Obesity and the impact it has on health-care costs have taken center stage in the debate about national health-care reform.
And it seems there may be as many ideas about how to address the problem as there are people who are obese.
The issues converged last week when a national study estimated the cost of obesity at $147 billion annually, almost double what it was 10 years ago; the Centers for Disease Control and Prevention held its first Weight of the Nation conference in Washington, and Congress debated how to account for wellness programs in the health-care reform package.
"If obesity was an infectious disease, it would be an epidemic," said Dr. Daniel Bessesen, professor of medicine at the University of Colorado at Denver and chief of endocrinology at the Denver Health Medical Center.
"To ignore the problem, you're keeping your head in the sand. If you could fix the obesity problem you would make a huge impact on the nation's health-care costs," Dr. Bessesen said.
But obesity is not just a health problem.
It's a national economic problem that is becoming more prominent as the country debates the cost of health-care reform.
"These results reveal that obesity continues to impose an economic burden on both public and private payers," writes Eric Finkelstein, director of the Public Health Economics Program at the North Carolina-based RTI International, which produced the national study. "The connection between rising obesity rates and rising medical spending is undeniable."
The CDC estimates that almost 40 percent of American adults are considered obese based on their body mass index, a mathematical formula that considers a person's height and weight. That extra weight frequently leads to additional health problems such as heart disease, diabetes, high blood pressure, and pulmonary difficulties.
An RTI study estimated that $1,429 a year is added to the nation's health-care costs for each obese patient. The overall cost is about 42 percent more annually for obese people and even higher for obese patients on Medicare. Obesity adds 9.1 percent to the annual cost of health care.
The study was published in the journal Health Affairs as a follow-up to a similar study 10 years ago and includes data through 2006.
Overall, adult obesity rates in Lucas County have jumped from 27 percent to 33 percent between 2003 and 2007, according to the latest Lucas County Adult Health Assessment report.
A smaller percentage of Hispanics in Lucas County were obese in 2007 - 33 percent, down from 47 percent in 2003 - but a larger percentage of African-Americans were obese, according to the adult assessment report.
In 2007, 44 percent of African-American adults in Lucas County were obese, compared to 29 percent of whites, it said.
Among Lucas County children, meanwhile, nearly 16 percent of 12-year-olds and 13-year-olds were overweight in 2007, while 15.5 percent of 18-year-olds were overweight, according to a classroom survey done by the Mental Health & Recovery Services Board of Lucas County.
Between 13 percent and 14 percent of other school-age teens in Lucas County are overweight too, according to results. The survey does not designate what percentage of overweight children are obese.
Kathleen Sebelius, secretary of Health and Human Services, told the CDC's Weight of the Nation conference last week she's particularly concerned about obese children. Statistics compiled by the CDC show that 25 percent of children who are obese stay obese as adults and have a raft of serious health problems.
"If there was an epidemic of little kids getting cancer, it would be a national crisis," Ms. Sebelius said. "But because it's obesity and the damage doesn't come until later in life, we've been slow to act. We can't ignore this problem any longer."
Obesity among children is a major focus of the Robert Wood Johnson Foundation, a Princeton, N.J., organization that helps fund health-care initiatives. It has committed $500 million to help reduce childhood obesity by 2015.
The call for health-care reform is causing greater emphasis on the cost of obesity, but there seems to be no consensus on the best approach to dealing with it.
William Dietz, a co-author of the RTI study, said he believes the key is offering people options such as healthy snacks and drinks in schools, supermarkets with fresh fruits and vegetables in poor neighborhoods, and neighborhoods with sidewalks to encourage walking.
Dr. Dietz cited Pennsylvania's Fresh Food Initiative, which provides grant money to help build groceries in under-served areas, as a positive approach.
Prevention is critical because obesity leads to other medical conditions - such as high blood pressure and diabetes - that can cause heart failure, stroke, kidney dysfunction, arthritis, and other problems, said Dr. Jonathon Ross, a Toledo internist.
Children, for example, should get healthy food and physical education in school. Farmers, long rewarded under federal policy for growing corn and soybeans that have been turned into fattening foods, should be subsidized for raising fruits and vegetables. And cities should be designed to promote walking, such as making it possible to cross the street from a mall to a strip center without battling traffic, Dr. Ross said.
Those and other moves would help prevent obesity, he said.
"It takes little bits," Dr. Ross said. "You can't just wait until somebody weighs 300 pounds and then say, 'Oh, what do we do?'"
Dr. Bessesen said it will take a different approach that involves better teaching for doctors and almost individual programs to change the lifestyle of each patient on a trial-and-error basis to find which approach works best for each one. He called obesity "a symptom of a lifestyle that really has gotten out of control."
"People don't like to be heavy," he said, pointing to widespread dieting and other efforts at weight control.
"Our bodies are really engineered for physical activity, but our lifestyle has evolved into spending a lot of time working at a desk or sitting in front of a television or a computer. It's going to take long-term treatment to change that."
Calls for a focus on preventive health care are rising as Congress grapples with the hard financial realities of how to pay for the health care of a population of more than 300 million.
Ms. Sebelius told the CDC conference that a significant amount of the $1 billion Congress appropriated in stimulus money for prevention and wellness will go "to help states and communities attack obesity."
"Reducing obesity - especially for children - would be one of the biggest steps we could take toward this country's health future," Ms. Sebelius said.
In Congress, lawmakers are having a hard time determining how to include preventive programs in the health-care package because the Congressional Budget Office has had a difficult time assessing the savings they could generate, said Rep. Jason Altmire, a Pennsylvania Republican. A former Pittsburgh hospital executive, he's a member of the House Education and Labor Committee.
Mr. Altmire said he's opposed to an initiative to tax sugary soda as a way to pay for health-care reform. He favors an approach to pay incentives to physicians based on the health of their patients, which he thinks would encourage them to tell patients about needed lifestyle changes rather than repeatedly treating their illnesses. The system would take into account the types of patients a doctor sees since those in poorer neighborhoods tend to have more health problems, he said.
Last week, he added a provision to the House bill that would withhold 2 percent of Medicare payments to hospitals that they could earn back if they improve patient outcomes. He voted against the overall bill but said that provision is needed.
Mr. Altmire said he expects that kind of provision for physicians to be in the final bill, which should help with a variety of medical problems over time, including obesity.
"A lot of people think they can take [a cholesterol medicine] and keep eating the pizza, and the doctors are allowing that to happen," he said.
"I think if the physician reimbursement was based on how healthy their patients are, we'd see healthier patients."
Blade staff writer Julie McKinnon contributed to this report.
Block News Alliance consists of The Blade and the Pittsburgh Post-Gazette. Ed Blazina is a staff writer at the Post-Gazette.
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