Dexter Shurney, MD, MBA, MPH

SVP/CMO

Implications of the Obesity EpidemicFebruary 4, 2008

Where the discussion should lead

ObesityChronic

Conditions

Diabetes Heart Disease

Cancer

Osteoarthritis Absenteeism

Premature Death

Presenteeism

Weight Matters

The prevalence of diabetes increases in a dose-response relationship with increasing BMI. BMI > 35. 38% of the excess risk of diabetes could be avoided if their BMI did not exceed 30. (Int.J. Obesity & Related Metabolic Disorders, 2000)

Tale of Two Epidemics"Increases in diabetes cases have been going on for 15 years, and it doesn't look like it's slowing down."

Dr. Linda Geiss, Chief of Diabetes Surveillance CDC believes the diabetes epidemic is largely being driven by obesity…

Source: HealthDay News, June 23, 2007

How Does Obesity Cause Disease?

Toxic Adiposity

•Excess production of hormones from fat•Angiotensinogen•Estrogen•TNF-alpha•Leptin•Insulin•IL-1

•Inflammation

Where the discussion should lead

Obesity

Lifestyle

Chronic

Conditions

Diabetes Heart Disease

Cancer

Osteoarthritis Absenteeism

Premature Death

Presenteeism

Exercise

Adequate Sleep

Stress Management

Healthy Diet

………………

LifeStyle

Lifestyle modification

the combination of •a proper diet •physical activity •behavior therapy

is the cornerstone of treatment for obesity

Source: Wadden et.al Lifestyle Modification for the Management of Obesity. Gastroenterology. 2007;132(6)

An estimated 300,000 preventable deaths occur each year in the U.S. due to diet and physical inactivity – only tobacco causes more preventable deaths.IOM Workshop on death/lifestyle (2004) M. McGinnis

Lifestyle: Current State of Affairs

.

•More than 50% of U.S. adults do not get enough physical activity to provide health benefits

•Insufficient physical activity is not limited to adults. About two-thirds of young people in grades 9–12 are not engaged in recommended levels of physical activity.

•Activity decreases among those with lower incomes and less education.

•In 2005, only one-fourth of U.S. adults ate five or more servings of fruits and vegetables each day.

Source: CDC, 2005

Where the discussion should lead

POLICY

Obesity

Lifestyle

Chronic

Conditions

Diabetes Heart Disease

Cancer

Osteoarthritis Absenteeism

Premature Death

Presenteeism

Exercise

Adequate Sleep

Stress Management

Healthy DietFederal

Local Community

Employer Worksite

DIABETES

OBESITY

POLICY

LIFESTYLE

Critical Path

Primary prevention and management of

overweight and physical inactivity offer

potential as cost-control strategies

Strategies to Overcome and Prevent (STOP) Obesity Alliance

new policy recommendations

1. Redefining Success

2. Encouraging Innovation and Best Practices in Obesity Treatment

3. Addressing and Reducing Stigma as a Barrier to Obesity Treatment

4. Broadening the Research Agenda for Obesity

http://www.stopobesityalliance.org.

Policy Challenges

• Built Environment

• Care Management

Policy Challenges

Built Environment• Worksite

• Culture of Health

• Incentives

• Wellness programs and services

• Addressing the Family Unit

• Community Involvement and Change

• Affordable Healthy Food

“Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions.”NEJM 2007;357:370-9

Cities Study Dearth of Healthy Food “Some areas suffer a grocery gap: They’re rife with fast food but lack fruits, vegetables…” USA Today Jan. 25, 2008

Policy Challenges

Care Management

• Build awareness and understanding to shape policy

• Lifestyle services need to be a core offering

• Articulate a new Value Proposition • Willingness to pay for new value proposition

• Creating policies that drive adoption

“Personal health behaviors are the primary determinant of disease, disability and death and primary drivers of health care costs. Prevention of illness, injury and associated risk factors is the ultimate cost trend mitigation strategy”.

Michael D. Parkinson, MD, MPHChief Health and Medical Officer

Lumenos

The Many Benefits of Lifestyle Change

> Reduce risk for Heart Disease and Stroke

> Back Pain

> Osteoporosis

> Psychological benefits including stress hardiness

Exercise

Benefits of Exercise

•A minimum of at least 30 minutes of moderate intensity exercise daily resulted in a reduced risk of coronary heart disease by more than 2-fold (Diabetes Care, 2005)

•Walking and losing 15 pounds decreased the risk of getting diabetes by 58% (NIH Study; n=3,284)

New Value Proposition

CHRONIC CONDITIONS

Matter of Choices

Diabetes

Hypertension

Coronary Heart

Disease

Obstructive Sleep Apnea

Dyslipidemia

Cataracts

StrokePhlebitis

Osteoarthritis

Cancer

Gallbladder Disease

Pancreatitis

Gynecologic abnormalities

Nonalcoholic fatty liver disease

Manage chronic conditions and treat the complications

OR

Help people with lifestyle and avoid majority of these problems altogether

Miscellaneous Facts

•The prevalence of diabetes increases in a dose-response relationship with increasing BMI. BMI > 35. 38% of the excess risk of diabetes could be avoided if their BMI did not exceed 30. (Int.J. Obesity & Related Metabolic Disorders, 2000)

•Average medical costs for an individual with diabetes are $10,071/yr. compared to $2,669 for a person without diabetes. (American Diabetes Association 2002)

•As smoking increased the rate of diabetes increased for men and women. > 2 packs/day increased risk 47% in men and 74% in women compared to non-smokers. (Int. J. Epidemiology, 2001)

•Stress management (lowered HbA1c 0.5%, n=108) improves long-term glycemic control in type-2 diabetics (Diabetes Care, 2002)

Questions?

Contact

Dexter Shurney

SVP / Chief Medical Officer

Healthways

615-565-5932

dexter.shurney@healthways.com