The Battle of the Bulge: Fighting Obesity, Part I

America is defined in many ways.

We are known around the world as being a military and economic superpower, and we are often admired for our athletic prowess, world-class cultural institutions and national parks, and for our commitment to a democratic government.

We are also increasingly defined by our ever-expanding waistlines.

Take the City of Huntington, West Virginia, for example.

This past fall, Huntington was named America’s “Fattest and Unhealthiest City,” after the Center for Disease Control (CDC) published a report based on data collected in 2006.

• 45% of adults age 20 and older in the Huntington metropolitan area are classified as obese; and
• 48% of adults age 65 and above have lost all of their natural teeth, compared with only 7% of seniors nationwide- yikes!

And while Huntington, WV, is an extreme example, the obesity epidemic is growing nationwide– at great cost to our health and finances.

The Numbers: People

More than one-third of American adults (72 million people) and 16% of children (ages 2 to 19) are obese.

Obesity is determined by using a person’s height and weight to calculate a number called the Body Mass Index (BMI).

The BMI is used because, for most people, it corresponds with their amount of body fat.

• Folks with BMIs between 25 and 29.9 are considered overweight, and someone with a BMI over 30 is classified as obese.
• Click here to calculate your BMI and to determine whether you are at-risk for obesity-related diseases.

Since 1980, obesity rates have doubled for adults and tripled for children.

Obesity rates are increasing amongst all segments of the population, irrespective of age, race, socioeconomic status, education or geographic region.

The number of type II diabetes cases is also rising. Type II diabetes is often associated with obesity, and over 10% of the population in four states now has the disease.

Click on this interactive map to see a breakdown of obesity rates per state between 1987 and 2007.

The Numbers: Cost

There is no way around it: obesity is costly.

As taxpayers, consumers and patients, we all pay for the cost of obesity whether or not we personally are overweight.

• In 2000, obesity-related health care costs totaled $117 billion.
• Medical expenditures for obese workers are between 29%-117% higher than for workers of healthy weight.
• Obesity is a major driver in healthcare spending growth. We showed here that obesity accounts for roughly 12% of spending growth (and some reports put that estimate much higher, around 26%).
• Being overweight leads to higher risk for numerous health problems, from type 2 diabetes, cancer and stroke to sleep apnea and gynecological disorders.
  • These conditions are expensive and difficult to treat, and they reduce a person’s quality of life and often lead to premature death.

In this As We See It article, “Where Do U.S. Health Dollars Go?” we promised to propose some solutions that might help folks improve their health (while reducing the impact of obesity-related costs).

It is important to note that many in the medical community classify obesity as a chronic disease, and a number of medical remedies, from bariatric surgery to various prescription drugs, have been developed to treat this condition.

But pharmacotherapy and other medical procedures alone usually are not sufficient to help patients overcome weight problems.

• In August of 2007, the Internal Medicine World Report published findings showing that currently available medications for weight loss produce only marginal benefits in the long-term, and that “greater efforts are needed by physicians to target therapies to individual patients.”

In other words, medical treatments must be combined with major lifestyle changes if patients want to see improvement. Research has consistently shown that obesity rates increase as our lifestyles become more sedentary – as we sit around instead of taking the recommended 10,000 steps per day.

In effect- we must get up and exercise!

While private-sector employers have moved quickly to promote physical activity and health and wellness programs, many insurers and state and local governments are still lagging when it comes to providing assistance to obese patients.

The majority of businesses now offer some form of wellness benefits, which include weight loss programs, gym membership discounts, on-site exercise facilities, smoking cessation classes, nutrition classes and web-based healthy living resources:

• 53% of small firms (3-199 workers) and 88% of large firms (200 or more workers) offer at least one of these listed benefits.

In contrast,

• 20 states explicitly do not cover nutritional assessment and consultation for obese adults under Medicaid; and
• 45 states allow using obesity or health status as a risk factor to deny coverage or raise insurance premiums. Only five states do not allow using obesity or health status to deny coverage or raise premiums.
• Requiring insurers to cover obesity-related surgeries is an uphill battle for lawmakers, as the experience of New Hampshire Senator (and formerly obese individual) Robert Clegg illustrates.
  • This is because obesity is still viewed as being a willpower issue and not a disease, or serious medical condition.
  • This is true even though an economic analysis by the firm Analysis Group showed that insurers recover the costs of bariatric surgery within two to four years following the operation.

The authors of an August 2008 report on obesity entitled “F as in Fat: How Obesity Policies are Failing America” argue that combating obesity must become a national priority.

The study was co-sponsored by the Robert Wood Johnson Foundation (RWJF) and by the Trust for America’s Health (TFAH).

• “America’s future depends on the health of our country. The obesity epidemic is lowering our productivity and dramatically increasing our health care costs. Our analysis shows that we’re not treating the obesity epidemic with the urgency it deserves,” said Jeff Levi, Ph.D., executive director of TFAH.

As President Obama and the newly-elect Congress aim to simultaneously cover more Americans while reducing the cost of our health care system, addressing the obesity epidemic is critical. We must move away from blaming overweight individuals, and begin to treat this issue as a public health concern. Our longevity, productivity and finances depend on it.

Tomorrow we’ll look at childhood obesity and the different approaches being taken to address the problem.