exercise is important, and what function both have on obesity.

Access to healthy foods is a difficult problem to address. Community gardens, farmer’s markets, and incentives for grocery stores to move into underserved areas can all be part of the solution.

Like many public health problems, the obesity crisis is not easily solved. Education, access, and an awareness of the severity of the problem will all help move Americans past this obesity crisis and positively affect the children of the future.  

Diane Carbonell
Weight Loss Expert, Health Advocate

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Diane Carbonell
Weight Loss Expert, Health Advocate

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Diane Carbonell lost 150 pounds through healthy eating and realistic exercise, and has maintained the weight loss for over 16 years. Author of the popular weight loss blog, Fit to the Finish, Diane is also the author of the book 150 Pounds Gone Forever. Diane has appeared on the Dr. Oz Show, the 700 Club, and been featured in Shape, Good Housekeeping, and Woman’s World magazines. Carbonell speaks nationally on weight loss and healthy family living, is the weight loss expert for Answers.com and is a frequent guest on radio talk shows. 

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