Obesity Medicine Ambassadors: What is Obesity Medicine?

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What Is Obesity Medicine Introduction to thethe Field ofObesity Medicine Objectives.
As a result of this presentation participants will better understand Definition of obesity medicine How to diagnose obesity History trends and evolution of obesity medicine Challenges and opportunities in the field.
What Is Obesity Medicine The field of medicine dedicated to thecomprehensive care of patients withSource Obesity Medicine Association 2016 Evolving Definitions of Obesity.
Weight Categories BMI kg m2Body mass index BMI hasUnderweight 18 5been the traditional method forHealthy Weight 18 5 and 25.
defining obesity BMI is aOverweight 25 and 30calculation of weight inObesity Class I 30 and 35kilograms to height in meters Obesity Class II 35 and 40.
squared Obesity Class III 40The field of obesity medicine Abnormal function or excessive fataccumulation or adiposity in the body that maylooks BEYOND BMI to better impair health assess and treat patients and.
address their individual needs World Health Organization Obesity preventing and managing the global epidemic Report of a WHO consultation World Health Organ TechRep Ser 2000 894 1 253 Taking It One Step Further The Edmonton Obesity Staging System EOSS for Assessing RISK.
co morbidityStage 1 moderate Stage 3Stage 0 Stage 4Sharma AM et al Int J Obes 2009 Edmonton Obesity Staging System.
Stage 0 No obesity related risk factors Stage 1 Pre clinical risk factors borderline HTNor DM minor aches or psychopathology Stage 2 Established obesity related disease HTN DM PCOS moderate limitations ADL.
Stage 3 Established organ damage MI CHF DMcomp significant limitations of ADL Stage 4 Severe disabilities end stage andlimitations like wheelchair useSharma AM and Kushner RF Int J Obes 2009 33 289 95.
Edmonton Staging System Can Predict Mortality Better than BMIPadwal R et al CMAJ 2011 R Sharma AM et al CMAJ 2011 Is Obesity a Disease Obesity is a complex multifactorial disease If obesity is truly a disease then over 78that develops from the interaction between million adults and 12 million children in.
genotype and the environment Our America just got classified as sick Everyoneunderstanding of how and why obesity occurs is has friends and acquintances who now qualifyincomplete however it involves the integration as diseased Yet many sensible people fromof social behavioral cultural and physicians to philosophers know thatphysiological metabolic and genetic declaring obesity a disease is a mistake .
factors Simply put obesity is not a disease To be1998 National Heart Lung and Blood Institute NHLBI sure it is a risk factor for some diseases But it would be false to say that everyone who Overweight and obesity are chronic diseases is obese is sick as to say that every normal.
with behavioral origins that can be traced weight person is well back to childhood 2013 Richard B Gunderman MD PhD2013 American Academy of Family Physicians Obesity Increasingly Becoming Officially Recognized as a Disease a chronic relapsing multi factorial neurobehavioral disease wherein an increase.
in body fat promotes adipose tissue dysfunction and abnormal fat mass physicalforces resulting in adverse metabolic biomechanical and psychosocial healthconsequences obesity is a serious chronic disease with extensive and well definedpathologies including illness and death .
Recognizing obesity as a disease will help change the way the medicalcommunity tackles this complex issue that affects approximately one in threeAmericans 2 Obesity is a chronic disease prevalent in both developed and developingcountries and affecting children as well as adults 3.
Mechanick JI et al Endocr Pract 2012 18 642 648 2 AMA position statement At http www ama assn org Accessed Oct 2014 3 WHO Obesity and overweight At http www who int dietphysicala... Accessed Oct 2014 4 US Food and DrugAdministration Federal Register 2000 65 4 1000 1050 Complexities of Appetite RegulationAGRP agouti related peptide MSH melanocyte stimulating hormone GHSR growth hormone secretagogue receptor INSR insulin.
receptor LepR leptin receptor MC4R melanocortin 4 receptor NPY neuropeptide Y POMC proopiomelanocortin PYY peptide YY Y1R neuropeptide Y1 receptor Y2R neuropeptide Y2 receptor Apovian CM Aronne LJ Bessesen D et al J Clin Endocrinol Metab 2015 100 342 Hypothetical Feed forward Positive Feedback Mechanismto Drive Weight UpIncreased Hypothalamic.
endocannabinoids injury CNSand resistance to insulin andleptin and insulin leptin resistance1 Increased Brain can t tellhow much fat is.
food intake stored how much2 Weight gain food is eaten of satiety2 CravingSlide courtesy of Louis J Aronne MD Wang J Diabetes 2001.
DiMarzo V pers comm Ozcan L et al Cell Metabolism 2009 Obesity Affects Millions of People in the United States Obesity No state has a prevalence ofobesity less than 20 6 states and the District of.
Columbia have a prevalenceof obesity between 20 and 19 states and Puerto Ricohave a prevalence of obesitybetween 25 and 30 .
21 states and Guam have aprevalence of obesity between30 and 35 4 states Alabama Louisiana Mississippi and West Virginia .
have a prevalence of obesityof 35 or greater Prevalence reflects Behavioral Risk Factor Surveillance System BRFSS methodological changes started in 2011 and these estimates should not becompared to those before 2011 Centers for Disease Control and Prevention Obesity Prevalence Maps https www cdc gov obesity data... maps html 2015 Obesity Prevalence map Accessed September 12 2016 .
Is This Our Future Obesity of Tomorrow Prevalence of Obesity Among U S Adults Ages 20 74 Yet Obesity Remains Underdiagnosed in the U S Proportion of Actual Diagnosesof Obesity by BMI.
Obesity diagnosis 30 34 9 35 39 9 40 44 9 45 49 9 50 23 of individuals with a BMI43 of patients with BMI 50 kg between 35 40 kg m2 are diagnosed.
m2 are not diagnosedwith obesityCrawford AG et al Popul Health Manag 2010 13 151 161 Data from the GE Centricity System EMR data of 6 millions records in the US The Economic Burden of Obesity in the U S Direct medical spending due to obesity and its comorbidities is estimated to be.
210 316 billion annually 21 28 of total U S healthcare spending When also accounting for the indirect non medical costs of obesity the overallannual cost is estimated to be 450 556 billionIndirect non medicalDirect medical costs costs Overall cost of.
U S healthcare spending food clothing employer obesity 21 costs absenteeism lost 450 556 billion yearproductivity Brill The Long Term Returns of Obesity Prevention Policies 2013 Available at http www rwjf org content dam ... Cawley et al PharmacoEconomics 2014 Nov 9 .
Cost of Living Changes with Weight Loss Reduces medication Reduces accident proneness Reduces co pays Reduces risk for cancer Reduces time off work and lost wages Reduces hospitalizations Reduces food costs Reduces doctor visits.
Change in the Cost of Living after Weight Loss Can Be Dramatic ITEMS Estimated Annual CostsMean medical drug costs BMI 35 1 7 337Out of pocket healthcare expenses2 2 684Employment inactivity costs3 1 017.
Commercial weight loss program fees4 678Prescription co pays 5 medications at 10 738Grocery and dining costs5 6 012TOTAL 18 4661 Health Management Research Center University of Michigan 2001 2 U S Bureau of Labor Statistics Consumer Expenditures in 2006 3 .
Source Colditz GA Economic costs of obesity and inactivity Med Science Sports Exercise 1999 4 Marketdata Enterprises Inc 10 02 5 U S Bureau of Labor Statistics Consumer Expenditures in 2006 The Good News Modest Weight Loss Can Reduce Disease Risk Potential impact of 5 average BMI reduction in the U S by 2020 3 5 million cases hypertension avoided.
0 3 million cases cancer avoided 2 9 million cases heart disease and stroke avoided 3 6 million cases diabetes avoided 1 9 million cases arthritis avoidedLevi et al F as in fat how obesity threatens America s future 2012 Available at http healthyamericans org asse... .
Obesity Care GapIf treating obesity reduces the risk of so many healthconditions and healthcare costs why do so fewhealthcare providers diagnose and treat obesity Few People with Obesity are Treated in the U S .
1 receive a 80 million adults prescription for an anti with obesity in obesity medication in a 195 000 people per yearthe U S given month receive bariatric surgerySources CDC 2014 adults is defined as 20yrs American Heart Association Statistical Fact Sheet 2013 Update Overweight and Obesity .
http www heart org idc groups ... Accessed June 9 2014 Understanding theTreatment Dynamics of the Obesity Market IMS Database NPA Aug 31 2014 ASMBS website estimated number of bariatric surgeries published July2016 asmbs org What Drives the Large Care Gap in Obesity Challenges and Barriers to Care.
Misaligned perceptions of success Past failuresPrescription coverage Clinician competence and confusion Patient engagementProvider Few effective treatmentLimited advocacyreimbursement options.
Time constraints Difficult emotional Cultural stigma and bias Lack of clear guidelinesconversationsRx market history of withdrawals Obesity as a disease vs conditionCompeting clinicianpriorities.
STOP Obesity Alliance Available at www stopobesityalliance org wp... Care Paper FINAL pdf Forman Hoffman V et al BMC Family Practice 2006 7 35 Challenges in the Past An Evolution of the Reimbursement LandscapeBehavioral Therapy ReimbursementAs of 2012 Going Forward .
Prior to 2012 Medicare and most private payers Affordable Care Act ACA mandatesBehavioral therapy often outrightcover USPSTF recommended coverage of screening andexcluded by most payers as well as.
screening and behavioral counseling counseling Coverage remainsmost other services Bariatricwhen delivered by a primary care inconsistent in terms of number ofsurgery intermittently covered provider not a specialist visits and insurer guidelines .
2010 2011 2012 2013 2014 2015Centers for Disease Control and Prevention http www cdc gov Department of Health and Human Services Centers for Medicare andMedicaid IBT for obesity ICN 907800 January 2014 What Is Weight Bias Negative attitudes toward individuals with obesity.
Stereotypes leading to stigma rejection prejudice discrimination.
Verbal physical relational cyber Subtle and overtSlide courtesy of the Obesity Action Coalition www obesityaction org Why Understanding Weight Bias Is Important It prevents patients affected by obesity from seeking care and professionals.
from offering care It s the last socially acceptable form of discrimination It hampers our nation s efforts to effectively combat the obesity epidemic It is a primary driver around the current limitations of access to treatment Recognizing and combatting bias both your own and in the community is an.
important step in addressing obesity Slide courtesy of the Obesity Action Coalition www obesityaction org Coping with Weight StigmaStudy Survey of 2 449 womenHow do they cope with weight stigma experiences .
79 reported eating turning to food as a coping mechanism Stigma is a stressor Both acute and chronic forms of stress Eating is a common response to stressPuhl and Brownell 2006 slide courtesy of the Obesity Action Coalition.
What Might Comprehensive Medical Obesity Treatment Include Physical ActivityMedication Growth of the Field of Obesity Medicine 2011 2015 saw a total of 36 303 newly certified physicians by the American.
Board of Internal Medicine New sub specialties include adolescent medicine transplant heart failure andtransplant cardiology critical care medicine geriatric medicine and addiction The American Board of Obesity Medicine ABOM was created by the ObesityMedicine Association and The Obesity Society in 2011 and has more than 2 000.
Diplomates as of 2017 The growth of this group is faster than any other field of This is a pathway many have and will continue to travel Now OBESITYMEDICINE is at the frontier Number of ABOM Diplomates2012 2013 2014 2015 2016.
Slide courtesy of the American Board of Obesity Medicine www abom org Acknowledgements and ResourcesPROS. CONS “Obesity is a complex, multifactorial disease that develops from the interaction between genotype and the environment.Our understanding of how and why obesity occurs is incomplete; however, it involves the integration of social, behavioral, cultural, and physiological, metabolic, and genetic factors”. 1998 - National Heart, Lung, and Blood Institute (NHLBI)

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