Past Present Future - CABPScabps.ca/Conference2012/POSTCONFERENCE/PDF/Fri-Concurrent5/… · Past...
Transcript of Past Present Future - CABPScabps.ca/Conference2012/POSTCONFERENCE/PDF/Fri-Concurrent5/… · Past...
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Bariatric Surgery
Past Present Future
An Economic Perspective
Ronald Eliosoff M.D., F.R.C.P.
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Prevalence of Obesity in the United States of America
1985 – 1998
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Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14%
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Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14% 15%–19% ≥20%
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UK PDS United Kingdom
Prospective Diabetes Study
ACP J Club. 1995 Jul-Aug; 123(1):5. BMJ. 1995 Apr 15; 310(6985): 1005-6.
Diabetes = $$$
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The New England Journal of Medicine
Body Weight and Mortality Among Women
JoAnn E. Manson, M.D., Walter C Willett, M.D., Meir J. Stampfer, M.D.,
Graham A. Colditz, M.B., B.S., David J. Hunter, M.B., B.S., Susan E. Hankinson, Sc.D., Charles H. Hennekens, M.D.,
and Frank E. Speizer, M.D.
Volume 333 September 14, 1995 Number 11
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115,000 nurses, aged 35-55 years old, from 5 Midwestern states All women, All white, All healthy, All non-smokers
1995 – 1998 Nurses Health Study
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Risk of Type II Diabetes BMI ≤ 22 = 1 BMI ≥ 35 = 2
6 11 30 93.2
?
1995 – 1998 Nurses Health Study
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New Diagnostic Criteria for Diabetes Mellitus
FBS 140 mg/DCL 126 mg/DCL
7.8 mmol/L 7 mmol/L
1995 – 1998
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1,700,000 new diabetics in the U.S.A.
1995 – 1998
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WAR ON
OBESITY
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• Fen Phen • Meridia • Xenical • Metabolife • Slim Fast • Nutrisystem
1995 – 1998
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• Atkins • Sugar Busters • South Beach Diet • Weight Watchers • Lo Carb • Lo Cal • Participaction Canada
1995 – 1998
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Prevalence of Obesity in the United States of America
1995 – 2010
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Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14% 15%–19% ≥20%
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Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
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(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
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Obesity Trends* Among U.S. Adults BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC.
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity Trends* Among U.S. Adults BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.
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WHY?
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Thrifty Gene Hypothesis
-James Neel
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Set Point Theory of Weight Regulation
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The New England Journal of Medicine
Changes in Energy Expenditure Resulting from Altered Body Weight
Rudolph L. Leibel, M.D., Michael Rosenbaum, M.D., and Jules Hirsch, M.D.
Volume 332: 621-628 March 9 1995
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Luxury Cruise Hypothesis
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The New England Journal of Medicine
A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obese
Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D.,
Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D.,
and Linda Stern, M.D.
Volume 348: 2074-2081 May 22, 2003
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Annals of Surgery Who Would Have Thought? An Operation Proves
to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus
Walter J. Pories, M.D., Melvin S. Swanson, Ph.D., Kenneth G. MacDonald, M.D.,
Stuart B. Long, B.S., Patricia G. Morris, B.S.N., Brenda M. Brown, M.R.A., Hisham A. Barakat, Ph.D., Richard A. deRamon, M.D., Gay Israel Ed.D.,
Jeanette M. Dolezal, Ph.D., and Lynis Dohm, Ph.D.
Volume 222: 339-352 September 1995 Number 3
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Diets
Weight Watchers
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Crestor 2 years
Bernstein Diet 2 years
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The New England Journal of Medicine
Long-Term Persistence of Hormonal Adaptations to Weight Loss
Priya Sumithran, M.B., B.S., Luke A. Pendergast, Ph.D.,
Elizabeth Delbridge, Ph.D., Katrina Purcell, B.Sc., Arthur Shulkes, Sc.D., Adamandia Kriketos, Ph.D., and Joseph Proietto, M.B., B.S., Ph.D.
Volume 365: 1597-1604 October 27, 2011 Number 17
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Medication Costs For 1 Month
U.S. Canada Metformin Hcl 500 mg 1 tab BID 30 days supply $27.98 $24.01 Actos 45 mg 1 tab QAM 30 days supply $310.00 $198.01 Lantus SoloStar 50 U BID 30 days supply $469.99 $231.61 Victoza 1.2 mg QAM 30 days supply $308.66 $103.03
Diovan HCT 160/25 1 tab BID 30 days supply $259.97 $104.44 Norvasc 10 mg 1 tab QAM 30 days supply $107.99 $88.40 Nexium 40 mg 1 tab BID 30 days supply $1,119.98 $504.94 Crestor 40 mg 1 tab QAM 30 days supply $155.98 $86.19 Effexor XR 150 mg 1 tab QAM 30 days supply $177.99 $82.80 Lyrica 50 mg 1 tab TID 30 days supply $253.97 $147.41 Advair Diskus 2 puffs QAM 30 days supply $465.98 $249.46
Total $3,658.49 $1,820.30
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Medical Costs of Treating the Obese Diabetic
Hypertensive Patient
More hospitalizations More physician visits More lab tests Diagnosis & treatment of sleep apnea Diagnosis & treatment of cardiovascular diseases -stroke -ischemic heart disease -peripheral vascular disease Medical and surgical treatment of common orthopedic problems
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Medical Costs of Treating the Obese Diabetic
Hypertensive Patient
Arthritis
Obstructive Sleep Apnea
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Condition Pre-Op Post-Op
GERD 269 4
Hypercholesterol 275 8
Hypertriglyceride 158 1
Diabetes 85 1
Glucose Intolerance 50 0
Stress Incontinence 201 6
Sleep Apnea 225 5
Hypertension 118 10
Arthritis (symptomatic) 371 36
Total 1752 71
Co-morbidity Comparison in Laparoscopic Gastric Bypass
Reference: Laparoscopic Gastric, Roux En-Y – 500 Patients: Technique and Results, with 3-60 Month Follow-up, Alan C. Wittgrove, MD, FACS; G. Wesley Clark , MD., Alvarado Hospital and Medical Center, San Diego, CA. , Obesity Surgery 2000, 3:233-39
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The New England Journal of Medicine
Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects
Lars Sjöström, M.D., Ph.D., Kristina Narbro, Ph.D., C. David Sjöström, M.D., Ph.D.,
Kristjan Karason, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Hans Wedel, Ph.D., Ted Lystig, Ph.D., Marianne Sullivan, Ph.D., Claude Bouchard, Ph.D.,
Björn Carlsson, M.D., Ph.D., Calle Bengtsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Anders Gummesson, M.D., Peter Jacobson, M.D., Ph.D.,
Jan Karlsson, Ph.D., Anna-Karin Lindroos, Ph.D., Hans Lönroth, M.D., Ph.D., Ingmar Näslund, M.D., Ph.D., Torsten Olbers, M.D., Ph.D., Kaj Stenlöf, M.D., Ph.D.,
Jarl Torgerson, M.D., Ph.D., Göran Ågren, M.D., and Lena M.S. Carlsson, M.D., Ph.D.
Volume 357: 741-752 August 23, 2007 Number 8
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Annals of Surgery Surgery Decreases Long-Term Mortality,
Morbidity, and Health Care Use In Morbidly Obese Patients
Nicolas V. Christou, M.D., Ph.D., John S. Sampalis, Ph.D.,
Moishe Liberman, M.D., Didier Look, M.D., Stephane Auger, B.Sc., Alexander P.H. McLean, M.D., and Lloyd D. MacLean, M.D., Ph.D.
Volume 240: 416-423 September 2004 Number 3
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The New England Journal of Medicine
Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes
Philip R. Schauer, M.D., Sangeeta R. Kashyap, M.D., Kathy Wolski, M.P.H., Stacy A. Brethauer, M.D., John P. Kirwan, Ph.D., Claire E. Pothier, M.P.H.,
Susan Thomas, R.N., Beth Abood, R.N., Steven E. Nissen, M.D., and Deepak L. Bhatt, M.D., M.P.H.
Original Article March 26, 2012 10.1056
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Those who cannot learn from the past are condemned to repeat it.
-George Santayana