Half of Americans Projected to Be Obese in 2030

Obesity is one of the major criteria when evaluating a patient for an organ transplant. For example,The Journal of Heart and Lung Transplantation stresses that caution should be exercised in considering obese patients for transplantation. Obese patients have a greater risk of morbidity and mortality after open-heart surgery. This is manifested in poor wound healing, increased risk of infection, lower-extremity thrombosis and pulmonary complications. The following report is scary, especially the prediction that 50% of the U.S. population will be obese. Now is the time for all of us to take a look at our lifestyle and aim for one that includes an acceptable body mass index for ourselves and our children.

If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.

By John Gever, Senior Editor, MedPage Today

If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.

Drawing on data from the National Health and Nutrition Examination Survey (NHANES) series from 1988 to 2008, Y. Claire Wang, MD, of Columbia University's Mailman School of Public Health, and colleagues projected that, compared with 2010, there will be "as many as 65 million more obese adults" in the U.S. by that year.

Obesity prevalence in both men and women in their 40s and 50s would approach 60%, the researchers indicated in the Aug. 27 issue of The Lancet, part of a series of papers on the growing worldwide burden of obesity.

Wang and colleagues also projected that, as a result of the burgeoning obese population, the U.S. will see the following health impacts:

• 6 to 8.5 million more people with diabetes
• 5.7 to 7.3 million more cases of heart disease and stroke
• 490,000 to 670,000 additional cancers
• 26 to 55 million quality-adjusted life-years lost

The economic burden of these increasing morbidities will be substantial, the researchers indicated -- medical expenditures alone will be higher by $48 to $66 billion annually by 2030, without taking into account lost productivity and other indirect costs associated with a generally sicker population.

Reduced productivity would add another $390 to $580 billion to the annual tab, the researchers said, based on a 2009 study linking obesity to lost work time.

Another country with an aging population and a growing problem with obesity is Great Britain. Wang and colleagues analyzed NHANES-like health data collected in England from 1993 to 2008, finding slightly lower prevalences of obesity relative to the U.S., but similar rates of increase.

If the current trends in England continue, they would project to obesity prevalences in 2030 of about 40% in men and 35% in women.

Both NHANES and the Health Survey for England (HSE) involve interviews and physical exams in more than 10,000 people per iteration. The HSE is repeated annually, while NHANES is conducted over two-year periods. In both programs, the individual participants change from one survey to the next, but they are selected to be sociodemographically representative of the national populations.

Wang and colleagues used epidemiological and outcomes data in the literature to estimate the disease burdens that would result from the growing prevalence of obesity.

They also calculated what would happen if everyone's BMI was 1% lower -- approximately 1 kg (2 lb) in an average adult.

"This change might sound small, but such a scenario would have a substantial effect on consequent health burdens," the researchers wrote.

In the U.S. more than 2 million cases of diabetes, roughly 1.5 million cardiovascular disease diagnoses, and about 100,000 cancers would be avoided, their models showed.

Wang and colleagues acknowledged that their calculations were "mere extrapolations from available data" and that current trends may very well not continue.

"Past trends do not always predict the future," they wrote.

An important finding was the rising burden of obesity among people 60 and older, the researchers emphasized. Of the 65 million additional obese people projected in the U.S. in 2030, 24 million would be in this age range.

This population -- already the sickest and most expensive in terms of medical costs -- is the fastest-growing in the U.S. and Britain. Therefore, the overall disease burden and economic effects of obesity may be magnified.

In addition to their caveat about extrapolating trends into the future, Wang and colleagues cited other limitations to the study: methodological issues related to the NHANES and HSE surveys; uncertainties in the relationships between obesity, other diseases, and economic impacts; and the study's 20-year timeframe, which may underestimate future impacts of pediatric obesity,

NOTE:
The study was supported by the National Collaborative on Childhood Obesity Research, which coordinates childhood obesity research across the National Institutes of Health, the CDC, the Department of Agriculture, and the Robert Wood Johnson Foundation.

Study authors declared they had no relevant financial interests.
Primary source: The Lancet
Source reference:
Wang Y, et al "Health and economic burden of the projected obesity trends in the USA and the UK" Lancet 2011; 378:815-25.

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Jackson offers 2nd chance to teen who needs transplant

From the MiamiHerald.com:

BY CAROL MARBIN MILLER
A disabled foster child whose quest for a life-saving liver transplant was rejected by a Central Florida hospital because he has no stable home is expected to arrive in Miami Wednesday to begin testing with Jackson Memorial Hospital's organ-transplant team.

Administrators with the Department of Children & Families got word Tuesday morning that the 15-year-old boy from Pinellas County had been cleared by doctors at Jackson to be evaluated for a new liver. The boy, who suffers from mental retardation, still must be approved by the organ team before he is listed on a national database to wait for a liver.

"f I have to, I'll drive him myself," Nick Cox, DCF's top administrator in the Tampa Bay area, said Tuesday. "They have not only cleared him, they have scheduled time for him to come down [Wednesday] to get tested."

On Tuesday, administrators of Pinellas' private foster care agency, Eckerd Community Alternatives, arranged for the boy to be driven to Miami along with staff members who will care for him during testing, said Marcie Biddleman, the agency's vice president.

TEMPORARY HOME

Eckerd administrators also have located a home where they think the boy can live while he recovers from the transplant, if Jackson agrees to perform the surgery, Biddleman said. "Our primary focus today was to get this child down there," she said. "We've beem pretty busy today trying to make sure he's OK."

Cox said the boy had been removed from a waiting list for available livers by doctors at Shands Hospital in Gainesville. The doctors said the boy was a poor candidate for an organ transplant because child welfare workers could not ensure he would remain in a permanent, stable home during recovery.

The staff at Shands Hospital declined to discuss the boy's case Tuesday.

"We take the role of transplant center very seriously," said LeAnne Jones, interim director of Shands' abdominal transplant program. "We are committed to making compassionate and responsible decisions about our patients, and the management of the life-saving resource of donated organs.

"We truly believe the worst thing you can do is perform an organ transplant on a patient who has a high probability of an unsuccessful outcome," Jones added. ``Doing so not only puts that patient at risk of death, but another patient on the wait list is denied a chance for a successful outcome and can also die.''

Jackson also declined to discuss the youth's case, citing privacy laws. Spokeswoman Lorraine Nelson said in a statement that "any patient in need of a transplant will be evaluated. This does not mean that the hospital has accepted the patient or that the patient will receive a transplant."

Kenneth Goodman, who heads the University of Miami's bioethics program, said he was not aware of any other case in which a foster child was rejected for a donor organ because he lacked the stability necessary for post-surgical recovery. It is well accepted among medical ethicists, he said, that people with disabilities are entitled to the same medical treatment, including transplants, as the nondisabled.

Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania's medical school, said in cases such as this, it's the state's duty to ensure the boy is provided the stability he needs to accept and protect his new liver.

`THE EXTRA MILE'

"I think it's their job to get him to an environment where he's not asked to die because his parents haven't gotten him into a stable environment," Caplan said. Shands' decision, he said, "makes no sense at all to me, ethically. You've got to go the extra mile with kids and get them into an environment where the transplant can work."

Children's advocates also directed their anger Tuesday at the state Agency for Persons with Disabilities, which has declined to accept the boy into a program that offers services to disabled people who live outside large institutions.

Spokeswoman Melanie Etters said the agency will do everything it can to ensure the teen receives proper medical care. ''We are working as part of a team of state agencies to make sure the young man gets all his needs met,'' she said. ``We are going to work to make sure he has a successful recovery and transition back into the community.''

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