Obesity and Diabetes Take Top Spots in Study on Preventable Life-years Lost in the United States Population

| May 1, 2017

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.


Dear Readers,
We now have another alarming fact about the disease of obesity—according to recent research; it is the top cause of preventable life-years lost among the United States adult population.

Data presented by a team of researchers from Cleveland Clinic and New York University School of Medicine ranks obesity number one among causes of greatest number of preventable life-years lost. Diabetes came in second with tobacco use, high blood pressure, and high cholesterol following in order from greatest to least.[1]
This finding may not be surprising, as we know having obesity is associated with numerous health consequences, including type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. What is worth addressing is the terminology used in news coverage of this research, which refers to these causes as “modifiable behavioral risk factors.” While I agree that obesity is “modifiable,” I question the inclusion of the word “behavioral” because we know obesity is a complex disease with many factors involved in its causation. We now have evidence of genetic, physiologic, and environmental influences on obesity, and, as I discussed in a previous editorial message, evidence of drug-induced weight gain/weight loss hindrance.

The message that obesity is a complex disease that is caused by more than individual behavior is spreading. For instance, a quick internet search on “causes of obesity,” returns a result from the National Institutes of Health National Heart, Lung, and Blood Institute stating: energy imbalances, some genetic or endocrine medical conditions, and certain medicines are known to cause overweight or obesity.[2] The Centers for Disease Control and Prevention website on overweight and obesity also includes a section addressing adult obesity causes and consequences. It states that obesity is a complex health issue to address, resulting from a combination of causes and contributing factors, including individual factors such as behavior and genetics, and contributing factors in our society, including the food and physical activity environment, education and skills, and food marketing and promotion.”[3]

I would add to this discussion the set-point theory, which suggests that body weight is maintained at a stable range (i.e., set-point) despite the variability in energy intake and expenditure. Evidence on set-point shows that the body works to protect against weight loss during caloric deprivation compared to conditions of weight gain with overfeeding.[4] This knowledge that our bodies try to defend adiposity and fight against weight loss despite behavioral modifications, such as diet and exercise, makes it even clearer to us that adjunctive therapy is often needed.

Life-years lost in any patient population is difficult to measure as a number of outside influences may impact conclusions, such as whether the patient smokes, where he or she lives, and again, genetics. Research on life expectancy after surgical and non-surgical weight loss is mounting, however, and the results are mostly positive.

Ted Adams, PhD, MPH, from the Division of Cardiovascular Genetics, University of Utah and Intermountain LiVe Well Center, in Salt Lake City, Utah, is an expert on this topic as a lead investigator on the Utah Obesity Study[5] and recently a review of all-cause and cause-specific mortality associated with bariatric surgery.[6] The latter study concluded that bariatric surgical patients have significantly reduced long-term all-cause mortality when compared to severely obese non-bariatric surgical control groups.

One meta-analysis examined the literature on lifestyle-based weight loss interventions (i.e., diet, exercise, pharmacotherapy) among adults with obesity and concluded that intentional weight loss may be associated with approximately a 15-percent reduction in all-cause mortality.[7]

These studies support the idea that weight loss, whether achieved via nonsurgical (diet, exercise, pharmacotherapy, endoscopic procedures) or surgical modifications (bariatric surgery) can positively impact the mortality, longevity, and quality of life of the patient with obesity. That is another message we should be touting—obesity is modifiable when the patient is steered toward the appropriate treatment(s).

Sincerely,

Christopher Still, DO, FACN, FACP

References
1.    Cleveland Clinic Study Finds Obesity as Top Cause of Preventable Life-Years Lost. April 22, 2017. https://newsroom.clevelandclinic.org/2017/04/22/cleveland-clinic-study-finds-obesity-top-cause-preventable-life-years-lost/. Accessed April 22, 2017.
2.    National Institutes of Health National Heart, Lung, and Blood Institute. Explore Overweight and Obesity: Causes. Updated: February 23, 2017. https://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes. Accessed April 22, 2017
3.    Centers for Disease Control and Prevention. Updated: August 15, 2016Adult Obesity Causes & Consequences. https://www.cdc.gov/obesity/adult/causes.html. Accessed April 22, 2017.
4.    Farias MM, Cuevas AM, Rodriguez F. Set-point theory and obesity. Metab Syndr Relat Disord. 2011;9(2):85–89.
5.    Adams TD, Avelar E, Cloward T, et al. Design and rationale of the Utah obesity study. A study to assess morbidity following gastric bypass surgery. Contemp Clin Trials. 2005;26(5):534–551.
6.    Adams TD, Mehta TS, Davidson LE, Hunt SC. All-cause and cause-specific mortality associated with bariatric surgery: A review. Curr Atheroscler Rep. 2015;17(12):74.
7.    Kritchevsky SB, Beavers KM, Miller ME, et al. Intentional weight loss and all-cause mortality: A meta-analysis of randomized clinical trials. PLoS One. 2015;10(3):e0121993.

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