Re: Deadweight? Longevity costs of obesity

[Guest guest]

Hi All,

It was unusual, it seemed, that the below paper, which is pdf-available, has the

same authors and title as a recent in the New Engl J Med.

Now, it appears that the paper is more of a rehash of the previous article.

First,

the authors present a different abstract on the previous article. Then

editorial

comments follow in the article that focus mainly on the previous article.

The previous article was discussed on the Community CR list at:

http://lists.calorierestriction.org/cgi-bin/wa?A2=ind0503 & L=crcommunity & P=R13239\

& X=60E90733B16C19F549 & Y=old542000

http://lists.calorierestriction.org/cgi-bin/wa?A2=ind0503 & L=crcommunity & P=R13874\

& X=60E90733B16C19F549 & Y=old542000

http://lists.calorierestriction.org/cgi-bin/wa?A2=ind0506 & L=crcommunity & P=R28918\

& X=60E90733B16C19F549 & Y=old542000

The previous article was:

Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L,

RN, DB, Ludwig DS.

A potential decline in life expectancy in the United States in the 21st century.

N Engl J Med. 2005 Mar 17;352(11):1138-45.

PMID: 15784668

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15784668 & query_hl=11

Here, is the current paper/review article, below.

Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L,

RN, DB, Ludwig DS.

A Potential Decline in Life Expectancy in the United States in the 21st Century.

Obstet Gynecol Surv. 2005 Jul;60(7):450-452.

PMID: 15995561

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15995561 & query_hl=11

N Engl J Med 2005;352:1138–1145

Since the 1970s, obesity has become approximately 50% more prevalent per decade.

Fully two thirds of U.S. adults now are obese or overweight. Extreme obesity has

increased at a particularly rapid rate. Obesity is associated with an increased

risk

of type 2 diabetes, coronary heart disease, cancer, and other conditions. Being

overweight in childhood increases the risk of death from any cause and also

death

from cardiovascular disease in men and cardiovascular morbidity increases in

both

men and women. Unless measures are taken to halt the rising prevalence of

obesity,

an increased risk of many fatal and nonfatal conditions can be expected as

people

become older.

The authors have estimated the effect of obesity on life expectancy in the

United

States by determining the reduction in death rates that would occur should every

person who currently is obese were to lose enough weight to achieve an “optimal”

body mass index of 24 kg/m2. A conservative estimate is that life expectancy at

birth in the United States would, if there was no obesity, be higher by 0.33 to

0.93

year for white males, 0.30 to 0.8 year for white females, 0.30 to 1.08 year for

black males, and 0.21 to 0.73 year for black females. If current rates of death

associated with obesity remain the same in this century, life expectancy would

decline from one third to three fourths of a year. This is greater than the

negative

effect of all accidental deaths combined, and in time it probably would rapidly

approach—or exceed—the negative effects on life expectancy of ischemic heart

disease

or cancer. Young people today may live less healthy and possibly shorter lives

than

their parents. The authors believe that the life-shortening effect of obesity

could

increase to 2 to 5 years or even more in the coming decades as younger obese

individuals carry their increased mortality risk into middle age and old age.

--------------------------------------------------------------------------------

EDITORIAL COMMENT

(Medical advances in disease management, improved public health measures, and

improved standards of living have increased life expectancy in developed

countries

markedly during the last century. However, there are ominous harbingers that

this

may be coming to an end, particularly in the United States, as a result of the

virtual epidemic of overweight and obese individuals, including children and

adolescents. This is the message in the present article, and, although I do not

usually review articles of this nature, the magnitude of the problem and its

potential consequences prompted me to include it.

Recognizing the magnitude and importance of the problem of obesity, The Hormone

Foundation, the public education affiliate of The Endocrine Society, in

partnership

with the Society, has mounted a major program on obesity for the public, the

media,

and appropriate members of government. Interested readers are encouraged to

visit

the Foundation’s web site (www.hormone.org ) for material that can be downloaded

at

no charge on this and numerous other hormone-related topics.

The authors of the present paper note that extrapolating life expectancy from

historical trends, which recently was predicted in 1 analysis to reach 100 years

in

the United States and other developed countries by the year 2060, may be in

error

because they do not consider the health status of individuals currently alive

and

assume that the past predicts the future. The authors note that an informed

approach

to predicting life expectancy should rely on trends in health and mortality

observed

in the current population, and that if not rectified, obesity and its

ramifications,

as well as its frequency, will have a negative effect on life expectancy.

Furthermore, although we have the knowledge to reduce the severity of the

problem,

trends in obesity continue to become worse and threaten to decrease the health

and

life expectancy of present and future generations.

The prevalence of obesity among adults in the United States increased by

approximately 50% per decade throughout the 1980s and 1990s (Flegal KM, et al.

JAMA

2002;288:1723). This has resulted in two thirds of adults in the United States

being

obese or overweight. The number of individuals with extreme obesity has

increased at

a strikingly rapid rate, particularly among children and minorities.

Part of the problem is that obesity is associated with a plethora of problems,

including risk of type 2 diabetes and its sequelae, increase in coronary heart

disease and cancer. Furthermore, being overweight in childhood increases the

risk of

cardiovascular morbidity in both women and men. At younger ages, disability

rates

have risen while fitness levels have declined dramatically, and both of these

are

attributed to the rise in obesity, at least in part. In children, largely as a

result of obesity, the incidence of type 2 diabetes has increased many fold.

Obesity has a substantial negative effect on longevity, reducing the lifespan of

severely obese individuals by 5 to 20 years. The authors used a variety of

statistical techniques to assess the effect of obesity on life expectancy in the

United States, and estimated that life expectancy at birth would be higher by

0.33

to 0.93 year for white males, 0.30 to 0.81 year for white males, 0.30 to 1.08

years

for black males, and 0.01 to 0.73 year for black females if obesity did not

exist.

This is not negligible; it is larger than the negative effect of all accidental

deaths combined, and the authors state that it will rapidly approach, and could

exceed, the negative effect that ischemic heart disease or cancer have on life

expectancy. The authors anticipate that as a result of the substantial rise in

the

prevalence of obesity and its life-shortening complications, life expectancy at

birth and at older ages could level off or even decline within the first half of

this century.

Unfortunately, there is no magic bullet. Although medications such as orlistat,

which I discuss elsewhere in this issue, may help, widespread education,

extensive

public health measures, and education and individual counseling by us, the

caregivers, are necessary to make a dent in this problem.

Of course, obesity and its consequences also have grave implications for

healthcare financing.—RBJ)

Al Pater, PhD; email: old542000@...

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