Fwd: qotd: Overweight, and our health care system

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-------- Original Message --------
Subject: qotd: Overweight, and our health care system
Date: Wed, 2 Jan 2013 11:36:34 -0800
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



JAMA
January 2, 2013
Association of All-Cause Mortality With Overweight and Obesity Using
Standard Body Mass Index Categories
By atherine M. Flegal, PhD; Brian K. Kit, MD; Heather Orpana, PhD; Barry
I. Graubard, PhD

In this study, we used the National Heart, Lung, and Blood Institute's
terminology with categories of underweight (BMI of <18.5), normal weight
(BMI of 18.5-<25), overweight (BMI of 25-<30), and obesity (BMI of ≥30).
Grade 1 obesity was defined as a BMI of 30 to less than 35; grade 2
obesity, a BMI of 35 to less than 40; and grade 3 obesity, a BMI of 40
or greater.

The most recent data from the United States show that almost 40% of
adult men and almost 30% of adult women fall into the overweight
category with a BMI of 25 to less than 30.

In the United States and Canada, more than half of those who are obese
fall into the grade 1 category (BMI of 30-<35).

According to the results presented herein, overweight (defined as a BMI
of 25-<30) is associated with significantly lower mortality overall
relative to the normal weight category with an overall summary HR
(hazard ratio) of 0.94.

The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95%
CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI,
0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades
2 and 3 obesity.

http://jama.jamanetwork.com/article.aspx?articleid=1555137

And...

OECD
Obesity Update 2012

Obesity rates

16.9% - All OECD nations

33.8% - United States

http://www.oecd.org/health/49716427.pdf

And...

NIH Body Mass Index (BMI) calculator:
http://nhlbisupport.com/bmi/


Comment: If you are amongst the 30 to 40 percent of Americans who are
overweight, you likely are resolving at the beginning of this year to
finally do something about your weight. The good news is that you don't
have to. Being overweight (BMI 25->30) is associated with a mortality
rate that is 6 percent lower than that for normal weight. Happy New Year.

In fact, even you fall into the category of grade 1 obesity (BMI
30->35), you still have no increase in mortality due to your weight
alone. (You can use the BMI calculator at the NIH link above to
determine where you fall.)

This, of course, does not mean that you are free to abandon healthy
habits. Good nutrition and regular exercise are still important. To
increase compliance, just be sure that the exercise program that you
select is enjoyable and that it is easily integrated into your daily
regimen. Same for selecting nutritious food.

Nevertheless, grade 2 and 3 obesity (BMI 35 or greater) are associated
with increased mortality, so prevention and intervention are important.
But is that primarily a responsibility of providers in the health care
delivery system? Telling people to exercise and eat well is great
advice, but it is not very effective, especially since everyone already
knows that.

Prevention of obesity is more a function of society at large. Health
education, school nutrition programs, responsible food product design by
the industry, planning of communities to promote physical activity such
as walking, biking or hiking, and including breaks for physical activity
for those in sedentary occupations are types of measures that would take
place out in the community rather than within the health care delivery
system.

However, Grade 2 and 3 obesity do place a burden on the health care
delivery system because of their association with chronic diseases. The
policy community correctly emphasizes that the delivery system must
provide chronic disease services. But that isn't new. That is what
primary care professionals have been doing all along.

What is a problem is that there has been a misplaced emphasis on chronic
disease management as if that were a new solution to health care cost
and quality issues. This has led to ineffectual tinkering by promoting
nebulous models such as accountable care organizations. The efforts
would be better directed toward reinforcing the primary care infrastructure.

If we really do want to improve the management of health care spending
while improving quality we need to implement fundamental structural
reform of our health care financing system by enacting a single payer,
improved Medicare for all. It's a system that would work great for all
of us, even for those of us who are overweight.