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Obesity

Obesity Health Issues

Premature Deaths

Premature deaths in Australia avoided because of weight loss surgery

There is ample evidence that weight loss surgery is effective in helping obese people lose weight and to resolve chronic disease like type 2 diabetes, high blood pressure, obstructive sleep apnea and arthritis. There is also clear evidence from a prospective study of more than half a million men and women in the United States that "excess body weight during midlife, including overweight, is associated with an increased risk of death." So, overweight people die prematurely compared to their "normal weight" colleagues. Can weight loss surgery – given its record in facilitating significant, long-term reductions in excess weight actually help people to live longer? Swedish researchers set out to determine whether obese people who had weight loss surgery lived longer than obese people who used conventional treatments. They matched 2010 obese people who had had a gastric band, a vertical banded gastroplasty or a gastric bypass with 2037 obese people who acted as the control group. They showed that after an average of 10.9 years 129 people in the control group had died whereas 101 people in the surgical group had died. Simple maths shows that 6.3% of the control group had died at 10.9 years down the track whereas only 5% of the surgical group had died. So, in layman's terms, the Swedish study showed that in addition to all the health benefits and savings to the medical system that come from weight loss surgery, every 2,000 procedures saves about 28 people from dying prematurely.

How many premature deaths have been avoided in Australia by weight loss surgery?

Medicare figures in Australia12 show there were 39,113 surgical weight loss procedures (including gastric band and gastric by-pass) in Australia in the ten years from 1998 to the end of 2007. Using the evidence from the Swedish study, it is possible to say that the surgical procedures in Australia over the past decade will have prevented (or is in the process of preventing) 547 premature deaths (i.e. 39,113÷2,000 x 28). This brief analysis however, examines a period during which weight loss surgery was relatively uncommon. As the graph on the facing page shows, there were less than 2,000 total procedures in each of the years between and including 1998 and 2001, whereas with the growing popularity of weight loss surgery, there were 9,577 procedures in 2007. So to the end of 2007 the number of premature deaths avoided because of weight loss surgery in the past decade is counted in its hundreds. But with the growing popularity of surgical approaches and improved holistic services including lifestyle modification and closer long-term monitoring, what might the contribution be in the future?

Diabetes

10.8% of people with Type 2 diabetes are diabetic as a consequence of being obese.

Based on these estimates, in 2005 102,204 Australians had Type 2 diabetes as a result of being obese.

Based on health expenditure data provided by the AIHW for Type 1 and 2 diabetes and the share of Type 2 diabetes provided by the ABS (2001), the allocated health costs arising from Type 2 diabetes are estimated to be $921.6 million in 2005.

  • The majority (28.8%) of health expenditure is directed to pharmaceuticals – $265.6 million in 2005. This item includes over the counter and prescription medication such as insulin, oral hypoglycaemic agents, lipid lowering and blood pressure lowering agents and non-steroidal anti-inflammatory drugs.
  • Inpatient expenditures were the second largest, comprising a further 28.4% or $262.2 million.
  • Out-of-hospital medical services were the third most substantial cost element at $207.7 million (22.5% of the total).
  • Outpatient expenditures accounted for 7.1% of total costs - 65.8 million.

The annual cost of lost earnings for people with Type 2 diabetes as a result of obesity was $429.1 million in 2005 (0.14% of GDP).

For people with Type 2 diabetes as a result of obesity the annual costs of absenteeism are $5.8 million ($0.9 million incurred by employees and $4.9 million incurred by employers) in 2005

For people aged 15-64 with Type 2 diabetes as a result of obesity the annual cost due to premature death was $7.0 million in 2005.

For Australians with Type 2 diabetes as a result of obesity (i.e. 10.8% of Type 2 diabetes sufferers), the replacement value of informal care is $478.5 million of which family and friends bore $455.5 million and the Government $23.0 million in 2005.

The annual cost for aids and equipment for people disabled by Type 2 diabetes as a result of obesity was $5.7 million in 2005. For individuals with Type 2, funeral costs due to premature death were $1.3 million in 2005).

The Total Health Costs arising from type 2 Diabetes caused by Obesity were $116.1 Million in 2005.

Cardiovascular Disease

In 2005 over 379,000 Australians had cardiovascular disease (chronic heart disease, ischaemic stroke and hypertension) as a result of being obese.

On this basis, obesity related cardiovascular disease is estimated to be responsible for 532,334 years of healthy Australian life lost in 2005.

In total, the loss of earnings from loss of employment and absenteeism is estimated for 2005 as $2.08 billion for obesity related cardiovascular diseases.

Tax revenue foregone on potential earnings lost were estimated as $608 million in 2005 for obesity related cardiovascular diseases, comprising $440 million of personal income tax and $167 million of indirect tax.

The total health costs arising from cardiovascular diseases due to obesity were $428.3 million in 2005.

Gall Stones

A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

Types of gallstones and causes:

  • Cholesterol stones
  • Pigment stones
  • Mixed stones - the most common type. They are comprised of cholesterol and salts.

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by liver through bile. They include the following:

  • Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
  • Obesity. Obesity is a major risk factor for gallstones, especially in women.

Infertility

Overweight and obesity are serious and prevalent conditions in Western countries and carry many health consequences, including reproductive dysfunction. In particular, excess fat in the abdominal area is strongly related to disorders of the reproductive system. Moderate weight loss and reduction of abdominal fat improves menstrual regularity, ovulation, and infertility in women. This may be etiologically related to insulin resistance, particularly in a subset of infertile women with polycystic ovary syndrome. As such, weight loss should be promoted as an initial treatment option for obese women with infertility. However, the most effective method for achieving and maintaining weight loss is unclear. Gradual weight loss is best achieved through a sensible eating plan that can be maintained over long periods of time. The likelihood of maintaining weight loss is increased when diet is combined with regular exercise, cognitive behavior therapy, and a supportive group environment. Adoption of these principles in a primary healthcare setting can therefore aid in treatment of infertility related to obesity.

Asthma

It is very important that you maintain an ideal weight and good physical fitness if you have asthma. Being overweight may certainly make breathing more difficult, and some people find that their ability to breathe is worsened by the feeling of being full. It is also postulated that being overweight encourages gastro-oesophageal reflux disease (GORD), which can be a trigger for asthma in some people.

An Australian study of nearly 2000 adults found that although adults with severe obesity had more wheeze and shortness of breath — which may suggest a diagnosis of asthma — they did not have an increased rate of airway responsiveness, or obstruction, which are measures used in the diagnosis of asthma.

The underweight group in the study had increased symptoms of shortness of breath, increased airway responsiveness and reduced lung function but without an increase in asthma medication use.

In 2003, a broad-ranging review of existing medical literature concerning evidence both for and against an association between obesity and asthma concluded that evidence of a link between the 2 conditions is strong, although it is unlikely that one condition is directly causing the other.

This review proposed 3 possible explanations for the asthma—obesity association that require further investigation to verify:

  • that GORD as a result of obesity causes asthma;
  • that physical inactivity promotes both obesity and asthma; and
  • that the diets of obese people may potentiate asthma.

Arthritis
Obesity may worsen arthritis symptoms

Being overweight does affect people with arthritis. Joints affected by arthritis are already under strain. If you are overweight or obese, the extra load on your joints may be exacerbating your symptoms, especially if your affected joints include those of the hip, knee or spine. There is also a clear link between being overweight and an increased risk of developing osteoarthritis.

To lose excess weight, you must be active, but this can be difficult for people with arthritis due to pain or stiffness. See your doctor, dietitian or health professional for information and advice. Weight reduction strategies may include:

  • • Switch to a diet that is high in nutrition, while low in kilojoules.
  • • Experiment with different sorts of activities - for example, it may be possible to enjoy swimming or some kinds of low impact exercises.
  • • Limit your exercise activities to unaffected joints - for example, if your hands are affected, you may be able to comfortably ride on a stationary bicycle.

The total health costs arising from osteoarthritis caused by obesity were $221.3 million in 2005.

Cancer

Based on the attributable fractions by age-gender group for each cancer, in 2005, 20,430 Australians had cancer as a result of being obese.

The total health costs arising from cancer due to obesity were $107.3 million in 2005

In total, in 2005 an estimated $414.3 million is incurred through long-term reductions in employment, hours worked and earnings per hour worked due to obesity-related cancer.

Overall in 2005, around 254,900 hours of informal care were provided to people with cancer (either colorectal, breast, kidney or uterine) in Australia, equivalent to 6 hours per person with active obesity related cancer per year.

The expected productivity and carer costs (on an opportunity cost basis) in 2005 of colorectal, breast, kidney or uterine cancer due to obesity in Australia is estimated as $221.5 million.

Overall, the expected out-of-pocket costs (aids, equipment and modifications, formal care, travel and accommodation, communication, and complementary or alternative therapies) were $125.2 million for obesity related cancers in 2005.

Heart Disease And Stroke

There is a link between obesity and stroke; this is particularly the case for people whose fat is situated predominantly in the abdominal region. Overweight people are more likely to have high blood cholesterol levels and high blood pressure, but these associations are not the only explanations for the greater stroke rate. Heart disease and stroke are the leading causes of death and disability for both men and women in the United States and Australia. Overweight people are more likely to have high blood pressure, a major risk factor for heart disease and stroke, than people who are not overweight. Very high blood levels of cholesterol and triglycerides (blood fats) can also lead to heart disease and often are linked to being overweight. Being overweight also contributes to angina (chest pain caused by decreased oxygen to the heart) and sudden death from heart disease or stroke without any signs or symptoms.

The good news is that losing a small amount of weight can reduce your chances of developing heart disease or a stroke. Reducing your weight by 10 percent can decrease your chance of developing heart disease by improving how your heart works, blood pressure, and levels of blood cholesterol and triglycerides.

Fatty Liver Disease

Fatty liver is also known as NASH, which stands for Non-Alcoholic Steatorrhoeic Hepatosis or Non-Alcoholic-Fatty-Liver-Disease (NAFLD). Fatty liver is due to excessive accumulation of fatty material in the hepatocytes (liver cells), which is the most common response of the liver to injury.

In countries where obesity is becoming a serious health issue, Fatty liver is predicted to affect approximately 25% of the general population. Fatty liver or NASH, is very common in overweight persons over the age of 30. The liver is invaded by an excessive amount of fat and a normal healthy liver tissue is partially replaced with areas of unhealthy fats. In such a liver, the liver cells and the spaces in the liver are filled with fat so the liver becomes slightly enlarged and heavier.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a common disease with an annual incidence of about 1 in 1000. Many risk factors have already been studied, both genetic and acquired. It is unclear whether obesity affects thrombotic risk in unselected patients. Obesity is common, with a prevalence of 20-25% and may therefore have a considerable impact on the overall incidence of thrombosis. We evaluated the risk of thrombosis due to overweight and obesity using data from a large population based case-control study. Four hundred and fifty-four consecutive patients with a first episode of objectively diagnosed thrombosis from three Anticoagulation Clinics in the Netherlands were enrolled in a case-control study. Controls were matched on age and sex to patients and were introduced by the patients. All patients completed a standard questionnaire and interview, with weight and height measured under standard conditions. The associations of obesity with clotting factor levels were studied to investigate possible mechanisms.

Obesity (BMI ?30 kg/m2) increased the risk of thrombosis twofold (CI95: 1.5 to 3.4), adjusted for age and sex. Obese individuals had higher levels of factor VIII and factor IX, but not of fibrinogen.The effect on risk of obesity was not changed after adjustment for coagulation factors levels (fibrinogen, F VIII, F IX, D-dimer). The relative risk estimates were similar in different age groups and in both sexes, indicating a larger absolute effect in older age groups. Evaluation of the combined effect of obesity and oral contraceptive pills among women aged 15-45 revealed that oral contraceptives further increased the effect of obesity on the risk of thrombosis, leading to 10-fold increased risk amongst women with a BMI greater than 25 kg/m2 who used oral contraceptives. Obesity is a risk factor for deep vein thrombosis. Among women with a BMI greater than 25 kg/m2 the synergistic effect with oral contraceptives should be considered when prescribing these.

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