Management of Obesity in the National Health and Nutrition Examination Survey (NHANES), 2007–2008

https://doi.org/10.1016/j.annepidem.2012.01.001Get rights and content

Purpose

The prevalence of obesity has been increasing in the United States. We set out to investigate the use of pharmacologic and non-pharmacologic therapy for the treatment of obesity in recent years.

Methods

We included 2630 men and 2702 women who took part in the National Health and Nutrition Examination Survey from 2007 to 2008. We analyzed their demographic and anthropometric data and their weight and drug history.

Results

A total of 45.9% of men and 45.0% of women were candidates for treatment (body mass index ≥30 kg/m2, or ≥27 kg/m2 with risk factors). Among these participants, 85.1% considered themselves overweight, 90.1% would like to lose weight, 61.9% had dietary changes, 36.5% exercised, 3.7% took nonprescription drugs, and 2.2% took prescription drugs to control weight during the preceding year. During the preceding month, 0.5% and 0.1% of participants were taking phentermine and orlistat, respectively. There were no participants on sibutramine.

Conclusions

Although obesity is highly prevalent, only a small percentage of obese Americans are on anti-obesity medication. The withdrawal of sibutramine would have minimal impact on the general population. There is a need for more lifestyle changes in the majority of obese individuals.

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.

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