Obesity and its impact on health care costs have taken center stage in the debate about national health care reform.
And it seems there may be as many ideas about how to address the problem as there are people who are obese.
The issues converged last week when a national study estimated the cost of obesity at $147 billion annually, nearly double what it was 10 years ago; the Centers for Disease Control and Prevention held its first Weight of the Nation conference in Washington, D.C., and Congress debated how to account for wellness programs in the health care reform package.
"If obesity was an infectious disease, it would be an epidemic," said Dr. Daniel Bessesen, professor of medicine at the University of Colorado at Denver and chief of endocrinology at the Denver Health Medical Center.
"To ignore the problem, you're keeping your head in the sand. If you could fix the obesity problem ... you would make a huge impact on the nation's health care costs."
But obesity is not just a health problem. It's a national economic problem that will become more prominent as the country debates the cost of health care reform.
"These results reveal that obesity continues to impose an economic burden on both public and private payers," writes Dr. Eric Finkelstein, director of the Public Health Economics Program at the North Carolina-based RTI International, which produced the national study.
"The connection between rising obesity rates and rising medical spending is undeniable."
The CDC estimates nearly 40 percent of American adults are considered obese based on their body mass index, a mathematical formula that considers a person's height and weight. That extra weight frequently leads to additional health problems such as heart disease, diabetes, high blood pressure and pulmonary difficulties.
A RTI study estimates $1,429 a year is added to the nation's health care costs for each obese patient. The overall cost is about 42 percent more annually for obese people and even higher for obese patients on Medicare. Obesity adds 9.1 percent to the annual cost of health care.
The study was published in the magazine "Health Affairs" as a followup to a similar study 10 years ago and includes data through 2006.
Allegheny County hasn't analyzed the cost of obesity, but a 2002 survey found about 59 percent of adults either overweight (a lower category) or obese, comparable to the national average of 59.2 percent and the state average of 59.5 percent. The county will begin a new telephone health survey tomorrow in which 5,000 randomly chosen people will answer 185 questions about their health and lifestyle.
"People will see tangible results if they eat better and exercise more," said Dr. Bruce Dixon, director of the Allegheny County Health Department. "But it's a very difficult issue that involves a lifestyle change. I think people have to ingrain it in their daily lives."
Most experts agree that is the solution, but the debate centers on how to get there. That was one of the key topics at the inaugural Weight of the Nation conference.
Kathleen Sebelius, U.S. Health & Human Services secretary, told the conference she's particularly concerned about obese children. Statistics compiled by the CDC show that 25 percent of obese children stay obese as adults and have a raft of serious health problems.
"If there was an epidemic of little kids getting cancer, it would be a national crisis," Ms. Sebelius said. "But because it's obesity and the damage doesn't come until later in life, we've been slow to act. We can't ignore this problem any longer."
Obesity among children is a major focus of the Robert Wood Johnson Foundation, a Princeton, N.J., organization that helps to fund health care initiatives. It has committed $500 million to help reduce childhood obesity by 2015.
The call for health care reform is causing greater emphasis on the cost of obesity, but there seems to be no consensus on the best approach to dealing with it.
Dr. William Dietz, a co-author of the RTI study, said he believes the key is offering people healthy options such as healthy snacks and drinks in schools, supermarkets with fresh fruits and vegetables in poor neighborhoods and neighborhoods with sidewalks to encourage walking.
He cited Pennsylvania's Fresh Food Initiative, which provides grant money to help build grocery stores in underserved areas, as a positive approach. The program provided $1 million to help build a new Kuhn's grocery in the Hill District.
"You can't expect people to make good choices where they don't have choices to make," said Dr. Dietz, who also is director of the CDC's division of nutrition and physical activity. "Just looking at communities with a different eye would help, allowing supermarkets and movie theaters to be close enough to housing so people could walk to them."
He cited Shelby County, Ala., as a community that has taken such an approach over the last decade and seen positive results. Alabama has the nation's highest percentage of obese people.
Dr. Bessesen said it will take a different approach that involves better teaching for doctors and almost individual programs to change the lifestyle of each patient on a trial-and-error basis to find which approach works best for each one. He called obesity "a symptom of a lifestyle that really has gotten out of control."
"People don't like to be heavy," he said, pointing to widespread dieting and other efforts at weight control.
"Our bodies are really engineered for physical activity, but our lifestyle has evolved into spending a lot of time working at a desk or sitting in front of a television or a computer. It's going to take long-term treatment to change that."
Locally, insurance provider Highmark offers a raft of programs aimed at improving customer health. Its wellness program offers employers the opportunity to provide workers with programs to lose weight, quit smoking and exercise, among others, while its Health High 5 program has committed $100 million over five years to improving the health of children.
Highmark tries out programs on its employees first, said Dr. Mary Goessler, medical director of quality and medical permanent management. For example, the agency saw the number of employees who get annual physicals increase from about 10 percent to just under 70 percent when it offered a financial incentive.
She acknowledges the numbers on obesity nationwide continue to grow.
"The progress is slow because there isn't one thing that works for everybody," she said. "Everybody has to take personal account for the changes they need to make."
Calls for a focus on preventative health care are rising as Congress grapples with the hard financial realities of how to pay for the health care of a population of more than 300 million.
Ms. Sebelius told the CDC conference a significant amount of the $1 billion Congress appropriated in stimulus money for prevention and wellness will go "to help states and communities attack obesity."
"Reducing obesity -- especially for children -- would be one of the biggest steps we could take toward this country's health future," said Ms. Sebelius.
In Congress, legislators are having a hard time determining how to include preventive programs in the health care package because the Congressional Budget Office has had a difficult time assessing the savings they could generate, said Rep. Jason Altmire, R-McCandless. He's a former UMPC executive and a member of the House Education and Labor Committee.
Mr. Altmire said he's opposed to an initiative to tax sugary soda as a way to pay for health care reform. He favors an approach to pay incentives to physicians based on the health of their patients, which he thinks would encourage them to tell patients about needed lifestyle changes rather than repeatedly treating their illnesses. The system would take into account the types of patients a doctor sees since those in poorer neighborhoods tend to have more health problems, he said.
Last week, he added a provision to the House bill that would withhold 2 percent of Medicare payments to hospitals that they could earn back if they improve patient outcomes. He voted against the overall bill but said that provision is needed.
Mr. Altmire said he expects that kind of provision for physicians to be in the final bill, which should help with a variety of medical problems over time, including obesity.
"A lot of people think they can take [a cholesterol medicine] and keep eating the pizza, and the doctors are allowing that to happen," he said. "I think if the physician reimbursement was based on how healthy their patients are, we'd see healthier patients."
Ed Blazina is a staff writer at the Pittsburgh Post-Gazette. He can be reached at: firstname.lastname@example.org or 412-263-1470.