It seems that we are reminded on a daily basis about the obesity epidemic, a leading cause of preventable death that afflicts about one third of adults in the United States. Obesity has been increasing at a frightening rate, more than doubling in incidence during the past 30 years, although recent data suggests that the rate of increase may be leveling off.
Obesity is most commonly measured by Body Mass Index (BMI), which is calculated by dividing weight in kilograms by height in meters squared. The calculation of BMI has been simplified by the presence of calculators readily available on the internet. For example, someone who is six feet tall and weighs 200 pounds has a BMI of 27.1.
A BMI of 25.0 to 29.9 is considered to be overweight, and obesity is defined as a BMI of 30.0 or greater.
Obesity increases the risk of heart disease, hypertension, type 2 diabetes, sleep apnea, abnormal lipids, cancer, stroke and numerous other impairments. The distribution of fat in the body helps determine its significance. For instance, excess fat in the abdominal area, which is termed visceral fat, is especially concerning. Visceral fat leads to the release of substances that promote inflammation and many obesity related conditions. These conditions can also include a decrease in pulmonary function and metabolic syndrome.
Even modest amounts of weight loss can significantly improve diseases related to obesity. The benefits are related more to the amount of weight lost rather than the methods utilized, which might include lifestyle changes, weight loss surgery, medications and psychosocial support.
Weight loss surgery, which is also called bariatric surgery, has increased in popularity. These procedures are usually performed using a laparoscope. Gastric banding and gastric bypass are the most common bariatric procedures performed in the US.
In gastric banding, an adjustable band is used to restrict the amount of food that can be accommodated by the stomach. In gastric bypass, the size of the stomach available for digestion is decreased which also restricts the amount of food that can be eaten. In addition, part of the small intestine is bypassed, resulting in decreased absorption of food eaten. When compared to gastric banding, gastric bypass is more invasive with a higher rate of early postoperative complications, but results in a greater degree of sustained weight loss.
The obesity epidemic also plagues young people. Over 20 million children and adolescents in the US are overweight or obese. As a result, they are experiencing an increased incidence of diseases that traditionally have been attributed to adulthood, such as type 2 diabetes, abnormal lipids, and hypertension.
The field of obesity is an area of active research, and new medical studies are frequently being published, making its underwriting both challenging and exciting.
Applicant One, who is a 52 year old non smoker with a history of obesity, type 2 diabetes, and sleep apnea, underwent successful gastric bypass five years ago with a resultant loss of 65 pounds. Glucose and hemoglobin A1C values have normalized and a recent sleep study showed marked improvement of sleep apnea. The applicant is 5 foot 10 inches tall and weighs 225 pounds, which comes out to a BMI of 32.3. Although the applicant is still considered obese with this BMI, due to the success of the surgery and improvement in the obesity related conditions Standard Plus Non Tobacco is possible.
Applicant Two, who is 38 years old, is 5 feet tall, weighs 250 pounds (BMI is 48.9), and has poorly controlled diabetes. Hospitalization was recently required for elevated blood pressure that caused severe headaches. Prior weight loss attempts were unsuccessful. This applicant is a decline.
Applicant Three is 60 years old, 6 feet tall, weighs 280 pounds (BMI is 38.0) has hypertension and hyperlipidemia that is well controlled with medications, is seen for regular physicals and is compliant with recommended preventative screening. Applicant three can qualify for Standard.
Applicant Four, who is 45 years old, is 5 foot 8 inches tall and weighs 160 pounds (BMI is 24.3). While in his 20s, he weighed 230 pounds (BMI 35.0), but when a colleague suffered from a heart attack, Applicant Four changed his eating habits, began an exercise program and has been able to maintain his current weight for many years. Applicant Four can qualify for Preferred Plus.