The obesity epidemic

Too many Americans are overweight

According to the Centers for Disease Control, two-thirds of adults are overweight or obese – and most are obese. Obesity ranks second, behind tobacco, among preventable causes of death. For anyone practicing medicine in Texas, these statistics come as no surprise. Day in and day out, Texas doctors see evidence of how out-of-shape and unhealthy the Lone Star state is. Across the country, Texas has the eighth-highest rate of physical inactivity, the tenth-highest rate of diabetes, and the fourteenth-highest rate of obesity. And, these are states of sickness we are doing to ourselves.

Research actuaries at Humana have calculated that of the 181 million Americans between the ages of 20 and 65, 122 million are a combined 6.5 billion pounds overweight. Maintaining these extra pounds means consuming 23 trillion extra calories a year – the equivalent of 42 billion Big Macs or 114 billion Krispie Crème Donuts.

This weight problem is not just private business. In 2000, the CDC calculated that the direct cost of obesity and lack of physical activity was $117 billion. These extra pounds play a role in many problems this country faces: escalating health care costs, diminishing resources for education and infrastructure, stagnant wages and staying competitive globally.

Wage a war on obesity

Doctors have been preaching moderation in diet and plenty of exercise as the remedy for weight problems for decades. While this approach remains the key to a healthy lifestyle, more immediate and drastic action needs to be undertaken.

What is needed is a war on obesity, like the ones waged against tobacco and drunk driving. There are plenty of lessons to be learned from those earlier crusades. The biggest is this: It takes a major cultural shift to change behaviors. Attitudes have to change.

That takes strong government advocates like the Surgeon General, strong special interest groups like Mothers Against Drunk Driving, and the willingness of Congress and state legislatures to step into what had been considered people’s private business and pass new laws.

There are plenty of ideas for ways to start. Some borrow from other battles: taxing junk foods, for example, as cigarettes are taxed, or banning high-fat and high-sugar foods from schools. Public health groups also have suggested that Health Impact Reports, like Environmental Impact Reports, become a required part of land-use planning, so decisions about how communities are configured include walking and bicycling as well as cars.

Here are some already existing programs that could be expanded to greater help the war on obesity.

  1. Over the course of 9 months, Humana enrolled obese people in a combined personal coaching and pedometer program. The average participant lost 12.4 pounds and 2 inches of waistline.
  2. The American Horsepower Challenge, a video exergame for school kids, increased physical activity by 13 percent by engaging kids in racking up steps via an actiped attached to their shoes.
  3. Users of Sensei, a diet and nutrition program delivered by cell phone, lost an average of 9 pounds lost in 3 months. People who are happier, healthier and wealthier

The truth is, the overweight wouldn’t be victims of this war – they’d be beneficiaries. Most overweight people are like smokers who have tried over and over again to quit, as the $50 billion-a-year diet industry proves.

In fact, between 15 and 30 percent of the respondents to a Yale study said they would rather give up the possibility of having children, be depressed or alcoholic than obese. Other studies have shown that obese people have a harder time getting a job and make less money. These studies speak to a quality of life that would benefit from a war on obesity.

And the obese pay more into the healthcare system. Humana actuaries have calculated that an obese 25-year-old who is still obese at 65 will cost the healthcare system $180,000 extra in today’s dollars. Adjusting for inflation in 40 years, that number may prove to be even more shocking.

Of course, this is a free country, and people should be allowed to make their own informed decisions. But there ought to be a national effort to help the obese get healthier. Some wars are humanitarian missions. A war against these outcomes would be a humanitarian war.