Obesity has been linked to a wide array of health problems. A new study suggests that abdominal obesity as measured by body mass index (BMI) and waist circumference, may result in a greater risk of chronic obstructive pulmonary disease (COPD) and asthma. Study results are published online recently in Menopause, the journal of The North American Menopause Society (NAMS). Previous studies have shown that women experience greater lung function impairment and have a higher risk of developing COPD than men, despite less exposure to smoke. In addition, female smokers, compared with male smokers, experience a more rapid decline in lung function between 45 and 50 years of age. The asthma incidence and hospitalisation rate because of asthma are also higher in women than in men. It is believed that female hormones contribute to the greater incidence of asthma in women. Obesity has been shown to affect the risk of these airway obstructive diseases and can lead to a decline in lung function. The incidence of COPD in people who are obese is significantly higher than in those of normal weight. In addition, women who are obese are more likely to experience asthma than men who are obese.
Until now, little has been known about the effects of obesity on COPD and asthma in women before and after menopause. This new study, based on data collected from more than one million women, aimed to determine the effect of BMI and waist circumference on COPD and asthma development in premenopausal and postmenopausal women.
The researchers concluded that, regardless of menopause status, high BMI and waist circumference were found to significantly increase the risk of COPD and asthma. In addition, being underweight was also identified as a risk factor for COPD in postmenopausal women, suggesting that controlling weight and maintaining a healthy body shape are key to helping prevent COPD and asthma in women.
Study results are published in the article, Obesity and abdominal obesity are risk factors for airway obstructive diseases in Korean women: nationwide population-based cohort study.
"This study highlights yet another detrimental effect of obesity and abdominal adiposity in women and specifically identified that women with a high BMI and/or waist circumference had a greater risk of developing COPD and asthma. In addition to avoiding tobacco use, maintaining a healthy body weight and composition may help reduce the incidence of COPD and asthma in women," says Dr Stephanie Faubion, NAMS medical director.
THE COST OF OBESITY
Obesity is a global public health challenge, and a significant issue in South Africa. Half of all South Africans are either overweight or obese, and this leads to an increased risk of heart disease, type 2 diabetes, certain cancers, and premature death. The high cost of obesity is not only felt by the healthcare sector and by medical schemes, but it also puts strain directly on the budgets of every individual as well as on the South African economy.
THE BURDEN OF COMORBIDITIES
One of the biggest challenges around obesity is that it can lead directly to other non-communicable diseases, including heart disease, diabetes, chronic kidney disease, musculoskeletal disorders, and specific types of cancer. All these conditions require ongoing, potentially lifelong care and treatment, and are costly for both the public and private healthcare sectors.
These conditions can also lead to further complications, for example, diabetes can cause blindness and circulatory problems that can, in turn, cause other issues. Heart disease often requires expensive and risky open-heart surgery, and cancer needs ongoing treatment and often also requires surgery. While medical aids will cover the cost of treatment for these conditions, there is still the potential for shortfalls, for which the patient will be liable to pay.
ADDED COSTS ON TOP
Aside from the cost of care – including medication and health complications – obesity increases the risk of surgery, especially if the patient’s body mass index (BMI) is greater than 35. For this reason, surgeons in private hospitals are permitted by the Council for Medical Schemes to charge a modifier for these patients.
This amounts to an additional 50% of the fee for surgeons, and a 50% increase in anaesthetic time units for anaesthesiologists. While again, this is covered by medical aids up to their specified rate, the patient will still be liable for any shortfalls over and above what their scheme will pay.
BARIATRIC SURGERY IS NOT A QUICK FIX OPTION
Reality television shows have normalised bariatric surgery (or ‘stomach stapling’) as a quick and easy solution to the challenge of obesity. However, this paints a very glamourous picture of a surgery that is, in fact, an absolute last resort. Bariatric surgery requires permanent lifelong changes to diet and exercise routine as well as constant monitoring of underlying diseases and risk factors.
There are also very specific clinical entry criteria that need to be met before a surgeon will even consider the procedure for a patient. In addition to this, there are very few medical schemes in South Africa that will cover the costs for bariatric surgery, and then only on a few of the very top plans and only under extremely specific conditions. This means that, in most cases, should a patient opt for this route as a method of weight loss, the cost will fall to them. Even if the medical scheme pays, they may only cover a portion of the costs.
Sources: The North American Menopause Society, Turnberry Risk Management Solutions