Vol.5 Issue 1
Obesity

The prevalence of overweight and obesity have increased dramatically in the United States (U.S.) over the past four decades (1).  According to national survey data collected by the Centers for Disease Control between 1960 and 1962, 31.6% of U.S. adults were overweight and 13.4% were obese.  In contrast, between 1999 and 2000, 64.5% of U.S. adults were overweight and 30.5% were obese (2,3).  Numerous social, economic, and cultural factors have contributed to the rise in overweight and obesity.  These include technological advances that reduce physical activity, increases in sedentary versus active leisure-time activities, declines in occupational physical activity, the proliferation of fast food outlets, increased portion sizes in restaurants, advertising campaigns that encourage consumption of energy-dense foods, and urban designs that discourage walking and bicycling (4). 

Overweight and obesity are associated with substantial morbidity. Numerous cohort and epidemiological studies have consistently linked overweight and obesity to highly prevalent medical conditions including cardiovascular and metabolic disease, hypertension, stroke, osteoarthritis, cholelithiasis, sleep apnea, and even some cancers, such as breast and colorectal (1,2,5).  A recent national survey of over 9500 U.S. adults concluded that obesity was more strongly predictive of the occurrence of chronic disease than smoking, poverty, or excessive alcohol intake (6).  These findings suggest that weight reduction and maintenance should be a high priority for clinicians and public health officials.

The economic burden associated with obesity is enormous, encompassing not only health care costs, but also costs related to lost productivity.  Recent studies have estimated that the costs attributable to overweight and obesity account for between 4% and 9% of total health care costs in the U.S. (7).  One study estimated that the health care costs of obesity in 1998 were between $51.5 and $78.5 billion; over half of these costs were paid by the public sector through Medicaid or Medicare (8).  Obesity also generates indirect costs related to lost productivity.  The Centers for Disease Control (CDC) has estimated that obesity resulted in a cost of $56 billion in lost productivity in 2000 (9).

Despite the availability of numerous weight loss programs that have demonstrated short-term effectiveness, long-term adherence is problematic and most individuals regain the majority of lost weight within one or two years (10).  Therefore, there is an urgent need to explore the use of complementary and alternative therapies to manage overweight and obesity.  In this issue of Flyway, we address the use of CAM therapies to manage this challenging problem.

Barbara Swanson, DNSc, RN, ACRN
Associate Professor
Rush University College of Nursing

References
1.         Must A, Spadano J. Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA 1999;282:1523-1529.

2.         Manson JE, Skerrett PJ, Greenland P, VanItallie TB. The escalating pandemics of  
            obesity and sedentary lifestyle: a call to action for clinicians. Arch Intern Med 
            2004;164:249-258.

3.         Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among U.S. adults, 1999-2000. JAMA 2002:288:1723-1727.

4.         French SA, Story M, Jeffery RW. Environmental influences on eating and physical activity. Ann Rev Public Health 2001;22:309-335.

5.         Friedman N, Fanning EL. Overweight and obesity: an overview of prevalence, clinical impact, and economic impact. Dis Manag 2004;7:S1-S6.

6.         Strum R, Wells KB. Does obesity contribute as much to morbidity as poverty or smoking? Public Health 2001;115:229-235.

7.         Wee C, Phillips RS, Legedza LT, Davis RB, Soukup J, Colditz GA, Hamel MB. Health care expenditures associated with overweight and obesity among U.S. adults: Importance of age and race. Am J Public Health 2004:95;159-165.

8.         Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: How much, and who’s paying? Health Affairs 2003;W3:219-226.

9.         Centers for Disease Control and Prevention. The Power of Prevention. Reducing the Health and Economic Burden of Chronic Disease. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, February 2003.

10.       Tsai AG, Wadden TA. Systematic review: An evaluation of major commercial weight loss programs in the United States. Ann Intern Med 2005;142:56-66.