The Heavy Burden of Obesity
With ageing populations, chronic diseases on the rise, and ever-evolving infectious diseases emerging, healthcare systems are already under massive strain. Despite the well-established burden of obesity on population health, it has continued to become a pervasive challenge for healthcare systems and providers.
Research has shown that over the last four decades in the USA, the mean BMI for an adult has increased from 23.1, which would be considered a healthy weight, to 27.7, which would be classed as overweight and approaching obese. Although not a perfect measurement indicator, this BMI increase shows that obesity is rapidly and dangerously on the rise. Widespread obesity has numerous repercussions to not only the individual, but the healthcare system and economic climate, too.
The multiplicative consequences of obesity can be extensive on the body. The individual may experience effects ranging from joint pain as a result of carrying extra weight, difficulty doing physical activity without breathlessness, poor sleep associated with snoring or sleep apnoea, and fatigue.
However, obesity also causes hidden chronic, systemic inflammation that can lead to insulin resistance and eventually, type 2 diabetes (T2D). When left uncontrolled, this can further contribute to more insidious inflammation-associated disease states, including cardiovascular disease, non-alcoholic fatty liver disease (NAFLD), Alzheimer’s disease, polycystic ovarian syndrome (PCOS), and rheumatoid arthritis (RA).
The serious symptoms and lasting damage of these conditions can result in a shorter life expectancy as well as a decrease in quality of life.
With the increased risk of comorbidities, patients with obesity account for a large proportion of healthcare usage globally.
In the UK, for example, the NHS reported in its recent Health Survey for England that 64% of adults were overweight or obese and up to 30% of children aged 2-15 were overweight or obese in 2019. In addition, there were over 1 million hospital admissions where obesity was the primary or secondary diagnosis and 294,000 prescriptions for obesity treatment, with similar trends seen in the USA.
This extensive use of healthcare system resources is disproportionate and unsustainable, particularly in light of already staggering general healthcare spending.
The Organisation for Economic Co-operation and Development (OECD) stated in its 2019 report that the economic case for investing in obesity prevention and treatment is urgent. The USA currently spends the most out of all 52 countries surveyed by the report on healthcare associated with obesity. (Fig.1)
It is expected that with rising cases of obesity, employment rates, absenteeism, presenteeism, and early retirement will also continue to increase. Inevitably, the workforce productivity is negatively affected, further contributing to economic loss.
How a DTx can Support Patients
Such stark statistics portray growing obesity rates as an insurmountable problem. Tackling such a large-scale issue requires an understanding of the root causes of obesity. Population health principles need to be applied creatively in order to design interventions that address underlying modifiable factors.
Population health stands on four key pillars which digital therapeutics (DTx) can address:
- Socio-economic determinants of health – employment, education, income, housing, food security, etc.
- Health behaviors and lifestyles – diet, smoking, exercise, and alcohol consumption, etc.
- Communities and infrastructure – social relationships and community networks
- Integrated, value-based healthcare systems – optimized treatment in the knowledge that comorbidities are common
Healthcare inequity is expanding and access to care can be very difficult for many communities. In the USA, one in five Americans live in rural areas, physically restricting their ability to reach healthcare centers. Likewise, those in under-resourced communities or of Black and Hispanic races also experience disparity in healthcare accessibility, which is particularly problematic as these communities are often at higher risk of obesity.
DTx offer a scalable, cost-efficient, and accessible solution for patients who may otherwise struggle to obtain access to treatment either physically or financially.
A recent RCT trial showed that a digital lifestyle-based intervention was effective in achieving significant weight-loss at two years in underserved populations, showing that a digital therapeutic can be an effective solution for those who are socio-economically vulnerable.