“What Is Obesity Medicine?” Sample Presentation

December 13, 2019 0 By Ewald Bahringer

Hello, thank you for coming to the
presentation of What is Obesity Medicine? An introduction to the field of obesity
medicine. Our objectives for this presentation is to help better define
what obesity medicine is, how to diagnose obesity beyond BMI, looking at the
challenges and opportunities in this field that is emerging in obesity
medicine as well as some trends and history of how obesity medicine was and
is now evolving into a new frontier. The field of a medicine dedicated to the
comprehensive care of patients with obesity is obesity medicine. Classic and
traditional methods for defining of obesity have been BMI or body mass index
which is where one’s individual weight in kilograms over meter over their
height over meters squared give them a number that puts them in a
classification of either underweight, healthy weight, overweight or class one,
two, or three obesity While BMI is an effective screening and epidemiologic
tool, it certainly has its limitations such as doesn’t take into consideration
gender differences, racial or ethnicity differences, or body type differences
such as a person with a more muscular build or less muscular build. And what’s
important in using BMI is a screen its determining whether or not an individual
is at risk for other disease states that would potentially impair their health. So
put another way is the abnormal function or excessive fat accumulation or
adiposity in the body potentially impairing the health of this individual.
One way to take BMI step further is utilizing a staging system called the
Edmondson obesity staging system for assessing risk. The staging system
utilizes different stages assessing the potential medical
psychological and functional disabilities an individual may be
struggling with as either a part of their weight, a result of their weight, or
caused by their weight. So for instance a stage zero would be an individual whose
weight does not have any of those obesity related risk factors but a stage
one an individual’s blood pressure might be borderline. Their blood sugars or
diabetes might be a consideration or pre-diabetes. They’re starting to
struggle with some minor aches and pains as they use the stairs or try to
exercise and they might be experiencing some mild stress from their weight. A
stage two would be where obesity related diseases are already there such as
hypertension, polycystic ovarian syndrome, or diabetes and this individual would be
being talking about their moderate limitations of activities of daily
living. For instance difficulty walking to the
mailbox or utilizing the stairs, experiencing shortness of breath or
aches and pains when they try to attempt activity. Stage three and four is a more
severe progression of the disease where an individual may have already
established organ damage such as a myocardial infarction
or congestive heart failure and so they significance of your disabilities that may
require wheelchair use or loss of ambulation capacity. And why is this
important? Because when we’re looking beyond BMI when we’re trying to find a
way to determine whether or not weight could be causing decreased survivability
or increased mortality. The Edmonton Obesity Staging System can help better
determine beyond BMI an individual’s risk for mortality. So is obesity really a disease? There are some individuals that agree with us, there are
many organizations that also agree with this. If there are still people and other
organizations that may have some concern or do not quite
believe that obesity is a disease, however it’s becoming more officially
recognized as a disease such as these organizations, Obesity Medicine Association, The Obesity Society, the American Medical Association and the
World Health Organization who fully stand by the fact that obesity is a
disease. Appetite regulation is complex. Any individual who struggles with weight
would be able to tell you that the discovery of leptin seems to be a
turning point in the thinking in the medical profession where understanding
obesity is a chronic disease is related to the science of understanding complex
appetite regulation. These complexities with appetite it’s further elucidated by
individuals who struggle with their choices of food and are struggling with
conditions such as high hypothalamic injury of the CNS insulin resistance and
leptin resistance. These individuals, their brains can’t tell how much fat is
stored or how much food is eaten. This results in an increased cravings and a
reduced sense of feeling full or satiety which ultimately leads to increased food
intake and weight gain. The weight gain further compounds the resistance to
leptin and insulin and increases those cravings, essentially a feed-forward
positive feedback mechanism or otherwise known as a vicious cycle. Obesity is the disease and obesity
prevalence is getting worse and worse. If you look at the data of prevalence of
obesity from the 1980s onward you will see a dramatic progression in states who
have more and more individuals struggling with this disease. As of 2015,
no state has a prevalence of obesity less than 20% in our country and more
states have a prevalence of obesity of greater than 35%. Why this is important,
when you look at the trends of how many individuals are struggling with obesity
there’s been a significant increase in the prevalence over the past thirty
years and when you look at what the projections will be for 2030 over 50% of
individuals in the United States ages 20 to 74 will have a BMI of 30 or higher. If
you take into consideration a BMI of 25 or higher
there will be over 85% of individuals with that diagnosis. That is a
significant amount of individuals that are struggling with weight in our
country yet obesity remains under diagnosed in the United States. This data
here is from the GE Centricity Electronic Health Records which
essentially looked at over 6 million individuals. The idea was to assess the
prevalence of chronic diseases such as diabetes, high blood pressure,
hyperlipidemia and whether or not BMI had a role in affecting disease
progression, but what was remarkable was how few individuals were diagnosed in
the electronic health record with a BMI code or an obesity code. Very few
individuals are being diagnosed with obesity and what is the economic burden in our
country? Direct medical costs or US health care spending is anywhere from 21
to 28 percent of our total U.S. spending. And what about the indirect non-medical
cost? Cost of the employer, lost productivity, absenteeism, overall cost of
obesity is up to five hundred billion dollars a year.
However reducing our weight, reducing our BMI, reducing our weight by a five to ten
percent clinically significant weight loss which has been understood in the
medical and scientific communities to be clinically significant weight loss can
result an estimated reduction of annual cost per individual of up to $20,000 and
this is reducing the costs through medications, reduced co-pays, doctor
visits, and hospitalizations. Reduce risk for cancer, accidents, and food costs. The
good news is that that 5% average BMI reduction in the United States, if we’re
able to accomplish that by 2020, will reduce three and a half million cases of
hypertension, avoid 2.9 million cases of heart disease and stroke, avoid 3.6
million cases of diabetes, and 1.9 million cases of arthritis. So if treating obesity reduces the risk
of so many health conditions and healthcare costs why do so few health
care providers diagnose and treat obesity? In the past very few patients
were offered medical or surgical treatments however we now have tools
that we can use both medically and surgically in addition to lifestyle to
help better get our patients access to the care and treatment that they so need
and deserve. There are many potential barriers in treating obesity: provider
reimbursement, limited prescription coverage, past failures both clinician as
well as for patient, lack of clear guideline,
time constraints in the office, as well as cultural stigma and bias, and it’s
hard to believe that it was actually considered fraud to bill for obesity
related services prior to 2012. But we have come a long way and since then
we’ve made great strides in the field of obesity medicine and being able to=
provide patients with access to care and treatment. Addressing weight bias is very
important for us as clinicians as well as for our patients. Negative attitudes
towards individuals who struggle with weight leads to rejection, prejudice,
discrimination, bullying and this comes in various forms of subtle as well as
overt. What it really does is prevents the proper care and communication
between providers as well as their patients. It hampers our efforts to be
able to effectively combat this epidemic and it unfortunately reduces our ability
to give patients the proper access and treatment that they need.
Recognizing this, helping combat this will only help our patients get better.
In fact they did a survey of over 2,400 women and they were asked well how do
you cope with stigma or bias, do you feel that you’re judged, and almost eighty
percent reported that yes they do and that eating, turning to food was a
coping mechanism further compounding the problems that our individuals face. So
what might comprehensive medical obesity treatment include? That would look like
nutritional counseling, physical activity, changing behaviors to a positive way and
positive lifestyle as well as considering pharmacotherapy when
indicated. This field is growing, by 2015 there’s been over thirty six thousand
newly certified physicians by the American Board of Internal Medicine
and new subspecialties are emerging such as adolescent medicine, geriatric
medicine, and addiction medicine. Obesity medicine is no different. The American
Board of Obesity Medicine was created in 2011 and has more than 2,000 diplomats. As of 2017 the growth of this group is faster than any other
field. Obesity Medicine is at its frontier. The number of diplomats from
2012 to 2017 ever continues to grow. There’s great resources out there for
your patients as well as for you. There are many organizations that helped
support the production of this presentation and are available for both
you and your patients and giving your patients the best access to care that
they most certainly deserve. Thank you for your time.