Gaithersburg, Maryland

March 13, 1998

Mr. Chairman, members of the Advisory Panel, guests, my name is Morgan Downey. I am a person with obesity and I am Executive Director of the American Obesity Association (AOA). AOA was founded in 1995 by Richard L. Atkinson and Judith Stern, Sc.D. and a distinguished Advisory Council as an advocacy organization for the interests of the millions of persons in this country with obesity. 

The American Obesity Association is proud to have received support from major pharmaceutical companies including Hoffman LaRoche, Knoll Pharmaceutical, Medeva Pharmaceuticals, American Home Products. In addition, AOA is supported by over 500 dues paying individuals.

It is the mission of the AOA to advocate for public recognition of the epidemic of obesity sweeping through the United States and other countries. We believe obesity is a disease and that weight loss is the only known therapy. We endorse patients taking control of this disease as they would any other chronic, life-threatening disease. This means being aggressive in managing the disease and its related co-morbidities, in finding support, in demanding knowledgeable and compassionate health care,  and in engaging in sustainable behavioral changes in  food intake and exercise.

Prevalence

According to the latest reports from the Center for Disease Control and Prevention about 58 million American adults are overweight to the point where they are incurring health risks. The percentage  of American adults with obesity has increased 30% in 10 years, from 25% in 1980 to 33% in 1991. Conservative estimates indicate that 14% of children and 12% of adolescents are overweight. 33% of men and 36% of women are overweight. Obesity disproportionately effects minorities; the prevalence is 48.5% of non-Hispanic black women and 47.2% of Mexican American women. The Centers for Disease Control and Prevention report that the prevalence of overweight in the United States has continued to increase. [1]

To put obesity figures in context, consider that there are 600,000-700,000 persons affected with HIV/AIDS, 8 million with cancer, 16 million with diabetes, 22 million with heart disease and 58 million with serious health risks from obesity.

Obesity is the second leading cause of preventable deaths in the United States after smoking. [2] Former Surgeon General C. Everett Koop, M.D. and others including the AOA support the estimate that 300,000 premature U.S. deaths a year attributable to poor diet and inactivity -- virtual synonyms for overweight and obesity. [3]

For too long, the official public health reaction to the epidemic of obesity has been virtual denial. Obesity is shortchanged when it comes to research funding at the National Institutes of Health. It is left out of major public health education campaigns and it is avoided like the plague by too many health insurers.

The reasons for this society’s avoidance and denial of obesity are not the subject of today’s hearing. We will leave those issues for another day.

What we can discuss today is the tremendous economic  and personal costs associated with obesity and the need to provide positive support for persons engaging in weight loss.

Obesity is a long term chronic disease. There are at least eight other diseases that worsen as obesity increases or decreases as weight is reduced. They include heart disease, hypertension, dyslipidemia, adult-onset diabetes, stroke, sleep apnea, osteoarthritis and deep vein thrombosis.

If obesity were prevented the United States could have saved approximately $45.8 billion in 1990 or 6.8% of health care expenditures that year. Similarly, 52.9 million days of lost productivity would have been averted saving employers around $4 billion. [4]

Nearly 80% of patients with adult onset or non-insulin-dependent diabetes mellitus are obese. Much of the estimated $11.3 billion spent each year to diagnose, treat and manage NIDDM stems from obesity. Nearly $2.4 billion dollars or 30% of the total amount spent on gallbladder disease and gallbladder surgery are related to obesity. Nearly 70% of the diagnosed cases of cardiovascular disease are related to obesity. Obesity accounts for $22.2 billion or 19% of the total costs of heart disease. Obesity more than doubles one’s chances of developing high blood pressure which affects approximately 26% of obese American men and women. The annual cost of obesity-related high blood pressure is close to $1.5 billion dollars. Almost half of breast cancer cases are diagnosed among obese women; an estimated 42% of colon cancer cases are diagnosed among obese individuals. Obesity-related breast cancer and colon cancer account for 2.5% of the total costs of cancer of $1 billion dollars annually. [5]

A recent study published in the Archives of Internal Medicine confirms an association between BMI and annual rates of inpatient days, number and costs of outpatient visits, costs of outpatient pharmacy and laboratory services. Relative to a BMI of 20 to 24.9 mean annual total costs were 25% greater among those with BMI of 30 to 34.9 and 44% greater among those with BMI of 35 or greater. The author concluded, "Given the high prevalence of obesity and the clearly elevated disease risks and increased use of health services, there is great potential for a reduction in health care expenditures through efforts in weight reduction and prevention of weight gain." [6]

Quality of Life

To these economic data must be added the tremendous costs in  quality of life of persons with obesity. It is hard to think of another condition which inspires as much external stigma and personal shame as obesity.

Whatever  label we use, “disease” or “condition”, there can be no mistaking  the toll  on professional and personal life that obesity can bring, with or without any co-morbid condition.  Many lean individuals have no idea of the self-discipline it takes to maintain  or lose weight over a long period of time.

Speaking personally, three years ago, I had a BMI of 40. I sought out medical treatment. I did not use medicines but I would have if my doctor had recommended them. Their availability was an important safety net which let me undertake my program with confidence that if it was not successful, there were other alternatives. During the course of that treatment, I was able to start the process of making changes in eating behavior and exercise which are still ongoing. While my current BMI of 29 represents an improvement, I have to work constantly to maintain and lower it further.

Clearly, many people wish that there was a silver bullet in the form of a pharmaceutical or herbal product which would simply remove fat. However, most adults realize that weight loss is not so simple or so easy. Pharmaceutical products are essential to assist patients who are making the effort to lead healthier lives.

The American Obesity Association trusts that this Advisory Committee will fully consider the safety and efficacy data on Xenical™.  Should this product be found to have an acceptable risk/benefit profile, we would hope that it would be promptly approved. Its availability would give millions of Americans  hope that they might be able to control their weight and the confidence to consult with their  physicians about their weight and health status.

Thank you.