For the past decade, a metaphorical fire has raged out of control, a conflagration of dire statistics on childhood obesity and the health and financial costs they portend. Here's a sampling: the tripling of obesity rates in kids over the past 30 years, $147 billion in annual health care costs related to obesity, and a projection that 40 percent of U.S. children born today will develop Type 2 diabetes in their lifetime.
Childhood obesity is a five-alarm fire, but we have responded as if it's just a drill. Public relations campaigns, public service announcements, and other laudable projects have raised awareness. But prevention of childhood obesity needs a more sustained, large-scale, multi-sector approach. Recent signs of gradual slowing in the growth of obesity rates is not cause for celebration; it is a sign of the limited impact of our efforts to date. We must do better unless we are content to live in a world where our children live shorter lives than we do.
How do we fight back?
One critical but missing component is ready access to support where many families seek it first: from their health care providers. There are programs and tools that show promise in addressing childhood obesity, teaching kids to make healthy eating choices and inspiring physical activity, but too often these programs are delivered in fragmented ways, for too little time to catalyze and sustain behavior change.
Fragmented, short-term efforts won't cut it. They fail to take into account the myriad challenges to motivating sustained lifestyle changes. As an analogy, smoking cessation programs have, at best, a 25 percent success rate -- but when offered over a sustained period of time, their success rate increases. Behavior change around eating and physical activity is similarly complex, requiring sustained effort and integrated solutions.
Will It Save Money?
Programs to help prevent childhood obesity are often seen by health care insurers and providers as too costly in the short run, but that is because they fail to take into account the full costs of neglecting our kids' health. We need to fundamentally reframe this equation. What kind of math makes neglecting prevention in favor of later, much more expensive treatments a rational decision? The adage "penny wise, pound foolish," comes to mind.
It is true that conditions linked to childhood obesity develop later in life, but choosing not to prevent them when possible is threatening the long-term viability of our health care system. Today, 75 cents of every health care dollar is spent to treat chronic, largely preventable conditions -- many linked to diet and sedentary behavior that drive obesity. Furthermore, we know that an obese child costs the health care system $2,741 per year in higher health care costs than a normal weigh child.
With such costs, how can we afford not to commit ourselves to finding innovative new approaches to preventing childhood obesity, proving they work through rigorous research and ensuring they are broadly available in health care settings?
A New Call to Action
We can't effectively address the complex causes of childhood obesity without fresh approaches and new models for working together to find sustainable solutions. In health care, sustainability equals reimbursement. Providing insurance coverage for effective childhood obesity prevention programs would align the financial interests of the health care sector with proven solutions to keep kids and families healthy. I believe this will only happen if we find new ways of working across sectors that leverage the strengths we all bring to this cause. But how?
Experience tells us that a robust body of evidence that measures both health outcomes and cost impact is critical. Health care payers and providers are justifiably skeptical of solutions that are not sufficiently tested. But we need to turn that concern into specific questions and metrics. By answering the following questions together, I believe we can begin to find reasonable answers to integrating childhood obesity prevention solutions into health care:
1. What outcomes from childhood obesity interventions must be demonstrated to support broad adoption by providers and payers?
2. How can we reframe the financial discussion so that the full costs of obesity to society are accounted for in evaluating the cost and benefits of prevention programs?
3. How can we harness new technologies and insights from behavior change science to develop effective childhood obesity interventions?
4. What will it take for childhood obesity interventions to become a covered benefit in private health plans and in Medicaid so that they are available to all kids and families?
There are likely other, more precise questions to address. If so, I invite you to share them. If you have answers, share those as well. We will not reverse the epidemic of childhood obesity without asking these questions, testing assumptions and being open to new approaches that bring practitioners, researchers, innovators and policy makers together to forge new paths that lead to lasting solutions.