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Lifting the unbearable weight of morbid obesity.

As the incidence and prevalence of morbid obesity relentlessly continue to rise, so do the personal, societal, and financial burdens associated with this chronic, multifaceted disease. The economic and technological progress achieved during the last century has resulted in unprecedented bounties of energy-dense food at an ever-decreasing cost to the consumer; factors that undoubtedly contributed to the development of the perfect storm of morbid obesity. The blustery winds of globalization and other market forces have helped spread the wildfire of morbid obesity to every corner of the planet, rendering it a worldwide pandemic. The World Health Organization reports that in 2005, 1.6 billion adults were overweight, of whom 400 million were considered obese. Furthermore, it issued predictions that in the year 2015, these numbers would rise to an alarming 2.3 billion overweight adults, including 700 million obese individuals. Children and adolescents are the most rapidly expanding segments of the population to be affected with obesity, representing a grim outlook for the future health and economic wellbeing of humankind. In the United States, at least 5% of the population is morbidly obese. According to the Centers for Disease Control, an American dies every 90 seconds from an illness related to obesity, adding up to 1,000 people every day and nearly 400,000 every year. And, before overweight people die, they often suffer for years with medical conditions including diabetes, heart disease, sleep apnea, gallbladder disease, hypertension, arthritis, infertility, cancer and psychologic diseases. Many of these conditions, or their treatments, result in additional weight gain, so that a lethal, unrelenting vicious cycle ensues. Even a cursory glance at recent reports on the dramatic rise in the incidence of these chronic, degenerative diseases will underscore the presence of a common denominator at play. Sadly, not only do these comorbidities markedly affect quality of life, but they also reduce life expectancy, such that an obese man at age 30 is predicted to die 11 to 13 years prematurely. The financial cost continues to grow exponentially. Although many employers and other payers carry the expenses, it is ultimately the taxpayer that pays. The direct financial cost to society due to overweight and obese employees is estimated to be $136 billion in health care expenditures for hospital stays, lost productivity, and drugs to treat chronic conditions. A 2003 study showed that more than $78 billion, out of total health care spending of $1.5 trillion, was expended in the treatment of obesity-related illnesses. The Medical Expenditure Panel Survey (MEPS) reported in 2002 that obese individuals over the age of 55 faced higher mean medical expenses ($7235) when compared with normal weight individuals ($5390). And clearly, there are significant indirect costs from increased absenteeism and decreased productivity that must be taken into account. We already witnessed the formidable impact exerted by health care costs on the potential demise of the beleaguered US automobile industry, where $3.8 billion are annually expended on the health of retirees, many of whom suffer chronic degenerative diseases. Finkelstein et al recently reported their findings of a clear association of sustaining injuries with body mass index, such that the odds of an injury were 48% higher in a person with class III obesity.