Over the past 15 years, smoking rates in the US have declined by 20%, whereas obesity rates have increased by 48%.

A new analysis published in the New England Journal of Medicine by Susan Stewart and colleagues from Harvard University, Boston, MA, forecasts the effect of trends in obesity and smoking on future U.S. life expectancy and quality-adjusted life expectancy.

The researchers used data from the past three decades to forecast future rates of obesity and smoking and estimate their effects on length and quality of life.

The net effect of the declines in smoking and the increases in BMI for an 18-year old is a reduction in life expectancy of 0.71 years and a reduction in quality-adjusted life expectancy of 0.91 years relative to the trend. This pattern of results is seen for every year between 2005 and 2020 and becomes more pronounced over time.

The calculations assume that if past trends continue, almost half the U.S. adult population will meet the WHO criteria for obesity by 2020 (currently the obesity rate already exceeds 35% in some states).

Obviously, these forecasts are at a population level and do not apply to a particular person who loses weight or stops smoking.

While these results do not imply that life expectancy will fall, they do suggest that as a result of increasing obesity rates life expectancy will rise less rapidly than it otherwise would.

While these are US data, there is little reason to assume that similar trends will not also be apparent in other countries including Canada.

Clearly, policy makers will likely now need to address obesity with the same vehemence as they did smoking - unfortunately, finding and implementing effective policies to reduce obesity makes smoking bans look like a walk in the park (no pun intended).

AMS
Edmonton, Alberta

Yesterday I had the pleasure of speaking to a group of Japanese colleagues from the Sapporo Medical University on the Edmonton Obesity Staging System (EOSS) and the recently published Etiological Framework for Obesity Assessment. The evening was chaired by Professor Kazuaki Shimamoto, who I have had the pleasure of meeting on several previous visits to Japan.

In my discussions with the participants it became immediately obvious that our proposed clinical staging of obesity can also be applied to obese patients in Japan, albeit using the lower BMI cutoff of 25 used to define obesity in this population.

Given the large number of nephrologists and cardiologists in the audience, I also found that the edema analogy, which I now often use to describe the state of excess caloric balance (or caloric “retention”), very much resonates with clinicians and provides an immediately understandable framework for approaching patients presenting with excess weight gain.

This evening I also plan to meet with a number of colleagues from Tokyo, who have previously attended the International Cardiovascular Expert Fora that I had organised during my time at McMaster University. These fora, which brought together a select group of clinical researchers from across several European and Asian countries, continues to be an interesting network of friends around the world, who always provide a sounding board for some of the issues that are relevant to cardiovascular and metabolic risk management.

As obesity rates continue to grow around the world, it is becoming painfully obvious that much needs to be done to address this issue at a global level. While we hope and wait for preventive measures to kick in, there is no doubt that the access to proper evidence-based obesity management remains a dire challenge in virtually all medical systems.

I am certainly grateful for the opportunity to share and learn from colleagues around the world on how best to approach this issue.

AMS
Tokyo, Japan

This post is not about the problems facing emergency responders because of the increase in severely obese clients. Nor is this post about the increasing need for “supersized” ambulances and rescue equipment. It is also not about teaching emergency responders sensitivity skills in their dealings with people with excess weight.

No, this post is about obesity in emergency responders themselves.

In a paper published in last month’s issue of OBESITY, Antonios Tsismenakis and colleagues from the Harvard School of Public Health, Boston, MA, USA, studied the prevalence and health associations of excess weight among 370 consecutive emergency responder candidates for fire and ambulance services in Massachusetts.

The average BMI of the young candidates (mean age 26.3 yrs) was 28.5, i.e. just below the BMI cutoff for obesity. In fact, 77% were in the overweight category and 33% had obesity (i.e. not very different from the US general population).

Not surprisingly higher BMI was associated with higher blood pressures, worse metabolic profiles, and lower exercise tolerance.

These findings are of particular concern as emergency responders are routinely required to perform demanding duties that require optimal cardiovascular fitness. A similar problem is faced by other services like the police, armed forces and other professions that have to rely on a constant supply of healthy and fit young adults.

Of course, as readers of these pages know, there is a wide range of weights across which people can be quite fit and healthy. Nevertheless, excess weight in prospective emergency responders is certainly not something to be taken lightly and how to deal with this issue without overtly discriminating against recruits simply based on BMI (just a number on your scale) may prove challenging.

AMS
Edmonton, Alberta

One of the most striking characteristics of the obesity epidemic is that it does not affect everyone alike. Indeed, it has long been noted, that despite correction for confounder, people living in metropolitan centres like Montreal, Toronto or Vancouver are far less likely to be obese than people living just outside the city in the suburb. Obesity rates increase further as one moves to more rural communities.

This issue was now analysed in detail by Theodora Pouliou and Susan Elliott, health geographers from McMaster University, Hamilton, Ontario, in a paper just published in Preventive Medicine.

The study examines sex-specific spatial patterns and clusters of obesity in Canada using BMI data from the 2005 Canadian Community Health Survey.

Results reveal marked geographical variation in obesity prevalence with higher values in the Northern and Atlantic health-regions and lower values in the Southern and Western health-regions of Canada.

Significant positive spatial autocorrelation was found for both males and females, with significant clusters of high values or ‘hot spots’ of obesity in the Atlantic and Northern health-regions of Alberta, Saskatchewan, Manitoba and Ontario.

Not only do these analyses point to important differences in obesity prevalence across Canada, but they also help identify hot spots, where it may beneficial to focus obesity prevention resources rather than spending these on areas, where obesity is far less prevalent (like inner city centres).

AMS
Toronto, Ontario

Excess weight markedly increases the risk for a wide range of health problems including diabetes, heart disease, gall bladder stones, back pain, hip and knee problems and certain cancers. It is therefore reasonable to hypothesize that obesity is associated with increased need for hospitalization. This question is important because hospitalization accounts for a substantial proportion of health care costs.

Han and colleagues from the University of North Carolina, Chapel Hill, NC examined the relationship between obesity and hospitalization in the around 15,000 participants of the ARIC (Atherosclerosis Risk in Communities) Study, prospectively followed for 13 years - the results were published online in the International Journal of Obesity last week.

The study examined associations between weight status and all-cause and cause-specific hospitalizations (for cardiovascular and a few selected non-cardiovascular conditions). Analyses were adjusted for numerous factors including race, gender, age, physical activity, education level, smoking status, alcoholic beverage consumption and health insurance at baseline.

The average number of all-cause hospitalizations increased from 1316 per 1000 in normal weight individuals to 1543 in overweight and 2025 in obese participants. While normal weight women had significantly fewer hospitalizations than normal weight men (1173 versus 1515 per 1000), but the increase associated with being obese on the number of all-cause hospitalizations was larger in women than men (791 versus 589 per 1000).

While obesity was associated with increased hospitalization rates for all cardiovascular disease-related primary causes (e.g. myocardial infarction, congestive heart failure, stroke, etc.), the biggest relative impact of obesity was seen on hospitalization for osteoarthritis (9 per 1000 in normal weight vs. 79 per 1000 - an almost 8-fold increase!).

Based on this clear evidence that overweight and obesity substantially increases the number of hospitalizations, the authors emphasize that continued research on obesity treatment and prevention (I would add: as well as increasing access to obesity treatments) is essential.

AMS
Edmonton, Alberta