Bariatric treatments for adult obesity - Institute of Health Economics

Severe obesity is associated with decreased health-related quality of life (HRQoL), a term that refersto the burden of suffering and the limitations in physical, occupational/vocational, and socialfunctioning associated with illness. 1,6,39,40,52-55,57,67,68,72 Affected individuals frequently report that thepervasiveness and severity of their impairments are their strongest motivators for seeking bariatrictreatment. Additionally, impairments in HRQoL may account for increased symptoms of depression.Persons who have significant limitations in their functional abilities due to obesity could be expectedto have impaired occupational function. 39,40,54 Severe obesity has been associated with greatermorbidity and a poorer HRQoL than smoking/drinking problems (alcoholism) or poverty. 40Emotional suffering may be one of the most painful consequences of obesity. 1,6,12,19,25,39,40,53-55,57,58,60,70,75Socially, individuals with obesity, particularly those affected by severe obesity, have to deal withstigmatization, prejudice, discrimination, and social rejection/isolation. The prevalence of weightbias and discrimination in the United States has increased by 66% over the past decade and iscomparable to rates of racial discrimination, especially among women. 75Society emphasizes physical appearance and often equates attractiveness with slimness, especially forwomen. 19,39,40,53-55,57,58,60,70,75,76 Obesity is often viewed as the physical manifestation of a character flaw,and the psychosocial problems of individuals with obesity are attributed to their character ratherthan to their condition. Also, weight bias and discrimination translate into inequities in employmentsettings, health-care facilities, and educational institutions. As a result, obese individuals feelmisunderstood and neglected.Epidemiology of adult obesity and population dynamics of affected individualsOver the past several decades, the worldwide prevalence of obesity (BMI ≥ 30 kg/m 2 ) has increasedsteadily among all demographic groups and countries with developed market economies are leadingthe way. 1,6,7,13,23-25,31,38,42,44,46,56,73,74,77-80 The obesity subgroups experiencing the most rapid growth arethe severe/extreme/morbid class and the moderate class (class III and class II, when BMI reaches40 kg/m 2 or even only 35 kg/m 2 if associated with comorbidities). 11,29,68,73,74,77,81-83The latest World Health Organization estimates indicate that globally in 2005 at least 400 millionadults were obese and, projecting that, by 2015 more than 700 million adults will be obese(www.who.int/mediacentre/factsheets/fs311/en/index.html, accessed 23 July 2010). According tothe WHO, there are 300 million adults with class I or II obesity and 30 million with class IIIobesity. 79The prevalence is rising at an even faster rate among children and adolescents. 2,27,56,61,69 TheInternational Obesity Task Force estimates that more than 155 million children worldwide areoverweight or obese. 56 According to the WHO, worldwide, at least 20 million children under the ageof 5 were overweight in 2005 (www.who.int/mediacentre/factsheets/fs311/en/index.html, accessed23 July 2010).At the same time, the prevalence of obesity is rapidly increasing in the elderly population; this hasbecome a growing concern. 14,15,56,61,63-66,78,84-87The reported gap in obesity prevalence between women and men is usually small and the ratesincrease for both men and women, up to age 60 to 69, and then decline. 6,17,25,28,29,38,43,44,46,61,77,88 Studiesin countries with developed market economies have usually noted an inverse relationship betweenBMI and socioeconomic status, particularly among women. 10,28,43,88,89Bariatric treatments for adult obesity – March 2012 8