Nation's Obesity Epidemic Carries Hefty Price Tag

The medical cost of treating the nation's obesity epidemic is growing rapidly -- right along with Americans' waistlines.

In fact, a recent study from the CDC and the Research Triangle Institute, Research Triangle Park, N.C., estimates that costs attributable to obesity could be as high as $147 billion in 2008, up from $78.5 billion in 1998. The study was released July 27 during the CDC's Weight of the Nation conference in Washington.

According to the study, Medicare beneficiaries who are obese cost the federal program $600 a year more than normal-weight beneficiaries did in 2006. Across all payers, the difference was even greater, at $1,429.

"The costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes," such as diabetes, according to the study's authors.

"Obesity, and with it, diabetes are the only major health problems that are getting worse in this country, and they're getting worse rapidly," said CDC Director Thomas Frieden, M.D., M.P.H, in a July 27 media briefing during the Weight of the Nation conference. "Beyond the economic costs are the disability, the suffering and the early deaths caused by obesity."

In 2000, HHS set a goal in its Healthy People 2010 program to reduce the prevalence of obesity in adults to 15 percent or less. However, more than a quarter of U.S. adults are obese, and Colorado is the only state where the prevalence of adult obesity is less than 20 percent.

According to data from the CDC's Behavioral Risk Factor Surveillance System, 26.1 percent of American adults were obese in 2008, up from 25.6 percent a year earlier. In six states -- Alabama, Mississippi, Oklahoma, South Carolina, Tennessee and West Virginia -- the prevalence of adult obesity was 30 percent or more.

The news was even worse for minorities, the CDC said in a Morbidity and Mortality Weekly Report, released July 17. For 2006-08, black people had a 51 percent higher prevalence of obesity than white people; Hispanic people had a 21 percent higher prevalence. Moreover, in 40 states, the prevalence of obesity among black people was 30 percent or higher; Alabama, Maine, Mississippi, Ohio and Oregon had rates of 40 percent or higher.

According to family physician Michelle May, M.D., of Phoenix, physicians can help patients who are obese make important, long-lasting changes.

"We have decades of evidence to show that diets don't work for most people long term," said May, who is a member of the AAFP Commission on Health of the Public and Science. "Instead, physicians should focus on helping their patients identify small steps they are willing to take toward a healthier lifestyle.

"For example, by asking open-ended, supportive questions, a patient may decide to decrease his or her soda intake, take a walk around the building during work breaks, or manage stress better. A small change practiced on a consistent basis will be more effective than a huge, short-term overhaul."

It's also important, May said, for physicians to advise their adult patients to be good role models for their children. Recent CDC data indicate that the prevalence of obesity in low-income, preschool-aged children increased steadily from 12.4 percent in 1998 to 14.5 percent in 2003 before leveling off at 14.6 in 2008.

That's a far cry from the Healthy People 2010 goal of 5 percent.

"Children learn many of their beliefs and behaviors from their parents," May told AAFP News Now. "When parents model healthy eating and a positive attitude about physical activity, their children are more likely to hold those same values. We can positively impact the entire family by encouraging family meal times, family activities like sports and bike riding, and getting rid of outdated messages like 'Clean your plate or you don't get dessert.'"

"If there was an epidemic of little kids getting cancer, it would be a national crisis," said HHS Secretary Kathleen Sebelius during a July 28 speech at the Weight of the Nation conference. "But because it's obesity and the damage doesn't come until later in life, we've been slow to act.

"I'm counting on people in this room to tell Americans that as our children's weight is growing, their lives are shrinking. We can't ignore this problem any longer."

The American Recovery and Reinvestment Act included $1 billion for medical prevention programs, Sebelius said. A significant amount of that funding will go to help state and local agencies address obesity and other public health challenges as part of an initiative being developed by the CDC and HHS' Office of Public Health and Science.

Meanwhile, the CDC -- in conjunction with the Robert Wood Johnson Foundation, Kaiser Permanente, the W. K. Kellogg Foundation, the U.S. Department of Agriculture and the NIH -- has issued 24 recommendations for communities to improve access to healthy foods, promote exercise and prevent obesity.

During the conference, Frieden suggested physicians take an active role in implementing the CDC's prevention strategies in their communities.

"I think there is a responsibility of physicians, the medical profession generally, to be active in their communities, promoting prevention as a policy focus in many different areas of public health and prevention," he said. "It is physicians who have been able to encourage concerted actions, physicians who can influence policymakers, physicians who often become policymakers. This is one way that physicians can be active.

"And, of course, there are important things that physicians can do in their own practices in terms of measuring BMI (body mass index), counseling patients, and taking action to encourage weight loss and maintenance of weight loss."