1. Dexter Shurney, MD, MBA, MPH SVP/CMO Implications of the Obesity Epidemic February 4, 2008

2. Where the discussion should lead Obesity Chronic Conditions Diabetes Heart Disease Cancer Osteoarthritis Absenteeism Premature Death Presenteeism

3. Weight Matters The prevalence of diabetes increases in a dose-response relationship with increasing BMI. BMI > 35. 38% of the excess risk of diabetes could be avoided if their BMI did not exceed 30. (Int.J. Obesity & Related Metabolic Disorders, 2000) Tale of Two Epidemics "Increases in diabetes cases have been going on for 15 years, and it doesn't look like it's slowing down." Dr. Linda Geiss, Chief of Diabetes Surveillance CDC believes the diabetes epidemic is largely being driven by obesity… Source: HealthDay News, June 23, 2007

4. How Does Obesity Cause Disease? Toxic Adiposity Excess production of hormones from fat Angiotensinogen Estrogen TNF-alpha Leptin Insulin IL-1 Inflammation

5. Where the discussion should lead Obesity Lifestyle Chronic Conditions Diabetes Heart Disease Cancer Osteoarthritis Absenteeism Premature Death Presenteeism Exercise Adequate Sleep Stress Management Healthy Diet

6. ……………… LifeStyle Lifestyle modification the combination of a proper diet physical activity behavior therapy is the cornerstone of treatment for obesity Source : Wadden et.al Lifestyle Modification for the Management of Obesity. Gastroenterology. 2007;132(6) An estimated 300,000 preventable deaths occur each year in the U.S. due to diet and physical inactivity – only tobacco causes more preventable deaths. IOM Workshop on death/lifestyle (2004) M. McGinnis

7. Lifestyle: Current State of Affairs. More than 50% of U.S. adults do not get enough physical activity to provide health benefits Insufficient physical activity is not limited to adults. About two-thirds of young people in grades 9–12 are not engaged in recommended levels of physical activity. Activity decreases among those with lower incomes and less education. In 2005, only one-fourth of U.S. adults ate five or more servings of fruits and vegetables each day. Source: CDC, 2005

8. Where the discussion should lead POLICY Obesity Lifestyle Chronic Conditions Diabetes Heart Disease Cancer Osteoarthritis Absenteeism Premature Death Presenteeism Exercise Adequate Sleep Stress Management Healthy Diet Federal Local Community Employer Worksite

9. DIABETES OBESITY POLICY LIFESTYLE Critical Path Primary prevention and management of overweight and physical inactivity offer potential as cost- control strategies

10. Strategies to Overcome and Prevent (STOP) Obesity Alliance new policy recommendations 1. Redefining Success 2. Encouraging Innovation and Best Practices in Obesity Treatment 3. Addressing and Reducing Stigma as a Barrier to Obesity Treatment 4. Broadening the Research Agenda for Obesity http://www.stopobesityalliance.orghttp://www.stopobesityalliance.org.

11. Policy Challenges Built Environment Care Management

12. Policy Challenges Built Environment Worksite Culture of Health Incentives Wellness programs and services Addressing the Family Unit Community Involvement and Change Affordable Healthy Food Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions. NEJM 2007;357:370-9 Cities Study Dearth of Healthy Food Some areas suffer a grocery gap: Theyre rife with fast food but lack fruits, vegetables… USA Today Jan. 25, 2008

13. Policy Challenges Care Management Build awareness and understanding to shape policy Lifestyle services need to be a core offering Articulate a new Value Proposition Willingness to pay for new value proposition Creating policies that drive adoption Personal health behaviors are the primary determinant of disease, disability and death and primary drivers of health care costs. Prevention of illness, injury and associated risk factors is the ultimate cost trend mitigation strategy. Michael D. Parkinson, MD, MPH Chief Health and Medical Officer Lumenos

14. The Many Benefits of Lifestyle Change > Reduce risk for Heart Disease and Stroke > Back Pain > Osteoporosis > Psychological benefits including stress hardiness Exercise Benefits of Exercise A minimum of at least 30 minutes of moderate intensity exercise daily resulted in a reduced risk of coronary heart disease by more than 2-fold (Diabetes Care, 2005) Walking and losing 15 pounds decreased the risk of getting diabetes by 58% (NIH Study; n=3,284) New Value Proposition

15. CHRONIC CONDITIONS Matter of Choices Diabetes Hypertension Coronary Heart Disease Obstructive Sleep Apnea Dyslipidemia Cataracts Stroke Phlebitis Osteoarthritis Cancer Gallbladder Disease Pancreatitis Gynecologic abnormalities Nonalcoholic fatty liver disease Manage chronic conditions and treat the complications OR Help people with lifestyle and avoid majority of these problems altogether

16. Miscellaneous Facts The prevalence of diabetes increases in a dose-response relationship with increasing BMI. BMI > 35. 38% of the excess risk of diabetes could be avoided if their BMI did not exceed 30. ( Int.J. Obesity & Related Metabolic Disorders, 2000 ) Average medical costs for an individual with diabetes are $10,071/yr. compared to $2,669 for a person without diabetes. ( American Diabetes Association 2002 ) As smoking increased the rate of diabetes increased for men and women. > 2 packs/day increased risk 47% in men and 74% in women compared to non- smokers. ( Int. J. Epidemiology, 2001 ) Stress management (lowered HbA1c 0.5%, n=108) improves long-term glycemic control in type-2 diabetics ( Diabetes Care, 2002 )

17. Questions?

18. Contact Dexter Shurney SVP / Chief Medical Officer Healthways 615-565-5932 dexter.shurney@healthways.com