The study forecasts future obesity over the next 20 years and related savings with obesity prevention efforts. It was conducted in 2009-2010 using data from the 1990 through 2008 Behavioral Risk Factor Surveillance System (BRFSS).
Although the study did not include children, “trends in childhood obesity prevalence will have a major impact on rates of adult obesity and related health care costs,” say the authors. One out of three children is overweight or obese, and obese kids are more likely to become obese adults.
“If the forecasts prove accurate, the rise in obesity and severe obesity will significantly hinder health care cost containment, “said Eric Finkelstein, lead author of the study. Obesity is directly related to a variety of medical conditions; type 2 diabetes, coronary heart disease, hypertension, gallbladder disease, breast cancer, endometrial cancer, colon cancer and osteoarthritis.
Given the relationship between excess weight, poor health, and high medical expenditure, successful cost containment efforts will need to address obesity. The study went on to say that if obesity were to remain at 2010 levels, the savings in medical expenditures over the next two decades would be $549.5 billion.
There is no doubt that intervention is crucial. The question is where and what types of strategies will be successful.
Lessons learned from tobacco
Tobacco usage rates in the U.S. have dropped by half, from 42 percent of adults in 1965 to 20.8 percent in 2006. If you need a reminder of the prevalence of past tobacco use, just watch the wildly popular television series “Mad Men.” The Emmy Award-winning drama is about a prestigious New York Madison Avenue ad agency set in the early 1960s.
The ad execs and staff smoke profusely in their offices; and the agency is deeply involved in helping a tobacco industry client maneuver through the Federal Trade Commission’s ban on positive health claim labels on cigarette packaging. An earlier episode even depicts a physician smoking in his office while examining a patient. We’ve come a long way since the sixties, and it was a combination of public and private sector strategies that got us there:
- Increases in the price and taxation of tobacco products.
- Implementation of smoke-free policies in workplaces, restaurants and bars,
- Insurance coverage of tobacco cessation products.
- Workplace incentives for non-tobacco use.
- Physicians/health care professionals advising patients not to smoke.
- Social pressure.
What can we learn from the tobacco story? How do we use the policies and interventions that led to the decline of tobacco use to achieve the same success in decreasing obesity? The authors of the study suggest that successful interventions which generate even small improvements in obesity prevalence could result in substantial savings:
- Increased access to recreational facilities.
- Better urban design.
- Anti-obesity social marketing campaigns.
- Work site health promotion.
- New drugs and technologies.
Why businesses should care
For businesses in the private sector who share 54 percent of total health care spending, there is a logical case to be made for investing in efforts to reduce the incidence of obesity. In a 2003 report on The Obesity Epidemic In America, Wellness Councils of America (WELCOA) outlined tips on managing obesity at the worksite. These are just a few of the strategies that if properly implemented can go a long way in changing the existing culture.
- Create financial incentives for participation in activities that lead to weight loss.
- Organize an annual company walk.
- Change the contents of vending machines.
- Teach cooking and smart shopping classes.
- Create a walking path with marked distances.
- Provide weight loss and physical activity competitions.
- Reward employees for achieving specific healthy outcomes.
- Place scales throughout the organization.
- Encourage people to take the stairs.
There is no doubt that in the last 50 years it’s become a lot easier to be obese. With convenient access to cheap, fast food, super size portions, and deceptively labeled food products, weight piles on in the normal course of sustenance. Add to it the misinformation that we the experts have advocated. It now appears the conventional thinking that low fat diets are beneficial to weight loss is changing.
Fat may not be the significant driver of obesity. We’re learning that many of the studies supporting low fat diets had serious flaws. Additionally, as Americans followed the recommendations of low fat foods, consumption of added sweeteners, especially high fructose corn syrup, has been rising. Processed, low fat foods, low fat yogurt for example, are often highly sweetened to replace the flavor that no longer comes with the elimination of fat.
A 2010 study from Emory University and the U.S. Centers for Disease Control and Prevention showed that sweeteners lower levels of HDL (good) cholesterol, and raise triglycerides; and that the direct effect of refined sugars and starches on insulin and blood sugar are more likely than saturated fat to be the main dietary cause of coronary heart disease and Type-2 diabetes.
Given the results of this and similar studies, many nutritionists are changing their recommendations on low fat to emphasize consuming moderate amounts of healthy fats in olive oil, nuts, and avocados; the omega 3 fats in fish, naturally raised hormone free poultry and beef, and natural cheeses; increased fruits, vegetables, and whole grains; and limits on sweeteners and other high carb foods.
Connie Roethel, R.N., MSH, is a wellness expert and is president of Core Health Group in Mequon.