In 2004, a landmark study was published in the Journal of the American Medical Association titled, “Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. “(2) The study followed more than 39,000 Chicago citizens over age 18 and from 84 different area organizations between 1967 and 1973. Their overall health status and cost of care was monitored over the following three to four decades. Between 1992 and 2002, nearly 16,000, or 40 percent, of the original study group passed age 65 and received Medicare for more than two years. In this group, annual charges for care of cardiovascular disease and diabetes, in both men and women, revealed a strong positive correlation with their BMI or Body Mass Index.
A BMI between 25 and 30 marks the individual as overweight. Over 30 is considered obese. In the study group, men with BMIs higher than 30 had health care costs exceeding non-overweight patients, controlled for age, race, education and smoking, by 42 percent. Women’s rates of increase in health care costs were even greater. Those with BMIs higher than 30 had 54 percent higher costs than non-overweight women.(2)
Lead author Dr. Martha Daviglus and colleagues from Northwestern University in Chicago recently noted that “…urgent preventive measures are required… to lessen the burden of disease and disability associated with excess weight…and to contain future health care costs incurred by the aging population.”(2)
What are the facts on aging and obesity? First, we know that people age 51 to 69 are the most vulnerable in terms of obesity and chronic disease. In this age group, rates of disease in obese people versus non-obese people are remarkable.(3,4) Heart disease is 19 percent in obese seniors and 14 percent in non-obese seniors. Diabetes is 24 percent in obese seniors and 9 percent in non-obese seniors. High blood pressure: 58 percent versus 35 percent, and arthritis: 58 percent versus 45 percent.(5)
Older adults who are obese are more likely to suffer from persistent symptoms of chronic disease, and the impact on daily living is obvious. Twenty-three percent of obese adults over age 51 have severe fatigue, 23 percent have shortness of breath, 15 percent wheeze, and 30 percent experience ankle swelling. Comparative rates are markedly lower among their non-obese counterparts. The same is true of mental health symptoms — obese seniors suffer feelings of worthlessness 8 percent of the time versus 5 percent in non-obese seniors. All of these symptoms, in turn, translate into higher rates of disability. While 3 percent of those over 51 who are not obese need help with three or more activities of daily living, 6 percent of obese seniors are similarly dependent.(5)
What, then, is the takeaway? We need to face the facts regarding obesity and aging: First, BMI is a marker for chronic disease, disability, and symptoms of disease. Further, BMI has strong predictive power – it’s not only able to point to a future cost in physical distress, altered lifestyle, and need for caregiver support in the later years, but it also signals an escalating expenditure of federal dollars — a burden each citizen will share.
We need cost efficient, proven behavioral modification approaches to weight loss that are home based, controlled by overweight individuals themselves, but also capable of reinforcing existing relationships between these individuals and their health care professionals. Do such programs exist? The answer is yes.
One such web-based approach (6) which will become available to the general public in February, 2011 allows participants to choose a range of behaviors themselves based on the research of obesity expert, Dr. George Bray, Chief, Division of Clinical Obesity and Metabolism at Pennington Biomedical Research Center at LSU (7) and Dr. Art Ulene, who pioneered the application of modern communication technology to advance public health challenges such as high blood pressure, cardiovascular disease and nicotine addiction. (8)
The program has just completed an 8 week beta-test on 120 individuals. (9) The results:
· 17% of participants lost 10-29 pounds
· 31% of participants lost 5-9 pounds
· 34% of participants lost 2-4 pounds
· 14 % of participants lost 0-1 pound
· 4% of participants gained weight
Accenting personal empowerment and “giving back”, the subscription program, titled “BUCKAPOUND”, includes a virtuous reinforcement cycle. Participants pledge 1 dollar for every pound they lose which is then donated to non-profit health organizations to advance public health. (6)
When the program goes public, it’s “smart software” will provide a modern day health-matching system. What do I mean? Each week, participants are asked to select a maximum of 4 strategies to focus on from a list of 30 plus evidence based, behavioral modification strategies to assist in reaching their self-proclaimed target weight. The sites “smart software” and real-time data base is then able to share with the individuals strategies that have worked best for people like them, as defined by the intake questionnaire they originally completed.(9)
Individuals also have acess to forums and social networks to share successful strategies. One last point of empowerment: participants are asked to identify up to 6 individuals on the front end to serve as a “personal support network” for the journey to better health. Health professional involvement in the support network is encouraged. With their acceptance of this role, and the participant’s permission, their daily updates on the site are shared with supporters who can contribute onsite words of encouragement.(9)
Participation appears to be one key to success. In the study group, the likelihood of losing weight during the test was strongly related to involvement with the program, as evidenced by these results:
Average number of website “check-ins” per week:
5 times/week or more: average weight loss = 8.4 lbs.
2 times/week or less: average weight loss = 2.5 lbs.
Comments posted on a blog at the website:
Posted at least one comment to a blog: average weight loss = 7.2 lbs.
Never posted a comment: average weight loss = 3.9 lbs.
Participation in a forum:
Posted at least one Forum comment: average weight loss = 8.6 lbs.
Never posted a comment: average weight loss = 4.2 lbs
Obesity is clearly the modern day marker for chronic disease. Most of the behavioral choices offered in BUCKAPOUND to address obesity are equally effective approaches to chronic disease management. The key is to empower individuals where they live, include their health professionals, encourage them along the way, and advantage technology to assure affordability and sustainability.
For Health Commentary, I’m Mike Magee.
1. Magee M. Health Politics: Power, Populism and Health. 2006. Spencer Books, NY, NY. www.spencerbooks.com.
2.Daviglus ML, Liu K, Yan LL, Pirzada A, et al. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA. 2004;292:2743-2749. http://jama.ama-assn.org/content/292/22/2743.full
3.Eckel RH, Krauss RM. American Heart Association call to action: obesity as a major risk factor for coronary heart disease. Circulation. 1998;97:2099-2100. http://circ.ahajournals.org/cgi/content/full/97/21/2099
4.Shaper AG, Wannamethee SG, Walker M. Body weight implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle-aged men. BMJ. 1997;314:1311-1317. bmj.com. http://bit.ly/eHNMhU
5.Obesity Among Older Americans. Center on an Aging Society, Georgetown University. Available at: http://hpi.georgetown.edu/agingsociety/pdfs/obesity2.pdf.
7. George Bray MD, Pennington Biomedical Research Center. http://www.pbrc.edu/the-center/faculty/?EmployeeID=23
8. Art Ulene MD. http://www.speakersonhealthcare.com/speakers/Art_Ulene_MD.php
9. Personal Communication. January 3, 2011.