The Twelve Pillars® Model of Obesity
Currently, our scientific community, healthcare delivery infrastructure, public and elected officials, media, and society as a whole lack consensus about the true nature of obesity. This environment, composed of key stakeholders who lack a clear definition of the problem, has dramatically slowed collective efforts to find solutions. Questions abound:
- Is obesity a disease?
- Who is accountable?
- What is the true cost of obesity to individuals, employers, and society?
- What are the ideal roles of public policy and government intervention?
- What treatments and policies are effective?
Unfortunately, our only authentic point of consensus is that obesity is a legitimate public health and economic crisis in the United States and the majority of the world's developed economies.
The Twelve Pillars® model is an etiological framework for obesity that defines and describes the complex interchange of shifting factors impacting individuals and populations. Our services and public outreach campaigns seek to clearly define the obesity problem space according to the Twelve Pillars®. Obesity PPM will make the underlying Twelve Pillars® obesity research tool, assessment instrument, and data model commercially available in the third quarter of 2013.
Every person suffering from obesity is, to varying degrees, impacted by each of the six individual pillars, and must successfully address each of them to maximize his or her likelihood of achieving and maintaining a healthy weight. They must also successfully navigate their environment, as defined by the six population pillars. Reversing the obesity epidemic requires careful balancing of education, personal accountability and motivation with highly-individualized and multidisciplinary clinical medicine, all in an environmental context that supports, rather than burdens, the obese.
Is the Obesity Epidemic Leveling Off? Don’t be Too Sure.
Recently, CDC epidemiologists published an article in the Journal of the American Medical Association to the effect that there was not a significant change over the past 12 years in the nation’s obesity rate of 35.5% for adult men and 35.8% for adult women. Many, but not all, media reports interpreted this as meaning the obesity epidemic was leveling off. But is that really the case? Let’s look behind the headlines.
First, let’s keep in mind that, even if BMI is highly correlated with body fatness, it still misses a lot of groups for whom the BMI is a crude indicator of body fatness or excess adipose tissue.
Second, obesity prevalence should not be judged by making the BMI of 30 the sole criteria. This is better explained if you look at the “etables” accompanying the article. These breakdown the categories by age and gender and graphically plot the changes in BMI from 1988 to 2010. While each graph is slightly different, they basically all show three trends: the population at normal weight is declining, the population with a BMI of 30 is getting even heavier and the BMI level for 90% of each subgroup is progressively increasing. Bottom line: fewer Americans are at a normal weight and the overweight and obese subgroups are gaining weight.
ASMBS Issues Statement on Gastric Plication
IOM Report on Early Childhood Obesity Prevention Policies
UPDATED June 23rd following live webcast: now access the complete IOM report, Childhood Obesity Prevention Policies, by clicking here to download the PDF.
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On June 23rd, 2011, the Food & Nutrition Board of the Institute of Medicine (IOM) will release a new strategic report: "Early Childhood Obesity Prevention Policies." All members of the public are invited to participate in the live event at the National Press Club, click here to register online. Interested parties may also view the live webcast: please click here to watch the event at 1:00PM EDT.
To read the IOM's previous report issued in March 2011, "Hunger and Obesity: Understanding a Food Insecurity Paradigm," click here.
International Diabetes Federation (IDF) Issues Statement on Bariatric Surgery
On March 28th, at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes in New York, the IDF Taskforce on Epidemiology & Prevention issued their first statement on bariatric surgery. The central theme of the report is reflected in this quote from paragraph 2.15: "...bariatric surgery for the severely obese with type 2 diabetes should be considered early as an option for eligible patients, rather than being held back as a last resort."
Some additional interesting points from the statement:
- The report asserts that access to bariatric surgery for obese type 2 diabetics is restricted both financially and clinically, due to the lack of provider awareness of efficacy and low risk profiles.
- The statement echos guidelines for bariatric surgery in adolescents made by the Australian and New Zealand Colleges for paediatric physicians and surgeons, and the Obesity Surgery Society of Australia and New Zealand (BMI > 40 with severe comorbidities, only LAGB & RNY considered appropriate). VSG still excluded for adolescents due to lack of long term data.
- In paragraph 3.1.1, the report states that "under some circumstances people with a BMI 30-35 should be eligible for surgery," but falls short of explicitely describing those circumstances.
- The Taskforce redirects the requirements for economic analysis back to "each health system," who must individually "determine whether bariatric surgery with its support services is economically appropriate." Based on their reported data, bariatric surgery is indeed cost effective in the treatment of type 2 diabetes, yet this guidance suggests that new economic analysis be undertaken at the initiation of each program.
- Section 2.18 addresses "Novel extra-luminal and endo-luminal procedures and devices and novel bariatric metabolic devices."
Type 2 diabetes is one of the world's fastest growing diseases, with obesity as its greatest single risk factor -- 450 million people worldwide are forecast to have the disease by 2030.
The full report is available here.
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OAC Webinar Series
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Free downloads of the following five archived webinars produced in partnership with the Obesity Action Coalition available now! Click here to watch the archived events.
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