Management of Obesity in the National Health and Nutrition Examination Survey (NHANES), 2007–2008
Introduction
Obesity is an epidemic worldwide. The prevalence of obesity is accelerating in developed and developing countries. Overweight and obese people are at a greater risk of developing conditions like hypertension, dyslipidemia, type 2 diabetes, and cardiovascular diseases including coronary atherosclerosis 1, 2, 3, 4. In the United States, approximately 300,000 people die annually from obesity-related causes. The morbidities associated with obesity account for a substantial amount of the national healthcare expenditure in United States. Therefore, it is time that obesity is accepted as a chronic disease and treatment directed towards achieving a sustainable and healthy body weight (5).
Lifestyle changes are an indispensible component in the treatment of obesity. A combination of dietary changes and exercise is more effective than either alone in achieving greater long-term weight loss (6), but the authors of a recent study showed that a substantial proportion of obese Americans engaged in either dietary changes or physical activities (73.5% women and 60.3% men), but few adopted both (7). Diet and exercise are mainly short-term remedies, so weight regain after 1 year is frequent (8). Some people gain weight more easily than others because of genetic and environmental factors 9, 10. Modern technologies that help people to perform daily tasks with less effort, the use of central heating, and sedentary jobs are factors contributing to obesity (10). Because they cannot be changed easily, losing weight is difficult. The American College of Physicians recommends pharmacologic therapy for people with a body mass index (BMI) ≥30 kg/m2 or those with a BMI ≥27 kg/m2 and the presence of associated comorbidities 5, 11.
The use of anti-obesity drug therapy alone causes only a modest weight loss, typically less than 5 kg, although this change has been shown to improve cardiovascular risk factors such as insulin sensitivity, glycemic control, dyslipidemia, and hypertension in overweight patients (12). Lifestyle changes that include dietary changes, exercise, and behavioral therapy enhance the effect of drug treatment (13). Therefore, the patient on an anti-obesity drug should continue lifestyle changes. Accordingly, we analyzed the use of pharmacologic and nonpharmacologic therapy for the treatment of obesity in the National Health and Nutrition Examination Survey (NHANES) study population.
Section snippets
Methods
NHANES was initiated in 1960 with the intention of assessing the health and nutritional status of adults and children in United States. After 1999, NHANES became a continuous study focusing on a variety of health and nutritional needs that concerns the U.S. population. The methodology of this study and the results are available online (14). Ethical approval was obtained from the National Center for Health Statistics Research Ethics Review Board.
A total of 5332 (2630 men and 2702 women)
Results
Among all participants, 34.3% were obese and had a BMI ≥30.0 kg/m2, and 11.1% had a BMI 27.0 to 29.0 kg/m2 with one or more risk factors (Table 1). Thus, 45.9% men and 45.0% women were candidates for treatment with anti-obesity drugs. Men and women 60 years of age or older were more likely to have BMI 27.0–29.9 kg/m2 and risk factors compared with other age groups. Non-Hispanic black subjects showed the greatest prevalence of obesity (44.1%), followed by Mexican American subjects (39.7%),
Discussion
Our study reports the use of pharmacologic and nonpharmacologic therapy in the treatment of obesity among U.S. adults in recent years. It is evident that the majority of American men and women are candidates for anti-obesity drug treatment. However, an important finding of this study was that very few of these candidates were on medication for obesity; the use of prescription or nonprescription medications was surprisingly low.
Given that sibutramine and orlistat were the drugs of choice for the
Conclusions
Obesity is highly prevalent in the United States, but only a very small percentage is on anti-obesity medication. The withdrawal of sibutramine in October 2010 would have minimal impact on the general population. While improvements in pharmacologic treatment of obesity are clearly needed, our study also revealed that there is a need for more lifestyle changes in the majority of obese individuals.
References (30)
- et al.
Obesity as an independent risk factor for cardiovascular disease: A 26- year follow-up of participants in the Framingham Heart Study
Circulation
(1983) - et al.
Impairment of health and quality of life in people with large waist circumference
Lancet
(1998) - et al.
Diet, lifestyle, and the risk of type 2 diabetes mellitus in women
N Engl J Med
(2001) - et al.
Obesity accelerates the progression of coronary atherosclerosis in young men
Circulation
(2002) - et al.
Pharmacotherapy for obesity
Br J Clin Pharmacol
(2009) - et al.
Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: A meta-analysis
Obes Rev
(2009) - et al.
Perceived weight status, overweight diagnosis, and weight control among US adults: The NHANES 2003–2008 Study
Int J Obes
(2011) - et al.
Comparison of 2-year weight loss trends in behavioral treatments of obesity: Diet, exercise, and combination interventions
J Am Diet Assoc
(1996) - et al.
The FTO gene and obesity in a large eastern European population sample: The HAPIEE study
Obesity (Silver Spring)
(2008) Eat less and exercise more—is it really enough to knock down the obesity pandemia?
Physiol Res
(2009)
Pharmacologic and surgical management of obesity in primary care: A clinical practice guideline from the American College of Physicians
Ann Intern Med
Beneficial health effects of modest weight loss
Intl J Obes Relat Metab Disord
Randomized trial of lifestyle modification and pharmacotherapy for obesity
N Engl J Med
Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)
JAMA
Cited by (46)
Medical and Surgical Treatment of Obesity
2022, Medical Clinics of North AmericaAntiobesity Medication Use Among Overweight and Obese Adults in the United States: 2015–2018
2021, Endocrine PracticeCitation Excerpt :Our estimates of the share of AOM-eligible individuals using AOMs are consistent with previous studies using claims data as well as 1 study using NHANES, which also reported AOM utilization rates below 2% and found that most AOM use is of older medications approved for short-term use. 26,27,30-33 Samaranayake et al33 used 2007-2008 NHANES data and estimated that 0.5% and 0.1% of eligible adults were using phentermine or orlistat, respectively. A study using pharmacy claims data from CVS Caremark also found that the use of AOMs was low and actually declined between 2008 and 2010.30
Persistence of newer anti-obesity medications in a real-world setting
2018, Diabetes Research and Clinical PracticeCitation Excerpt :It is also possible that given the relatively recent recognition of obesity as a disease, lingering physician apathy about treating obesity may influence patient attitudes about the importance of treatment. Data gathered in the US between 1999 and 2010 suggest that almost half of adults in the US meet criteria for treatment with AOMs, but only 2% of those eligible are managed with pharmacotherapy [32,33]. Multiple and likely complex factors may contribute to non-persistence.
Introduction: The State of Obesity in 2017
2018, Medical Clinics of North AmericaCitation Excerpt :However, unlike other medical diseases, AOMs are infrequently prescribed by HCPs, even when clear indicators for use are present. Data from the 2007 to 2008 NHANES survey showed that only 2.2% of eligible respondents took prescription drugs for weight control.43 Another retrospective analysis using information from the GE Centricity database from 2002 to 2011 and covering 1.8 million patients with overweight or obesity was recently published.44
The association between ethnicity, socioeconomic status and compliance to pediatric weight-management interventions – A systematic review
2017, Obesity Research and Clinical PracticeCitation Excerpt :Rates are generally higher in ethnic minorities [6–9]: in the US the highest prevalence is found in Native Americans and African Americans, and in England Black African and Black Caribbean adolescent girls were reported to be more vulnerable to overweight and obesity [6,9]. Not is only the prevalence of overweight and obesity higher among ethnic minorities, the incidence of overweight is also increasing more rapidly [10,11]. Another factor which is reported to be associated with a higher prevalence of childhood obesity is socioeconomic status (SES) [12].
Weight Loss Strategies for Treatment of Obesity: Lifestyle Management and Pharmacotherapy
2018, Progress in Cardiovascular Diseases