Category: Obesity Updates

Failing to Change Behavior

According to the July 11, 2013 issue of The New England Journal of Medicine, the Look AHEAD trial has been canceled on the “basis of a futility analysis” after 9.6 years of follow-up. It was designed to study whether an intensive lifestyle intervention for weight loss would decrease cardiovascular morbidity and mortality among overweight or obese patients with Type 2 diabetes. Short of interning people in exercise camps, it is hard to imagine a more intensive intervention.

The 5,145 participants were randomly assigned to either a control group or an intensive lifestyle intervention group. The control group received the usual information about behavioral strategies for adopting standard recommendations about how to eat right and exercise.

The Cost of Being Fat

In the past 30 years, the percentage of American adults who are obese has doubled, driving a sharp rise in such chronic conditions as diabetes, heart disease and hypertension.

The ramifications for health spending are significant. Annual health costs for obese individuals are more than $2,700 higher than for non-obese people. That adds up to about $190 billion every year. And many of these costs are borne by Medicare, which will spend a half-trillion dollars over the next decade on preventable hospital readmissions alone.

Ken Thorpe and Tommy Thompson in USA Today.

Who Pays For Obesity?

A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population — a statement which is then taken to justify public policy interventions…We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity…

Oops. There goes the whole reason for Mayor Bloomberg’s soda ban and his call for a soda tax. The study. HT: Jason Shafrin.

Weight Loss Therapy a Bargain for Medicare

Emory Professor, Kenneth Thorpe, examines the costs of treating obesity-related conditions and found medications that help Medicare enrollees lose weight could save money for Medicare in the long term.

Permanent weight loss of 10 to 15% will yield $9,445 to $15,987 in gross per capita savings throughout their lifetime, and $8,070 to $13,474 over ten years. Similarly, initial weight loss of 10 to 15% followed by 90% weight regain will result in gross per capita savings of $7,556 to $11,109 over their lifetime, and $6,456 to $8,911 over ten years. Targeting weight loss medications to adults with obesity (BMI ≥ 30) produces greater savings to the Medicare program.

Three Oreo Cookies a Day

That’s all it takes to make us fat. From Timothy Taylor at the Conversable Economist:

The rise in American rates of obesity can be traced back to what seems like a fairly small rise in daily calories consumed, I learned this lesson from an article on the causes of obesity about 10 years back in my own Journal of Economic Perspectives. In “Why Have Americans Become More Obese?” David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro wrote that the “10- to 12-pound increase in median weight we observe in the past two decades requires a net caloric imbalance of about 100 to 150 calories per day. These calorie numbers are strikingly small. One hundred and fifty calories per day is three Oreo cookies or one can of Pepsi. It is about a mile and a half of walking.”

More Myths about Obesity

There were some myths that I already knew were false. But the presumptions pretty much blew me away. Early childhood weight and habits predicting later outcomes? No evidence. Eating more fruits and vegetables? No effect on their own. Snacking associated with weight gain? Nope. Built environment related to obesity? Try again.

Granted some things about obesity are correct. Exercise is good for you no matter what, and it can help in long term weight loss. Programs that involve families are more likely to help children. Bariatric surgery can be a real life saver for some people.

Austin Frakt summaryNEJM study.

Myths About Losing Weight

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Source: Gina Kolata in The New York Times

Being Overweight = Longer Life + Higher Medical Bills

Re: last week’s finding that overweight people may live longer. Here’s the rest of the story:

“The study looked at quantity of life, not quality of life, and that’s a very important distinction,” noted Dana Goldman, director of the University of Southern California’s Leonard D. Schaeffer Center for Health Policy and Economics.

A higher body mass index — a standard measure for determining whether people are overweight or obese — is associated with a number of chronic illnesses, including diabetes, heart disease and hypertension. These chronic illnesses are expensive to treat. If, as it now turns out, overweight people are living longer in addition to racking up more chronic illnesses, that means Medicare is on the hook for paying for more expensive people for more years.

Catherine Rampell. Critique of the study here. A defense of fat here.

Less Smoking vs. More Obesity: Is It a Wash?

We find that both changes in smoking and in obesity are expected to have large effects on mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.92 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.26 years expected by 2040.

Source: NBER paper.

Inactivity is Not the Source of Modern Obesity

My colleagues and I recently measured daily energy expenditure among the Hadza people of Tanzania, one of the few remaining populations of traditional hunter-gatherers.

We found that despite all this physical activity, the number of calories that the Hadza burned per day was indistinguishable from that of typical adults in Europe and the United States. We ran a number of statistical tests, accounting for body mass, lean body mass, age, sex and fat mass, and still found no difference in daily energy expenditure between the Hadza and their Western counterparts.

See more of Herman Pontzer’s findings in the NYT.