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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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2
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Kocol D, Bäuerle A, Schadendorf T, Geiger S, Krakowczyk JB, Skoda EM, Teufel M. Efficacy of eHealth interventions to reduce depression symptoms in individuals with obesity: a systematic review of randomized controlled trials. Front Psychiatry 2024; 15:1296433. [PMID: 38516265 PMCID: PMC10954845 DOI: 10.3389/fpsyt.2024.1296433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Obesity and depression are inter-related health concerns, demanding a high level of treatment and costs in the health care system. The development of eHealth interventions that simultaneously address obesity and mental health can be supportive in this regard. However, evidence of the efficacy of eHealth interventions in the treatment of depression symptoms in individuals with obesity is lacking. The aim of this systematic literature review is to evaluate the efficacy of existing eHealth interventions for individuals with obesity that target depression symptoms. Methods We systematically searched electronic databases (Cochrane Library, PubMed, Scopus) to identify studies published in English between January 2016 and January 2023, that focused on eHealth interventions, targeting depression symptoms in individuals with obesity people. Exclusion criteria were study objectives that (1) focused specifically on one or more metabolic comorbidities of individuals with obesity, e.g., hypertension, hyperlipidemia, diabetes; (2) focused specifically on eating disorders comorbidities e.g., binge eating disorder, and (3) focused specifically on patients before or after bariatric surgery. Results The database search identified 214 records. Six articles were included in this review. Sample sizes ranged from 70 to 1267 participants of ages 18-60 years. All included studies were randomized controlled trials. Two of the six included studies were web-based interventions guided either by medical doctors or psychologists. All interventions included video, printed materials, and interactive parts of which two studies integrated elements of Cognitive Behavioural Therapy and Social Cognitive Therapy. The findings showed that eHealth treatment services, supported and guided throughout the intervention had high acceptance and efficacy in the reduction of depression symptoms among individuals with obesity. Conclusion EHealth interventions that address and target both mental and physical health with interactive strategies calls for better efficacy in the reduction of depression symptoms. Future eHealth interventions that target depression symptoms in individuals with obesity should integrate digital strategies that address both mental and physical health through interactive modules.
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Affiliation(s)
- Dilara Kocol
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Theresa Schadendorf
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Sheila Geiger
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Julia Barbara Krakowczyk
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
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Vesikansa A, Mehtälä J, Mutanen K, Lundqvist A, Laatikainen T, Ylisaukko-Oja T, Saukkonen T, Pietiläinen KH. Obesity and metabolic state are associated with increased healthcare resource and medication use and costs: a Finnish population-based study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:769-781. [PMID: 36063259 DOI: 10.1007/s10198-022-01507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/28/2022] [Indexed: 05/20/2023]
Abstract
AIM To characterize healthcare resource (HCRU) and medication use and associated costs in individuals with obesity compared with individuals with normal weight or overweight in a population-based cohort of Finnish adults. The association between metabolic state and direct costs was also assessed. METHODS The study cohort included 5587 randomly selected individuals who participated in the national FinHealth 2017 health examination survey. Data on healthcare visits and hospital stays, including diagnoses (ICD-10), and purchases and costs of prescription medicines were collected from the nationwide registers by the Finnish Institute for Health and Welfare and Social Insurance Institution of Finland. The healthcare costs were calculated based on standard unit costs reported by the Finnish Institute for Health and Welfare. RESULTS The total annual direct costs were €2665 (SD €5673) and €1799 (SD €3874) per person with obesity and with normal weight or overweight, respectively. Obesity was associated with significantly increased total direct (age- and sex-adjusted cost rate ratio, RR, 1.356; p < 0.001), HCRU-related (1.273; p = 0.002), and medication (1.669; p < 0.001) costs. A vast majority (90%) of individuals with obesity were classified as metabolically unhealthy based on clinical measurements. The metabolically unhealthy state was associated with increased costs in individuals with obesity but not in individuals with normal weight or overweight. CONCLUSION Obesity is associated with a significant and complex direct cost burden to society, arising primarily from increased comorbidity. Metabolically healthy obesity is uncommon and obesity prevention and timely treatment should be of high priority to tackle the increasing burden of obesity.
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Affiliation(s)
| | - Juha Mehtälä
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
| | | | | | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Tero Ylisaukko-Oja
- MedEngine Oy, Eteläranta 14, 00130, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - Kirsi H Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Obesity Center, Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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4
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Doukas SG, Doukas PG, Vageli DP, Broder A. Gastric cancer after Bariatric Bypass Surgery. Do they relate? (A Systematic Review). Obes Surg 2023; 33:1876-1888. [PMID: 37041375 DOI: 10.1007/s11695-023-06567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/18/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
Bariatric bypass surgery has been an effective treatment for morbid obesity. However, there is an increasing number of reported cases of gastric cancer after bypass surgery. Our systematic review showed an increasing trend of gastric cancer cases after bariatric bypass surgery in the last decade, mostly located in the excluded stomach (77%) and diagnosed in an advanced stage. In addition to known risk factors such as tobacco smoking (17%), H. pylori infection (6%), and family history of gastric cancer (3%), bile reflux, a recently proposed cancer-promoting factor, was also estimated in 18% of the cases. Our data suggest that gastric cancer risk assessment should be considered before gastric bypass surgery, and further investigations are needed to determine the value of post-operative gastric cancer surveillance.
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Affiliation(s)
- Sotirios G Doukas
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA.
| | - Panagiotis G Doukas
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Dimitra P Vageli
- Departmengt of Surgery, Yale University School of Medicine, New Haven, CT, 06510, USA
| | - Arkady Broder
- Department of Medicine, Division of Gastroenterology and Hepatology, Saint Peter's University Hospital/Rutgers-RWJ Medical School, 254 Easton Avenue, New Brunswick, NJ, 08901, USA
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Guerra Valencia J, Saavedra-Garcia L, Vera-Ponce VJ, Espinoza-Rojas R, Barengo NC. Factors Associated with Normal-Weight Abdominal Obesity Phenotype in a Representative Sample of the Peruvian Population: A 4-Year Pooled Cross-Sectional Study. J Clin Med 2023; 12:jcm12103482. [PMID: 37240588 DOI: 10.3390/jcm12103482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018-2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43-11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65-1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81-2.02); and 70 or older(aPR: 1.99; 95% CI 1.87-2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15-1.28); 2020 (aPR: 1.17; 95% CI 1.11-1.24); and 2021 (aPR: 1.12; 95% CI 1.06-1.18); living in Andean region (aPR: 0.91; 95% CI 0.86-0.95); wealth index poor (aPR: 1.26; 95% CI 1.18-1.35); middle (aPR: 1.17; 95% CI 1.08-1.26); rich (aPR: 1.26; 95% CI 1.17-1.36); and richest (aPR: 1.25; 95% CI 1.16-1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92-0.98); history of hypertension (aPR: 1.08; 95% CI 1.03-1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07-1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89-0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.
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Affiliation(s)
| | | | - Víctor Juan Vera-Ponce
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima 15039, Peru
- Facultad de Psicología, Universidad Tecnológica del Perú, Lima 15046, Peru
| | - Rubén Espinoza-Rojas
- Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima 15039, Peru
| | - Noel C Barengo
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
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Tentolouris A, Ntanasis-Stathopoulos I, Terpos E. Obesity and multiple myeloma: emerging mechanisms and perspectives. Semin Cancer Biol 2023; 92:45-60. [PMID: 37030643 DOI: 10.1016/j.semcancer.2023.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 04/08/2023]
Abstract
Obesity is a global pandemic that has been associated with the development of breast, endometrial, large intestine, renal, esophageal, and pancreatic cancer. Obesity is also involved in the development of cardiovascular disease and type 2 diabetes mellitus. Recently, an increase in the incidence of obesity-related cancers has been reported. Multiple myeloma (MM) is the second most common hematological malignancy, after lymphoma. The aim of this review is to examine the epidemiological data on obesity and MM, assess the effect of obesity on MM outcomes, evaluate the possible mechanisms through which obesity might increase the incidence of MM and provide the effects of obesity management on MM. Current evidence indicates that obesity may have an impact on the progression of monoclonal gammopathy of undetermined significance (MGUS) to MM and increase the prevalence of MM. However, data regarding the effect of obesity on MGUS incidence are controversial; further studies are needed to examine whether obesity affects the development of MGUS or the progression of MGUS to MM. In addition, obesity affects MM outcomes. Increased BMI is associated with decreased survival in patients with MM, while data regarding the effect of obesity on newly diagnosed MM subjects and autologous stem cell transplantation are limited. Interestingly, the obesity paradox may also apply to patients with relapsed/refractory MM who are overweight or obese, because they may have a survival advantage. The pathophysiological pathways linking obesity to MM are very complicated and include bone marrow adipose tissue; adipokines, such as adiponectin, leptin, resistin, and visfatin; inflammatory cytokines and growth factors, such as TNF-α and IL-6; hormones including insulin and the insulin-like growth factor system as well as sex hormones. In terms of the effect of pharmacological management of obesity, orlistat has been shown to alter the proliferation of MM cells, whereas no data exist on glucagon-like peptide-1 receptor agonists, naltrexone/bupropion, or phentermine/topiramate. Bariatric surgery may be associated with a reduction in the incidence of MM, however, further studies are needed.
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Marsall M, Engelmann G, Teufel M, Bäuerle A. Exploring the Applicability of General Dietary Recommendations for People Affected by Obesity. Nutrients 2023; 15:nu15071604. [PMID: 37049445 PMCID: PMC10097167 DOI: 10.3390/nu15071604] [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: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Obesity has emerged as a major public health challenge with increasing prevalence globally. The General Dietary Behavior Inventory (GDBI) was developed based on official dietary recommendations. However, little is known about whether general dietary recommendations also apply to people affected by obesity and whether the GDBI can be used appropriately. (2) A cross-sectional study was conducted. A total of 458 people meeting the inclusion criteria participated in the study. The assessment consisted of the GDBI and behavioral, dietary, and health-related variables. We used descriptive analysis to examine the item characteristics of the GDBI and inferential statistics to investigate the associations between the GDBI score and behavioral, dietary, and health-related outcomes. (3) Several items of the GDBI were concerned by ceiling effects. A higher GDBI score (indicating a higher adherence to dietary recommendations) was related to higher age, higher nutrition knowledge, more restrained eating behavior, lower impulsivity, and higher body mass index. There were no associations between the GDBI score and reported physical and mental health or quality of life. (4) The GDBI showed inconsistent relationships with the study outcomes. General dietary recommendations do not appear to be applicable to people with obesity. Hence, there is an urgent need for specific recommendations and subsequent assessments of behavioral adherence for people affected by obesity.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, 53127 Bonn, Germany
- Correspondence:
| | - Gerrit Engelmann
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-University Hospital Essen, 45147 Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, 45147 Essen, Germany
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Jeon J, Lee S, Oh C. Age-specific risk factors for the prediction of obesity using a machine learning approach. Front Public Health 2023; 10:998782. [PMID: 36733276 PMCID: PMC9887184 DOI: 10.3389/fpubh.2022.998782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/06/2022] [Indexed: 01/18/2023] Open
Abstract
Machine Learning is a powerful tool to discover hidden information and relationships in various data-driven research fields. Obesity is an extremely complex topic, involving biological, physiological, psychological, and environmental factors. One successful approach to the topic is machine learning frameworks, which can reveal complex and essential risk factors of obesity. Over the last two decades, the obese population (BMI of above 23) in Korea has grown. The purpose of this study is to identify risk factors that predict obesity using machine learning classifiers and identify the algorithm with the best accuracy among classifiers used for obesity prediction. This work will allow people to assess obesity risk from blood tests and blood pressure data based on the KNHANES, which used data constructed by the annual survey. Our data include a total of 21,100 participants (male 10,000 and female 11,100). We assess obesity prediction by utilizing six machine learning algorithms. We explore age- and gender-specific risk factors of obesity for adults (19-79 years old). Our results highlight the four most significant features in all age-gender groups for predicting obesity: triglycerides, ALT (SGPT), glycated hemoglobin, and uric acid. Our findings show that the risk factors for obesity are sensitive to age and gender under different machine learning algorithms. Performance is highest for the 19-39 age group of both genders, with over 70% accuracy and AUC, while the 60-79 age group shows around 65% accuracy and AUC. For the 40-59 age groups, the proposed algorithm achieved over 70% in AUC, but for the female participants, it achieved lower than 70% accuracy. For all classifiers and age groups, there is no big difference in the accuracy ratio when the number of features is more than six; however, the accuracy ratio decreased in the female 19-39 age group.
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Affiliation(s)
- Junhwi Jeon
- Department of Applied Mathematics, Kyung Hee University, Yongin, South Korea
| | - Sunmi Lee
- Department of Applied Mathematics, Kyung Hee University, Yongin, South Korea
| | - Chunyoung Oh
- Department of Mathematics Education, Chonnam National University, Gwangju, South Korea,*Correspondence: Chunyoung Oh ✉
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Destri K, Alves J, Gregório MJ, Dias SS, Henriques AR, Mendonça N, Canhão H, Rodrigues AM. Obesity- attributable costs of absenteeism among working adults in Portugal. BMC Public Health 2022; 22:978. [PMID: 35568836 PMCID: PMC9107744 DOI: 10.1186/s12889-022-13337-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal. Methods The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition. Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach. Results The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year. Conclusion Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13337-z.
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Affiliation(s)
- Kelli Destri
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal. .,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Joana Alves
- Comprehensive Health Research Center (CHRC), NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Programa Nacional Para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisbon, Portugal.,Faculdade de Ciências da Nutrição E Alimentação, Universidade Do Porto, Porto, Portugal
| | - Sara Simões Dias
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Center for Innovative Care and Health Technology, CiTechCare, Instituto Politécnico de Leiria/Escola Superior de Saúde, Leiria, Portugal
| | - Ana Rita Henriques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nuno Mendonça
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,National School of Public Health, UNL, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Hospital Dos Lusíadas, Lisboa, Portugal
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10
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Edwards CH, Vie GÅ, Kinge JM. Body mass index and healthcare costs: using genetic variants from the HUNT study as instrumental variables. BMC Health Serv Res 2022; 22:396. [PMID: 35337320 PMCID: PMC8957125 DOI: 10.1186/s12913-022-07597-z] [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: 07/09/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background Past studies have found associations between obesity and healthcare costs, however, these studies have suffered from bias due to omitted variables, reverse causality, and measurement error. Methods We used genetic variants related to body mass index (BMI) as instruments for BMI; thereby exploiting the natural randomization of genetic variants that occurs at conception. We used data on measured height and weight, genetic information, and sociodemographic factors from the Nord-Trøndelag Health Studies (HUNT), and individual-level registry data on healthcare costs, educational level, registration status, and biological relatives. We studied associations between BMI and general practitioner (GP)-, specialist-, and total healthcare costs in the Norwegian setting using instrumental variable (IV) regressions, and compared our findings with effect estimates from ordinary least squares (OLS) regressions. The sensitivity of our findings to underlying IV-assumptions was explored using two-sample Mendelian randomization methods, non-linear analyses, sex-, healthcare provider-, and age-specific analyses, within-family analyses, and outlier removal. We also conducted power calculations to assess the likelihood of detecting an effect given our sample 60,786 individuals. Results We found that increased BMI resulted in significantly higher GP costs; however, the IV-based effect estimate was smaller than the OLS-based estimate. We found no evidence of an association between BMI and specialist or total healthcare costs. Conclusions Elevated BMI leads to higher GP costs, and more studies are needed to understand the causal mechanisms between BMI and specialist costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07597-z.
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Affiliation(s)
- Christina Hansen Edwards
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. .,Centre for Fertility and Health & Centre for Disease Burden, Norwegian Institute of Public Health, Oslo, Norway.
| | - Gunnhild Åberge Vie
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jonas Minet Kinge
- Centre for Fertility and Health & Centre for Disease Burden, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Effects of weight change on all causes, digestive system and other causes mortality in Southern Italy: a competing risk approach. Int J Obes (Lond) 2022; 46:113-120. [PMID: 34522001 DOI: 10.1038/s41366-021-00954-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
Weight change is associated with all causes of death, cardiovascular, and cancer mortality and a heterogeneous group of other causes of death. We aimed to estimate the effect of weight change on all causes and cause-specific mortality in a cohort with a high prevalence of deaths due to diseases of the digestive system.MethodsIn this prospective cohort study, 2230 subjects aged 30 to 50 years were examined. The study consisted of a 32-year longitudinal study period (January 1985 to December 2017) and mortality follow-up. Outcomes were mortality from all causes and deaths from gastrointestinal disease. Root Mean Squared Error (RMSE) was evaluated to capture individual residual variation in Body Mass Index (BMI) after adjustment for baseline BMI, and the relationship of residual variation with mortality was calculated as cumulative incidence function and cause-specific hazard (CSH) rate.ResultsIn total, 793 participants died during the follow-up, 96 of them due to Digestive system causes. Magnitude of residual variation weight in the last quintile was associated with all-cause mortality (relative risk, 2.00; 95% CI, 1.54-2.59) and Digestive system causes (relative risk, 3.82; 95% CI, 1.86-7.81).ConclusionThe findings suggest an association between weight change and gastrointestinal disease mortality. Epidemiological works studying the correlation between weight change and mortality should consider this aspect.
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Costa A, Konieczna J, Reynés B, Martín M, Fiol M, Palou A, Romaguera D, Oliver P. CUN-BAE Index as a Screening Tool to Identify Increased Metabolic Risk in Apparently Healthy Normal-Weight Adults and Those with Obesity. J Nutr 2021; 151:2215-2225. [PMID: 33978191 DOI: 10.1093/jn/nxab117] [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] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Imbalanced dietary intake is related to increased adiposity, which is linked to increased metabolic risk even in the absence of obesity. BMI is traditionally used to classify body fatness and weight range, but it only considers body weight and height. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) equation has appeared as an additional tool to estimate adiposity considering also other relevant parameters, i.e., sex and age. OBJECTIVES We aimed to determine whether the CUN-BAE index could estimate adiposity-related metabolic risk in apparently healthy, normoglycemic adults. METHODS In this case-control study, men and women (18-45 y old) were classified as normal-weight (NW) [n = 20; BMI (in kg/m2) <25] or overweight-obese (OW-OB) (n = 34; BMI ≥25). The primary outcome was body fat content and clinical circulating parameters to assess by correlation analysis CUN-BAE's usefulness as a predictor of metabolic risk. In addition, transcriptomic biomarkers of lipid metabolism were analyzed in peripheral blood mononuclear cells (PBMCs) as secondary outcome indicators of metabolic impairment. Data were analyzed by correlation analysis and comparison of means. RESULTS CUN-BAE values correlated directly with body fatness obtained by DXA (r = 0.89, P < 0.01), with classical molecular biomarkers of metabolic risk, and with PBMC gene expression of carnitine palmitoyltransferase 1A (CPT1A), sterol regulatory element binding transcription factor 1c (SREBP-1c), and fatty acid synthase (FASN), early markers of metabolic impairment (P < 0.05). Moreover, CUN-BAE allowed identification of NW individuals with excessive body fatness, who were not yet presenting obesity-related molecular alterations. In these subjects, visceral fat correlated directly with circulating glucose, triglycerides, and total and LDL cholesterol, and with triglyceride-glucose and fatty liver indexes (P < 0.05). This is indicative of a metabolically obese NW phenotype. CONCLUSIONS Data obtained in our cohort of young normoglycemic volunteers support the use of the CUN-BAE index as a tool to estimate accurately body fat mass, but also as a first easy/effective screening tool to identify lean people with increased fat mass and increased metabolic risk.This trial was registered at clinicaltrials.gov as NCT04402697.
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Affiliation(s)
- Andrea Costa
- Nutrigenomics and Obesity Group, University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Jadwiga Konieczna
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), University Hospital Son Espases (HUSE), Palma, Spain
| | - Bàrbara Reynés
- Nutrigenomics and Obesity Group, University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Marian Martín
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), University Hospital Son Espases (HUSE), Palma, Spain
| | - Miquel Fiol
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), University Hospital Son Espases (HUSE), Palma, Spain
| | - Andreu Palou
- Nutrigenomics and Obesity Group, University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Dora Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain.,Research Group on Nutritional Epidemiology & Cardiovascular Physiopathology (NUTRECOR), University Hospital Son Espases (HUSE), Palma, Spain
| | - Paula Oliver
- Nutrigenomics and Obesity Group, University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
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Obesity as the 21st Century's major disease: The role of probiotics and prebiotics in prevention and treatment. FOOD BIOSCI 2021. [DOI: 10.1016/j.fbio.2021.101115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Nuijten M, Dainelli L, Rasouli B, Araujo Torres K, Perugini M, Marczewska A. A Meal Replacement Program for the Treatment of Obesity: A Cost-Effectiveness Analysis from the Swiss Payer's Perspective. Diabetes Metab Syndr Obes 2021; 14:3147-3160. [PMID: 34267531 PMCID: PMC8275158 DOI: 10.2147/dmso.s284855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/04/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Obesity is a disease associated with high direct medical costs and high indirect costs resulting from productivity loss. The high prevalence of obesity generates the need for payers to identify cost-effective weight loss approaches. Among various weight management techniques, the OPTI (Optifast®) program is a clinically recognised total meal replacement diet that can lead to significant weight loss and reduction in complications. This study's objective is to assess OPTI program's cost-effectiveness in Switzerland in comparison to "no intervention" and pharmacotherapy. METHODS An event-driven decision-analytic model was used to estimate the payer's cost savings through the reimbursement of OPTI program over a 1-year period as well as a lifetime in Switzerland. The analysis was performed on a broad population of people with obesity with a body mass index (BMI) higher than 30 kg/m2 following the OPTI program vs two comparators (liraglutide and "no intervention"). The model incorporated a higher risk of complications due to an increased BMI and their related healthcare costs. Data sources included published literature, clinical trials, official Swiss price/tariff lists and national population statistics. The primary perspective was that of a Swiss payer. Scenario analyses - for example, for patients with existing complications (such as myocardial infarction, stroke, type 2 diabetes mellitus) or severe obesity - were conducted to test the robustness of the results. RESULTS The OPTI program results in cost savings of CHF 20,886 (€ 18,724) and CHF 15,382 (€ 13,790) per person compared with "no intervention" and liraglutide 3 mg, respectively. In addition, OPTI program led to 1.133 and 0.734 quality-adjusted life years (QALYs) gained respectively against its comparators. Scenario analyses showed similar outcomes with cost savings and QALYs gained. CONCLUSION OPTI program is a dominant strategy compared to "no intervention" and liraglutide 3 mg as it leads to both cost savings and QALY gain. Therefore, reimbursing the OPTI program for patients with obesity would be cost-effective for Swiss payers.
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Affiliation(s)
- Mark Nuijten
- Health Economics and Valuation, A2M, Amsterdam, the Netherlands
| | - Livia Dainelli
- Global Market Access & Pricing, Nestlé Health Science, Vevey, Switzerland
| | - Bahareh Rasouli
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Moreno Perugini
- Commercial and Medical Affairs, Pharmaceuticals, Nestlé Health Science, Bridgewater, MA, USA
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Johnson E, Millar SR, Shiely F. The association between BMI self-selection, self-reported BMI and objectively measured BMI. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13252.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: It is challenging to measure BMI accurately in population studies because it is an expensive and time-consuming task. As a result, subjectively measured BMI, calculated from self-reported height and weight, which we know to be inaccurate, is often used. The purpose of this study is to determine whether using a different, subjective method of measuring BMI, BMI self-selection, would be more accurate. BMI self-selection is determined by asking participants to place themselves in one of the BMI categories, underweight, normal weight, overweight or obese. Methods: A quantitative survey conducted in the outpatient departments of two hospitals in the South West of Ireland. Participants >18 years were included. Pregnant women were excluded. The final sample included 70 participants. Survey completion, including self-reported height and weight and BMI self-selection, preceded the objectively measured weight and height. Demographic and lifestyle factors were also recorded. Results: 59% of the sample were overweight or obese –63% of females and 54% of males. The sensitivity for correct BMI self-selection for normal weight, overweight and obese categories was 90%, 36% and 33% respectively. The sensitivity for BMI categories calculated from self-reported height and weight was 83%, 57% and 59% respectively. In analysis, age, regular alcohol consumption, unhealthy diet and lower levels of physical activity were all associated with underestimation of BMI. Conclusion: BMI self-selection is an accurate tool when used with normal weight individuals but shows poorer ability to demonstrate accurate measurement in overweight and obese BMI categories. It is inferior to the traditional self-reported BMI method for measuring BMI levels in the general population. Presently, we recommend continuing with self-reported BMI for BMI measurement in large population studies. However, further testing of BMI classification in larger studies is suggested and investigation into alternative objective methods of measurement is warranted.
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Gong W, Li H, Song C, Yuan F, Ma Y, Chen Z, Wang R, Fang H, Liu A. Effects of Gene-Environment Interaction on Obesity among Chinese Adults Born in the Early 1960s. Genes (Basel) 2021; 12:genes12020270. [PMID: 33668547 PMCID: PMC7918169 DOI: 10.3390/genes12020270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 01/21/2023] Open
Abstract
The prevalence of obesity has been increasing sharply and has become a serious public health problem worldwide. Gene–environment interaction in obesity is a relatively new field, and little is known about it in Chinese adults. This study aimed to provide the effects of gene–environment interaction on obesity among Chinese adults. A stratified multistage cluster sampling method was conducted to recruit participants from 150 surveillance sites. Subjects born in 1960, 1961 and 1963 were selected. An exploratory factor analysis was used to classify the environmental factors. The interaction of single nucleotide polymorphisms (SNPs) and environmental factors on body mass index (BMI) and waist circumference were analyzed using a general linear model. A multiple logistic regression model combined with an additive model was performed to analyze the interaction between SNPs and environmental factors in obesity and central obesity. A total of 2216 subjects were included in the study (mean age, 49.7 years; male, 39.7%, female, 60.3%). Engaging in physical activity (PA) could reduce the effect of MC4R rs12970134 on BMI (β = −0.16kg/m2, p = 0.030), and also reduce the effect of TRHR rs7832552 and BCL2 rs12454712 on waist circumference (WC). Sedentary behaviors increased the effects of SNPs on BMI and WC, and simultaneously increased the effects of FTO rs9939609 and FTO rs8050136 on obesity and central obesity. A higher socioeconomic status aggravated the influence of SNPs (including FTO rs9939609, BNDF rs11030104, etc.) on BMI and WC, and aggravated the influence of SEC16B rs574367 on central obesity. The MC4R rs12970134 association with BMI and the FTO rs8050136 association with central obesity appeared to be more pronounced with higher energy intake (β = 0.140 kg/m2, p = 0.049; OR = 1.77, p = 0.004, respectively). Engaging in PA could reduce the effects of SNPs on BMI and WC; nevertheless, a higher socioeconomic status, higher dietary energy intake and sedentary behaviors accentuated the influences of SNPs on BMI, WC, obesity and central obesity. Preventative measures for obesity should consider addressing the gene–environment interaction.
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Impact of dietary and lifestyle interventions in elderly or people diagnosed with diabetes, metabolic disorders, cardiovascular disease, cancer and micronutrient deficiency on micronuclei frequency - A systematic review and meta-analysis. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2021; 787:108367. [PMID: 34083034 DOI: 10.1016/j.mrrev.2021.108367] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 01/29/2023]
Abstract
Chronic diseases such as cardiovascular diseases, type 2 diabetes or cancer are the global leading cause of mortality. Lifestyle interventions are most effective in reducing metabolic risk factors, disease progression or even side effects of a disease. They are also contributing to decelerate the aging process. Genome instability is very often associated with aging or the above-mentioned diseases, and triggered by inflammation and oxidative stress. An established method to measure chromosomal damage is the cytokinesis block micronucleus (CBMN) cytome assay. The aim of this review and meta-analysis is to collect and analyse the current literature regarding the effects of a lifestyle based (dietary) intervention on changes of micronuclei (MNi), nucleoplasmic bridges (NPBs) and nuclear buds (NBUDs) in elderly subjects or people diagnosed with diabetes, metabolic disorders, cardiovascular disease, cancer or micronutrient deficiency. Although the main important diseases were considered as well as the large topic of aging, the number and methodological quality in terms of samples size, duration and rationale of the intervention or an inclusion of a control group of available intervention studies with these backgrounds was low. Most of the studies used antioxidant vitamins or folate, few investigated the whole diet. Only one study showed a physical activity intervention approach. The interventions did not lead to decreased genomic marker despite a few cancer related studies, where particularly MN frequency in mucosa lesions and leukoplakia was reduced by green tea and antioxidants. The performed meta-analysis of the available RCTs did not show a significant reduction of MNi, NBUDs or NPBs of most of the interventions performed, except for green tea. Data show in general a lack of an appropriate number of sound lifestyle based intervention studies linking cytogenetic damage and chronic diseases.
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Asahara SI, Miura H, Ogawa W, Tamori Y. Sex difference in the association of obesity with personal or social background among urban residents in Japan. PLoS One 2020; 15:e0242105. [PMID: 33237961 PMCID: PMC7688126 DOI: 10.1371/journal.pone.0242105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
The development of obesity is influenced by genetic and environmental factors and is associated with a variety of health problems. To gain insight into environmental factors that contribute to obesity, we analyzed the relation of personal or social background to obesity in men and women separately with the use of data from a community-based questionnaire survey of 5425 residents aged 20 to 64 years of Kobe, a representative large city in Japan. Obesity and normal weight were defined as a body mass index (BMI) of ≥25 and of ≥ 18.5 and < 25 kg/m2, respectively, according to the diagnostic criteria of the Japan Society for the Study of Obesity. The personal or social background factors examined included marital status, family structure, employment, household income, residence type, welfare enrollment, economic conditions of current life, educational level, extracurricular activity in school, living conditions at 15 years of age, and childhood adversity. We found that the prevalence of obesity was 27.2% and 10.6% in men and women, respectively. Among women, unmarried status, a low household income, welfare enrollment, difficult current economic conditions, a low educational level, and childhood adversity were associated with obesity, whereas none of the personal or social background factors examined were associated with obesity in men. Our results suggest that the development of obesity in women is strongly influenced by personal or social background, and such factors should be taken into consideration in the management of this condition in women.
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Affiliation(s)
- Shun-ichiro Asahara
- Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Miura
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshikazu Tamori
- Division of Creative Health Promotion, Department of Social/Community Medicine and Health Science, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Franzke B, Schwingshackl L, Wagner KH. Chromosomal damage measured by the cytokinesis block micronucleus cytome assay in diabetes and obesity - A systematic review and meta-analysis. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2020; 786:108343. [DOI: 10.1016/j.mrrev.2020.108343] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/18/2020] [Accepted: 10/23/2020] [Indexed: 12/11/2022]
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Correa-Rodríguez M, Luis Gómez-Urquiza J, Medina-Martínez I, González-Jiménez E, Schmidt-RioValle J, Rueda-Medina B. Low intakes of vitamins C and A are associated with obesity in early adulthood. INT J VITAM NUTR RES 2020; 92:204-213. [PMID: 32646290 DOI: 10.1024/0300-9831/a000661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
To evaluate the relationships between the intake of individual antioxidants as well as the dietary antioxidant quality score and obesity-related measures. A cross-sectional study was conducted on 562 young adults. Fat mass, fat-mass percentage, and fat-free mass were measured using a body composition analyzer. The intake of antioxidant nutrients including vitamins C, E, and A, selenium, zinc, and magnesium were calculated based on a 72-hour diet recall interview. We observed significant differences in the vitamin C (88.6 ± 72.6 mg/day vs. 70.7 ± 60.6 mg/day, p = 0.010), vitamin A (635.8 ± 519.8 μg/day vs. 492.6 ± 318.9 μg/day, p = 0.014), and selenium (135.3 ± 88.7 μg/day vs. 139.3 ± 79.3 μg/day, p = 0.034) intake between normal-weight and overweight or obese young adults. When the Dietary Antioxidant Quality Score (DAQS) was analyzed, there were no significant differences between normal-weight versus overweight or obese young adults after adjusting for confounders. Logistic regression analysis revealed that vitamin C intake (odds ratio (OR) 0.995, 95% CI 0.992-0.999, p = 0.013) and vitamin A intake (OR 0.999, 95% CI 0.999-1.000, p = 0.016) were independent predictors of overweight/obesity after adjusting for age, sex and energy intake. In contrast, a higher selenium intake was associated with an increased risk of overweight/obesity (OR 1.003, 95% CI 1.000-1.006, p = 0.034). Future longitudinal investigations of dietary antioxidant intake in relation to the development of obesity would be of interest to better understand the effect of dietary antioxidants on obesity.
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Matthews GDK, Grace AA. Unmasking Adenosine: The Purinergic Signalling Molecule Critical to Arrhythmia Pathophysiology and Management. Arrhythm Electrophysiol Rev 2020; 8:240-248. [PMID: 32685154 PMCID: PMC7358948 DOI: 10.15420/aer.2019.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Adenosine was identified in 1929 and immediately recognised as having a potential role in therapy for arrhythmia because of its negative chronotropic and dromotropic effects. Adenosine entered mainstream use in the 1980s as a highly effective agent for the termination of supraventricular tachycardia (SVT) involving the atrioventricular node, as well as for its ability to unmask the underlying rhythm in other SVTs. Adenosine has subsequently been found to have applications in interventional electrophysiology. While considered a safe agent because of its short half-life, adenosine may provoke arrhythmias in the form of AF, bradyarrhythmia and ventricular tachyarrhythmia. Adenosine is also associated with bronchospasm, although this may reflect irritant-induced dyspnoea rather than true obstruction. Adenosine is linked to numerous pathologies relevant to arrhythmia predisposition, including heart failure, obesity, ischaemia and the ageing process itself. This article examines 90 years of experience with adenosine in the light of new European Society of Cardiology guidelines for the management of SVT.
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Affiliation(s)
- Gareth DK Matthews
- Cambridge University NHS Foundation Trust, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Andrew A Grace
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Department of Biochemistry, University of Cambridge, Cambridge, UK
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Diniz-Sousa F, Veras L, Ribeiro JC, Boppre G, Devezas V, Santos-Sousa H, Preto J, Machado L, Vilas-Boas JP, Oliveira J, Fonseca H. Accelerometry calibration in people with class II-III obesity: Energy expenditure prediction and physical activity intensity identification. Gait Posture 2020; 76:104-109. [PMID: 31756665 DOI: 10.1016/j.gaitpost.2019.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/19/2019] [Accepted: 11/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Almost all accelerometer calibration studies were developed for non-obese people, which hampers an accurate prediction of energy expenditure (EE) and induces a misclassification of sedentary activity (SA) and physical activity intensities (PAI) in class II-III obese people. RESEARCH QUESTION The purpose of this study was to develop regression equations to predict EE and cut-points to classify SA and PAI in severe obese people based on several metrics obtained from hip and back accelerometer placement data. METHODS 43 class II-III obese participants performed a protocol that included sitting and standing positions and walking at several speeds. During the protocol participants wore an accelerometer at hip and back, and respiratory gas exchange was measured by indirect calorimetry. Accelerometer metrics analyzed were: activity counts, mean amplitude deviation and euclidean norm minus one. EE was predicted through linear mixed models while cut-points to classify SA and PAI were obtained applying receiver operating characteristic curves. Leave-one-out cross-validation data was used to calculate Bland-Altman plots, prediction accuracy, Kappa statistic and percent agreement. RESULTS All prediction models presented a quadratic equation that had as predictors body mass and one of the accelerometer metrics. Predicted EE indicated a good agreement and a root mean square error below 1.02 kcal min-1. Global classification agreement from developed cut-points was categorized as almost perfect with a percent agreement above 84 %. Prediction accuracy and classification agreement were similar among accelerometer metrics in each position and between them in hip and back placement. SIGNIFICANCE Hip and back accelerometer data collected in severe obese people allow to accurately estimate EE and to correctly classify SA and PAI. These results enable future studies to adopt appropriate regression equations and cut-points developed for class II-III obese people rather than those established for non-obese people.
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Affiliation(s)
- Florêncio Diniz-Sousa
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.
| | - Lucas Veras
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - José Carlos Ribeiro
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Giorjines Boppre
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Vítor Devezas
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - Hugo Santos-Sousa
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - John Preto
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - Leandro Machado
- Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal; Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - João Paulo Vilas-Boas
- Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal; Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - José Oliveira
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
| | - Hélder Fonseca
- Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; General Surgery Department, São João Medical Center, Porto, Portugal
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Naimo GD, Gelsomino L, Catalano S, Mauro L, Andò S. Interfering Role of ERα on Adiponectin Action in Breast Cancer. Front Endocrinol (Lausanne) 2020; 11:66. [PMID: 32132979 PMCID: PMC7041409 DOI: 10.3389/fendo.2020.00066] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Obesity is characterized by an excess of adipose tissue, due to adipocyte hypertrophy and hyperplasia. Adipose tissue is an endocrine organ producing many bioactive molecules, called adipokines. During obesity, dysfunctional adipocytes alter adipokine secretion, contributing to pathophysiology of obesity-associated diseases, including metabolic syndrome, type 2-diabetes, cardiovascular diseases and many types of malignancies. Circulating adiponectin levels are inversely correlated with BMI, thus adiponectin concentrations are lower in obese than normal-weight subjects. Many clinical investigations highlight that low adiponectin levels represent a serious risk factor in breast carcinogenesis, and are associated with the development of more aggressive phenotype. A large-scale meta-analysis suggests that BMI was positively associated with breast cancer mortality in women with ERα-positive disease, regardless menopausal status. This suggests the importance of estrogen signaling contribution in breast tumorigenesis of obese patients. It has been largely demonstrated that adiponectin exerts a protective role in ERα-negative cells, promoting anti-proliferative and pro-apoptotic effects, while controversial data have been reported in ERα-positive cells. Indeed, emerging data provide evidences that adiponectin in obese patients behave as growth factor in ERα-positive breast cancer cells. This addresses how ERα signaling interference may enhance the potential inhibitory threshold of adiponectin in ERα-positive cells. Thus, we may reasonably speculate that the relatively low adiponectin concentrations could be still not adequate to elicit, in ERα-positive breast cancer cells, the same inhibitory effects observed in ERα-negative cells. In the present review we will focus on the molecular mechanisms through which adiponectin affects breast cancer cell behavior in relationship to ERα expression.
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Affiliation(s)
- Giuseppina Daniela Naimo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata, Italy
| | - Luca Gelsomino
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata, Italy
| | - Stefania Catalano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata, Italy
| | - Loredana Mauro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata, Italy
- *Correspondence: Loredana Mauro
| | - Sebastiano Andò
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata, Italy
- Health Center, University of Calabria, Arcavacata, Italy
- Sebastiano Andò
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The Role of Diet and Weight Loss in Improving Secondary Hypogonadism in Men with Obesity with or without Type 2 Diabetes Mellitus. Nutrients 2019; 11:nu11122975. [PMID: 31817436 PMCID: PMC6950423 DOI: 10.3390/nu11122975] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022] Open
Abstract
Despite growing recognition of the issue, obesity represents one of the most common public health problems, and its rates are still increasing globally. Among the number of comorbidities and complications associated with obesity, hypogonadism is listed, and this disorder, although frequently neglected, is characterized by a relevant impact on both quality of life and life expectancy. It is generally accepted that hypogonadism secondary to obesity is functional since it is reversible following weight loss. This review summarizes all current research examining the bidirectional relationship between excess body weight and low testosterone levels. Specifically, it evaluates the role that diet, with or without physical activity, plays in improving body weight and hypogonadism in adult and elderly men with obesity, with or without type 2 diabetes mellitus.
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Vieira M, Carvalho GS. Costs and benefits of a school-based health intervention in Portugal. Health Promot Int 2019; 34:1141-1148. [PMID: 30339196 DOI: 10.1093/heapro/day085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
School-based programmes for preventing childhood obesity have been shown to be effective in improving eating habits and nutritional status, but few intervention programmes with a controlled design have included an economic evaluation. In this study, we conducted a cost-consequence analysis to evaluate the costs and the health benefits of the 'Planning Health in School' programme (PHS-pro) implemented in the Northern region of Portugal to 449 children of 10-14 years old. Previous study has showed that after PHS-pro, several anthropometric measures significantly improved in the intervention group (height, waist circumference and waist-height ratio) compared with the control group, followed by significant improvements on soft drinks, fruit and vegetables daily consumptions. Costs were estimated according the two phases of the programme: designing and preparation of schools, and school setting implementation, and included all the direct costs on human and material resources. PHS-pro total costs were estimated as 7915.53€/year with an intervention cost of 36.14€/year/child attending the programme. This is much lower than the direct costs for treating an obese adult in Portugal, which was calculated as 3849.15€/year. A scale-up costing projection for implementing the PHS-pro to a larger young population was estimated to be even lower: 18.18€/year/child. This cost-consequence analysis provided evidence that the PHS-pro was economically feasible especially if compared with the medical costs for treating adult obesity. The PHS-pro can be a beneficial investment and may give a promising contribution to addressing overweight over childhood and adolescence, which are developmental stages that determine adulthood chronic diseases.
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Affiliation(s)
- Margarida Vieira
- Research Centre on Child Studies, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
| | - Graça S Carvalho
- Research Centre on Child Studies, University of Minho, Campus Gualtar, Braga 4710-057, Portugal
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Riedel N, Laubner K, Lautenbach A, Schön G, Schlensak M, Stengel R, Eberl T, Dederichs F, Aberle J, Seufert J. Trends in BMI, Glycemic Control and Obesity-Associated Comorbidities After Explantation of the Duodenal-Jejunal Bypass Liner (DJBL). Obes Surg 2019; 28:2187-2196. [PMID: 29504053 DOI: 10.1007/s11695-018-3144-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A novel-approach for treatment of obesity and diabetes mellitus type 2 (T2DM) is represented by the endoscopic duodenal-jejunal bypass liner (DJBL). Recent data from the German DJBL registry provide evidence for substantial efficacy of the DJBL during the implantation period in obese patients with T2DM. However, little is known about the trends of glycemic control, BMI, and comorbidities after explantation of the DJBL, which have been investigated in the registry in this report. METHODS Patients were selected from the registry if they had a dataset at implantation, explantation, and at least one time point after explantation of the DJBL (n = 77). We also investigated a subgroup of patients with available data at least 1 year (-2 weeks) after explantation of the DJBL (n = 32). RESULTS For a mean BMI at implantation and a mean follow-up period, an increase of BMI of 2.1 kg/m2 (CI 0.8-3.2; p = 0.013) had to be expected (for HbA1c 0.3% (CI - 0.0-0.7; p = n.s.), respectively). In the subgroup analysis, HbA1c and BMI increased after explantation of the DJBL but stayed significantly below baseline levels. Meanwhile, the mean number of antidiabetic drugs slightly increased. There was deterioration seen for blood pressure and LDL cholesterol over the postexplantation period to approximately baseline levels (or higher). CONCLUSION With this data, we show that improvement of HbA1c and BMI can be partly maintained over a time of nearly 1-year postexplantation of the DJBL. However, for HbA1c, this may be biased by intensified medical treatment and effects deteriorated with time after explantation. These results suggest that implantation of the DJBL needs to be integrated in a long-term weight management program as most of other interventions in obese patients with T2DM. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02731859.
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Affiliation(s)
- Nina Riedel
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Anne Lautenbach
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Schlensak
- Department of Surgery, Schön Klinik Düsseldorf SE & Co. KG, Düsseldorf, Germany
| | | | | | - Frank Dederichs
- Department of Internal Medicine/Gastroenterology, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
- Department of Internal Medicine/Gastroenterology, Kath, Kliniken Hagen, Hagen, Germany
| | - Jens Aberle
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
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Larg A, Moss JR, Spurrier N. Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia. AUST HEALTH REV 2019; 43:148-156. [PMID: 29467071 DOI: 10.1071/ah17147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
Objective Arguments to fund obesity prevention have often focused on the growing hospital costs of associated diseases. However, the relative contribution of overweight and obesity to public hospital expenditure growth is not well understood. This paper examines the effect of overweight and obesity on acute public hospital in-patient expenditure in South Australia over time compared with other expenditure drivers. Methods Annual inflation-adjusted acute public admitted expenditure attributable to a high body mass index was estimated for 2007-08 and 2011-12 and compared with other expenditure drivers. Results Expenditure attributable to overweight and obesity increased by A$45million, from 4.7% to 5.4% of total acute public in-patient expenditure. This increase accounted for 7.8% of the A$583million total expenditure growth, whereas the largest component of total growth (62.4%) was a real increase in the average cost per separation. Conclusions The relatively minor contribution of overweight and obesity to expenditure growth over the time period examined invites reflection on arguments to boost preventive spending that centre upon reducing hospital costs. These arguments may inadvertently detract attention from the considerable health and social burdens of overweight and obesity and from unrelated sources of expenditure growth that reduce opportunities for state governments to fund obesity prevention programs despite their comparative benefits to population health. What is known about the topic? Stand-alone estimates suggest that overweight and obesity are placing a considerable financial burden on the Australian public healthcare system. What does this paper add? Our findings challenge common perceptions about the relative importance of overweight and obesity in the context of rising public in-patient expenditure in Australia. What are the implications for practitioners? Consistent serial estimates of overweight- and obesity-attributable expenditure enable its tracking and comparison with other potentially controllable expenditure drivers that may also warrant attention. Explicit consideration of population health trade-offs in expenditure-related decisions, including in enterprise bargaining, would enhance transparency in priority setting.
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Affiliation(s)
- Allison Larg
- Central Adelaide Local Health Network, Royal Adelaide Hospital, 130/136 North Terrace, Adelaide, SA 5000, Australia
| | - John R Moss
- The University of Adelaide, School of Public Health, North Terrace, Adelaide, SA 5000, Australia. Email
| | - Nicola Spurrier
- Public Health Services, SA Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia. Email
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López-Galán B, de-Magistris T. Testing Emotional Eating Style in Relation to Willingness to Pay for Nutritional Claims. Nutrients 2019; 11:nu11081773. [PMID: 31374898 PMCID: PMC6723849 DOI: 10.3390/nu11081773] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022] Open
Abstract
In face of the high prevalence of non-communicable diseases, nutritional claims represent a useful tool to help people to make healthier food choices. However, recent research notes that when some people experience an intense emotional state, they increase their food consumption, particularly of energy-dense and sweet foods. In consequence, this study aims to assess whether emotional eating (EE) style influences the purchase of food products carrying these claims. To this end, a real choice experiment (RCE) was conducted with 306 participants who were asked to evaluate different types of toast. An error component random parameter logit (ECRPL) was used to analyze their preferences for reduced-fat and low-salt claims toast and the effects of the variation of the EE score on individual preferences. Findings of this study suggest that emotional eating negatively impacts purchasing behavior related to nutritional claims. In particular, a decrease of the willingness to pay between 9% and 16% for every unit of toast with nutritional claims was noted when an increase of EE individual score was registered. In this regard, to increase the effectiveness of the nutritional claims, policymakers and private sectors should consider the management of individuals’ emotional states in designing public health policies and marketing strategies, respectively.
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Affiliation(s)
- Belinda López-Galán
- Centro de Investigación y Tecnología Agroalimentaria de Aragón (CITA), Unidad de Economía Agroalimentaria y de los Recursos Naturales, Saragossa 50013, Spain
| | - Tiziana de-Magistris
- Centro de Investigación y Tecnología Agroalimentaria de Aragón (CITA), Unidad de Economía Agroalimentaria y de los Recursos Naturales, Saragossa 50013, Spain.
- Instituto Agroalimentario de Aragón (IA2), CITA-Universidad de Zaragoza, Saragossa 50059, Spain.
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Holman H, Dey S, Drobish I, Aquino L, Davis AT, Koehler TJ, Malouin R. Obesity education in the family medicine clerkship: a US and Canadian survey of clerkship directors' beliefs, barriers, and curriculum content. BMC MEDICAL EDUCATION 2019; 19:169. [PMID: 31133020 PMCID: PMC6537396 DOI: 10.1186/s12909-019-1614-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite concerns regarding the increasing obesity epidemic, little is known regarding obesity curricula in medical education. Medical school family medicine clerkships address common primary care topics during clinical training. However, studies have shown that many family physicians feel unprepared at addressing obesity. The purpose of this study was to evaluate factors related to obesity education provided during family medicine clerkships as well as identify future plans regarding obesity education. METHODS Data were collected through the 2017 Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors (CDs) in the United States and Canada. Survey items included the level of importance of obesity education, teaching methods, barriers to teaching, and obesity related topics taught during the clerkship. Survey data were summarized and analyzed. RESULTS The survey response rate was 71.2%. The most frequent barrier to teaching obesity related topics was time constraints (89%). The most commonly taught topics were co-morbid conditions (82.1%), diet (76.9%), and exercise (76.9%). The least commonly taught topics were addressed less than 30% of the time, and included cultural aspects, obesity bias, medications than can cause weight gain, medications to treat obesity, and bariatric surgery. Over half of CDs (59%) are not planning to change existing curriculum, with 39% planning to add to the current curriculum. The CDs' perceptions of the importance of obesity education were significantly associated with the number of topics covered during clerkship (p < 0.001). No relationship was found between clerkship duration and the number of obesity topics taught. CONCLUSION The majority of clerkship directors are planning no changes to their existing curricula which consist of three common topics: obesity related co-morbid conditions, diet, and exercise. While time was the largest self-rated barrier in teaching obesity related topics, clerkship duration didn't impact the number of topics taught. However, the relative amount of importance placed by CDs upon obesity education was significantly associated with the number of topics covered during clerkship.
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Affiliation(s)
- Harland Holman
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Sumi Dey
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Ian Drobish
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Leora Aquino
- Spectrum Health Family Medicine Department, 25 Michigan Ave, Suite 5100, Grand Rapids, MI 49503 USA
| | - Alan T. Davis
- Spectrum Health, Office of Medical Education, 945 Ottawa Ave NW, Grand Rapids, MI 49503 USA
| | - Tracy J. Koehler
- Spectrum Health, Office of Medical Education, 945 Ottawa Ave NW, Grand Rapids, MI 49503 USA
| | - Rebecca Malouin
- Michigan State University College of Human Medicine, 909 Fee Road, B201, East Lansing, MI 48824 USA
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Employment Outcomes 2 Years After Bariatric Surgery: Relationship to Quality of Life and Psychosocial Predictors. Obes Surg 2019; 29:2854-2861. [DOI: 10.1007/s11695-019-03905-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Obesity is a complex multifactorial disease. The worldwide prevalence of overweight and obesity has doubled since 1980 to an extent that nearly a third of the world's population is now classified as overweight or obese. Obesity rates have increased in all ages and both sexes irrespective of geographical locality, ethnicity or socioeconomic status, although the prevalence of obesity is generally greater in older persons and women. This trend was similar across regions and countries, although absolute prevalence rates of overweight and obesity varied widely. For some developed countries, the prevalence rates of obesity seem to have levelled off during the past few years. Body mass index (BMI) is typically used to define overweight and obesity in epidemiological studies. However, BMI has low sensitivity and there is a large inter-individual variability in the percent body fat for any given BMI value, partly attributed to age, sex, and ethnicity. For instance, Asians have greater percent body fat than Caucasians for the same BMI. Greater cardiometabolic risk has also been associated with the localization of excess fat in the visceral adipose tissue and ectopic depots (such as muscle and liver), as well as in cases of increased fat to lean mass ratio (e.g. metabolically-obese normal-weight). These data suggest that obesity may be far more common and requires more urgent attention than what large epidemiological studies suggest. Simply relying on BMI to assess its prevalence could hinder future interventions aimed at obesity prevention and control.
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Affiliation(s)
- Yu Chung Chooi
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore
| | - Cherlyn Ding
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore
| | - Faidon Magkos
- Clinical Nutrition Research Centre (CNRC), Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), National University Health System, Singapore; Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore; Department of Nutrition, Exercise and Sports - Obesity Research, University of Copenhagen, Denmark.
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Hsieh CH, Tseng CC, Shen JY, Chuang PY. Randomized controlled trial testing weight loss and abdominal obesity outcomes of moxibustion. Biomed Eng Online 2018; 17:149. [PMID: 30396343 PMCID: PMC6219029 DOI: 10.1186/s12938-018-0571-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the efficacy of moxibustion therapy on weight loss, waist circumference and waist-to-hip ratio in young adult females. An experimental design, 51 Asian females were enrolled. Inclusion criteria included females with ages between 21 and 25 years-old and waist circumference ≥ 80 cm, and the exclusion criteria included intolerance to moxibustion therapy and current illness. Two groups were formed, and the subjects in the experimental group received moxibustion sessions lasting 20 min and an educational video program for 30 min; however, participants in the control group received only the educational program every other week for 8 weeks. Dependent variable measurements (e.g., body weight, waist circumference and waist-to-hip ratio) were collected at baseline and follow-up for 8 weeks. RESULTS Average body weight of the treatment group decreased significantly from - 1.478 kg (p < 0.0001), while the average body weight in the control group did not decrease significantly - 0.038 kg (p = 0.7197). Also, individuals in the moxibustion experimental group showed significant reductions (p < 0.0001) in both waist circumference and waist-to-hip ratio. CONCLUSION Positive effects on anthropometry can be achieved by moxibustion intervention in conjunction with a weight loss education program. Especially waist circumference and waist-to-hip ratio had more clinically significant and more pronounced for health reasons Future studies can focus on the functional assessment of biomarkers associated with the immune system and relevant mechanisms of action.
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Affiliation(s)
- Ching-Hsiu Hsieh
- Department of Nursing, Chang Gung University of Science and Technology, ChiayiCampus: 2, Chia-pu Rd, West Sec. Pu-tz, 613, Chia-Yi, Taiwan.
| | - Chi-Chuan Tseng
- Department of Traditional Chinese Medicine Chang, Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Ju-Yu Shen
- Department of Early Childhood Educare, Tainan University of Technology, Tainan, Taiwan
| | - Pei-Ying Chuang
- School of Nursing, University of Maryland School of Nursing, Baltimore, MD, USA
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Longitudinal evaluation of efficacy, safety and nutritional status during one-year treatment with the duodenal-jejunal bypass liner. Surg Obes Relat Dis 2018; 14:769-779. [DOI: 10.1016/j.soard.2018.02.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/08/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022]
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Feral-Pierssens AL, Carette C, Rives-Lange C, Matta J, Goldberg M, Juvin P, Zins M, Czernichow S. Obesity and emergency care in the French CONSTANCES cohort. PLoS One 2018; 13:e0194831. [PMID: 29579083 PMCID: PMC5868832 DOI: 10.1371/journal.pone.0194831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/09/2018] [Indexed: 12/29/2022] Open
Abstract
Context Obese patients are raising specific questions in emergency care such as equipment issues or urgent procedures. Even though obesity prevalence and subsequent health expenditure are increasing worldwide, there is scarce literature about their specific resource utilization of Emergency Departments (ED). These few studies do not take into account both socio-economic situation and comorbidities which are well-known factors influencing healthcare use. Our objective was to assess the emergency care resource utilization of obese individuals (Body Mass Index (BMI) ≥ 30kg.m-2) compared to normal-weight individuals taking into account comorbidities and social-economic situations. Methods The French CONSTANCES epidemiologic cohort is a randomly selected sample of French adults. Participants data are linked to the National Health Insurance Database collecting all medical acts. The rate of ED visits of obese (and each obesity class) and normal-weight participants were compared considering confounding factors (comorbidities, various socio-economic data). The primary endpoint was to have visited the ED between 2010 and 2013. Sex-separated analysis and multivariate logistic regression models were performed and adjusted odds-ratios [OR] (95% Confidence Intervals [CI]) were calculated. Results We included 21,035 normal-weight and 5,003 obese participants. Obese participants visited the ED more often than normal-weight participants (men: 30.5% vs. 26.7%; women: 30.3% vs. 24.4%, P<0.001). Obese participants presented more comorbidities and a lower socio-economic situation than normal-weight participants. After adjustment, obese participants had a higher risk of visiting ED (men: OR = 1.18; 95% CI: 1.04–1.33; and women: OR = 1.36; 95% CI: 1.22–1.52), with a higher risk for class III participants (BMI ≥ 40 kg.m-2) (men: OR = 2.18; CI 95%: 1.32–3.63; and women: OR = 1.85; 95% CI: 1.38–2.49). Conclusion Obese individuals have a higher level of emergency care resource utilization than normal-weight individuals and it increases with severe obesity. Further studies are needed to better understand their healthcare pathways leading to EDs.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou european Hospital, Paris, France
- * E-mail:
| | - Claire Carette
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou european Hospital, Centre Spécialisé Obésité IdF, Paris, France
| | - Claire Rives-Lange
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou european Hospital, Centre Spécialisé Obésité IdF, Paris, France
- Paris Descartes University, Paris, France
| | - Joane Matta
- Nutrition Department, Faculty of Agricultural and Food Sciences, Holy Spirit University, Jounieh, Lebanon
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Philippe Juvin
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou european Hospital, Paris, France
- Paris Descartes University, Paris, France
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Paris Descartes University, Paris, France
| | - Sebastien Czernichow
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou european Hospital, Centre Spécialisé Obésité IdF, Paris, France
- Nutrition Department, Faculty of Agricultural and Food Sciences, Holy Spirit University, Jounieh, Lebanon
- INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
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Agarwal E, Ferguson M, Banks M, Vivanti A, Batterham M, Bauer J, Capra S, Isenring E. Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients. Clin Nutr 2018; 38:759-766. [PMID: 29559233 DOI: 10.1016/j.clnu.2018.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND & AIMS Obesity, defined as a BMI ≥ 30 kg/m2, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients. METHODS This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N = 3122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes. RESULTS Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n = 750; 75% females; 61 ± 15 years; 37 ± 7 kg/m2). Fourteen percent (n = 105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N = 30/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients. CONCLUSION Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients.
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Affiliation(s)
- Ekta Agarwal
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Master of Nutrition and Dietetic Practice Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia.
| | - Maree Ferguson
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Merrilyn Banks
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Angela Vivanti
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - Marijka Batterham
- National Institute for Applied Statistics Research Australia, The University of Wollongong, Wollongong, NSW 2522, Australia
| | - Judy Bauer
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Sandra Capra
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Elisabeth Isenring
- Centre for Dietetics Research, School of Human Movement and Nutritional Sciences, The University of Queensland, St Lucia, QLD 4072, Australia; Master of Nutrition and Dietetic Practice Program, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4229, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
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Abstract
OBJECTIVE The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. METHODS A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. RESULTS Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. CONCLUSION The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.
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Affiliation(s)
- Andrea Goettler
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Grosse
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
- Department of Health Sciences, University of York, York, UK
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Sonntag D, Jarczok MN, Ali S. DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status. Obesity (Silver Spring) 2017; 25:1603-1609. [PMID: 28845610 DOI: 10.1002/oby.21913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). METHODS Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. RESULTS DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). CONCLUSIONS The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups.
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Affiliation(s)
- Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Department of Health Sciences, University of York, York, UK
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Shehzad Ali
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
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Laxy M, Stark R, Peters A, Hauner H, Holle R, Teuner CM. The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14090984. [PMID: 28867791 PMCID: PMC5615521 DOI: 10.3390/ijerph14090984] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 12/31/2022]
Abstract
This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31–96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m2, this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.
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Affiliation(s)
- Michael Laxy
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
| | - Renée Stark
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
| | - Annette Peters
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, 85764 Neuherberg, Germany.
| | - Hans Hauner
- Technische Universität München, Klinikum Rechts der Isar, Institute for Nutritional Medicine, 81675 Munich, Germany.
| | - Rolf Holle
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
- German Center for Diabetes Research, 85764 Neuherberg, Germany.
| | - Christina M Teuner
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, 85764 Neuherberg, Germany.
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39
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Prichystalova R, Fini JB, Trasande L, Bellanger M, Demeneix B, Maxim L. Comparison of methods for calculating the health costs of endocrine disrupters: a case study on triclosan. Environ Health 2017; 16:55. [PMID: 28599657 PMCID: PMC5466740 DOI: 10.1186/s12940-017-0265-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 05/26/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies. METHODS This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data. RESULTS The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development. The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year. CONCLUSIONS The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method in the socio-economic analysis will therefore significantly impact the estimated health costs and consequently the political risk management decision. Additional work should be done for understanding the reasons of these significant differences.
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Affiliation(s)
- Radka Prichystalova
- Institut des Sciences de la Communication (UMS 3665), CNRS (Centre National de la Recherche Scientifique)/Université Paris Sorbonne/UPMC (Université Pierre et Marie Curie), 20 rue Berbier du Mets, 75013 Paris, France
| | - Jean-Baptiste Fini
- Sorbonne Universités, CNRS UMR 7221, RDDM, Muséum d’Histoire Naturelle, F-75005 Paris, France
| | - Leonardo Trasande
- Department of Pediatrics, NYU School of Medicine, 403 E 34th St, New York, NY 10016 USA
| | - Martine Bellanger
- School of Public Health, University Sorbonne Paris Cité, EA7348 MOS, Paris, France
| | - Barbara Demeneix
- Sorbonne Universités, CNRS UMR 7221, RDDM, Muséum d’Histoire Naturelle, F-75005 Paris, France
| | - Laura Maxim
- Institut des Sciences de la Communication (UMS 3665), CNRS (Centre National de la Recherche Scientifique)/Université Paris Sorbonne/UPMC (Université Pierre et Marie Curie), 20 rue Berbier du Mets, 75013 Paris, France
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40
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Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic Burden of Obesity: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E435. [PMID: 28422077 PMCID: PMC5409636 DOI: 10.3390/ijerph14040435] [Citation(s) in RCA: 602] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 02/06/2023]
Abstract
Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.
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Affiliation(s)
- Maximilian Tremmel
- Institute for Medical Informatics, Biometry and Epidemiology (IBE), LMU Munich, 81377 Bavaria, Germany.
| | - Ulf-G Gerdtham
- Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden.
- Centre for Primary Health Care Research, Faculty of Medicine, Lund University/Region Skåne, Skåne University Hospital, S-22241 Lund, Skåne, Sweden.
- Department of Economics, Lund University, S-22363 Lund, Skåne, Sweden.
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, S-20502 Malmö, Skåne, Sweden.
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Sciences, Lund University, 22381 Lund, Sweden.
- Centre for Primary Health Care Research, Faculty of Medicine, Lund University/Region Skåne, Skåne University Hospital, S-22241 Lund, Skåne, Sweden.
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41
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Anaissie J, Roberts NH, Wang P, Yafi FA. Testosterone Replacement Therapy and Components of the Metabolic Syndrome. Sex Med Rev 2017; 5:200-210. [DOI: 10.1016/j.sxmr.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/07/2017] [Accepted: 01/07/2017] [Indexed: 12/15/2022]
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Ilvig PM, Christensen JR. Degree of disability among female healthcare workers who are overweight or obese. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1282032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Pia Maria Ilvig
- Department of Public Health, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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43
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Ricci G, Pirillo I, Tomassoni D, Sirignano A, Grappasonni I. Metabolic syndrome, hypertension, and nervous system injury: Epidemiological correlates. Clin Exp Hypertens 2017; 39:8-16. [PMID: 28071980 DOI: 10.1080/10641963.2016.1210629] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metabolic syndrome (MetS) is a common and complex disorder combining hypertension, obesity, dyslipidemia, and insulin resistance. MetS represents a risk factor for changes in cognitive functions in older age, and several studies have suggested that MetS may be linked to dementia. This article reviews the main evidences about the relationship between MetS and neurodegenerative disease. Starting from an epidemiological point of view, the article analyzes medico-social aspects related to MetS, considering the reduction of work capacity and the condition of disability that it involves. Some authors affirm that on the basis of current Italian legislation, it is possible to consider the syndrome as a disability. This is because all the diseases that make up MetS are high-risk clinical pathological conditions. For these reasons, a joint action is required to contain the incidence of MetS, the high social costs, and the loss of productivity related to the syndrome. In conclusion, healthcare initiatives could be adopted in order to increase the understanding of the pathogenic contributions of each element on MetS and how they can be modified. These actions will be useful to reduce healthcare costs and can lead to more effective prevention of metabolic disease, thus promoting good health. ABBREVIATIONS MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps.
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Affiliation(s)
- Giovanna Ricci
- a School of Law , University of Camerino , Camerino , Italy
| | - Isabel Pirillo
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
| | - Daniele Tomassoni
- c School of Biosciences and Veterinary Medicine , University of Camerino , Camerino , Italy
| | - Ascanio Sirignano
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
| | - Iolanda Grappasonni
- b School of Medicinal and Health Products Sciences , University of Camerino , Camerino , Italy
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44
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Kjellberg J, Tange Larsen A, Ibsen R, Højgaard B. The Socioeconomic Burden of Obesity. Obes Facts 2017; 10:493-502. [PMID: 29020681 PMCID: PMC5741162 DOI: 10.1159/000480404] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the socioeconomic impact of obesity by estimating the direct and indirect costs associated with obesity in Denmark, based on individual level data. METHODS Costs were assessed for different BMI groups, and the relative risks for change in direct and indirect costs per BMI point above 30 were estimated. A fourth analysis estimated the odds ratio for comorbidities per BMI point above 30. Individual data on income, social transfer payments, healthcare costs and diagnoses were retrieved from national registries. RESULTS One BMI point above 30 was associated with a 2% decrease in income, a 3% increase in social transfer payments, and a 4% increase in healthcare costs. In absolute numbers, income contributed to most of the total economic burden. One BMI point above 30 was also associated with increased comorbidity, which explains the increase in both direct and indirect costs. CONCLUSION Obesity is associated with increased comorbidity, giving rise to an increase in both direct and indirect costs. Especially income is affected, which emphasizes the importance of including both measures when evaluating the total socioeconomic burden of obesity. Our findings draw attention to the potential for saving public resources and preventing loss of income by preventing obesity.
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Affiliation(s)
- Jakob Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
- *Dr. Jakob Kjellberg, Danish Institute for Local and Regional Government Research, Købmagergade 22, Copenhagen, Denmark,
| | | | | | - Betina Højgaard
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
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45
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Effertz T, Engel S, Verheyen F, Linder R. The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:1141-1158. [PMID: 26701837 DOI: 10.1007/s10198-015-0751-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.
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Affiliation(s)
- Tobias Effertz
- Institut für Recht der Wirtschaft, Universität Hamburg, Max Brauer Allee 60, 22765, Hamburg, Germany.
| | - Susanne Engel
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Frank Verheyen
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
| | - Roland Linder
- WINEG | Wissenschaftliches Institut der TK, für Nutzen und Effizienz im Gesundheitswesen, Bramfelder Straße 140, 22305, Hamburg, Germany
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Skjåkødegård HF, Danielsen YS, Morken M, Linde SRF, Kolko RP, Balantekin KN, Wilfley DE, Júlíusson PB. Study Protocol: A randomized controlled trial evaluating the effect of family-based behavioral treatment of childhood and adolescent obesity-The FABO-study. BMC Public Health 2016; 16:1106. [PMID: 27769209 PMCID: PMC5073413 DOI: 10.1186/s12889-016-3755-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children’s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Methods Randomized controlled trial (RCT), in which families (n = 120) are recruited from the children and adolescents (ages 6–18 years) referred to the Obesity Outpatient Clinic (OOC), Haukeland University Hospital, Norway. Criteria for admission to the OOC are BMI above the International Obesity Task Force (IOTF) cut-off ≥ 35, or IOTF ≥ 30 with obesity related co-morbidity. Families are randomized to receive FBSFT immediately or following one year of TAU. All participants receive a multidisciplinary assessment. For TAU this assessment results in a plan and a contract for chancing specific lifestyle behaviors. Thereafter each family participates in monthly counselling sessions with their primary health care nurse to work on implementing these goals, including measuring their weight change, and also meet every third month for sessions at the OOC. In FBSFT, following assessment, families participate in 17 weekly sessions at the OOC, in which each family works on changing lifestyle behaviors using a structured cognitive-behavioral, socio-ecological approach targeting both parents and children with strategies for behavioral maintenance and sustainable weight change. Outcome variables include body mass index (BMI; kg/m2), BMI standard deviation score (SDS) and percentage above the IOTF definition of overweight, waist-circumference, body composition (bioelectric impedance (BIA) and dual-X-ray-absorptiometry (DXA)), blood tests, blood pressure, activity/inactivity and sleep pattern (measured by accelerometer), as well as questionnaires measuring depression, general psychological symptomatology, self-esteem, disturbed eating and eating disorder symptoms. Finally, barriers to treatment and parenting styles are measured via questionnaires. Discussion This is the first systematic application of FBSFT in the treatment of obesity among youth in Norway. The study gives an opportunity to evaluate the effect of FBSFT implemented in routine clinical practice across a range of youth with severe obesity. Trial registration ClinicalTrails.gov NCT02687516. Registered 16th of February, 2016 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3755-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanna F Skjåkødegård
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway. .,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.
| | | | - Mette Morken
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Sara-Rebekka F Linde
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway
| | - Rachel P Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katherine N Balantekin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Department of Psychology, Washington University School of Medicine, St. Louis, MO, USA
| | - Pétur B Júlíusson
- Department of Medicine, the Obesity Outpatient Clinic, Haukeland University Hospital, N-5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Cuschieri S, Mamo J. Getting to grips with the obesity epidemic in Europe. SAGE Open Med 2016; 4:2050312116670406. [PMID: 27708778 PMCID: PMC5034461 DOI: 10.1177/2050312116670406] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/22/2016] [Indexed: 11/17/2022] Open
Abstract
Obesity is a global epidemic. It is responsible for increased patient morbidity and mortality. Significant related pathologies including diabetes mellitus compound the overall risks. Obesity is a significant financial burden. This includes direct and indirect medical costs, amounting to millions of euros each year. Multiple European studies have outlined a steady incline in obesity prevalence rates. Tackling obesity is no easy task. Policy makers aiming to reduce obesity rates should adopt an evidence-based approach. This entails adopting both micro- and macro-interventions tweaked to each country’s individual requirements. The ideal way forward would be to tackle obesity from the individual, population-wide and food industry angles. The key towards a successful intervention is for each country to carry out well-planned health examination studies, in an attempt to pin point local risk factors. Having a correct individualized picture, each country can move forward and draw policies and interventional procedures. The aim should be to primarily improve the quality of life. Second, the country’s capital expenditure is also reduced.
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Affiliation(s)
- Sarah Cuschieri
- Department of Anatomy, Faculty of Medicine & Surgery, University of Malta, Msida, Malta
| | - Julian Mamo
- Department of Public Health, Faculty of Medicine & Surgery, University of Malta, Msida, Malta
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48
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Turnin MC, Buisson JC, Ahluwalia N, Cazals L, Bolzonella-Pene C, Fouquet-Martineau C, Martini P, Tauber M, Hanaire H. Effect of Nutritional Intervention on Food Choices of French Students in Middle School Cafeterias, Using an Interactive Educational Software Program (Nutri-Advice). JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:131-7.e1. [PMID: 26548405 DOI: 10.1016/j.jneb.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the impact of interactive Nutri-Advice kiosks on children's nutritional skills and their ability to apply it to food choices in a middle school cafeteria menu (food choice competencies). DESIGN Quasi-experimental design; pre/post-test. SETTING Freestanding interactive computer terminals (kiosks) were installed in three middle schools in Toulouse, France. PARTICIPANTS A total of 580 children were enrolled into the study (mean age, 13 ± 1 years). INTERVENTION Each child's physiological profile was stored in a personal barcode card. During 1 school year, once a day, each child could access the kiosk with this card, trying to find the most balanced meal according to his or her profile and the food available on the cafeteria menu. MAIN OUTCOME MEASURES Children's food choice competency changes and body mass index z-score were evaluated. ANALYSIS Significance of change in food choice competencies (postintervention vs baseline) was examined using paired t test. RESULTS Across the study, children chose significantly less cheese and pastry or desserts, and significantly more starchy food and dairy, and tended to choose fruits and vegetables more often. Body mass index z-score decreased significantly during the period. CONCLUSIONS AND IMPLICATIONS Personalized nutrition counseling through an interactive device has the potential to improve the food choice competencies of children.
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Affiliation(s)
- Marie-Christine Turnin
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France.
| | - Jean-Christophe Buisson
- University of Toulouse, Institut National Polytechnique de Toulouse-Ecole Nationale Supérieure d'Électrotechnique, d'Électronique, d'Informatique, d'Hydraulique, et des Télécommunications, Toulouse, France
| | - Namanjeet Ahluwalia
- Department of Epidemiology and Analyses in Public Health: Risks, Chronic Diseases, Handicaps, University Hospital of Toulouse, Toulouse, France
| | - Laurent Cazals
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France
| | - Caroline Bolzonella-Pene
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France
| | - Caroline Fouquet-Martineau
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France
| | - Pascale Martini
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France
| | - Maïthé Tauber
- Department of Paediatrics, Endocrinology, Genetics, and Medical Gynaecology, University Hospital of Toulouse, Hôpital des Enfants, Toulouse, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic and Nutrition Disease, University Hospital of Toulouse, Toulouse, France
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Yates N, Teuner CM, Hunger M, Holle R, Stark R, Laxy M, Hauner H, Peters A, Wolfenstetter SB. The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies. Obes Facts 2016; 9:397-409. [PMID: 27951530 PMCID: PMC5644792 DOI: 10.1159/000452248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To estimate the excess costs of obese compared to normal-weight persons in Germany based on self-reported resource utilisation and work absence. METHODS Five cross sectional surveys of cohort studies in southern Germany were pooled resulting in 9,070 observations for 6,731 individuals (31-96 years). BMI was measured in the study centre. Self-reported health care utilisation and work absence was used to estimate direct and indirect costs for the year 2011 based on unit costs. Using regression analyses, adjusted costs for different BMI groups were calculated. RESULTS Overweight and obese people showed significantly higher odds of health care utilisation and productivity losses compared with normal-weight people in most categories. Total direct/indirect costs were significantly higher with increasing severity of obesity (pre-obese (1.05 (0.90-1.23) / 1.38 (1.11-1.71)), obesity level I (1.18 (1.00-1.39) / 1.33 (1.02-1.73)), obesity level II (1.46 (1.14-1.87) / 1.77 (1.18-2.65)) or level III (2.04 (1.40-2.97) / 1.99 (1.20-3.30)) compared to normal-weight participants. In particular, higher obesity classes were significantly associated with increased costs for medication, general practitioner utilisation and work absence. CONCLUSION Our results show that overweight and obesity are associated with enormous societal direct and indirect costs in Germany. This supports the evidence from previous top-down studies, but provides important new information based on a large pooled data set and measured BMI.
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Affiliation(s)
- Nichola Yates
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christina M. Teuner
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- *Dr. Christina M. Teuner, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany,
| | - Matthias Hunger
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
| | - Renée Stark
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany, Neuherberg, Germany
| | - Annette Peters
- German Centre for Diabetes Research, Neuherberg, Germany
- Institute of Epidemiology II, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Silke B. Wolfenstetter
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
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50
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Clifford SA, Gold L, Mensah FK, Jansen PW, Lucas N, Nicholson JM, Wake M. Health-care costs of underweight, overweight and obesity: Australian population-based study. J Paediatr Child Health 2015; 51:1199-206. [PMID: 26059311 DOI: 10.1111/jpc.12932] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
AIM Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. PARTICIPANTS Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. OUTCOME Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. PREDICTOR biennial BMI measurements over the same period. RESULTS Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. CONCLUSIONS Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.
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Affiliation(s)
- Susan A Clifford
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Gold
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Pauline W Jansen
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Child & Adolescent Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Nina Lucas
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia.,School of Sociology, College of Arts and Social Sciences, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jan M Nicholson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Parenting Research Centre, Melbourne, Victoria, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
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