Is obesity genetic?

While lifestyle contributes substantially more to risk of cancer (and other chronic diseases) than genetics alone, the interplay between genetics and lifestyle is a subject of increasing interest. That's what makes a new study out of the UK, published in PLoS Medicine so exciting.

The researchers took 12 genetic mutations that had previously been found to be associated with obesity risk and examined how they combined to be associated with risk of weight gain. The presence of each additional mutation increased risk of weight gain -- the more mutations, the greater the risk. The mutations significantly increased the risk of obesity by 16%. The researchers then did something quite novel, using the data the participants reported about how physically active (or not) they were, the researchers re-examined the associations. In the inactive men and women, the association was stronger than in the inactive people. What this means is that the effect of genes were stronger in the people who were inactive - or - that physical activity "erased" some of the genetic predisposition - about 40% of it.

What does this mean for those of us who have no idea how "genetically predisposed" we might be to obesity? Physical activity has benefits for everyone, but for individuals who are genetically predisposed to obesity, physical activity is especially important. It also means that a genetic predisposition to obesity isn't cause for "doom and gloom" - there ARE things you can do to counter it - notably, being physically active!

Medicare: putting their money where the evidence is

On Friday, the federal government announced that effective immediately Medicare would cover the cost of smoking cessation counseling. Anyone covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognized practitioner who can work with them to help them quit. (All people with Medicare will continue to have access to tobacco cessation prescription medication through the Medicare Prescription Drug Program.)

This is great news on several fronts:
- there is great evidence for the value of this kind of coverage so it is nice to see the goverment implementing evidence-based medicine
- other insurers typically follow what Medicare does
- it keeps tobacco in the news - an issue we've discussed before

The price we pay for obesity: diabetes drives hospital costs


The Agency for Healthcare Research and Quality reported yesterday (see full report) that 1 in 5 hospitalizations in 2008 involved a person with diabetes. This amounted to 7.7 million hospital stays at a cost of $83 billion in just the hospital costs. Diabetics had hospital stays that were longer, on average, and more likely to originate in the emergency department than stays for patients without diabetes. While diabetes was the indication for hospitalization, many of these patients were admitted with circulatory disorders or complications due to their diabetes.

Why this matters
Medicare covered almost 60% of the total hospital costs for these diabetic patients. So we all paid our share.
Second, diabetes is driven by obesity and lack of physical activity, with poor diet adding further risk. We have previously shown that the vast majority of diabetes in adults is preventable. This is supported by randomized trial evidence that weight loss reduces incidence of diabetes.
Importantly, we have discussed the role of diabetes and obesity as causes of cancer, yet another cost to society.  These disease and their costs are avoidable through prevention.

Context
So while the pattern of hospitalization for diabetes tracks the CDC maps of obesity – higher rates of hospital sat in the South, the cost to society of not acting to prevent adult weight gain and the ensuing health consequences is adding enormously to the costs of our health care system. We have the strongest evidence that weight control can avoid many of the complications of overweight and obesity, not just diabetes but also cancer and heart disease.

Action
Following the steps we outline can prevent cancer now. We need to increase our focus on weight control at the clinical level of primary cancer; at the policy level through strategies that can make activity a part of our everyday lives (and reinforce these behaviors once we all adopt them); and through our communities and schools so that we all move to a healthier lifestyle before our hospitals buckle and collapse under the weight of obese diabetic patients.