Put the Obesity Epidemic at the Top of the Agenda

Obesity is historically linked to about one third of the increase in domestic health spending since the mid-1980s and is a key factor in the rise in private insurance premiums, Medicare and Medicaid spending.
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If Congress wishes to control costs in health care, they must put the obesity epidemic at the top of the agenda.

Why? Because as much of a problem as obesity is today -- believe it or not, it is going to get worse -- and we will all be paying more for it.

A new study released today by the UnitedHealth Foundation, American Public Health Association and Partnership for Prevention in conjunction with their annual America's Health Rankings report shows us what the world will look like a decade from now if current trends continue. The study, which was based on my research, finds that:

•By 2018, 103 million American adults -- or 43 percent of the population -- will be considered obese;
•US spending on health care costs attributable to obesity will quadruple - to $344 billion - over that same period; and,
•By 2018, obesity will account for more than 21 percent of health care spending.

Obesity is historically linked to about one third of the increase in domestic health spending since the mid-1980s and is a key factor in the rise in private insurance premiums, Medicare and Medicaid spending. These new findings show there's no question that as a nation, we need to take action -- and fast -- to control our weight.

While health reform provides us with a great opportunity to consider the obesity epidemic from a national policy perspective, there are things we can do right away that don't necessarily require legislative action. We can meaningfully reduce costs and improve quality of life simply by changing the way we think about and treat obesity. Here are four examples of where to focus our efforts:

1. Get Americans to see being obese as a serious medical condition that significantly heightens their risk for other health problems, not as a lifestyle choice.

Obesity can kill you. It's true: Obesity is responsible for 112,000 deaths and for more than 100,000 cases of cancer annually, as well as being closely linked to the explosion of chronic disease rates in our country. Yet, Americans generally view being obese as a choice rather than a medical condition. Congress can help change this by ensuring that obesity is recognized officially as a chronic condition, qualifying obese patients for many of the care coordination and preventive care provisions being considered in current health reform legislation.

2. Ensure that fear about the stigma of obesity does not eclipse the need to combat it.

States like Arkansas have been taken to task by parents and critics for weighing and measuring school children to identify and monitor obesity, despite the fact obesity is linked to our nation's high levels of "type 2" diabetes in children and that -- given the strong association between diabetes and heart disease -- they may be at risk for heart attacks in their teens. Screenings and other monitoring tools, when administered appropriately, can be incredibly helpful in catching potentially life-threatening cases. Ultimately, efforts to identify and control obesity are not meant to point fingers or label but to improve health, avoid death and reduce costs.

3. Get employers invested in promoting wellness.

A number of employers are embracing the idea of workplace health promotion through on-site programs or incentives for gym memberships, etc. With such progress being made by the private sector, Congress should look for responsible ways to encourage it. Health care proposals would allow employers to do more to encourage "good" health behaviors among their employees as a means of reigning in rising health care premiums. Providing such incentives for health and wellness programs is a terrific start, but overall design will be the true deciding factor as to whether the programs are effective.

Congress can help by ensuring that programs must be voluntary, easy to access and have a well-designed and well-communicated structure. Most importantly, any financial incentives to participate in health risk assessments or care plans must not be related to family or genetic information. Instead, these incentives should be available to all workers -- disabled, healthy, and chronically ill -- and geared to encourage filling out a health risk appraisal and working on their care plan, not on issues related to health, disability status or family history.

4. Ensure that our health care system is oriented to help health care providers treat obesity like a preventable medical condition.

Current incentives within the health care system make it more profitable to treat disease than to prevent it. Health care incentives should instead encourage health care providers to spend time discussing preventive care and prescribing the appropriate diet and exercise regimens that can help their patients to avoid obesity. Current health reform legislation would link payments to the quality of care and improved health outcomes, which is a good start. We should also pay physicians for weight loss counseling, reimburse nutritionists and other specialists by using community health teams of providers that work with provider practices and clinics, and expand coverage of comprehensive primary care, which should, in theory, include better obesity monitoring and prevention.

If we fail to take action to curb obesity, we face a grim future. But if we do take action, the future looks significantly brighter, according to my new study. If obesity levels are held at their current rates, I estimated that the U.S. could save over $800 per adult by 2018 -- a savings of nearly $200 billion. As Congress debates pushing health care to the early 2010 agenda, they should remember that number -- and make sure that tackling our nation's obesity epidemic and rise in obesity linked chronic illness is moved to the top of the list.

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