2/5/2008
Where the discussion should lead
Diabetes
Implications of the Obesity
Epidemic
February 4, 2008
Cancer
Presenteeism
Heart
Disease
Chronic
Premature
Death
Obesity
Conditions
Absenteeism
Osteoarthritis
Dexter Shurney, MD, MBA, MPH
SVP/CMO
How Does Obesity Cause
Disease?
Weight Matters
The prevalence of
diabetes increases in a
dose-response
relationship with
increasing BMI. BMI >
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)
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…
Toxic Adiposity
•Excess production of hormones from fat
•Angiotensinogen
•Estrogen
•TNF-alpha
•Leptin
•Insulin
•IL-1
•Inflammation
Source: HealthDay News, June 23, 2007
LifeStyle
Where the discussion should lead
Diabetes
Cancer
Heart
Disease
Chronic
Presenteeism
Premature
Death
Obesity
Conditions
Absenteeism
Osteoarthritis
Healthy Diet
the combination of
•a proper diet
•physical activity
•behavior therapy
Exercise
Lifestyle
Adequate Sleep
Stress
Management
© 2008 Healthways, Inc.
………………
Lifestyle modification
is the cornerstone of treatment
for obesity
Source: Wadden et.al Lifestyle Modification for the Management
of Obesity. Gastroenterology. 2007;132(6)
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
1
2/5/2008
Lifestyle: Current State of Affairs
Where the discussion should lead
.
•More than 50% of U.S. adults do not get enough physical
activity to provide health benefits
Diabetes
Cancer
Presenteeism
Absenteeism
Osteoarthritis
Local
Community
Federal
Premature
Death
Obesity
Conditions
•Insufficient physical activity is not limited to adults. About
two-thirds of young people in grades 9–12 are not
engaged in recommended levels of physical activity.
•Activity decreases among those with lower incomes and
less education.
Heart
Disease
Chronic
Healthy Diet
Exercise
Lifestyle
POLICY
Adequate Sleep
•In 2005, only one-fourth of U.S. adults ate five or more
servings of fruits and vegetables each day.
Employer
Worksite
Stress
Management
Source: CDC, 2005
Strategies to Overcome and Prevent
(STOP) Obesity Alliance new policy
Critical Path
recommendations
DIABETES
OBESITY
LIFESTYLE
POLICY
Primary prevention
and management of
overweight and
physical inactivity offer
potential as costcontrol strategies
1. Redefining Success
2. Encouraging Innovation and Best Practices in Obesity
Treatment
3. Addressing and Reducing Stigma as a Barrier to Obesity
Treatment
4. Broadening the Research Agenda for Obesity
http://www.stopobesityalliance.org.
Policy Challenges
Policy Challenges
Built Environment
• Built Environment
• Care Management
• Worksite
• Culture of Health
• Incentives
• Wellness programs and
services
• Addressing the Family Unit
“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 2007;357:370-9
• Community Involvement and Change
• Affordable Healthy Food
Cities Study Dearth of Healthy Food “Some areas suffer a grocery gap:
They’re rife with fast food but lack fruits, vegetables…” USA Today Jan. 25, 2008
© 2008 Healthways, Inc.
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2/5/2008
The Many Benefits of Lifestyle Change
Policy Challenges
Care Management
• Build awareness and understanding to shape policy
• Lifestyle services need to be a core offering
New Value Proposition
> Reduce risk for Heart Disease and
Exercise
Stroke
• Articulate a new Value Proposition
> Back Pain
> Osteoporosis
• Willingness to pay for new value proposition
> Psychological benefits including
• Creating policies that drive adoption
stress hardiness
“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”.
•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; n=3,284)
Michael D. Parkinson, MD, MPH
Chief Health and Medical Officer
Lumenos
Miscellaneous Facts
Matter of Choices
CHRONIC CONDITIONS
Manage chronic
conditions and treat
the complications
Diabetes
Pancreatitis
Cancer
Nonalcoholic
fatty liver
disease
Coronary
Heart
Disease
Dyslipidemia
Gynecologic
abnormalities
OR
Help people with
lifestyle and avoid
majority of these
problems altogether
Benefits of Exercise
Cataracts
Stroke
Osteoarthritis
Obstructive
Sleep
Apnea
Hypertension
•The prevalence of diabetes increases in a dose-response relationship with
increasing BMI. BMI > 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. > 2
packs/day increased risk 47% in men and 74% in women compared to nonsmokers. (Int. J. Epidemiology, 2001)
•Stress management (lowered HbA1c 0.5%, n=108) improves long-term
glycemic control in type-2 diabetics (Diabetes Care, 2002)
Phlebitis
Gallbladder
Disease
Contact
Questions?
Dexter Shurney
SVP / Chief Medical Officer
Healthways
615-565-5932
dexter.shurney@healthways.com
© 2008 Healthways, Inc.
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