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Dr. Marvin: We're talking about obesity, but really, morbid obesity is the major health problem. So, morbid obesity is defined as a level of obesity where other medical problems start to happen, and those medical problems are what put people at medical risk over the course of their lives. And that's the justification for doing something like placing a balloon in your stomach with a procedure, or having an operation.
Okay, so when we talk about obesity in the United States, or internationally, we define it by the body mass index. That's sort of a measure...it's a relationship of the weight to the body surface area. It's supposed to be a better number than just throwing up the weight because you could have a male who's 6'6", who weighs 300 pounds, and that's not really that out of bounds for him. But obviously, a female who's 5'2" and weighs 300 pounds, that's a really different story from...the terms of risk, so normal weight is considered to be 20 to 25.
In reality, most Americans are overweight, they're in the 25-to-30 range. Obese is defined as having a BMI greater 30, and then morbidly obese, where the medical problems start to accumulate, more at 35 or 40. And then, super obese, which is, not to be pejorative, but super obesity is a high-risk category, and anyone with a body mass index over 50 is really looking at significant risks for the future from a medical standpoint.
Obesity causes a variety of other medical problems and probably because the biochemistry suggests now that fat cells, by themselves, elaborate chemicals that get the body stirred up into an inflammatory state. And some of these disease processes come from that. There's also a concept now of lipotoxicity, and that's where the fat starts to accumulate in cells other than fat cells, so, liver cells for example, or heart cells. And that affects the function of those organs, so obesity is not a benign problem. Carrying around that extra fat is not just a self-image issue, it really does cause medical problem, medical dysfunction.
If we look at just a number of things that obesity leads to, surprisingly, now well proven is, cancer's more likely to occur if you're significantly overweight, particularly breast cancer and colon cancer, and other forms of cancer. These first six things on the list though are all independent risk factors for heart disease, for hardening of the arteries, for strokes, and heart attacks. One in five Americans dies from a heart attack and one in seven dies from a stroke.
So, these are risk factors for that and that's why obesity's commonly the root problem for those issues, and that's why we're seeing increased number of patients in the United States with diabetes, and therefore...and high blood pressure and high cholesterol, and that leads to more heart attacks, and strokes, and increased healthcare costs.
So, if you look at the United States, the percentage of the population that's obese varies from state to state. Usually, West Virginia and Mississippi are kind of fighting it out for who's the biggest state. Colorado's probably the healthiest state. Texas is about 10th, so we have a 30.9% obesity rate, that's very large. Our population's 25.6 million, so, you know, that's over 10 million people that are materially affected by this.
The cost is tremendous, $147 billion to $210 billion in direct costs. People missing work probably adds another $4.3 billion in costs to that and then, people who are at work but not productive because of limitations from their weight probably also contribute to decreased productivity, and is a financial strain.
Individually, heavy people pay more for their healthcare. They pay directly, indirectly, or someone else pays it, but they spend about 42% more than an average person or a normal weight person. Even patients who are moderately obese, not considered morbidly obese, end up being placed on medications more commonly, which suggest that they really are morbidly obese, it's just earlier in the spectrum than end-stage obesity with major medical problems. |