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Alhusban IM, Hayajneh AA, Rababa M, Tawalbeh R, Al-Nusour EA, Al-Mugheed K, Alsenany SA, Abdelaliem SM, Alsatari ES. The variations in health cost based on the traditional obesity parameters among patients with coronary artery diseases undergoing cardiac catheterization. BMC Health Serv Res 2024; 24:1071. [PMID: 39285375 PMCID: PMC11403883 DOI: 10.1186/s12913-024-11486-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/23/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND In the literature, obesity has been correlated with coronary artery diseases (CADs) and high health costs. This study aimed to investigate the relationships between obesity parameters and the health costs among patients with CADs undergoing cardiac catheterization. METHOD A secondary data analysis was done for an original study. The original study was conducted among 220 hospitalized patients undergoing cardiac catheterization from two main hospitals located in the Middle and Northern regions of Jordan. Bivariate Pearson's correlation and forward linear regression analysis were calculated in this study. RESULTS The average health cost for the participants was 1,344 JOD (1,895.63 USD). A significant positive moderate correlation (r = 0.4) was found between hip circumference (HC) and health cost. There were significant positive weak correlations between low-density lipoprotein (LDL), triglycerides, high-sensitivity C-reactive protein (HS-CRP), hemoglobin A1c (HbA1c), and depression, and the health cost (correlation coefficient 0.17, 0.3, 0.29, 0.22 and 0.17, respectively. HC, waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and body adiposity index (BAI) were significantly associated with health costs among male participants. In contrast, among females, none of the obesity parameters was significantly associated with health costs. The forward regression analysis illustrated that an increase of HC by 3.9 cm (β (0.292) * SD (13.4)) will increase the health cost by 1 JOD (0.71 USD). The same analysis revealed that HS-CRP increased by 0.4 mg/dl (β (0.258)*SD (1.43)), or triglycerides increased by 8.3 mg/dl (β (0.241)* SD (34.3)), or depression score increased by 0.32 score (β (0.137)* SD (2.3)), or total cholesterol increased by 4 mg/dl (β (0.163)* SD (24.7)), the health cost will increase by one JOD (0.71 USD). CONCLUSION Healthcare providers, including nurses, should significantly consider these factors to reduce the health costs for those at-risk patients by providing the appropriate healthcare on time.
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Affiliation(s)
- Islam M Alhusban
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Audai A Hayajneh
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan.
| | - Mohammad Rababa
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Raghad Tawalbeh
- Adult Health-Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Esraa A Al-Nusour
- Prince Al Hussein Bin Abdullah II Academy for Civil Protection AlBalqa Applied University, P.O.Box 206, Salt, 19117, Jordan
| | - Khalid Al-Mugheed
- Adult Health Nursing Department, College of Nursing, Riyadh Elm University, Riyadh, 12734, Saudi Arabia
| | - Samira Ahmed Alsenany
- Public Health Department, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sally Mohammed Abdelaliem
- Department of Nursing Management and Education, College of Nursing, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
| | - Eman S Alsatari
- School of Nursing, University of Louisville, Louisville, KY, 40202, USA
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Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Gorter TM, Hanssen H, Marx N, McDonagh TA, Mingrone G, Rosengren A, Prescott EB. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur J Prev Cardiol 2024:zwae279. [PMID: 39210708 DOI: 10.1093/eurjpc/zwae279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
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Affiliation(s)
- Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital-INSELSPITAL, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Emeline M Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium
- Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthias Blüher
- Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, RWTH Aachen University, Aachen, Germany
| | - Theresa A McDonagh
- Cardiology Department, King's College Hospital, London, UK
- King's College, London, UK
| | - Geltrude Mingrone
- Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli & Catholic University, Rome, Italy
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital/Ostra, Västra Götaland Region, Gothenburg, Sweden
| | - Eva B Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
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Koskinas KC, Van Craenenbroeck EM, Antoniades C, Blüher M, Gorter TM, Hanssen H, Marx N, McDonagh TA, Mingrone G, Rosengren A, Prescott EB. Obesity and cardiovascular disease: an ESC clinical consensus statement. Eur Heart J 2024:ehae508. [PMID: 39210706 DOI: 10.1093/eurheartj/ehae508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
The global prevalence of obesity has more than doubled over the past four decades, currently affecting more than a billion individuals. Beyond its recognition as a high-risk condition that is causally linked to many chronic illnesses, obesity has been declared a disease per se that results in impaired quality of life and reduced life expectancy. Notably, two-thirds of obesity-related excess mortality is attributable to cardiovascular disease. Despite the increasingly appreciated link between obesity and a broad range of cardiovascular disease manifestations including atherosclerotic disease, heart failure, thromboembolic disease, arrhythmias, and sudden cardiac death, obesity has been underrecognized and sub-optimally addressed compared with other modifiable cardiovascular risk factors. In the view of major repercussions of the obesity epidemic on public health, attention has focused on population-based and personalized approaches to prevent excess weight gain and maintain a healthy body weight from early childhood and throughout adult life, as well as on comprehensive weight loss interventions for persons with established obesity. This clinical consensus statement by the European Society of Cardiology discusses current evidence on the epidemiology and aetiology of obesity; the interplay between obesity, cardiovascular risk factors and cardiac conditions; the clinical management of patients with cardiac disease and obesity; and weight loss strategies including lifestyle changes, interventional procedures, and anti-obesity medications with particular focus on their impact on cardiometabolic risk and cardiac outcomes. The document aims to raise awareness on obesity as a major risk factor and provide guidance for implementing evidence-based practices for its prevention and optimal management within the context of primary and secondary cardiovascular disease prevention.
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Affiliation(s)
- Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital-INSELSPITAL, University of Bern, Freiburgstrasse 18, Bern 3010, Switzerland
| | - Emeline M Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Drie Eikenstraat 655, Antwerp 2650, Belgium
- Research group Cardiovascular Diseases, GENCOR, University of Antwerp, Antwerp, Belgium
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthias Blüher
- Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Henner Hanssen
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Nikolaus Marx
- Department of Internal Medicine I-Cardiology, RWTH Aachen University, Aachen, Germany
| | - Theresa A McDonagh
- Cardiology Department, King's College Hospital, London, UK
- King's College, London, UK
| | - Geltrude Mingrone
- Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, UK
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli & Catholic University, Rome, Italy
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital/Ostra, Västra Götaland Region, Gothenburg, Sweden
| | - Eva B Prescott
- Bispebjerg Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen 2400, Denmark
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Reitzinger S, Czypionka T. Low-, moderate-, and high-risk obesity in association with cost drivers, costs over the lifecycle, and life expectancy. BMC Public Health 2024; 24:2069. [PMID: 39085809 PMCID: PMC11293064 DOI: 10.1186/s12889-024-19574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal-annual perspective and an individual-life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy. METHODS We used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources. RESULTS About 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years. CONCLUSIONS We have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal-annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future.
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Affiliation(s)
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstaedter Strasse 39, Vienna, 1080, Austria.
- London School of Economics and Political Science, London, UK.
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Sun KA, Moon J. Exploration of the Determinants of Subjective Health and Depression Using Korean Longitudinal Study of Aging Data. Healthcare (Basel) 2024; 12:1424. [PMID: 39057567 PMCID: PMC11276224 DOI: 10.3390/healthcare12141424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Aging is an imperative issue in Korean society, and a healthy life is important for a better quality of life for older adults. Therefore, the purpose of this research was to investigate the determinants of subjective health and depression in middle-aged and elderly Korean individuals. This study used three attributes as the determinants of subjective health and depression, including the curve linear effect of medical expenses and eating-out expenses and the linear impact of regular exercise. We utilized the Korean Longitudinal Study of Aging (KLOSA) to determine the associations between five attributes: subjective health, depression, medical expenses, eating-out expenses, and regular exercise. Research panel data were employed as the data source. The study period was between 2018 and 2020. This research implemented various multiple linear panel regression econometric analysis instruments: ordinary least squares, random effects, and fixed effects. The mean age of survey participants was 72.10 years, and 35 percent of participants were female. The number of observations for data analysis was 7197. The results revealed that medical and eating-out expenses had a curved linear effect on subjective health and depression. Moreover, regular exercise positively affected subjective health and resulted in less depression. These findings may inform policy decisions that promote regular exercise and manage medical and eating-out expenses, thereby enhancing subjective health and mitigating depression.
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Affiliation(s)
- Kyung-A Sun
- Department of Tourism Management, Gachon University, Sungnam-si 13120, Republic of Korea;
| | - Joonho Moon
- Department of Tourism Administration, Kangwon National University, Chuncheon 24341, Republic of Korea
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Griauzde DH, Turner CD, Othman A, Oshman L, Gabison J, Arizaca-Dileo PK, Walford E, Henderson J, Beckius D, Lee JM, Carter EW, Dallas C, Herrera-Theut K, Richardson CR, Kullgren JT, Piatt G, Heisler M, Kraftson A. A Primary Care-Based Weight Navigation Program. JAMA Netw Open 2024; 7:e2412192. [PMID: 38771575 PMCID: PMC11109771 DOI: 10.1001/jamanetworkopen.2024.12192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/18/2024] [Indexed: 05/22/2024] Open
Abstract
Importance Evidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss. Objective To evaluate the association of a primary care-based weight navigation program (WNP) with WMT use and weight loss. Design, Setting, and Participants This cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors. Exposure WNP, in which American Board of Obesity Medicine-certified primary care physicians offered weight-focused visits and guided patients' selection of preference-sensitive WMTs. Main Outcomes and Measures Primary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months. Results Of 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P < .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P < .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P < .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing. Conclusions and Relevance The findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.
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Affiliation(s)
- Dina H. Griauzde
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Cassie D. Turner
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
| | - Amal Othman
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Lauren Oshman
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | - Jonathan Gabison
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Eric Walford
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - James Henderson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Deena Beckius
- University of Michigan Elizabeth Weiser Caswell Diabetes Institute, Ann Arbor
| | - Joyce M. Lee
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Eli W. Carter
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Chris Dallas
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- University of Michigan Elizabeth Weiser Caswell Diabetes Institute, Ann Arbor
| | - Kathyrn Herrera-Theut
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Caroline R. Richardson
- Department of Family Medicine, The Warren Alpert Medical School of Brown University and Care New England, Providence, Rhode Island
| | - Jeffrey T. Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Maheshwer B, Halkiadakis P, Ina JG, Bafus BT, Lee A. Demographics and Outcomes of Glenohumeral Dislocations in Individuals With Elevated Body Mass Index. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00013. [PMID: 38603558 PMCID: PMC11003501 DOI: 10.5435/jaaosglobal-d-24-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/20/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40. METHODS A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020. Dislocation patterns, associated injuries, treatment modalities, and associated complications were recorded. RESULTS A significant increase was noted in the number of patients with BMI greater than 40 presenting per year (r2 = -0.831, P < 0.01) over the past 20 years. A significant increase was noted in the average BMI per year in this population (r2 = 0.504, P = 0.028). Fifteen patients (19.5%) experienced at least one recurrent dislocation episode. Ten patients had a Bankart lesion that was associated with an elevated BMI (P = 0.04). Nine patients (11.7%) sustained an associated neurologic injury (no association with BMI). CONCLUSIONS Over time, there has been an increase in shoulder dislocations in morbidly obese individuals in the United States, alongside an overall increase in the average BMI of patients who present with shoulder dislocations.
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Affiliation(s)
- Bhargavi Maheshwer
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Penelope Halkiadakis
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Jason G. Ina
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Blaine T. Bafus
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
| | - Adrienne Lee
- From the University Hospitals Cleveland Medical Center (Dr. Maheshwer, and Dr. Ina); the Case Western Reserve University School of Medicine (Ms. Halkiadakis); the Veterans Affairs Medical Center (Dr. Bafus); and the MetroHealth Medical Center, Cleveland, OH (Dr. Bafus, and Dr. Lee)
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Atella V, Belotti F, Giaccherini M, Medea G, Nicolucci A, Sbraccia P, Mortari AP. Lifetime costs of overweight and obesity in Italy. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101366. [PMID: 38354596 DOI: 10.1016/j.ehb.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
We use longitudinal electronic clinical data on a large representative sample of the Italian population to estimate the lifetime profile costs of different BMI classes - normal weight, overweight, and obese (I, II, and III) - in a primary care setting. Our research reveals that obese patients generate the highest cost differential throughout their lives compared to normal weight patients. Moreover, we show that overweight individuals spend less than those with normal weight, primarily due to reduced expenditures beginning in early middle age. Our estimates could serve as a vital benchmark for policymakers looking to prioritize public interventions that address the obesity pandemic while considering the increasing obesity rates projected by the OECD until 2030.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy.
| | - Federico Belotti
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy
| | | | - Gerardo Medea
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - Paolo Sbraccia
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Piano Mortari
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; Department Programming, Ministry of Health, Rome, Italy
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Lu D, Yuan Z, Guo X, Zhu L, Zhang F, Li X, Wang W, Lin H, Luo J. Efficacy and safety of intragastric expandable oral capsules in adults with overweight or obesity: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2024; 26:1224-1233. [PMID: 38253466 DOI: 10.1111/dom.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
AIM This trial assessed the efficacy and safety of 2.24 g intragastric expandable capsules twice per day versus placebo for weight management in adults with overweight or obesity. METHODS This double-blind, placebo-controlled study included adults with a body mass index of at least 24 kg/m2 and no more than 40 kg/m2 . In total, 280 participants were recruited from six hospitals in China and were assigned in a 1:1 ratio to receive 2.24 g oral intragastric expandable capsules or placebo for 24 weeks. Coprimary endpoints were the percentage change in body weight from baseline and the rate of weight reduction of ≥5%, assessed using both the full analysis set and per protocol set. RESULTS At baseline, the mean body weight was 81.8 kg, and the mean body mass index was 29.4 kg/m2 . The mean body weight change at week 24 was -4.9% with intragastric expandable capsules versus -1.9% with placebo [estimated treatment difference (ETD) -3.0%, 95% confidence interval (CI) -4.1 to -1.9; p < .001] using the full analysis set and -6.1% versus -2.5% (ETD -3.6%, 95% CI -5.0 to -2.3; p < .001), respectively, using the per protocol set. The percentage of participants who had weight loss exceeding 5% was 45.0% in the intragastric expandable capsule group versus 19.7% in the placebo group (ETD 25.3%, 95% CI 14.7-35.9; p < .001) in the full analysis set and 55.9% versus 26.2% (ETD 29.6%, 95% CI 17.1-42.2; p < .001), respectively, in the per protocol set. Waist circumference significantly decreased at week 24 (intragastric expandable capsules vs. placebo: -5.6 ± 8.3 cm vs. -2.9 ± 4.8 cm; p = .003). The most common adverse events associated with the use of intragastric expandable capsules were gastrointestinal disorders (intragastric expandable capsule vs. placebo, 25.0% vs. 21.9%), and most were mild and transient. CONCLUSIONS In this 24-week trial including participants with overweight or obesity, 2.24 g of intragastric expandable capsules twice daily led to a clinically meaningful reduction in body weight compared with placebo.
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Affiliation(s)
- Difei Lu
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Zhenfang Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Liyong Zhu
- Department of Gastrointestinal Surgery, Xiangya Third Hospital of Central South University, Changsha, China
| | - Fan Zhang
- Department of Endocrinology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xuejun Li
- Department of Endocrinology, Xiamen University First Affiliation Hospital, Xiamen, China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing, China
| | - Huandong Lin
- Department of Endocrinology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Jingnan Luo
- Junion Therapeutics (Xiamen) Co. Ltd, Xiamen, China
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10
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Galekop MMJ, Del Bas JM, Calder PC, Uyl-De Groot CA, Redekop WK. A health technology assessment of personalized nutrition interventions using the EUnetHTA HTA Core Model. Int J Technol Assess Health Care 2024; 40:e15. [PMID: 38444327 DOI: 10.1017/s0266462324000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Poor nutrition links to chronic diseases, emphasizing the need for optimized diets. The EU-funded project PREVENTOMICS, introduced personalized nutrition to address this. This study aims to perform a health technology assessment (HTA) comparing personalized nutrition interventions developed through this project, with non-personalized nutrition interventions (control) for people with normal weight, overweight, or obesity. The goal is to support decisions about further development and implementation of personalized nutrition. METHODS The PREVENTOMICS interventions were evaluated using the European Network for HTA Core Model, which includes a methodological framework that encompasses different domains for value assessment. Information was gathered via [1] different statistical analyses and modeling studies, [2] questions asked of project partners and, [3] other (un)published materials. RESULTS Clinical trials of PREVENTOMICS interventions demonstrated different body mass index changes compared to control; differences ranged from -0.80 to 0.20 kg/m2. Long-term outcome predictions showed generally improved health outcomes for the interventions; some appeared cost-effective (e.g., interventions in UK). Ethical concerns around health inequality and the lack of specific legal regulations for personalized nutrition interventions were identified. Choice modeling studies indicated openness to personalized nutrition interventions; decisions were primarily affected by intervention's price. CONCLUSIONS PREVENTOMICS clinical trials have shown promising effectiveness with no major safety concerns, although uncertainties about effectiveness exist due to small samples (n=60-264) and short follow-ups (10-16 weeks). Larger, longer trials are needed for robust evidence before implementation could be considered. Among other considerations, developers should explore financing options and collaborate with policymakers to prevent exclusion of specific groups due to information shortages.
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Affiliation(s)
| | | | - Philip C Calder
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Carin A Uyl-De Groot
- Erasmus School of Health, Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - William Ken Redekop
- Erasmus School of Health, Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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11
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Hermeling L, Steinacker JM, Kobel S. Beyond correlates: the social gradient in childhood overweight. Arch Public Health 2024; 82:3. [PMID: 38195594 PMCID: PMC10775653 DOI: 10.1186/s13690-023-01232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Health (in)equity has a high priority on research and policy agendas. Even though it is known that inequalities in overweight prevalence accumulate with age and are already existent among children below the age of six, research on this topic is scarce. In this young age group, parents play an important role in preventing overweight and associated adverse consequences. This study examines the magnitude of parental misclassification of child weight status and its correlates, focussing on the factors that determine social status and equity. METHODS Preschool children's weight and height was measured objectively. Parents gave information on their socioeconomic background. Family education was dichotomised into tertiary and non-tertiary educational level, according to CASMIN. Binary logistic regression, adjusted for parental BMI, was applied to detect odds of childhood overweight. RESULTS Data on family educational level and anthropometrics were available from 643 children (4.5 ± 0.82 years, 52.7% male) and their parents of which 46.5% (n = 299) had a tertiary educational background. The groups (tertiary vs. non-tertiary educational level) differ significantly in overweight prevalence (3.7% vs. 11.9%, p ≤ 0.001). Odds of overweight were two times higher in children with non-tertiary educational background (OR: 2.123, CI: 1.010-4.461, p < 0.05), adjusted for parental BMI. CONCLUSION Children from families with low educational background have an elevated risk of overweight, already at a very young age. Education in general (not explicitly health education) seems to play a tremendous role in the prevention of overweight and obesity and should therefore be implied in policies enhancing health equity. TRIAL REGISTRATION DRKS-ID: DRKS00010089.
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Affiliation(s)
- Lina Hermeling
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany
| | - Susanne Kobel
- Division of Sports- and Rehabilitation Medicine, Centre of Medicine, Ulm University Hospital, Ulm, Germany.
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12
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Hull HR, Gajewski BJ, Sullivan DK, Carson SE. Growth and adiposity in newborns study (GAINS): The influence of prenatal DHA supplementation protocol. Contemp Clin Trials 2023; 132:107279. [PMID: 37406769 PMCID: PMC10852997 DOI: 10.1016/j.cct.2023.107279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/22/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Obesity and central fat mass (FM) accrual drive disease development and are related to greater morbidity and mortality. Excessive gestational weight gain (GWG) increases fetal fat accretion resulting in greater offspring FM across the lifespan. Studies associate greater maternal docosahexaenoic acid (DHA) levels with lower offspring FM and lower visceral adipose tissue during childhood, however, most U.S. pregnant women do not consume an adequate amount of DHA. We will determine if prenatal DHA supplementation is protective for body composition changes during infancy and toddlerhood in offspring exposed to excessive GWG. METHODS AND DESIGN Infants born to women who participated in the Assessment of DHA on Reducing Early Preterm Birth randomized controlled trial (ADORE; NCT02626299) will be invited to participate. Women were randomized to either a high 1000 mg or low 200 mg daily prenatal DHA supplement starting in the first trimester of pregnancy. Offspring body composition and adipose tissue distribution will be measured at 2 weeks, 6 months, 12 months, and 24 months using dual energy x-ray absorptiometry. Maternal GWG will be categorized as excessive or not excessive based on clinical guidelines. DISCUSSION Effective strategies to prevent obesity development are lacking. Exposures during the prenatal period are important in the establishment of the offspring phenotype. However, it is largely unknown which exposures can be successfully targeted to have a meaningful impact. This study will determine if prenatal DHA supplementation modifies the relationship between maternal weight gain and offspring FM and FM distribution at 24 months of age. ETHICS AND DISSEMINATION The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00140895). The results of the trial will be disseminated at conferences and in peer reviewed publications. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03310983.
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Affiliation(s)
- Holly R Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America.
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Susan E Carson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
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13
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Phillips E, Traina A, Smolarz BG. A Survey of Obesity Education and Training in United States Pharmacy Schools. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100109. [PMID: 37597919 DOI: 10.1016/j.ajpe.2023.100109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/24/2023] [Accepted: 03/17/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To assess how obesity is addressed in Doctor of Pharmacy (PharmD) schools and colleges, identify the extent to which core obesity competencies are covered in the curricula, and identify opportunities for expanding obesity management training. METHODS An online survey was conducted with PharmD program leaders in the United States. Respondents answered questions regarding obesity education in their pharmacy school curricula. Data were analyzed in aggregate, using descriptive statistics. RESULTS We collected responses from 75 of 150 (50%) PharmD programs. One-third (32%) of respondents thought their graduating students were very prepared to discuss obesity pharmacotherapy (anti-obesity medication) options with patients. A total of 45% reported obesity pharmacological treatment was covered to a great extent. Few respondents (19%) were very familiar with anti-obesity medications; 21% thought their students were similarly familiar. No programs covered weight stigma and discrimination to a great extent. Most respondents (88%) believed obesity education was fairly/very important to include in PharmD curricula, and 96% thought it was similarly appropriate to include. But 72% indicated that expanding obesity education was not a priority/low priority. Lack of room in the curricula was cited as the greatest barrier, with 60% of PharmD programs reporting this to be a large barrier. CONCLUSION Pharmacists, as medication experts, are key members of the care team. However, obesity management/pharmacotherapy is not emphasized in most pharmacy schools. Therefore, pharmacists are not well-prepared to provide counseling on medications for obesity. Leveraging guidance on core obesity competencies and available resources could help expand obesity education in pharmacy schools.
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Affiliation(s)
- Elizabeth Phillips
- St. John Fisher University, Wegmans School of Pharmacy, Rochester, NY, USA
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14
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Nguyen T, Wong E, Cope R. Evaluating the Efficacy and Pharmacoeconomics of Semaglutide and Tirzepatide in the Setting of Obesity. Am J Ther 2023; 30:e347-e352. [PMID: 37449929 DOI: 10.1097/mjt.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Obesity is a major and growing public health concern. The associated cost for obesity and its related comorbidities is approximately 30% of US health care expenditures annually. As additional pharmacotherapeutic options join the market to combat obesity, it is important to understand the financial impact it may have on overall health care costs. This article explores the efficacy and pharmacoeconomics of incretin mimetics, semaglutide and tirzepatide, in the setting of obesity. AREA OF UNCERTAINTY The cost of incretin mimetics (semaglutide and tirzepatide) and its overall impact on obesity management within the health care arena is being explored. The cost comparison of these medications is to be determined; however, it may represent an added cost to the total US health care expenditures. DATA SOURCES A PubMed and Google Scholar search was conducted using various search terms (eg, semaglutide, tirzepatide, pharmacoeconomics, and obesity). THERAPEUTIC ADVANCES Based on the data reviewed, both semaglutide and tirzepatide are effective medication options for obesity management. Obesity-related management expenditures exceed $173 billion for the US health care system annually. The cost needed to treat for 1% of weight loss with semaglutide and tirzepatide was reported as $1845 and $985, respectively. More than 40% of adults (60 years or older) experience obesity. If 1%, 5%, or 10% of this population is treated with semaglutide, the annual Medicare costs will translate to excess of $2.6 billion, $13.3 billion, and $26.8 billion, respectively. Tirzepatide is not yet approved in the United States for obesity and its financial impact remains to be seen. CONCLUSIONS Obesity is associated with burdensome health complications and costs. Semaglutide and tirzepatide are effective drug options for the management of obesity. The cost of these medications will no doubt present a challenge to the total health care expenditures, although the cost-benefit ratio may ultimately be favorable.
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Affiliation(s)
- Timothy Nguyen
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY
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15
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Abstract
The prevalence of preobesity and obesity is rising globally, multiple epidemiologic studies have identified preobesity and obesity as predisposing factors to a number of noncommunicable diseases including type 2 diabetes (T2DM), cardiovascular disease (CVD), and cancer. In this review, we discuss the epidemiology of obesity in both children and adults in different regions of the world. We also explore the impact of obesity as a disease not only on physical and mental health but also its economic impact.
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Affiliation(s)
- Nasreen Alfaris
- King Fahad Medical City, 3895 Susah, Alwurud, Riyadh 12252-7111, Saudi Arabia.
| | | | - Naji Alamuddin
- RCSI Bahrain, King Hamad University Hospital, Alsayh, Sheikh Eisa Bin Salman Bridge, 7J62+X92, Bahrain
| | - Georgia Rigas
- St George Private Hospital, 1 South Street, Kogarah, New South Wales 2217, Australia
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16
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Araujo MYC, da Guarda FRB, Nakamura PM, Dos Santos LL, Lynch BCT, Codogno JS. Comorbidities do not mitigate the effect of habitual physical activity on the reduction of healthcare costs among adults with cardiovascular diseases: A mediation analysis. Obes Res Clin Pract 2023:S1871-403X(23)00043-1. [PMID: 37202240 DOI: 10.1016/j.orcp.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Habitual Physical activity (HPA) is a non-pharmacological strategy to prevent and control chronic diseases, and it plays an important role in minimizing healthcare costs. OBJECTIVES This study aimed to investigate the relationship between HPA and healthcare costs from the perspective of the Brazilian National Healthcare System, and to establish the mediating role of comorbidities in this relationship among patients with cardiovascular diseases (CVD). DESIGN AND SETTING This longitudinal study was conducted in a medium-sized Brazilian city and included 278 participants assisted by the Brazilian National Healthcare System. METHODS Information on healthcare costs were obtained from medical records and included primary, secondary, and tertiary levels. Comorbidities (diabetes, dyslipidemia, and arterial hypertension) were self-reported, and obesity was confirmed with the percentage of body fat. HPA was measured using a questionnaire (Baecke questionnaire). Face-to-face interviews provided information on sex, age, and education level. Statistical analysis included linear regression and Structural Equation Modeling, significance was set at 5 % and the Stata software (version 16.0) was used to perform the analysis. RESULTS The sample included 278 adults with a mean age of 54.49 (8.32) years. For each score of HPA, there was a reduction in healthcare costs of US$ 83.99/24 months (95 % CI: - 159.15; - 8.84), and the sum of comorbidities did not mediate this relationship. CONCLUSION It is concluded that healthcare costs seem to be affected by HPA among patients with CVD, while this phenomenon seems not to be mediated by the sum of comorbidities.
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Affiliation(s)
- Monique Yndawe Castanho Araujo
- Post-graduation Program in Movement Sciences, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil; Group of Studies in Health, Physical Activity, and Economy (GESAFE), São Paulo State University-UNESP, Presidente Prudente, São Paulo, Brazil.
| | | | | | - Lionai Lima Dos Santos
- Group of Studies in Health, Physical Activity, and Economy (GESAFE), São Paulo State University-UNESP, Presidente Prudente, São Paulo, Brazil
| | - Bruna Camilo Turi Lynch
- Department of Physical Education and Exercise Science, Lander University, Greenwood, SC, USA
| | - Jamile Sanches Codogno
- Post-graduation Program in Movement Sciences, São Paulo State University - UNESP, Presidente Prudente, São Paulo, Brazil; Group of Studies in Health, Physical Activity, and Economy (GESAFE), São Paulo State University-UNESP, Presidente Prudente, São Paulo, Brazil
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Wei JH, Lee WJ, Luo JL, Huang HL, Wang SC, Chou RH, Huang PH, Lin SJ. Vertical Sleeve Gastrectomy Offers Protection against Disturbed Flow-Induced Atherosclerosis in High-Fat Diet-Fed Mice. Int J Mol Sci 2023; 24:ijms24065669. [PMID: 36982743 PMCID: PMC10051344 DOI: 10.3390/ijms24065669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Bariatric surgery reduces body weight, enhances metabolic and diabetic control, and improves outcomes on obesity-related comorbidities. However, the mechanisms mediating this protection against cardiovascular diseases remain unclear. We investigated the effect of sleeve gastrectomy (SG) on vascular protection in response to shear stress-induced atherosclerosis using an overweighted and carotid artery ligation mouse model. Eight-week-old male wild-type mice (C57BL/6J) were fed a high-fat diet (HFD) for two weeks to induce weight gain and dysmetabolism. SG was performed in HFD-fed mice. Two weeks after the SG procedure, partial carotid-artery ligation was performed to promote disturbed flow-induced atherosclerosis. Compared with the control mice, HFD-fed wild-type mice exhibited increased body weight, total cholesterol level, hemoglobin A1c, and enhanced insulin resistance; SG significantly reversed these adverse effects. As expected, HFD-fed mice exhibited greater neointimal hyperplasia and atherosclerotic plaques than the control group, and the SG procedure attenuated HFD-promoted ligation-induced neointimal hyperplasia and arterial elastin fragmentation. Besides, HFD promoted ligation-induced macrophage infiltration, matrix metalloproteinase-9 expression, upregulation of inflammatory cytokines, and increased vascular endothelial growth factor secretion. SG significantly reduced the above-mentioned effects. Moreover, HFD restriction partially reversed the intimal hyperplasia caused by carotid artery ligation; however, this protective effect was significantly lower than that observed in SG-operated mice. Our study demonstrated that HFD deteriorates shear stress-induced atherosclerosis and SG mitigates vascular remodeling, and this protective effect was not comparable in HFD restriction group. These findings provide a rationale for using bariatric surgery to counter atherosclerosis in morbid obesity.
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Affiliation(s)
- Jih-Hua Wei
- Division of Cardiology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan 330, Taiwan; (J.-H.W.)
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan 330, Taiwan
| | - Jing-Lin Luo
- Division of Cardiology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan 330, Taiwan; (J.-H.W.)
| | - Hsin-Lei Huang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Shen-Chih Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ruey-Hsing Chou
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Anesthesiology, Taipei Veteran General Hospital, Taipei 112, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 112, Taiwan
| | - Po-Hsun Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Anesthesiology, Taipei Veteran General Hospital, Taipei 112, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7374; Fax: +886-2-2875-7375
| | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Anesthesiology, Taipei Veteran General Hospital, Taipei 112, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei 112, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
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18
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The Fruit Intake-Adiposity Paradox: Findings from a Peruvian Cross-Sectional Study. Nutrients 2023; 15:nu15051183. [PMID: 36904181 PMCID: PMC10004770 DOI: 10.3390/nu15051183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019-2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (β = -0.15; 95% CI -0.24 to -0.07), while the WC was reduced by 0.40 cm (β = -0.40; 95% CI -0.52 to -0.27). A negative association between fruit salad intake and WC was found (β = -0.28; 95% CI -0.56 to -0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (β = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (β = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC.
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Kim N, Estrada J, Chow I, Ruseva A, Ramasamy A, Burudpakdee C, Blanchette CM. The Relative Value of Anti-Obesity Medications Compared to Similar Therapies. Clinicoecon Outcomes Res 2023; 15:51-62. [PMID: 36726966 PMCID: PMC9886521 DOI: 10.2147/ceor.s392276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Purpose To demonstrate a need for improved health insurance coverage for anti-obesity medications (AOMs) by comparing clinical and economic benefits of obesity treatments to covered medications for selected therapeutic areas. Methods Using a grey literature search, we identified and prioritized therapeutic areas and treatment analogues for comparison to obesity. A targeted literature review identified clinical and economic outcomes research across the therapeutic area analogues. Associated comorbidities, clinical evidence, indirect costs (ie, absenteeism and productivity loss), and direct medical costs were evaluated to determine the relative value of treating obesity. Results Four therapeutic areas/treatment analogues were selected for comparison to obesity: smoking cessation (varenicline), daytime sleepiness (modafinil), migraines (erenumab), and fibromyalgia (pregabalin). Obesity was associated with 17 comorbidities, more than migraine (9), smoking (8), daytime sleepiness (5), and fibromyalgia (2). Economic burden was greatest for obesity, followed by smoking, with yearly indirect and direct medical costs totaling $676 and $345 billion, respectively. AOMs resulted in cost savings of $2586 in direct medical costs per patient per year (PPPY), greater than that for varenicline at $930 PPPY, modafinil at $1045 PPPY, and erenumab at $468 PPPY; pregabalin utilization increased costs by $924 PPPY. AOMs were covered by 10-16% of United States health insurance plans, compared to 45-59% for the four comparators. Conclusion Compared to four therapeutic analogues, obesity represented the highest economic burden and was associated with more comorbidities. AOMs provide greater cost savings compared to selected analogues. However, AOMs have limited formulary coverage. Improved coverage of AOMs may increase access to these treatments and may help address the clinical and economic burden associated with obesity and its comorbidities.
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Affiliation(s)
- Nina Kim
- Novo Nordisk, Inc, Plainsboro, NJ, USA
| | | | | | - Aleksandrina Ruseva
- Novo Nordisk, Inc, Plainsboro, NJ, USA,Correspondence: Aleksandrina Ruseva, Novo Nordisk, Inc, 800 Scudders Mill Road, Plainsboro, NJ, 08536, USA, Tel +1 609-598-8146, Email
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20
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Watkins S, Toliver JC, Kim N, Whitmire S, Garvey WT. Economic outcomes of antiobesity medication use among adults in the United States: A retrospective cohort study. J Manag Care Spec Pharm 2022; 28:1066-1079. [DOI: 10.18553/jmcp.2022.22116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | | | - Nina Kim
- Novo Nordisk Inc, Plainsboro, NJ
| | | | - W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham
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21
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Alam MT, Veettil ST, Abdulmajeed J, Sait NS, Krishnan JI. A 4-year Retrospective Study on the Impact of the Dietary Program on Anthropometric and Metabolic Parameters among Overweight and Obese Subjects in Primary Health Care Centers in Qatar. Am J Lifestyle Med 2022. [DOI: 10.1177/15598276221120786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aim. Obesity is a worldwide epidemic and one of the risk factors for many diseases including heart disease, diabetes mellitus, kidney disease, and cancer. The aim of this study was to review the impact of the local dietary program on anthropometric and metabolic parameters among overweight and obese subjects attending Primary Health Care Centers in Qatar from 2016 to 2019. Methods. A 4-year retrospective cohort study. Results. Among 10451 patients, the overall success rate of BMI reduction was 10% while 22.22% of population had ≥5% reduction in BMI from baseline. The median time for weight reduction was 3.2 years, with women showing earlier significant weight loss than men. The patients with 3–5 number of visits had earlier significant weight reduction than those with ≤3 visits and >5 number of visits. Greater weight reduction was seen in those with chronic diseases and who had constant follow up visits in the dietetic clinic during the study period. Conclusion. Our results are encouraging, showing improvement in the management of adult obesity with medical nutrition therapy through involvement and guidance in the community dietetic clinics. The dietetic clinic services could be an operative strategy to prevent expensive diabetic and cardiovascular events, mainly in high-risk patients.
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Affiliation(s)
- Muhammad T. Alam
- Airport Health Center, Consultant Family Medicine, Primary Health Care Corporation, Doha, Qatar
| | | | - Jazeel Abdulmajeed
- Strategy Planning & HI - Business & Health Intelligence Department, Primary Health Care Corporation, Doha, Qatar
| | - Neelufur S. Sait
- Dietician,Department of Operations, Airport Health Center,Primary Health Care Corporation, Doha, Qatar
| | - Jeyaram I. Krishnan
- Biostatistician Second \x{2022} Strategy Planning & HI - Business & Health Intelligence Department, Primary Health Care Corporation, Doha, Qatar
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Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel) 2022; 12:1222. [PMID: 36013401 PMCID: PMC9410036 DOI: 10.3390/life12081222] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug-drug and drug-disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a "one-stop shop" for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA.
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Affiliation(s)
- Rizwana Sultana
- Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Fatoumatta Sissoho
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Vinod P. Kaushik
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
| | - Mukaila A. Raji
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, University of Texas Medical Branch (UTMB), Galveston, TX 77555, USA
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Lee SW, Han K, Kwon HS. Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study. Osteoporos Int 2022; 33:1755-1767. [PMID: 35438308 DOI: 10.1007/s00198-022-06398-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
UNLABELLED Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. INTRODUCTION In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. MATERIALS AND METHODS A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). RESULTS Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. CONCLUSIONS In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
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Affiliation(s)
- S-W Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, 06978, Seoul, Republic of Korea.
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, Yuksam-ro, Youngdeungpo-gu, 07345, Seoul, Republic of Korea.
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Wei J, Lei L, Shieh A, Gupta D, Ahern S, Shen N. Program for Reducing Obesity (PRO): An institutional review of an insurance-based weight loss program utilizing shared medical appointments. Obes Sci Pract 2022; 8:272-278. [PMID: 35664242 PMCID: PMC9159562 DOI: 10.1002/osp4.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/06/2022] Open
Abstract
Background Based on CDC estimates in the United States, the prevalence of obesity was 42.4% in 2017-2018, and the annual cost of obesity was $147 billion in 2008. Yet studies estimate that only 20-40% of adults with obesity received counseling from their primary care providers. Recent studies using shared medical appointments (SMA), where patients are seen by a multidisciplinary team, have shown promising results in obesity management. We developed an insurance-based weight loss program incorporating SMA, called the Program for Reducing Obesity (PRO), and report our findings here. Methods Enrollment began in January 2019 at the UCLA Health Thousand Oaks clinic. Patients age ≥18 years with BMI ≥30 kg/m2 were eligible by referral to PRO, a program consisting of individual visits and SMAs with an obesity medicine board certified endocrinologist and registered dietitian. Primary outcomes were change in weight after 3, 6, and 12 months. Secondary outcomes included proportion that achieved ≥5% weight loss, change in percent body fat, HbA1c, HDL, triglycerides, and blood pressure. Results 102 patients (mean age 59.7 years, 72% women, mean weight 103.6 kg, mean BMI 36.6 kg/m2) have been analyzed, with 91 patients completing at least 12 months of the program. Patients achieved significant weight loss: 3.0%, 5.0%, and 7.8% of their baseline weight after 3, 6, and 12 months respectively. 52% of patients lost ≥5% of their baseline weight after 12 months. Patients had significant reductions in body fat: 2.1%, 7.4%, and 6.7% of their baseline (all p ≤ 0.01) after 3, 6, and 12 months respectively. Improvements were also seen in HbA1c (p ≤ 0.01), triglycerides (p ≤ 0.04), and systolic blood pressure (p ≤ 0.07) after 12 months although not all results achieved statistical significance. Conclusion Our institutional review of PRO, an insurance-based obesity program utilizing SMA, demonstrates a successful approach to promoting weight loss in a community-based setting.
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Affiliation(s)
- Jeffrey Wei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Lei Lei
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Albert Shieh
- Division of GeriatricsDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Deepashree Gupta
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Susan Ahern
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Na Shen
- Department of MedicineDivision of EndocrinologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Changes in healthcare spending attributable to obesity and overweight: payer- and service-specific estimates. BMC Public Health 2022; 22:962. [PMID: 35562724 PMCID: PMC9101934 DOI: 10.1186/s12889-022-13176-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background National efforts to control US healthcare spending are potentially undermined by changes in patient characteristics, and in particular increases in rates of obesity and overweight. The objective of this study was to provide current estimates of the effect of obesity and overweight on healthcare spending overall, by service line and by payer using the National Institutes of Health classifications for BMI. Methods We used a quasi-experimental design and analyzed the data using generalized linear models and two-part models to estimate obesity- and overweight-attributable spending. Data was drawn from the 2006 and 2016 Medical Expenditures Panel Survey. We identified individuals in the different BMI classes based on self-reported height and weight. Results Total medical costs attributable to obesity rose to $126 billion per year by 2016, although the marginal cost of obesity declined for all obesity classes. The overall spending increase was due to an increase in obesity prevalence and a population shift to higher obesity classes. Obesity related spending between 2006 and 2016 was relatively constant due to decreases in inpatient spending, which were only partially offset by increases in outpatient spending. Conclusions While total obesity related spending between 2006 and 2016 was relatively constant, by examining the effect of different obesity classes and overweight, it provides insight into spend for each level of obesity and overweight across service line and payer mix. Obesity class 2 and 3 were the main factors driving spending increases, suggesting that persons over BMI of 35 should be the focus for policies focused on controlling spending, such as prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13176-y.
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Griauzde DH, Othman A, Dallas C, Oshman L, Gabison J, Markel DS, Richardson CR, Kullgren JT, Piatt G, Heisler M, Kilbourne AM, Kraftson A. Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study. Prim Health Care Res Dev 2022; 23:e14. [PMID: 35234116 PMCID: PMC8919179 DOI: 10.1017/s1463423621000906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/03/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care providers (PCPs) are expected to help patients with obesity to lose weight through behavior change counseling and patient-centered use of available weight management resources. Yet, many PCPs face knowledge gaps and clinical time constraints that hinder their ability to successfully support patients' weight loss. Fortunately, a small and growing number of physicians are now certified in obesity medicine through the American Board of Obesity Medicine (ABOM) and can provide personalized and effective obesity treatment to individual patients. Little is known, however, about how to extend the expertise of ABOM-certified physicians to support PCPs and their many patients with obesity. AIM To develop and pilot test an innovative care model - the Weight Navigation Program (WNP) - to integrate ABOM-certified physicians into primary care settings and to enhance the delivery of personalized, effective obesity care. METHODS Quality improvement program with an embedded, 12-month, single-arm pilot study. Patients with obesity and ≥1 weight-related co-morbidity may be referred to the WNP by PCPs. All patients seen within the WNP during the first 12 months of clinical operations will be compared to a matched cohort of patients from another primary care site. We will recruit a subset of WNP patients (n = 30) to participate in a remote weight monitoring pilot program, which will include surveys at 0, 6, and 12 months, qualitative interviews at 0 and 6 months, and use of an electronic health record (EHR)-based text messaging program for remote weight monitoring. DISCUSSION Obesity is a complex chronic condition that requires evidence-based, personalized, and longitudinal care. To deliver such care in general practice, the WNP leverages the expertise of ABOM-certified physicians, health system and community weight management resources, and EHR-based population health management tools. The WNP is an innovative model with the potential to be implemented, scaled, and sustained in diverse primary care settings.
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Affiliation(s)
- Dina H. Griauzde
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amal Othman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Chris Dallas
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jonathan Gabison
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Dorene S. Markel
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Caroline R. Richardson
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Family Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Jeffrey T. Kullgren
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Michele Heisler
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Medical School, Ann Arbor, MI, USA
| | - Andrew Kraftson
- Department of Internal Medicine, University of Michigan, Medical School, Ann Arbor, MI, USA
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Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA 2022; 327:138-150. [PMID: 35015037 PMCID: PMC8753508 DOI: 10.1001/jama.2021.23619] [Citation(s) in RCA: 309] [Impact Index Per Article: 154.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Phase 3 trials have not compared semaglutide and liraglutide, glucagon-like peptide-1 analogues available for weight management. OBJECTIVE To compare the efficacy and adverse event profiles of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg (both with diet and physical activity), in people with overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, 68-week, phase 3b trial conducted at 19 US sites from September 2019 (enrollment: September 11-November 26) to May 2021 (end of follow-up: May 11) in adults with body mass index of 30 or greater or 27 or greater with 1 or more weight-related comorbidities, without diabetes (N = 338). INTERVENTIONS Participants were randomized (3:1:3:1) to receive once-weekly subcutaneous semaglutide, 2.4 mg (16-week escalation; n = 126), or matching placebo, or once-daily subcutaneous liraglutide, 3.0 mg (4-week escalation; n = 127), or matching placebo, plus diet and physical activity. Participants unable to tolerate 2.4 mg of semaglutide could receive 1.7 mg; participants unable to tolerate 3.0 mg of liraglutide discontinued treatment and could restart the 4-week titration. Placebo groups were pooled (n = 85). MAIN OUTCOMES AND MEASURES The primary end point was percentage change in body weight, and confirmatory secondary end points were achievement of 10% or more, 15% or more, and 20% or more weight loss, assessed for semaglutide vs liraglutide at week 68. Semaglutide vs liraglutide comparisons were open-label, with active treatment groups double-blinded against matched placebo groups. Comparisons of active treatments vs pooled placebo were supportive secondary end points. RESULTS Of 338 randomized participants (mean [SD] age, 49 [13] years; 265 women [78.4%]; mean [SD] body weight, 104.5 [23.8] kg; mean [SD] body mass index, 37.5 [6.8]), 319 (94.4%) completed the trial, and 271 (80.2%) completed treatment. The mean weight change from baseline was -15.8% with semaglutide vs -6.4% with liraglutide (difference, -9.4 percentage points [95% CI, -12.0 to -6.8]; P < .001); weight change with pooled placebo was -1.9%. Participants had significantly greater odds of achieving 10% or more, 15% or more, and 20% or more weight loss with semaglutide vs liraglutide (70.9% of participants vs 25.6% [odds ratio, 6.3 {95% CI, 3.5 to 11.2}], 55.6% vs 12.0% [odds ratio, 7.9 {95% CI, 4.1 to 15.4}], and 38.5% vs 6.0% [odds ratio, 8.2 {95% CI, 3.5 to 19.1}], respectively; all P < .001). Proportions of participants discontinuing treatment for any reason were 13.5% with semaglutide and 27.6% with liraglutide. Gastrointestinal adverse events were reported by 84.1% with semaglutide and 82.7% with liraglutide. CONCLUSIONS AND RELEVANCE Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity, resulted in significantly greater weight loss at 68 weeks. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04074161.
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Affiliation(s)
- Domenica M. Rubino
- Washington Center for Weight Management and Research, Arlington, Virginia
| | - Frank L. Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
| | | | - Patrick M. O’Neil
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | | | | | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham
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Prevalence of Antiobesity Treatment and Weight-Inducing Antihyperglycemic Agents Among Patients With Type 2 Diabetes in the United States. Clin Ther 2022; 44:e35-e44. [DOI: 10.1016/j.clinthera.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
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Shahu A, Okunrintemi V, Tibuakuu M, Khan SU, Gulati M, Marvel F, Blumenthal RS, Michos ED. Income disparity and utilization of cardiovascular preventive care services among U.S. adults. Am J Prev Cardiol 2021; 8:100286. [PMID: 34816144 PMCID: PMC8593567 DOI: 10.1016/j.ajpc.2021.100286] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Low income individuals are less likely to receive smoking cessation counseling. Low income individuals are less likely to have their blood pressure checked. Low income individuals are less likely to be receive exercise counseling. Low income individuals are less likely to receive dietary counseling. Low income individuals are less likely to have their cholesterol levels checked.
Objective : Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults. Methods : We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200–400% of FPL), low-income (125–200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities. Results : The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37–0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33–0.38)] or receive counseling about diet modifications [0.77 (0.74–0.81)], exercise [0.81 (0.77–0.85)], or smoking cessation [0.71 (0.63–0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22–0.46)] or cholesterol [0.33 (0.26–0.42)] checked and receive counseling about exercise [0.84 (0.76–0.93)] or smoking cessation [0.78 (0.61–0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants. Conclusions : VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.
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Affiliation(s)
- Andi Shahu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Victor Okunrintemi
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Martin Tibuakuu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ
| | - Francoise Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
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Ahmad NN, Robinson S, Kennedy-Martin T, Poon JL, Kan H. Clinical outcomes associated with anti-obesity medications in real-world practice: A systematic literature review. Obes Rev 2021; 22:e13326. [PMID: 34423889 PMCID: PMC9285776 DOI: 10.1111/obr.13326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
Anti-obesity medications (AOMs) are efficacious and well tolerated in randomized controlled trials, but findings may not be generalizable to routine clinical practice. This systematic literature review aimed to identify real-world (RW) evidence for AOMs to treat adults ( ≥ 18 years) with obesity or overweight (BMI ≥ 27 kg/m2 ). Searches conducted in MEDLINE, Embase, Health Technology Assessment (HTA) Database, National Health Service (NHS) Economic Evaluation Database, and Cochrane Central Register of Controlled Trials for studies of relevant FDA-approved AOMs yielded 41 publications. Weight loss (WL) was consistently observed, with 14% to 58.6% of patients achieving ≥ 5% WL on orlistat, phentermine/topiramate, naltrexone/bupropion, phentermine, or liraglutide in studies of 3-6 months' duration where this was measured. When cardiometabolic risk factors were assessed, AOMs reduced or had no impact on blood pressure, lipids, or glycemia. RW data on the impact of AOMs on existing obesity-related comorbidities and mortality were generally lacking. AOMs were associated with various adverse events, but these were of mild to moderate severity and no unexpected safety signals were reported. A pattern of poor adherence and persistence with AOMs was observed across studies. Overall, the review confirmed the effectiveness of AOMs in RW settings but demonstrated large gaps in the evidence base.
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Affiliation(s)
- Nadia N Ahmad
- Research and Development - Obesity, Lilly Diabetes, Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Jiat Ling Poon
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
| | - Hong Kan
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
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Livingston KA, Freeman KJ, Friedman SM, Stout RW, Lianov LS, Drozek D, Shallow J, Shurney D, Patel PM, Campbell TM, Pauly KR, Pollard KJ, Karlsen MC. Lifestyle Medicine and Economics: A Proposal for Research Priorities Informed by a Case Series of Disease Reversal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111364. [PMID: 34769879 PMCID: PMC8583680 DOI: 10.3390/ijerph182111364] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 12/20/2022]
Abstract
Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.
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Affiliation(s)
- Kara A. Livingston
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.A.L.); (L.S.L.); (D.D.); (D.S.); (P.M.P.)
| | - Kelly J. Freeman
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.F.); (K.R.P.)
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
| | - Susan M. Friedman
- School of Medicine and Dentistry, University of Rochester, Rochester, NY 14620, USA;
| | - Ron W. Stout
- Ardmore Institute of Health, Ardmore, OK 73401, USA;
| | - Liana S. Lianov
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.A.L.); (L.S.L.); (D.D.); (D.S.); (P.M.P.)
- Global Positive Health Institute, Sacramento, CA 95825, USA
| | - David Drozek
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.A.L.); (L.S.L.); (D.D.); (D.S.); (P.M.P.)
- Department of Specialty Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA
| | | | - Dexter Shurney
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.A.L.); (L.S.L.); (D.D.); (D.S.); (P.M.P.)
- BlueZones Well-Being Institute, Adventist Health, Roseville, CA 95661, USA
| | - Padmaja M. Patel
- American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.A.L.); (L.S.L.); (D.D.); (D.S.); (P.M.P.)
- Midland Health, Midland, TX 79703, USA
| | | | - Kaitlyn R. Pauly
- Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA; (K.J.F.); (K.R.P.)
| | - Kathryn J. Pollard
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
- Correspondence:
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Thorpe K, Toles A, Shah B, Schneider J, Bravata DM. Weight Loss-Associated Decreases in Medical Care Expenditures for Commercially Insured Patients With Chronic Conditions. J Occup Environ Med 2021; 63:847-851. [PMID: 34138824 PMCID: PMC8478295 DOI: 10.1097/jom.0000000000002296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Savings associated with weight loss for populations with chronic conditions are poorly understood. The purpose of this study was to estimate medical expenditure savings associated with weight loss among commercially insured adults with chronic medical conditions. METHODS THE 2001-2015 Medical Expenditure Panel Survey data were used to estimate the effect of changes in body mass index (BMI) on health expenditures from instrumental variable regression models. RESULTS Decreases in annual medical expenditures associated with a reduction in BMI of 1 kg/m2 varied by condition (eg, $289 for back pain and $752 for diabetes). The greater the weight loss, the greater the savings. The higher the baseline BMI, the greater the savings for similar levels of weight loss. CONCLUSIONS The detailed estimates of savings for populations with chronic conditions can be used by employers to evaluate the cost-effectiveness of weight management interventions.
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Affiliation(s)
- Kenneth Thorpe
- Department of Public Health, Emory University, Atlanta, Georgia (Thorpe); Livongo, Mt. View, California (Thorpe, Toles, Schneider, and Bravata); Duke School of Medicine, Duke University, Durham, North Carolina (Shah); Teladoc, Mt. View, California (Shah); Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California (Bravata)
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Rezai R, SantaBarbara N, Almirol E, Shedd K, Terry E, Park M, Comulada WS. Efficacy and costs of a workplace wellness programme. Occup Med (Lond) 2021; 70:649-655. [PMID: 33289018 DOI: 10.1093/occmed/kqaa189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Research investigating the efficacy of workplace wellness programmes to promote exercise, and by extension, reduce obesity and increase productivity has proliferated in recent years. Although preliminary work is encouraging, more work is needed. AIMS To evaluate the effects and overall cost of a workplace exercise programme on multiple physical outcomes, including body mass index, aerobic fitness and muscular fitness. METHODS Data from the Bruin Health Improvement Programme .5 (BHIP) between August 2013 and July 2018 were analysed. BHIP is a 12-week workplace wellness programme that assesses multiple areas of physical and mental health. For this study, changes in weight, waist-to-hip ratio, aerobic fitness and muscular endurance were analysed using paired samples t-tests and chi-squared tests. Using results from a prior analysis of Medical Expenditure Panel Survey, the estimated medical expenditure savings associated with weight loss were also analysed. RESULTS A total of 518 participants (84% female) took part in the BHIP programme (mean age = 41 years, SD = 1.17). There were significant decreases in all anthropometric indices and significant increases in all fitness outcomes (P < 0.01) from baseline to follow-up. Estimated programme cost per participant, per session was $473 US Dollars (USD), and weight loss is estimated to reduce annual medical care costs by ~$2200 USD. CONCLUSIONS Results showed significant improvements in all physical outcomes of interest. Additionally, there appears to be an inverse relationship between improvements in employee health and employer healthcare costs. Strengths, limitations and future directions are discussed.
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Affiliation(s)
- R Rezai
- Department of Epidemiology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - N SantaBarbara
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - E Almirol
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - K Shedd
- Department of Recreation, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - E Terry
- Department of Recreation, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - M Park
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - W S Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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Wu CC, Suen SC. Optimizing diabetes screening frequencies for at-risk groups. Health Care Manag Sci 2021; 25:1-23. [PMID: 34357488 DOI: 10.1007/s10729-021-09575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
There is strong evidence that diabetes is underdiagnosed in the US: the Centers for Disease Control and Prevention (CDC) estimates that approximately 25% of diabetic patients are unaware of their condition. To encourage timely diagnosis of at-risk patients, we develop screening guidelines stratified by body mass index (BMI), age, and prior test history by using a Partially Observed Markov Decision Process (POMDP) framework to provide more personalized screening frequency recommendations. We identify structural results that prove the existence of threshold solutions in our problem and allow us to determine the relative timing and frequency of screening given different risk profiles. We then use nationally representative empirical data to identify a policy that provides the optimal action (screen or wait) every six months from age 45 to 90. We find that the current screening guidelines are suboptimal, and the recommended diabetes screening policy should be stratified by age and by finer BMI thresholds than in the status quo. We identify age ranges and BMI categories for which relatively less or more screening is needed compared to the existing guidelines to help physicians target patients most at risk. Compared to the status quo, we estimate that an optimal screening policy would generate higher net monetary benefits by $3,200-$3,570 and save $120-$1,290 in health expenditures per individual in the US above age 45.
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Affiliation(s)
- Chou-Chun Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA.
| | - Sze-Chuan Suen
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, Los Angeles, CA, USA
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Pantalone KM, Smolarz BG, Ramasamy A, Baz Hecht M, Harty BJ, Rogen B, Griebeler ML, Borukh E, Young JB, Burguera B. Effectiveness of Combining Antiobesity Medication With an Employer-Based Weight Management Program for Treatment of Obesity: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116595. [PMID: 34255049 PMCID: PMC8278271 DOI: 10.1001/jamanetworkopen.2021.16595] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The clinical efficacy of antiobesity medications (AOMs) as adjuncts to lifestyle intervention is well characterized, but data regarding their use in conjunction with workplace wellness plans are lacking, and coverage of AOMs by US private employers is limited. OBJECTIVE To determine the effect of combining AOMs with a comprehensive, interdisciplinary, employer-based weight management program (WMP) compared with the WMP alone on weight loss, treatment adherence, and work productivity and limitations. DESIGN, SETTING, AND PARTICIPANTS This 1-year, single-center, open-label, parallel-group, real-world, randomized clinical trial was conducted at the Cleveland Clinic's Endocrinology and Metabolism Institute in Cleveland, Ohio, from January 7, 2019, to May 22, 2020. Participants were adults with obesity (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared] ≥30) enrolled in the Cleveland Clinic Employee Health Plan. INTERVENTIONS In total, 200 participants were randomized 1:1, 100 participants to WMP combined with an AOM (WMP+Rx), and 100 participants to WMP alone. The WMP was the Cleveland Clinic Endocrinology and Metabolism Institute's employer-based integrated medical WMP implemented through monthly multidisciplinary shared medical appointments. Participants in the WMP+Rx group initiated treatment with 1 of 5 US Food and Drug Administration-approved medications for chronic weight management (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide, 3.0 mg) according to standard clinical practice. MAIN OUTCOMES AND MEASURES The primary end point was the percentage change in body weight from baseline to month 12. RESULTS The 200 participants were predominately (177 of 200 [88.5%]) women, had a mean (SD) age of 50.0 (10.3) years, and a mean (SD) baseline weight of 105.0 (19.0) kg. For the primary intention-to-treat estimand, the estimated mean (SE) weight loss was -7.7% (0.7%) for the WMP+Rx group vs -4.2% (0.7%) for the WMP group, with an estimated treatment difference of -3.5% (95% CI, -5.5% to -1.5%) (P < .001). The estimated percentage of participants achieving at least 5% weight loss was 62.5% for WMP+Rx vs 44.8% for WMP (P = .02). The rate of attendance at shared medical appointments was higher for the WMP+Rx group than for the WMP group. No meaningful differences in patient-reported work productivity or limitation measures were observed. CONCLUSIONS AND RELEVANCE Clinically meaningful superior mean weight loss was achieved when access to AOMs was provided in the real-world setting of an employer-based WMP, compared with the WMP alone. Such results may inform employer decisions regarding AOM coverage and guide best practices for comprehensive, interdisciplinary employer-based WMPs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03799198.
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Affiliation(s)
- Kevin M. Pantalone
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Bruce Rogen
- Cleveland Clinic Employee Health Plan, Cleveland, Ohio
| | | | - Elena Borukh
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - James B. Young
- Cleveland Clinic Executive Administration, Cleveland, Ohio
| | - Bartolome Burguera
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
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Bozzi DG, Nicholas LH. A Causal Estimate of Long-Term Health Care Spending Attributable to Body Mass Index Among Adults. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100985. [PMID: 33529918 DOI: 10.1016/j.ehb.2021.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
While high body mass index (BMI) is believed to be a major driver of poor health, there is little evidence about whether it leads to higher health care spending. Understanding the causal contribution of BMI to health care spending is necessary to estimate the returns to investment in weight loss efforts. We exploit genetic variation in BMI across siblings as a natural experiment to estimate the impact of BMI on cumulative third party and out-of-pocket health care spending among adults using the Panel Study of Income Dynamics data from 1999 through 2011. We estimate a two-stage residual inclusion model with a generalized linear model. We find a $611.60 increase in cumulative insurer spending for each one-unit increase in BMI. This amounts to $130.49 in mean annual spending, and is two times higher than the non-causal estimate. We find no difference in out-of-pocket spending by BMI. These findings suggest that having a higher BMI in young/middle adulthood leads to significantly higher insurer health expenditures over the life course, which can help to inform public and private insurer policies on BMI reduction and control.
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Affiliation(s)
- Debra G Bozzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Lauren Hersch Nicholas
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States; Department of Health Systems, Management & Policy, Colorado School of Public Health, United States
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Horstman CM, Ryan DH, Aronne LJ, Apovian CM, Foreyt JP, Tuttle HM, Williamson DA. Return on Investment: Medical Savings of an Employer-Sponsored Digital Intensive Lifestyle Intervention, Weight Loss. Obesity (Silver Spring) 2021; 29:654-661. [PMID: 33759385 PMCID: PMC8252728 DOI: 10.1002/oby.23117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to determine the medical cost impact and return on investment (ROI) of a large, commercial, digital, weight-management intensive lifestyle intervention (ILI) program (Real Appeal). METHODS Participants in this program were compared with a control group matched by age, sex, geographic region, health risk, baseline medical costs, and chronic conditions. Medical costs were defined as the total amount paid for all medical expenses, inclusive of both the insurers' and the study participants' responsibility. RESULTS In the 3 years following program registration, the intent-to-treat (ITT) cohort had significantly lower medical expenditures than the matched controls, with an average of -$771 or 12% lower costs (P = 0.002). Among 4,790 ITT participants, a total savings of $3,693,090 compared with total program costs of $1,639,961 translated into a 2.3:1 ROI. Program completers (n = 3,990), who attended more sessions than the overall ITT group, had greater mean weight loss (-4.4%), greater cost savings (-$956 or 14%), and an ROI of 2.0:1 over the 3-year time frame compared with matched controls. CONCLUSIONS The findings demonstrated that the digital weight-management ILI was associated with a significantly positive ROI. Employers and payers willing to cover the cost of an ILI that produces both weight loss and demonstrated cost benefits can improve health and save money for their population with overweight or obesity.
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Affiliation(s)
| | - Donna H. Ryan
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
| | - Louis J. Aronne
- Division of Endocrinology, Diabetes and MetabolismComprehensive Weight Control CenterWeill Cornell MedicineNew YorkNew YorkUSA
| | - Caroline M. Apovian
- Section for Endocrinology, Diabetes, Nutrition and Weight ManagementNutrition and Weight Management CenterBoston Medical CenterSchool of MedicineBoston UniversityBostonMassachusettsUSA
| | - John P. Foreyt
- Behavioral Medicine Research CenterBaylor College of MedicineHoustonTexasUSA
| | | | - Donald A. Williamson
- Pennington Biomedical Research CenterLouisiana State UniversityBaton RougeLouisianaUSA
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Haase CL, Lopes S, Olsen AH, Satylganova A, Schnecke V, McEwan P. Weight loss and risk reduction of obesity-related outcomes in 0.5 million people: evidence from a UK primary care database. Int J Obes (Lond) 2021; 45:1249-1258. [PMID: 33658682 PMCID: PMC8159734 DOI: 10.1038/s41366-021-00788-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 01/06/2023]
Abstract
High body mass index (BMI) is known to be associated with various conditions, including type 2 diabetes (T2D), osteoarthritis, cardiovascular disease (CVD) and sleep apnoea; however, the impact of intentional weight loss on the risk of these and other outcomes is not well quantified. We examined the effect of weight loss on ten selected outcomes in a population from the UK Clinical Practice Research Datalink (CPRD) GOLD database. Included individuals were >18 years old at the index date (first BMI value between January 2001 and December 2010). They were categorised by their weight pattern between year 1 post-index and year 4 post-index (baseline period) as having stable weight (−5% to +5%) or weight loss (−25% to −10%, plus evidence of intervention or dietary advice to confirm intention to lose weight). For inclusion, individuals also required a BMI of 25.0–50.0 kg/m2 at the start of the follow-up period, during which the occurrence of ten obesity-related outcomes was recorded. Cox proportional hazard models adjusted for BMI, comorbidities, age, sex and smoking status were used to estimate relative risks for weight loss compared with stable weight. Individuals in the weight-loss cohort had median 13% weight loss. Assuming a BMI of 40 kg/m2 before weight loss, this resulted in risk reductions for T2D (41%), sleep apnoea (40%), hypertension (22%), dyslipidaemia (19%) and asthma (18%). Furthermore, weight loss was associated with additional benefits, with lower risk of T2D, chronic kidney disease, hypertension and dyslipidaemia compared with maintaining the corresponding stable lower BMI throughout the study. This study provides objective, real-world quantification of the effects of weight loss on selected outcomes, with the greatest benefits observed for the established CVD risk factors T2D, hypertension and dyslipidaemia.
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Affiliation(s)
| | | | | | | | | | - Phil McEwan
- Health Economics and Outcomes Research (HEOR) Ltd, Cardiff, UK
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Agrawal S, Wojtanowski AC, Tringali L, Foster GD, Finkelstein EA. Financial implications of New York City's weight management initiative. PLoS One 2021; 16:e0246621. [PMID: 33571249 PMCID: PMC7877753 DOI: 10.1371/journal.pone.0246621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. Design Longitudinal observational study. Setting Employees of New York City (NYC) government and enrolled dependents. Sample 14,946 participants with overweight and obesity. Intervention WW (formerly Weight Watchers®) ‘Workshop’ and ‘Digital’ programs. Measures Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). Analysis Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. Results In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in ‘Workshops’ and ‘Digital’ was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. Conclusion An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.
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Affiliation(s)
- Sagun Agrawal
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Laura Tringali
- WW International (formerly Weight Watchers), New York, NY, United States of America
| | - Gary D. Foster
- WW International (formerly Weight Watchers), New York, NY, United States of America
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States of America
| | - Eric A. Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- * E-mail:
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Cawley J, Biener A, Meyerhoefer C, Ding Y, Zvenyach T, Smolarz BG, Ramasamy A. Direct medical costs of obesity in the United States and the most populous states. J Manag Care Spec Pharm 2021; 27:354-366. [PMID: 33470881 PMCID: PMC10394178 DOI: 10.18553/jmcp.2021.20410] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: After a dramatic increase in prevalence over several decades, obesity has become a major public health crisis in the United States. Research to date has consistently demonstrated a correlation between obesity and higher medical costs for a variety of U.S. subpopulations and specific categories of care. However, by examining associations rather than causal effects, previous studies likely underestimated the effect of obesity on medical expenditures. OBJECTIVE: To estimate the causal effect of obesity on direct medical care costs at the national and state levels. METHODS: This study is a pooled cross-sectional analysis of retrospective data from the 2001-2016 Medical Expenditure Panel Surveys. Adults aged 20-65 years with a biological child living in the household were included in the study sample. Primary outcomes were individual-level medical expenditures due to obesity, overall, as well as separately by type of payer and category of medical care. Results were reported at the national level and separately for the 20 most populous states. The expenditure estimates were obtained from 2-part models of instrumental variables in which the respondent's body mass index (BMI) was instrumented using the BMI of their biological child. RESULTS: Adults with obesity in the United States compared with those with normal weight experienced higher annual medical care costs by $2,505 or 100%, with costs increasing significantly with class of obesity, from 68.4% for class 1 to 233.6% for class 3. The effects of obesity raised costs in every category of care: inpatient, outpatient, and prescription drugs. Increases in medical expenditures due to obesity were higher for adults covered by public health insurance programs ($2,868) than for those having private health insurance ($2,058). In 2016, the aggregate medical cost due to obesity among adults in the United States was $260.6 billion. The increase in individual-level expenditures due to obesity varied considerably by state (e.g., 24.0% in Florida, 66.4% in New York, and 104.9% in Texas). CONCLUSIONS: The 2-part models of instrumental variables, which estimate the causal effects of obesity on direct medical costs, showed that the effect of obesity is greater than suggested by previous studies, which estimated only correlations. Much of the aggregate national cost of obesity-$260.6 billion-represents external costs, providing a rationale for interventions to prevent and reduce obesity. DISCLOSURES: Novo Nordisk financed the development of the study design, analysis, and interpretation of data, as well as writing support of the manuscript. Cawley, Biener, and Meyerhoefer received financial support from Novo Nordisk to conduct the research study on which this manuscript is based. Smolarz and Ramasamy are employees of Novo Nordisk. Ding and Zvenyach have no conflicts to declare. Our research has been presented as a poster at the 2020 Academy Health Annual Research Meeting (Virtual), July 28-August 6, 2020.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management and Department of Economics, Cornell University, Ithaca, NY
| | - Adam Biener
- Department of Economics, Lafayette College, Easton, PA
| | | | | | - Tracy Zvenyach
- Independent Advisor, Healthcare and Obesity Public Policy, Madison, WI
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Haase CL, Eriksen KT, Lopes S, Satylganova A, Schnecke V, McEwan P. Body mass index and risk of obesity-related conditions in a cohort of 2.9 million people: Evidence from a UK primary care database. Obes Sci Pract 2020; 7:137-147. [PMID: 33841883 PMCID: PMC8019280 DOI: 10.1002/osp4.474] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/12/2020] [Accepted: 11/28/2020] [Indexed: 11/08/2022] Open
Abstract
Objective Obesity rates in the United Kingdom are some of the highest in Western Europe, with considerable clinical and societal impacts. Obesity is associated with type 2 diabetes (T2D), osteoarthritis, cardiovascular disease, and increased mortality; however, relatively few studies have examined the occurrence of multiple obesity‐related outcomes in the same patient population. This study was designed to examine the associations between body mass index (BMI) and a broad range of obesity‐related conditions in the same large cohort from a UK‐representative primary care database. Methods Demographic data and diagnosis codes were extracted from the Clinical Practice Research Datalink GOLD database in January 2019. Adults registered for ≥ 3 years were grouped by BMI, with BMI 18.5–24.9 kg/m2 as reference group. Associations between BMI and 12 obesity‐related outcomes were estimated using Cox proportional hazard models, adjusted for age, sex, and smoking. Results More than 2.9 million individuals were included in the analyses and were followed up for occurrence of relevant outcomes for a median of 11.4 years during the study period. Generally, there was a stepwise increase in risk of all outcomes with higher BMI. Individuals with BMI 40.0–45.0 kg/m2 were at particularly high risk of sleep apnea (hazard ratio [95% confidence interval] vs. reference group: 19.8 [18.9–20.8]), T2D (12.4 [12.1–12.7]), heart failure (3.46 [3.35–3.57]), and hypertension (3.21 [3.15–3.26]). Conclusions This study substantiates evidence linking higher BMI to higher risk of a range of serious health conditions, in a large, representative UK cohort. By focusing on obesity‐related conditions, this demonstrates the wider clinical impact and the healthcare burden of obesity, and highlights the vital importance of management, treatment approaches, and public health programs to mitigate the impact of this disease.
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Affiliation(s)
| | | | | | | | | | - Phil McEwan
- Health Economics and Outcomes Research Ltd Cardiff UK
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Ono H, Akahoshi K, Kai M. The Trends of Medical Care Expenditure with Adjustment of Lifestyle Habits and Medication; 10-Year Retrospective Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9546. [PMID: 33419363 PMCID: PMC7767014 DOI: 10.3390/ijerph17249546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
In Japan, the prevention of lifestyle-related diseases is the most important issue for the optimization of medical expenditure. This study aimed to analyze the impact of lifestyle and medication status on medical expenditure. Health checkup data and medical expenditure records of a retrospective cohort of 1463 people aged between 40 and 65 years old who underwent specific health checks at least three times between 2008 and 2017 were analyzed. Regression analysis was performed with medical expenditure as the dependent variable and age, gender, waist ratio, medication status, and lifestyle habits as independent variables using a Tobit model. Focusing on the factors that increase medical expenditure, the regression coefficients of age, medication status, weight gain of 10 kg or more since the age of 20, and walking more than 1 h per day were 0.048 (95% CI 0.04 to 0.06), 1.020 (95% CI 0.88 to 1.16), 0.210 (95% CI 0.06 to 0.36), and -0.208 (95% CI -0.35 to -0.07), respectively. The estimate of 5-year cumulative medical expenditure showed that those with walking habits without medication had the lowest medical expenditure. The result of this study suggests that walking more than 1 h a day may lower health expenditure in the general population.
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Affiliation(s)
- Haruko Ono
- Department of Community Health Nursing, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
| | - Kotomi Akahoshi
- Department of Community Health Nursing, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
| | - Michiaki Kai
- Department of Environmental Health Science, Oita University of Nursing and Health Science, Oita 870-1201, Japan;
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Divino V, Ramasamy A, Anupindi VR, Eriksen KT, Olsen AH, DeKoven M, Meincke HH. Complication-specific direct medical costs by body mass index for 13 obesity-related complications: a retrospective database study. J Manag Care Spec Pharm 2020; 27:210-222. [PMID: 33307936 PMCID: PMC10394187 DOI: 10.18553/jmcp.2020.20272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Obesity, a multifactorial disease associated with many severe complications, affects more than 40% of adults in the United States. OBJECTIVE: To quantify the cost burden of 13 obesity-related complications (ORCs), overall and by body mass index (BMI) class. METHODS: Adult patients (aged ≥ 18 years) with ≥ 1 medical claim with an ICD-9/10 diagnosis code for the ORC of interest were identified using linked data from IQVIA's Ambulatory Electronic Medical Records and PharMetrics Plus. Thirteen ORCs were separately assessed (asthma, dyslipidemia, gastroesophageal reflux disease [GERD], heart failure with preserved ejection fraction [HFpEF], hypertension, musculoskeletal pain, obstructive sleep apnea [OSA], osteoarthritis [OA] of the knee, polycystic ovary syndrome [PCOS], prediabetes, psoriasis, type 2 diabetes mellitus [T2DM], and urinary incontinence); ORC cohorts were not mutually exclusive. For each ORC, the first claim identified for the ORC from January 2010-December 2016 was termed the index date. Patients had continuous enrollment in the 1-year pre-index (without a diagnosis code of the specific ORC under study) and the 1-year post-index, with ≥ 1 BMI value in the 6-months pre-index. Patients with underweight (BMI < 18.5 kg/m2) and those with cancer or pregnancy were excluded. Complication-specific costs were identified as claims with a diagnosis code for the ORC (primary position only for hospitalizations) or ORC-specific medications or procedures. Baseline demographic/clinical characteristics and complication-specific costs over the 1-year follow-up were assessed for each ORC cohort, overall and by BMI class (18.5-24.9; 25.0-29.9; 30.0-34.9; 35.0-39.9; ≥ 40 kg/m2). The association between total complication-specific costs and BMI class was assessed by generalized linear regression model for each ORC, adjusting for baseline characteristics. RESULTS: The total number of patients that comprised the ORC cohorts ranged from 1,275 (HFpEF) to 101,784 (musculoskeletal pain). Across ORC cohorts, 41.6% (musculoskeletal pain) to 73.5% (OSA) had obesity (BMI ≥ 30 kg/m2). For 4 ORC cohorts, more than one fifth of patients had class III obesity (BMI ≥ 40 kg/m2): T2DM, OSA, PCOS, and HFpEF. Baseline mean Charlson Comorbidity Index score increased with increasing BMI class for most ORC cohorts. The most costly ORCs overall based on mean total 1-year cost were: OA of the knee ($3,697 [range from normal weight (BMI: 18.5-24.9 kg/m2) to class III obesity: $2,453-$4,518]), HFpEF ($3,586 [range: $3,402-$4,685]), OSA ($2,768 [$2,442-$2,974]), and psoriasis ($2,711 [$2,131-$3,292]). The highest cost differences (≥20%) were observed among those with class III obesity versus those with normal weight for these aforementioned ORCs, as well as for GERD ($1,719 [$1,484-$1,893]) and asthma ($1,531 [$1,361-$1,780]). Following adjustment, most cost comparisons by BMI class were significantly higher versus those for normal weight for 6 ORCs. CONCLUSIONS: ORCs are important drivers of the economic burden of obesity, indicating an unmet need for the treatment of obesity. Appropriate weight management may reduce ORC-associated costs. DISCLOSURES: This study and its publication were supported by Novo Nordisk. Divino, Anupindi, and DeKoven are employed by IQVIA, which received funding from Novo Nordisk for this study. Ramasamy, Eriksen, Olsen, and Meincke are employed by and shareholders of Novo Nordisk. Material reported in this manuscript was presented in an abstract accepted by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2020, to be published in Value in Health. There was no presentation at ISPOR 2020.
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Ding Y, Fan X, Blanchette CM, Smolarz BG, Weng W, Ramasamy A. Economic value of nonsurgical weight loss in adults with obesity. J Manag Care Spec Pharm 2020; 27:37-50. [PMID: 33164723 PMCID: PMC10394211 DOI: 10.18553/jmcp.2020.20036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Obesity imposes a substantial economic burden on the United States. The short-term value of nonsurgical weight loss (WL) and nonsurgical sustained WL (i.e., WL not resulting from bariatric surgery) is poorly understood. OBJECTIVES: To assess short-term (1 year) effect of nonsurgical WL and sustained nonsurgical WL (i.e., approximately 2 years) on per-patient-per-month (PPPM) total all-cause health care costs among adults with obesity in the United States. METHODS: In this retrospective cohort study, we analyzed data from the IBM MarketScan Explorys Claims-EMR Data Set from January 1, 2012, through June 30, 2018. Adults aged 18-64 years with a body mass index (BMI) measurement ≥ 30 kg/m2 on the index date and BMI measurements at 12, 24, and 36 months were classified into weight-gain (≥ 3%), no-weight-change (within ± 3%), and WL (≥ 3%-≤ 5%, > 5%-≤ 10%, and > 10%-≤ 20%) cohorts based on the change from first to second BMI measurements (baseline), and sustained nonsurgical WL based on WL during baseline and < 3% weight gain from second to third BMI measurement. PPPM all-cause health care costs were calculated for baseline, first year, and second year of follow-up. Generalized linear models were used to examine if PPPM all-cause health care cost change (ΔPPPM) from baseline to follow-up differed significantly between nonsurgical WL/sustained WL and no-weight-change cohorts. Analyses were stratified by index obesity class (class 1: BMI 30- < 34.9 kg/m2, class 2: BMI 35- < 39.9 kg/m2, class 3: BMI ≥ 40 kg/m2). Specific nonsurgical WL treatments used by individuals in the study were not studied. RESULTS: The sample included 20,488 adults who were grouped as follows: weight-gain cohort (24.8%), no-weight-change cohort (56.6%), ≥ 3%- ≤ 5% WL cohort (8.2%), > 5%- ≤ 10% WL cohort (7.7%), and > 10%- ≤ 20% WL cohort (2.8%). Compared with the no-weight-change cohort, adjusted mean ΔPPPM all-cause health care cost from baseline to first year of follow-up was lower in all WL cohorts (≥ 3%- ≤ 5% WL: -$57.36, > 5%- ≤ 10% WL: -$135.35 [P < 0.05], > 10%- ≤ 20% WL: -$193.54 [P < 0.05]). In the second year of follow-up (n = 15,307), the cohorts were weight-gain (43.4%), no-weight-change (59.4%), ≥ 3%- ≤ 5% sustained WL (7.3%), ≥ 5%- ≤ 10% sustained WL (6.3%), and > 10%- ≤ 20% sustained WL (1.8%). Adjusted mean ΔPPPM all-cause health care cost was lower in all sustained WL groups (-$26.38, -$157.41 [P < 0.05], and -$185.41 for ≥ 3%- ≤ 5%, ≥ 5%- ≤ 10%, and > 10%- ≤ 20% WL, respectively). Greater nonsurgical WL and sustained nonsurgical WL were generally associated with larger reduction in short-term all-cause health care costs. Results stratified by index obesity class were mixed, due to small samples. CONCLUSIONS: Substantial all-cause health care cost savings were observed 1 year after nonsurgical WL and after sustained (on average for 2 years) nonsurgical WL in adults with obesity, with greater nonsurgical WL and sustained nonsurgical WL associated with greater cost savings. Comprehensive solutions to chronic weight management, including improved access to antiobesity medications in combination with lifestyle interventions, could be valuable to patients, employers, and payers. DISCLOSURES: This study was sponsored by Novo Nordisk, which also purchased the data. Blanchette is an employee of Novo Nordisk. Smolarz and Ramasamy are employees of Novo Nordisk and hold equity in Novo Nordisk. Ding, Fan, and Weng were employees of Novo Nordisk at the time this study was conducted. The findings from this study were previously presented at Obesity Week 2019; November 3-7, 2019; Las Vegas, NV.
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Affiliation(s)
- Yuchen Ding
- Health Economics and Outcomes Research, Novo Nordisk, Plainsboro, NJ
| | - Xiaozhou Fan
- HEOR Real World Data Analytics, Novo Nordisk, Plainsboro, NJ
| | | | | | - Wayne Weng
- HEOR Real World Data Analytics, Novo Nordisk, Plainsboro, NJ
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Huckfeldt PJ, Frenier C, Pajewski NM, Espeland M, Peters A, Casanova R, Pi-Sunyer X, Cheskin L, Goldman DP. Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability: An Ancillary Study of the Look AHEAD Study. JAMA Netw Open 2020; 3:e2025488. [PMID: 33231638 PMCID: PMC7686866 DOI: 10.1001/jamanetworkopen.2020.25488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Intensive lifestyle interventions focused on diet and exercise can reduce weight and improve diabetes management. However, the long-term effects on health care use and spending are unclear, especially for public payers. OBJECTIVE To estimate the association of effective intensive lifestyle intervention for weight loss with long-term health care use and Medicare spending. DESIGN, SETTING, AND PARTICIPANTS This ancillary study used data from the Look AHEAD randomized clinical trial, which randomized participants with type 2 diabetes to an intensive lifestyle intervention or control group (ie, diabetes support and education), provided ongoing intervention from 2001 to 2012, and demonstrated improved diabetes management and reduced health care costs during the intervention. This study compared Medicare data between study arms from 2012 to 2015 to determine whether the intervention was associated with persistent reductions in health care spending. EXPOSURE Starting in 2001, Look AHEAD's intervention group participated in sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists with the goal of reducing weight 7% in the first year. Sessions occurred weekly in the first 6 months of the intervention and decreased over the intervention period. The controls participated in periodic group education sessions that occurred 3 times per year in the first year and decreased to 1 time per year later in the trial. MAIN OUTCOMES AND MEASURES Outcomes included total Medicare spending, Part D prescription drug costs, Part A and Part B Medicare spending, hospital admissions, emergency department visits, and disability-related Medicare eligibility. RESULTS This study matched Medicare administrative records for 2796 Look AHEAD study participants (54% of 5145 participants initially randomized and 86% of 3246 participants consenting to linkages). Linked intervention and control participants were of a similar age (mean [SD] age, 59.6 [5.4] years vs 59.6 [5.5] years at randomization) and sex (818 [58.1%] women vs 822 [59.3%] women). There was no statistically significant difference in total Medicare spending between groups (difference, -$133 [95% CI, -$1946 to $1681]; P = .89). In the intervention group, compared with the control group, there was statistically significantly higher Part B spending (difference, $513 [95% CI, $70 to $955]; P = .02) but lower prescription drug costs (difference, -$803 [95% CI, -$1522 to -$83]; P = .03). CONCLUSIONS AND RELEVANCE This ancillary study of a randomized clinical trial found that reductions in health care use and spending associated with an intensive lifestyle intervention for type 2 diabetes diminished as participants aged. Intensive lifestyle interventions may need to be sustained to reduce long-term health care spending. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03952728.
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Affiliation(s)
- Peter J. Huckfeldt
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Chris Frenier
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | | | - Dana P. Goldman
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
- School of Pharmacy, University of Southern California, Los Angeles
- Price School of Public Policy, University of Southern California, Los Angeles
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Hull HR, Herman A, Gibbs H, Gajewski B, Krase K, Carlson SE, Sullivan DK, Goetz J. The effect of high dietary fiber intake on gestational weight gain, fat accrual, and postpartum weight retention: a randomized clinical trial. BMC Pregnancy Childbirth 2020; 20:319. [PMID: 32448177 PMCID: PMC7247271 DOI: 10.1186/s12884-020-03016-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/14/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interventions to prevent excessive gestational weight gain (GWG) have had limited success This pilot study examined the effectiveness of a single goal (SG) high dietary fiber intervention to prevent excessive GWG. METHODS Twelve weekly lessons focused on consuming a high fiber diet (≥30 g/day). Snacks containing 10-12 g of dietary fiber were given for the first 6 weeks only. Body composition was measured at baseline and at the end of the intervention. At one-year postpartum, body weight retention and dietary practices were assessed. A p-value is reported for the primary analysis only. For all other comparisons, Cohen's d is reported to indicate effect size. RESULTS The SG group increased fiber intake during the study (32 g/day at 6 weeks, 27 g/day at 12 weeks), whereas the UC group did not (~ 17 g/day). No differences were found for the proportion of women classified as excessive gainers (p = 0.13). During the intervention, the SG group gained less body weight (- 4.1 kg) and less fat mass (- 2.8 kg) (d = 1.3). At 1 year postpartum, the SG group retained less weight (0.35 vs. 4.4 kg, respectively, d = 1.8), and reported trying to currently eat high fiber foods. CONCLUSION The SG intervention resulted in less weight gain, fat accrual, and weight retention at 1 year postpartum. A residual intervention effect was detected postpartum with the participants reporting continued efforts to consume a high fiber diet. TRIAL REGISTRATION NCT03984630; Trial registered June 13, 2019 (retrospectively registered).
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Affiliation(s)
- Holly R Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA.
| | - Amy Herman
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA
| | - Heather Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelli Krase
- Department of Obstetrics and Gynecology, University of Kansas Hospital, Kansas City, KS, USA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, University of Kansas Medical Center, 3901 Rainbow BLVD, MS 4013, Kansas City, KS, 66160, USA
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Pearson AL, Pfeiffer KA, Gardiner J, Horton T, Buxton RT, Hunter RF, Breeze V, McDade T. Study of active neighborhoods in Detroit (StAND): study protocol for a natural experiment evaluating the health benefits of ecological restoration of parks. BMC Public Health 2020; 20:638. [PMID: 32380967 PMCID: PMC7204306 DOI: 10.1186/s12889-020-08716-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals living in deprived inner cities have disproportionately high rates of cancers, Type 2 diabetes and obesity, which have stress- and physical inactivity-related etiologies. This study aims to quantify effects of ecological park restoration on physical activity, stress and cardio-metabolic health outcomes. METHODS The Study of Active Neighborhoods in Detroit is a quasi-experimental, longitudinal panel natural experiment with two conditions (restored park intervention (INT) and control (CNT)) and annual measurements at baseline and 3-years post-restoration. Individuals (sampled within 500 m of an INT/CNT park) serve as the unit of analysis. Restoration (n = 4 parks) involves replacing non-native plants and turf with native plants; creating trails; posting signage; and leading community stewardship events. The CNT condition (n = 5) is an unmaintained park, matched to INT based on specified neighborhood conditions. Recruitment involves several avenues, with a retention goal of 450 participants. Park measures include plant/avian diversity; usage of the park (SOPARC); signs of care; auditory environment recordings; and visual greenness using 360 imagery. Health outcomes include device-based physical activity behavior (primary outcome); salivary cortisol (secondary outcome); and several downstream health outcomes. Exposure to the INT will be assessed through visual contact time and time spent in the park using GPS data. Changes in health outcomes between years and INT versus CNT will be tested using generalized linear (mixed) models. DISCUSSION Our study will examine whether restored urban greenspaces increase physical activity and lower stress, with public health planning implications, where small changes in neighborhood greenspaces may have large health benefits in low-income neighborhoods. STUDY REGISTRATION Registration: OSF Preregistration registered March 31, 2020. Accessible from https://osf.io/surx7.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Karin A. Pfeiffer
- Department of Kinesiology, Michigan State University, 27R Intramural Rec Sports- Circle, 308 West Circle Drive, East Lansing, MI 48824 USA
| | - Joseph Gardiner
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Wilson Road, Room B601, East Lansing, MI 48824 USA
| | - Teresa Horton
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
| | - Rachel T. Buxton
- Department of Biology, Carleton University, 209 Nesbitt Biology Building, Ottawa, ON K1S 5B6 Canada
| | - Ruth F. Hunter
- Centre for Public Health, Queen’s University Belfast, University Road, Belfast, BT7 1NN Northern Ireland, UK
| | - Victoria Breeze
- Department of Geography, Environment and Spatial Sciences, Michigan State University, 673 Auditorium Road, East Lansing, MI 48824 USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, 1810 Hinman Ave, Evanston, IL 60208 USA
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Neuhofer Z, McFadden BR, Rihn A, Wei X, Khachatryan H, House L. Can the updated nutrition facts label decrease sugar-sweetened beverage consumption? ECONOMICS AND HUMAN BIOLOGY 2020; 37:100867. [PMID: 32114326 DOI: 10.1016/j.ehb.2020.100867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Sugar-sweetened beverages are the primary source of added sugar consumption in the U.S, and the Food and Drug Administration recently updated the Nutrition Facts Label to communicate the amount of added sugars in manufactured food. The changes to the Nutrition Facts Label (NFL) is concurrent with some cities implementing policies that place an excise tax on sugar-sweetened beverages. While sugar-sweetened beverages taxes may be effective at changing quantity demanded, the updated NFL has the potential to shift the demand curve by decreasing friction and mental gaps associated with the communication of nutrition information. We conducted a randomized control trial using eye tracking technology to determine if the updated NFL garnered more visual attention or affected beverage choice. Participants were also exposed to an information intervention to determine if the updated NFL affected choice after receiving information about added sugars. We found that consumers were more visually attentive to nutrition information displayed by the updated NFL; however, viewing the updated label did not affect choice of beverages nor did it improve the effectiveness of the dietary information on subsequent choices.
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Affiliation(s)
- Zachary Neuhofer
- Department of Agricultural Economics, Purdue University, 403 West State Street, West Lafayette, IN 47907, United States
| | - Brandon R McFadden
- Department of Applied Economics and Statistics, University of Delaware, 531 S. College Avenue, Rm 224, Newark, DE 19716, United States.
| | - Alicia Rihn
- Food and Resource Economics Department, University of Florida, 2725 S. Binion Road, Apopka, FL 32703-8504, United States
| | - Xuan Wei
- Food and Resource Economics Department, University of Florida, 2725 S. Binion Road, Apopka, FL 32703-8504, United States
| | - Hayk Khachatryan
- Food and Resource Economics Department, University of Florida, 2725 S. Binion Road, Apopka, FL 32703-8504, United States
| | - Lisa House
- Food and Resource Economics Department, University of Florida, P.O. Box 110240, Gainesville, FL 32611-0240, United States
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Biener AI, Cawley J, Meyerhoefer C. The medical care costs of obesity and severe obesity in youth: An instrumental variables approach. HEALTH ECONOMICS 2020; 29:624-639. [PMID: 32090412 DOI: 10.1002/hec.4007] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
This paper is the first to use the method of instrumental variables to estimate the impact of obesity and severe obesity in youth. on U.S. medical care costs. We examine data from the Medical Expenditure Panel Survey for 2001-2015 and instrument for child BMI using the BMI of the child's biological mother. Instrumental variables estimates indicate that obesity in youth raises annual medical care costs by $907 (in 2015 dollars) or 92%, which is considerably higher than previous estimates of the association of youth obesity with medical costs. We find that obesity in youth significantly raises costs in all major categories of medical care: outpatient doctor visits, inpatient hospital stays, and prescription drugs. The costs of youth obesity are borne almost entirely by third-party payers, which is consistent with substantial externalities of youth obesity, which in turn represents an economic rationale for government intervention.
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Affiliation(s)
- Adam I Biener
- Department of Economics, Lafayette College, Easton, Pennsylvania, USA
| | - John Cawley
- Department of Policy Analysis and Management and Department of Economics, Cornell University, New York, USA
| | - Chad Meyerhoefer
- College of Business and Economics, Lehigh University, Bethlehem, Pennsylvania, USA
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Diaz S, Hite A, Plunkett BA, Elue R, Victorson D. An exploration of the diagnosis and treatment of obesity among integrative medicine health care providers. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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