Disease Management Update
Volume V, No. 15
August 7, 2008

Dear Healthcare Intelligence Network Client,

Obesity is a major epidemic: More than 1 billion adults are overweight globally and an estimated 300 million are obese. Furthermore, overweight or obese patients are at a greater risk for chronic diseases like type 2 diabetes, CVD, hypertension, stroke and even some forms of cancer. This week's Disease Management Update looks at America's weight problem — an alarming study predicts almost 90 percent of Americans will be obese in the next 20 years.

And visit HIN's blog to find out how being overweight is affecting children in some surprising ways.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Recommendations for Treating Pre-diabetes Patients
  2. Disease Management Q&A: DM & the Media
  3. HealthSounds Podcast: Behavior Modification in DM
  4. Large Percent of Americans Overweight or Obese by 2030
  5. Survey of the Month: Obesity Management and Prevention
  6. Lifestyle Incentives: Rewards Programs Encourage Healthy Lifestyles

1. Recommendations for Treating Pre-diabetes Patients

A consensus of diabetes and metabolic disorder experts call for specific guidelines on both lifestyle, and pharmaceutical intervention where appropriate when treating patients with pre-diabetes. The recommendation calls for patients to adhere to the guidelines set forth in the Diabetes Prevention Program, established by the U.S. government.

At this time, there are no pharmacologic therapies that have been approved by the FDA for prevention of the conversion of pre-diabetes to diabetes. That’s why the expert panel has recommended a two-pronged approach to treating pre-diabetes. The first is intensive lifestyle management to prevent the progression to type 2 diabetes. The second approach is to prevent the development of cardiovascular complications and to help those patients where lifestyle modifications have been insufficient to modify cardiovascular risk factors. This requires cardiovascular risk reduction medications for abnormal blood pressure and cholesterol independent of glucose control medications.

“Although lifestyle can clearly modify the progression of patients towards overt diabetes, it may not be sufficient,” said Alan J. Garber, MD, PhD, FACE, Professor of Medicine, Baylor College of Medicine, Houston, and Chairman of the Consensus Conference. “Medications may well be required, particularly in high risk groups.”

To learn more about this research, please visit:

2. Disease Management Q&A: DM & the Media

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Scott Smith, M.D., vice president and chief medical officer for First Health.

Question:Has anyone tried to get the media to help promote healthy lifestyles? We see a lot of advertising for medications, diseases and obesity but not many public service messages for achieving a healthier lifestyle.

Response: (Scott Smith) This is a major issue. First, whoever is addressing the issue of wellness or healthy lifestyles needs to define their terms clearly. For a patient with a chronic illness, the elements of a healthy lifestyle are different than for a person in a pre-morbid state or a young person. The reality is that we only engage the media or get any kind of reaction from them when something happens that everybody wants to get involved in or excited about. Recently we’ve had a number of discussions with the media about obesity. But this was as a result of Medicare activity and other payor activity relative to paying for services in that regard.

It would be wonderful if the media could be involved, but I’ve not found them to have interest in the non-morbid situations because these issues don’t sell as many papers or are not quite as interesting to people. Unfortunately we have a cure-focused and a disease-focused society.

Talking to somebody who’s 30 or even 13 about establishing healthy habits when they’re not currently in a morbid state is tough. It definitely would be a better investment of resources than some of the things we do today. The only time you hear about the health of children is when there’s a crisis of some kind such as obesity, influenza or whooping cough.

For more details on modifying patients' behavior, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Behavior Modification in DM

Dr. Rick Botelho, a professor of family medicine and nursing at the University of Rochester, advises practitioners to put four key motivational principles into practice when helping patients change behaviors.

To listen to this complimentary HIN podcast, please visit:

4. Large Percent of Americans Overweight or Obese by 2030

Most adults in the United States will be overweight or obese by 2030, with related healthcare spending projected to be as much as $956.9 billion, according to researchers at the Johns Hopkins Bloomberg School of Public Health, the Agency for Healthcare Research and Quality and the University of Pennsylvania School of Medicine. The researchers conducted projection analyses based on data collected over the past three decades from nationally representative surveys. Their projections illustrate the potential burden of the U.S. obesity epidemic if current trends continue.

“National survey data show that the prevalence of overweight and obese adults in the U.S. has increased steadily over the past three decades,” said Youfa Wang, M.D., Ph.D., lead author of the study and associate professor with the Bloomberg School’s Center for Human Nutrition. “If these trends continue, more than 86 percent of adults will be overweight or obese by 2030 with approximately 96 percent of non-Hispanic black women and 91 percent of Mexican-American men affected. This would result in one of every six healthcare dollars spent in total direct healthcare costs paying for overweight and obesity-related costs.”

Moreover, both the overweight and obese are at an increased risk for developing a number of health conditions, including hypertension, type 2 diabetes, heart disease and stroke. Researchers estimate that children and young adults may have a shorter life expectancy than their parents if the obesity epidemic is left unaddressed. Additionally, if current trends continue, the researchers say HHS will not meet its Healthy People 2010 initiative to increase the proportion of adults who are at a healthy weight and to reduce the proportion of adults who are obese.

To learn more about this research, please visit:

5. Survey of the Month: Obesity Management and Prevention

In 2004, HHS reclassified obesity from a lifestyle behavior to a medical condition. And for the last decade, many healthcare organizations have directed initiatives at the estimated 67 million obese Americans, 75 million overweight citizens and 10 million overweight children and adolescents. The obesity epidemic triggers upward of $117 billion in healthcare costs annually and is implicated in a host of related health conditions.

To participate in this survey and receive its results, please visit:

6. Lifestyle Incentives: Rewards Programs Encourage Healthy Lifestyles

Lifestyle incentive programs — rewarding health-conscious behavior like stopping smoking and losing weight — are emerging resolutions to the modern dilemma of chronic care. In this new age of consumer-driven healthcare, improved self-awareness and information access encourage consumers to take charge of their own health. Employers are instituting lifestyle incentive programs to promote consumer accountability and cut excessive costs before getting out the checkbooks. In an e-survey, employers and health plans discussed incentive program development within their companies. In considering specific incentives, rewards and initiatives, the survey analysis underscores an industry-wide effort to adapt to healthcare trends and simultaneously reward employees for healthy choices.

To download this complimentary white paper, please visit:
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Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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