Dexter Shurney, MD, MBA, MPH

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Implications of the Obesity EpidemicFebruary 4,
2008

• Dexter Shurney, MD, MBA, MPH
• SVP/CMO

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Where the discussion should lead
Premature Death
Presenteeism
Diabetes
Heart Disease
Chronic Conditions
Obesity
Cancer
Absenteeism
Osteoarthritis
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Weight Matters
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

• The prevalence of diabetes increases in a
  dose-response relationship with increasing BMI.
  BMI gt 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)

Source HealthDay News, June 23, 2007
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How Does Obesity Cause Disease?

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

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Where the discussion should lead
Premature Death
Presenteeism
Diabetes
Heart Disease
Chronic Conditions
Obesity
Cancer
Absenteeism
Osteoarthritis
Healthy Diet
Exercise
Lifestyle
Adequate Sleep
Stress Management
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LifeStyle

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 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.
2007132(6)
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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 912 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
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Where the discussion should lead
Premature Death
Presenteeism
Diabetes
Heart Disease
Chronic Conditions
Obesity
Cancer
Absenteeism
Osteoarthritis
Local Community
Healthy Diet
Exercise
Federal
Lifestyle
POLICY
Adequate Sleep
Employer Worksite
Stress Management
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Critical Path
DIABETES
Primary prevention and management of overweight
and physical inactivity offer potential as
cost-control strategies
OBESITY
LIFESTYLE
POLICY
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Strategies to Overcome and Prevent (STOP) Obesity
Alliance new policy recommendations

• Redefining Success
• Encouraging Innovation and Best Practices in
  Obesity Treatment
• Addressing and Reducing Stigma as a Barrier to
  Obesity Treatment
• Broadening the Research Agenda for Obesity
• http//www.stopobesityalliance.org.

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Policy Challenges

• Built Environment
• Care Management

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Policy Challenges
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 2007357370-9

• Built Environment
• Worksite
• Culture of Health
• Incentives
• Wellness programs and services
• Addressing the Family Unit
• Community Involvement and Change
• Affordable Healthy Food

Cities Study Dearth of Healthy Food Some areas
suffer a grocery gap Theyre rife with fast food
but lack fruits, vegetables USA Today Jan. 25,
2008
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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, MPH Chief
Health and Medical Officer Lumenos
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The Many Benefits of Lifestyle Change
Benefits of Exercise

• Reduce risk for Heart Disease and Stroke
• Back Pain
• Osteoporosis
• Psychological benefits including stress hardiness

New Value Proposition
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 n3,284)

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Matter of Choices
CHRONIC CONDITIONS
Manage chronic conditions and treat the
complications OR Help people with lifestyle and
avoid majority of these problems altogether
Nonalcoholic fatty liver disease
Dyslipidemia
Gynecologic abnormalities
Coronary Heart Disease
Diabetes
Cataracts
Pancreatitis
Hypertension
Cancer
Stroke
Phlebitis
Osteoarthritis
Gallbladder Disease
Obstructive Sleep Apnea
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Miscellaneous Facts

• The prevalence of diabetes increases in a
  dose-response relationship with increasing BMI.
  BMI gt 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. gt 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, n108)
  improves long-term glycemic control in type-2
  diabetics (Diabetes Care, 2002)

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Questions?
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Contact

• Dexter Shurney
• SVP / Chief Medical Officer
• Healthways
• 615-565-5932
• dexter.shurney_at_healthways.com