Obesity is second only to tobacco as the leading cause of preventable death in the United States. The costs of treating adults with obesity are over $238 billion a year, making it one of the most expensive diseases in the country. It is increasing among all age, gender, racial and ethnic groups and it is increasing across the entire world. The United States Government, the leader in the world's public health efforts, has a minimal research program for obesity, and spends no money for prevention and virtually none for treatment. There is no trend to indicate a reversal in the increasing prevalence of obesity.

According to a recent study by the RAND organization, obesity is more damaging to health than smoking, high levels of alcohol drinking, and poverty. Obesity affects all major bodily systems - heart, lung, muscle and bones. (American Obesity Association - http://www.obesity.org)

The all-cause mortality rate for individuals with obesity, particularly with cardiovascular disease, is 50% to 100% greater than for normal weight individuals. (National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Obesity in Adults: The Evidence Report. NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults. Washington, DC: U.S. Department of Health and Human Services, 1998)

In 1997 2,314,245 people died in the United States. 13% of all these deaths were related to or the direct result of obesity. (American Obesity Association - http://www.obesity.org)

Obesity is a multifactorial chronic disease caused by an interaction between environmental and genetic factors. Obesity is an increasingly important health problem not only in the U.S. but worldwide. Obesity contributes to the causes of many chronic diseases including type 2 diabetes, heart disease, hypertension, and cancer. Family, twin, and adoption studies have explored the fraction of the population variation in weight or body mass index (weight/height2) (BMI) that can be explained by the passing on of genes. These studies suggest that 25 to 70 percent of the individual differences in weight may depend on genetic factors. (OUTLINE OF PROPOSED GENETIC ACTIVITIES IN OBESITY RESEARCH DIVISION OF NUTRITION AND PHYSICAL ACTIVITY, CDC January 2002 CONTACT: Heidi Blanck)

Persons with obesity are at risk of developing one or more serious medical conditions. Obesity is associated with more than 30 medical conditions. Strong relationships have been scientifically established between obesity and at least 15 conditions, including arthritis, breast cancer, heart disease, colorectal cancer, type 2 diabetes, endometrial cancer, end-stage renal disease, gallbladder disease, hypertension, liver disease, low back pain, renal cell cancer, obstructive sleep apnea, stroke, and urinary incontinence.

(Press Release. HHH News – DHHS, New Report Documents Improvement in Americans' Health. U.S. Department of Health and Human Services, Washington, DC, June 10, 1999.

National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Obesity in Adults: The Evidence Report. NHLBI Obesity Education Initiative Expert Panel on Health and Human Services, 1998.

Shape Up America! and American Obesity Association, Guidance for Treatment of Adult Obesity, 1998.

AACE/ACE Obesity Task Force. Position Statement on the Prevention, Diagnosis and Treatment of Obesity [online]. The American Association of Clinical Endocrinologists and The American College of Endocrinology, 1998 revision. Available at http://www.aace.com/clinguideindex.htm)

Poor diet and inactivity, contributors of obesity, are responsible for between 300,000 and 587,000 deaths a year, making it the second leading cause of preventable death in the U.S. (McGinnis, J.M. and Foege, W.H. Actual causes of death in the United States. Journal of the American Medical Association 270:2207-2212, 1993.)

Obesity is a risk factor or an aggravating agent for more than 30 conditions. They are: arthritis (osteoarthritis and rheumatoid arthritis), birth defects, cancers (breast cancer in women, breast cancer in men, cancers of the esophagus and gastric cardia, colorectal cancer, endometrial cancer, renal cancer), carpal tunnel syndrome, cardiovascular disease, chronic venous insufficiency, daytime sleepiness, deep vein thrombosis, end stage renal disease, gallbladder disease, gout, heat disorders, hypertension, impaired immune response, impaired respiratory function, infections following wounds, liver disease, obstetric and gynecologic complications, pain, severe acute biliary and alcoholic pancreatitis, sleep apnea, stroke, surgical complications, traumatic injuries to teeth, type 2 diabetes, and urinary stress incontinence. (Press Release. HHH News – DHHS, New Report Documents Improvement in Americans' Health. U.S. Department of Health and Human Services, Washington, DC, June 10, 1999.

National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Obesity in Adults: The Evidence Report. NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults. Washington, DC: U.S. Department of Health and Human Services, 1998.

Shape Up America! and American Obesity Association, Guidance for Treatment of Adult Obesity, 1998.

AACE/ACE Obesity Task Force. Position Statement on the Prevention, Diagnosis and Treatment of Obesity [online]. The American Association of Clinical Endocrinologists and The American College of Endocrinology, 1998 revision. Available at http://www.aace.com/clinguideindex.htm

Obese males, regardless of smoking habits, had a higher mortality from cancer of the colon, rectum, and prostate. Obese females had a higher mortality from cancer of the gallbladder, biliary passages, breast (postmenopausal), uterus (including both cervix and endometrium), and ovaries. In the case of endometrial cancer, women with marked obesity showed the highest relative risk (5.4) for the obese versus the none obese. (Health Implications of Obesity. NIH Consens Statement Online 1985 Feb 11-13 [cited year month day]; 5(9):1-7.)

Reductions in weight can lead to improvements in many health markers associated with obesity.19 A weight loss of 10% to 15% can improve blood lipids, insulin resistance, and glucose tolerance, decrease total cholesterol and triglycerides and increase HDL cholesterol, which protects against heart disease. (Meisler, J.G. and St. Jeor, S.T. Summary and recommendations from the American health foundation's expert panel of healthy weight. American Journal of Clinical Nutrition 63:474S-477S, 1996.

American Obesity Association. What Works in Obesity Treatment. AOA Report. Vol. 3, No. 3., 1999.)

The impact of obesity is manifest not only on the nation's health, but also on the nation's economy. The high economic cost of obesity is a clear contributor to today's growing health care costs. Obesity has increased direct costs, due to greater use of medical services, and indirect costs, due to reduced productivity stemming from related illnesses and premature death.

(Wolf, A.M. and Colditz, G.A. Current estimates of the economic cost of obesity in the United States. Obesity Research 6(2):97-106, 1998.)

Obesity is a Chronic Disease. The American Obesity Association (AOA) believes that obesity is a disease. They want obesity understood by the health care community and patients as a serious disease of epidemic portions.

Why do they think obesity is a disease?

First, let's define our terms. Dictionaries agree: obesity is excess body fat. It is not defined as a behavior. However, many people use the term obesity as short-hand for overeating or lack of exercise. But that is not its definition.

Consider this: most people can distinguish between smoking and lung cancer. One is a behavior and one is a disease. Or problem drinking of alcohol and liver disease. One is a behavior and one is a disease. Sunbathing without protection is a behavior; skin cancer is a disease.

Second, obesity - the excess accumulation of body fat - fits all the definitions of "disease." How is "disease" defined? Most dictionaries, general as well as medical, define a disease as an interruption, cessation or disorder of a bodily function, organ or system. Obesity certainly fits this definition.

Some dictionaries have a more precise definition. Stedman's Medical Dictionary says that to be a disease it should have at least two of the following three features:

Recognized etiologic agents

• Identifiable signs and symptoms, and,
• Consistent anatomical alterations.
• The "recognized etiologic agents" for obesity include social, behavioral, cultural, physiological, metabolic and genetic factors.

The "identifiable signs and symptoms" of obesity include an excess accumulation of fat or adipose tissue, an increase in the size or number of fat cells, insulin resistance, increased glucose levels, increased blood pressure, elevated cholesterol and triglyceride levels, decreased levels of high-density lipoprotein and norepinephrine and alterations in the activity of the sympathetic and parasympathetic nervous system. One is also likely to find shortness of breath and back pain.

The "consistent anatomic alteration" of obesity is the increase in body mass. Therefore, obesity meets all three of the dictionary criteria for disease.

Likewise, coverage for surgical treatment of obesity is often denied or precluded by low reimbursement rates. Poor access to treatment remains regardless of the significant weight loss, long-term maintenance of weight loss, and relief from serious co-morbidities that result from surgery

There is no justification for denial of benefits to treat obesity when considering the standards of health insurance otherwise available. Preventive programs should also be covered or reimbursed, since they can help to reduce disease risks associated with obesity, and minimize costs that are compounded once these diseases manifest themselves.

(American Obesity Association. Getting Obesity Treatment to Where It Is Needed. AOA Report. Vol. 3, No. 3., 1999.)

Tucker, L.A. and Friedman, G.M. Obesity and absenteeism: an epidemiologic study of 10,825 employed adults. American Journal of Health Promotion 12(3):202-207, 1998.

Frank, A. Conflicts in the care of overweight patients: inconsistent rules and insufficient money. Obesity Research 5(3):268-270, 1997.

In a 5 Year Study of 500 Roux En Y Surgical Weight Loss Patients:

77% Of Excess Body Weight Was Lost in 1 Year & Maintained For 60 Months

96% Of Severe Co-Morbidities Were Eliminated Within 1 Year

98% Of Type II Diabetes Was Clinically Reversed

(Dr.'s Wittgrove & Clark 1993-1999)

Conclusion

The evidence is now overwhelming that obesity, defined as excessive storage of energy in the form of fat, has adverse effects on health and longevity. Obesity is clearly associated with hypertension, hypercholesterolemia, NIDDM, and excess of certain cancers and other medical problems. Height and weight tables based on mortality data or the body mass index are helpful measures to determine the presence of obesity and the need for treatment. Thirty-four million adult Americans have a body mass index greater than 27.8 (men) or 27.3 (women). At this level of obesity, which is very close to a weight increase of 20 percent above desirable, treatment is strongly advised. When diabetes, hypertension, or a family history for these diseases is present, treatment will lead to benefits even when lesser degrees of obesity are present. (Health Implications of Obesity. NIH Consens Statement Online 1985 Feb 11-13 [cited year month day]; 5(9):1-7.)