Although the prevalence of obesity and obesity-attributable deaths has steadily increased, the resultant burden of disease associated with obesity has not been well understood. A new study published in the September issue of the American Journal of Preventive Medicine indicates that Quality-Adjusted Life Years (QALYs) lost to U.S. adults due to morbidity and mortality from obesity have more than doubled from 1993-2008 and the prevalence of obesity has increased 89.9% during the same period.
Using data from the 1993-2008 Behavioral Risk Factor Surveillance System, the largest ongoing state- based health survey of U.S. adults, Haomiao Jia, PhD, Columbia University, and Erica I. Lubetkin, MD, MPH, The City College of New York, examined trends in the burden of obesity by estimating the obesity-related QALYs lost, defined as the sum of QALYs lost due to morbidity and future QALYs lost in expected life years due to premature deaths, among U.S. adults. They found the overall health burden of obesity has significantly increased since 1993 and such increases were observed in all gender and race/ethnicity subgroups and across all 50 states and the District of Columbia.
"The ability to collect data at the state and local levels is essential for designing and implementing interventions, such as promoting physical activity, that target the relevant at-risk populations," according to Dr. Lubetkin. "Although the prevalence of obesity has been well documented in the general population, less is known about the impact on QALYs both in the general population and at the state and local levels….Our analysis enables the impact of obesity on morbidity and mortality to be examined using a single value to measure the Healthy People 2020 objectives and goals at the national, state, and local levels and for population subgroups."
From 1993 to 2008, the obesity prevalence for U.S. adults increased from 14.1% to 26.7% (89.9%). Black women had the most QALYs lost due to obesity, at 0.0676 per person in 2008, which was 31% higher than QALYs lost in black men and about 50% higher than QALYs lost in white women and white men. A direct correlation between obesity- related QALYs lost and the percentage of the population reporting no leisure-time physical activity at the state level also was found.
The prevalence of obesity increased over time for all states, while obesity-related QALYs lost tended to follow a similar pattern. However, disparities among states lessened over time, with less obese states "catching up" to more obese states and producing a greater percentage change of QALYs lost.
"Collaborative efforts among groups at the national, state, and community (local) levels are needed in order to establish and sustain effective programs to reduce the prevalence of obesity," commented Dr. Jia. "Although the impact of current and future interventions on curtailing the burden of disease might not be available for a number of years, this method can provide an additional tool for the Healthy People 2020 toolbox by providing a means to measure objectives and goals. The availability of timely data would enable the impact of evidence-based interventions to be assessed on targeted populations and subgroups, promote continuous quality improvement through monitoring trends, and facilitate head-to-head comparisons with other modifiable health behaviors/risk factors and diseases."
Obesity-Related Quality-Adjusted Life Years Lost in the U.S. from 1993 to 2008.
Haomiao Jia, Erica I. Lubetkin.
American Journal of Preventive Medicine, 2010; 39 (3) DOI: 10.1016/j.amepre.2010.03.026
Link to AJPM [Sept issue to be published]