Karen Kovach M.S, R.D Chief Scientific Officer Weight Watchers International Inc.

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1 Waking up to real solutions to Chronic Disease: Tackling obesity can reduce the burden of chronic disease and deliver substantial cost savings to struggling European healthcare systems Karen Kovach M.S, R.D Chief Scientific Officer Weight Watchers International Inc.

2 Raised BMI and Waist Circumference are independent predictors of risk of future ill health Waist circumference Low High Very high Men: <94cm Men: cm Men: >102cm BMI Women: <80cm Women: 80-88cm Women: >88cm Underweight (< 18.5 kg/m 2 ) Underweight (Not Applicable) Underweight (Not Applicable) Underweight (Not Applicable) Healthy weight ( kg/m 2 ) No Increased Risk No Increased Risk Increased Risk Overweight ( kg/m 2 ) No Increased Risk Increased Risk High Risk Obese ( kg/m 2 ) Increased Risk High Risk Very High Risk Very Obese (>35 kg/m 2 ) Very High Risk Very High Risk Very High Risk National Institute of Health and Clinical Excellence (2006) Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children.

3 There is now good evidence to show that adult obesity is associated with a wide range of health problems Strain on the body's joints, increasing the risk of osteoarthritis and low back pain Increased risk of hypertension (high blood pressure), which is itself a risk factor for coronary heart disease and stroke and can contribute to other conditions such as renal failure Increased risk of coronary heart disease (including heart attacks and heart failure) and stroke Increased risks of deep vein thrombosis and pulmonary embolism Increased risk of dyslipidemia (for example, high total cholesterol or high levels of triglycerides) Metabolic syndrome Increased risk of several cancers (endometrial, breast and colon) Increased risk of menstrual abnormalities, polycystic ovarian syndrome and infertility Maternal obesity is associated with health risks for both the mother and the child during and after pregnancy Increased risk of sleep apnoea and other respiratory problems such as asthma Increased risk of non-alcoholic fatty liver disease Increased risk of gastro-oesophageal reflux Increased risk of gall stones Stress, low self-esteem, social disadvantage and depression Substantially increased risk of Type 2 diabetes

4 National Health Survey, Australia,

5 More than half the EU population is overweight or obese % men overweight and obese (2008) % women overweight and obese (2008) All data: Eurostat

6 * WHO Adult obesity and overweight are responsible for up to 6% of healthcare expenditure in the European Region*

7 There are estimated to be over 60 million people living with diabetes in the European Region*, driving significant healthcare expenditure, and it s set to get worse as life expectancy is on the rise Prevalence (%) of people with diabetes by age and sex 2011** *WHO **International Diabetes Foundation/Europe

8 There is no country in the world that has healthcare costs under control. Spend on healthcare is increasing across Europe 6, % 12.4% 14.0% 5,000 4,000 3, % 2, % 2, % 2, % 9.4% 2,754 2, % 3, % 10.5% 3,277 3, % 3,652 3,869 3, % 10.0% 8.0% 6.0% 2, % 1, % Healthcare Exp per Capita as % of GDP 0.0% Eurostat

9 A major culprit of these out of control costs is chronic disease A health threat. 40% of the European population above the age of 15 have a chronic disease*. and an economic threat Between 70% and 80% of European healthcare costs are spent on chronic care ( 700bn in the EU)** Chronic diseases currently account for over 86% of deaths in the EU** *European Chronic Disease Alliance **Never too early: tackling Chronic Disease to extend healthy life years. EIU 2012

10 There is a link between chronic disease and the economy* *WHO (2006) An estimation of the economic impact of chronic noncommunicable diseases in selected countries.

11

12 There is a growing need for effective solutions that prevent and treat chronic disease, which are affordable and scalable

13 Weight loss treatment is a solution Lifestyle interventions that deliver medically significant weight loss (>5% initial weight) have been shown to lead to multiple clinical benefits

14 Hamman et al (2006) Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care;29(9):2102-7

15 The progression to diabetes can be controlled by lifestyle factors Incidence per 100 person years 10 HR Number of goals achieved Weight reduction > 5% Moderate fat <30 E% Low saturated fat <10 E% High fibre >15g/1000kcal Physical activity >30 min /day Lindström et al on behalf of the Finnish Diabetes Prevention Study Group (2006). Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention. Lancet; 368:

16 Preventing or delaying the onset of type 2 diabetes saves money Direct costs of treating diabetes Costs of treating diabetes-related complications (heart disease, strikes, blindness, kidney disease etc) Cost to society: Time off work, patient & carer costs, premature death UK Case Study It is estimated that around 2600 is saved per year for each case-year of type 2 diabetes prevented (from an healthcare perspective) and a further 3800 in terms of costs to society

17 Treating 100 high risk adults with a lifestyle prevention programme can. Prevent 15 new cases of type 2 diabetes 1 Prevent 162 missed work days 2 Avoid the need for BP/Cholesterol pills in 11 people 3 Add the equivalent of 20 good years of health 4 Avoid 70,000 in healthcare costs 5 1. Knolwer et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med; 7: 346(6): DPP Research Group (2003) Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care;26(9): Ratner et al (2005) Impact of Intensive Lifestyle and Metformin Therapy on Cardiovascular Disease Risk Factors in the Diabetes Prevention Program. Diabetes Care 28 (4): Herman et al (2005) The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142: Ackermann et al (2008) Translating the DPP into the community. Am J Prev Med 35 (4), pp ; estimates scaled to 2008

18 Populations don t have to achieve an ideal weight to have significant benefits Think of the potential if we start to get it right ; tackling obesity more effectively

19 Despite the significant benefit of relatively small changes in weight; current approaches in public health are not making a dent in obesity rates men women Trends in age-standardised mean BMI between 1980 and 2008 for men & women in Europe (Finucane et al (2011) National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 91 million participants. Lancet; 377 (9765): )

20 It s simple but not easy

21 Focusing on the major recognised risk factors for chronic disease (tobacco use, poor diet, low physical activity and harmful alcohol consumption) has not been shown to directly reduce weight Specific weight management solutions are needed

22 A portfolio of solutions that reverse or prevent the progression of weight gain are needed Progression of Weight Gain Morbid Obese Obese Overweight Healthy Weight Risk function of life stage, SES, ethnicity, etc. Surgeries (e.g., banding, gastric sleeve) Medical Devices (e.g., VBLOC) Medications (e.g., Orlistat) Lifestyle Modification Structured eating plan Regular physical activity Cognitive skills Support

23 There are established best practices for lifestyle modification programmes* Help people decide on a realistic healthy target weight Focus on long-term lifestyle changes Address both diet and activity, and offering a variety of approaches Use a balanced, healthy-eating approach Offer practical, safe advice about being more active Include some behaviour-change techniques Recommend and/or providing ongoing support However lifestyle modification programmes can be highly variable in delivery, expertise, frequency and evidence of efficacy: Individual, Small Group, Large Group In-person, Internet Lay providers, Trained Staff, Healthcare team Weekly, Monthly, Periodic Contact No evidence, internal unpublished data, published independent data, published controlled trials National Institute of Health and Clinical Excellence (2006) Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children.

24 Ida Mercedes Glenn Wendy Agathe

25 Heshka et al (2003) Weight Loss with Self-help Compared with a Structured Commercial Program: a Randomized Controlled Trial. Journal of the American Medical Association; 289 (14):

26 Tackling obesity through lifestyle modification programmes that meet best practices represent a tangible preventative solution for chronic disease They have to be scalable, effective and affordable

27

28 New and innovative partnerships between healthcare and industry have been proven to be scalable, effective and affordable

29 NHS partnerships % of NHS Primary Care Trusts who have worked in partnership with Weight Watchers % of PCTs Year

30 Audit data from almost 30,000 NHS patients, across 74 different organisations with an average BMI 35kg/m 2 Ahern et al (2011) Weight Watchers on Prescription: An Observational Study of Weight Change among Adults Referred to Weight Watchers by the NHS. BMC Public Health; 11:434

31 1 year prospective 3 country randomised controlled trial Compared 12 months referral to Weight Watchers to 12 months standard care by health professionals in primary care (n=772) At 12 months average weight loss was significantly greater with Weight Watchers vs standard care Jebb et al (2011) Primary care referral to a commercial provider for weight loss treatment, relative to standard care: An international randomised controlled trial. Lancet September 7

32 Referral to Weight Watchers significantly increases weight loss in primary care Weight (kg) Baseline kg kg Weight Watchers Standard Care 7.7% p <0.001 *Completer analysis Treatment Duration (months)

33 5% Weight Loss 10% Weight Loss Percentage of Participants All SC participants SC completers All WW participants WW completers SC WW SC WW Treatment Group Percentage of randomised participants and completers in each treatment group who had lost 5% and 10% initial weight at the12 month assessment.

34 Eberhard et al (2011) Greater Improvements in Diet Quality in Participants Randomised to a Commercial Weight Loss Programme Compared to Standard Care Delivered in GP Practices. Proceedings of the Nutrition Society; Vol. 70, Issue OCE4, p. E252.

35 Proven to be a cost effective approach It is cost effective for general practitioners (GPs) to refer overweight and obese patients to a Commercial Provider [Weight Watchers], which may be better value than expending public funds on GP visits to manage this problem Fuller et al (2012) A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care an international randomised controlled trial. International Journal of Obesity: 1 7

36 Trends for patient-centred care are evolving Segment at risk and chronic care patients by their specific needs Task-shift from expensive and highly trained doctors and nurses to community workers and support teams Treat patients closer to home Support for self-help groups at local community level (UK) In-home nurse visits (Denmark) Information campaigns and community support (Finland) Healthcare centres for lifestyle training (Sweden) Pharmacy support systems (Spain)

37 The trends for patient-centred care are evolving, but not quick enough. Policies to support the prevention of chronic disease need to change quickly but there is no need to re-invent the wheel There are already scalable, effective and affordable solutions available Small Reductions in Weight = Big Impact in health

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