COPE: 56336-PB Is Apple Stealing Healthcare fo Optoety? Bryan M. Rogoff, OD, MBA, CPHM Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Oveview: Healthcae Technoogy Optoety History & Obesity Competitive Short-Term Body Mass Index Landscape Strategies Diabetes Announcements Hypertension & Data Long-Term CV Disease Acquisitions Strategies Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY It is a health condition 20% or more above you ideal weight What is it? NIH defines as having too much body fat that has a negative effect on health Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Leading cause of mortality morbidity, What is it? disability, healthcare utilization and healthcare costs in the United States. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY More that 1/3 of U.S. adults have obesity. Non-Hispanic blacks 48.1% What is it? Hispanics 42.5% Non-Hispanic Whites 34.5% Non-Hispanic Asians 11.7% Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY There is no significant relationship however there is a trend: Higher income women are less likely to What is it? have obesity lower income. Those with college degrees are less likely to have obesity. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Dietary Excessive Junk Food Causes: Processed Food Sugary / Sweet Drinks Soy Products (Obesogens) Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Dietary Excessive Junk Food • Termed coined in 2006 • Endocrine disrupters • Do not directly cause obesity, Processed Food Causes: but increase sensitivity to gaining weight. Sugary / Sweet Drinks • Changes how a person’s fat develops; Increases fat storage Soy Products (Obesogens) capacity Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Dietary Lack of Fiber in diet Not washing fruits & veggies Causes: (Pesticides = Obesogens) Imbalance of gut Bacteria Excessive Omega-6 Fatty Acids Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Non-Dietary Sedentary Lifestyle Lack of sleeping / Over- Causes: Sleeping Anxiety / Depression Vitamin D deficiency Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Non-Dietary Sedentary Lifestyle • Under conditions of regular sun exposure, dietary intake is of Lack of sleeping / Over- minor importance. Causes: Sleeping • Naturally only in a few foods: fish-liver oils, fatty fish, mushrooms, egg yolks, and liver. Anxiety / Depression • Fortified milk products and other fortified foods such as Vitamin D deficiency breakfast cereals and orange juice Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Non-Dietary Sedentary Lifestyle • Promotes calcium absorption in the gut and maintains adequate serum calcium Lack of sleeping / Over- Causes: Sleeping • Other roles: modulation of cell growth, neuromuscular and immune function, and reduction Anxiety / Depression of inflammation Vitamin D deficiency Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Non-Dietary Sedentary Lifestyle • Corticosteroid medications can reduce calcium absorption and Lack of sleeping / Over- impair vitamin D metabolism. Causes: Sleeping • Weight-loss drug orlistat & cholestyramine can reduce the absorption of vitamin D Anxiety / Depression • Phenobarbital & phenytoin increase the hepatic metabolism Vitamin D deficiency of vitamin D to inactive compounds and reduce calcium absorption Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Non-Dietary Chronic Dehydration Plastic Containers (Bisphenol- Causes: A - obesogen) Eating too quickly / Improper Chewing Medications Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Body Mass Index Screening tool to indicate whether a person is underweight, overweight, obese or a healthy weight for their height, but not accurate enough to be used Ho? as a diagnostic tool. Age-independent and the same for both sexes. BMI may not correspond to the same degree of body fat in different populations due to different body proportions. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Body Mass Index The higher the BMI, the greater the risk of some diseases, including high blood pressure, coronary artery disease, stroke, osteoarthritis, some cancers, Ho? and type-2 diabetes. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Body Mass Index Formula: - Weight (kg) / Height (m)2 -(Weight (lbs.) x 703) / Height (inches)2 Ho? Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Body Mass Index BMI is accepted as a reliable indicator of total body fat but it does have some limits. It may overestimate body fat in athletes and others Ho? who have a muscular build. It may underestimate body fat in older persons and others who have lost muscle mass. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Body Mass Index Skinfold calipers are more accurate for measuring body fat if the person using the calipers has been properly trained. Ho? However this type of testing isn't as accurate in people who are very obese. It can't be used to measure the dangerous, deep belly fat, which isn't just under the skin. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 1962 1962 2018 United States obesity rate is 13%! 45% of U.S. adults are overweight! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 1995 1962 2018 United States consumption of fast-food TRIPLED since 1977! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 1997 1962 2018 James Cameron’s Titanic becomes highest grossing film. The Dow Jones closes about 8,000 for the first time! The Notorious B.I.G. is killed in drive-by shooting. United States obesity rate climbed to 19.4%! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2004 1962 2018 United States’s obesity rates reach 24.5%! World Health Organization estimates at least 400 million adults are obese. Women obesity rate is higher than men The Boston Red Sox win the World Series! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2007 1962 2018 United States obesity rate climbs to 26.6%! Barry Bonds breaks Hank Aaron’s Home Run record (756th)! Dow Jones Industrial Average breaks 14,000! Nancy Pelosi becomes the 1st female Speaker of USHOR! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2008 1962 2018 United States obesity rate climbs to 33.8%! WHO claimed 1.5 Billion adults (20 years and older) were overweight! 200 Million Men Obese / 300 Million Women Obese! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2009 1962 2018 Research links sugar consumption to the rising obesity trend. Dr. Robert Lustig lectures on the Evils of Sugar in a 90 minute YouTube video which has over 3 Million views. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2010 1962 2018 U.S. obesity rates reaching catastrophic levels at 35.7%! Study: Financial Cost of Obesity direct obesity related medical expenses in America are $160 billion per year! Estimated indirect costs $450 billion per year! Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2010 1962 2018 U.S. government effort to improve the health of Americans by reducing obesity - Healthy People 2020 The initiative aimed to lower obesity rates to 14.5% among youth and 30.5% among adults by 2020. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2012 1962 2018 Of all countries, the U.S. has the highest rate of obesity! 74.1% of people are overweight & 30% of those are obese! 70% of diagnosed heart disease cases are linked directly to obesity, according to the American Heart Association Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2016 1962 2018 Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB 2017 1962 2018 U.S> obesity rate is nearly 40% of adults & 19% of youth! One in ten preschoolers aged 2-5, one in five children aged 6-11 and one in five adolescents aged 12-19 is considered obese. Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Sex Hormone Imbalance Increased Free Fatty Acids Mechanical Stress Metabolic Syndrome Insulin Resistance Hypertension Sleep Apnea Dyslipidemia Osteoarthritis Hormone Dependent Tumors Shortness of Breath Lower Back Pain Type 2 Diabetes DISABILITY Cardiovascular Disease MORTALITY Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Sex Hormone Imbalance Hormone Dependent Tumors • Less exercise, toxin absorption plus increased weight increases stress. • Hormone production is then taken over by the adrenal gland. • Cortisol (stress hormone) is then made from available progesterone; depleting the balancing hormone of estrogen. • Prolonged cortisol leads to bone fractures, muscle depletion, decreases in strength & energy, lowers libido & decreases immunity. DISABILITY MORTALITY Is Apple Stealing Healthcare from Optometry? COPE: 56336-PB Healthcae: OBESITY Sex Hormone Imbalance Hormone Dependent Tumors • This leads to the reduction of SHBG (sex hormone binding globulin, a protein that binds estrogen levels and keeps them out of circulation). • Estrogen levels go up & become active, and stimulate the growth of breast cancer cells. • Overweight or obese women have a 30-50% greater risk of postmenopausal breast cancer than leaner women. • There is a strong link