Obesity

In order to understand the obesity problem in the United States, it is essential to first to put a face to the abstract concept of obesity. It is not surprising to note that obesity not only affects adults but equally children. According to a 2001-2002 study, 30.6% of adults were obese, 5.1% were extremely obese, and 31.5% of children aged-6-19 were at risk for obesity and overweight (Hedley et al, 2004). Although obesity is high for all demographic groups, results indicate that there are continuing disparities between the sexes and racial and ethic groups (Hedley et al, 2004). Not only does obesity affect individuals but it also affects society as whole. Obesity is an important risk factor that may increase the incidence and severity of associated diseases like heart disease and diabetes. For example, obese individuals are 2 times more likely to have hypertension and three times more likely to have type II diabetes mellitus than non-obese individuals (Thompson et al, 1999). This in turn means deteriorating health for the American population and extra costs associated with increased consumption of medical care (Miljkoviv, 2006). According to the Center for Disease Control and Prevention, 9.1% of total U.S medical expenditures, which may be as high as $78.5 billion, in 1998 were medical expenses attributed to overweight and obesity (CDC). State-level costs range from $87 million in Wyoming to $7.7 billion in California (Finkelstein et. al, 2004). These rising costs indicate that the United States government should intervene to alleviate the social costs that ultimately are carried by the American citizens.

With the increasing serving portions at fast-food chains and the rise of obesity, both the federal and state governments are becoming more active in their response to this concern. Results from lawsuits against fast-food chains such as Pelman vs. McDonalds Corp. are shaping U.S policy with respect to regulation in food distribution (Mello et al, 2003). State governments are executing new nutritional and physical activity programs (CDC). And local governments are making use of zoning laws to regulate the number of fast food chains in a particular area (Fernandez, NYTimes). Moreover, the federal, state, and local governments are working together to improve the health environment in local schools by requiring food vendors to schools to distribute only snacks that meet RDA recommendations and requiring schools to promote a school health program. It is with this concerted effort that obesity could be fought at all fronts and thus provide a healthier environment for future generations.

Private health insurance spending on illnesses related to obesity has increased more than tenfold since 1987, according to Nanci Hellmick of USA Today. Overall, employers and privately insured families spent $36.5 billion on obesity-linked illnesses in 2002, up from an inflation-adjusted $3.6 billion in 1987. That’s up from 2% of total health care spending on obesity in 1987 to 11.6% in 2002, according to USA Today. On average, treating an obese person cost $1,244 more in 2002 than treating a healthy-weight person did. About 31% of U.S. adults are obese — 30 or more pounds over a healthy weight. That’s up from 23% in the late 1980s and 15% in the late 1970s. The study comes as businesses, the government and consumers are struggling with soaring health care costs. Costs that are predicted to rise exponentially include health care spending, medical conditions and trips to the doctor, hospital and pharmacy.
Currently, Medicaid does not cover obesity, though under Medicare, hospital and physician services to treat obesity are excluded unless the treatment is for certain co-existing conditions. Typically, the condition is considered on a case-to-case basis, which only contributes to the tremendous health care costs. Given the high prevalence of obesity among women and poorly educated populations–both of which contribute largely to the obese population—, it could be presumed that many current Medicaid recipients are likely to have obesity. Surgery for the treatment of obesity, a widely accepted “treatment” for obesity is covered on a limited basis. According to the Medicare Coverage Manual, gastric bypass surgery, which is a variation of the gastrojejunostomy, is performed for patients with extreme obesity, and will be covered if it is medically appropriate for the individual to have such surgery. The number of surgical procedures for weight loss has been rising as rapidly as the overweight and obesity epidemic, which United States Health officials have stated consists of a minimum of 30% of the US adult population alone. According to Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, obesity surgery has helped thousands of Americans lose weight and reduce the risk of diabetes and other life-threatening chronic diseases that are commonly associated with prolonged obesity. However, she does indicate that it is important for patients to consider the potential complications, of which there are plenty. In an article by Robert Pear of the New York Times, the federal government reported that four out of every ten patients that undergo weight loss surgery (such as gastric-bypass) develop complications within six months. Federal researchers found that these complications increased health care costs substantially. According to William E. Encinosa, an economist at the health research agency, medical spending averaged $29,921 for obesity surgery and six months of follow-up care. For patients who experienced complications, spending averaged $36,542. And for those with complications that required readmission to a hospital, the average was $65,031. Because the costs are up because so many more Americans are obese, they are being more aggressively treated for weight-related illness, and the problem is only going to get worse unless different policies are implemented. If more cost-efficient strategies are not employed, then the US government faces outrunning its health care spending capacity, leading to incredible economic debt in the long run.

Results of the National Health and Nutrition Examination Survey for 1999–2002 indicate that an estimated 16 percent of children and adolescents ages 6–19 years are overweight. For children, overweight is defined as a body mass index (BMI) at or above the 95th percentile of the CDC growth charts for age and gender. According to the National Center for Health Statistics (NHANES), the 1999-2002 findings for children and adolescents suggest the likelihood of another generation of overweight adults who may be at risk for subsequent overweight and obesity related health conditions. According to the Surgeon General, this is an incredible health care concern; this implies that, despite that it is not the leading cause of death in the United States currently, overweight and obesity rates have been increasing so exponentially in the past decade alone that it is predicted to be the primary cause of premature death within the next ten years—even before tobacco. Thus, policies aimed at reducing overweight and obesity would indeed be a high priority. In the words of the Surgeon General, “the primary concern of overweight and obesity is one of health and not appearance.” This is because obesity has a high risk of premature death—an estimated 300,000 deaths per year may be attributable to obesity; the risk of death rises with increasing weight. Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years. Individuals who are obese (BMI > 30)* have a 50 to 100% increased risk of premature death from all causes, compared to individuals with a healthy weight. The majority of these deaths are due to chronic disease, which induces tremendous economic and policy-oriented costs. Obesity is a primary contributor to heart disease, a leading chronic disease in the United States. The incidence of heart disease (heart attack, congestive heart failure, sudden cardiac death, angina or chest pain, and abnormal heart rhythm) is increased in persons who are overweight or obese (BMI > 25). High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight. Obesity is also associated with elevated triglycerides (blood fat) and decreased HDL cholesterol (“good cholesterol”). Type 2 diabetes is commonly found among obese patients, where even a weight gain of 11 to 18 pounds increases a person’s risk of developing this disease; over 80% of people with diabetes are overweight or obese. Overweight and obesity are associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and postmenopausal breast cancer. Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausal breast cancer, compared to women whose weight remains stable. Sleep apnea (interrupted breathing while sleeping) is more common in obese persons, and obesity is associated with a higher prevalence of asthma. For every 2-pound increase in weight, the risk of developing arthritis is increased by 9 to 13%; several studies have shown that symptoms of arthritis can improve with weight loss. Additional health consequences include that overweight and obesity are associated with increased risks of gall bladder disease, incontinence, increased surgical risk, and depression. Because it is such an incapacitating disease, obesity can affect the quality of life through limited mobility and decreased physical endurance as well as through social, academic, and job discrimination.