Obesity epidemic could overwhelm health care system

by

Published: May 26,2003

Forget about SARS. There is another epidemic, one with far more immediate and long-time health and financial consequences, that isn’t caused by a virus and affects millions of Americans. The epidemic is obesity.

The culprits? A society where food is cheap, plentiful, tasty, readily available and wrapped around all different types of social events. Add to that the increasingly sedentary American lifestyle, and the result is the most overweight generation ever seen.

“One thing we try to do is educate the public — children, families and communities — that it really is an epidemic,” said Victor D. Sutton, office director of health promotions for the Mississippi Department of Health (MSDH). “We must look at vehicles to address the problem.”

The average weight of both children and adults in the U.S. is increasing, and Mississippi has the highest obesity rate in the nation. Sutton reels off a long list of serious health problems that result from being overweight: high blood pressure, cardiovascular disease, heart disease, stroke, diabetes, gallbladder disease, lower back problems, arthritis and cancer.

Despite the burden on people’s health and the resulting strain on the health care system, America’s weight problem is a tough nut to crack. If current trends hold, things will get worse before they get better.

Overweight children usually become overweight adults. And since behavior patterns are most difficult to change after they have been established in childhood, Sutton believes one of the most important ways to address the obesity epidemic is encouraging children to make better food choices and to be physically active.

“We really want to look at the school system and promote healthy choices,” Sutton said.

Currently not only do most schools have candy and soft drink vending machines available to students, some also allow kids to eat pizza or hamburgers for lunch every day. Guess how many kids choose the balanced school lunch instead?

Banning the vending machines isn’t popular because schools make money from vending sales. But it can help by offering healthy alternatives such nutritious snacks, juices and bottled water. When is comes to school lunch menus, Sutton said that nutritional standards should be enforced to make sure healthy meals are made available each and every day.

Another change that could be contributing to the increasing weights of children is lack of mandatory physical education in schools. A generation ago, physical education was mandatory, and some are advocating bringing that back as a way to instill healthy habits in children that hopefully will carry over into adulthood.

“Definitely, mandatory physical activity for the school system is an important public policy issue,” Sutton said. “You can’t educate enough focusing on school age children. Unhealthy kids become unhealthy adults. Across the board, physical activity and exercise create a healthier, happier kid who has better attention and can learn better.”

Communities also need to do more to create environments that are healthy for physical activity, Sutton said, such as sidewalks, walking paths, bike paths and walking/running tracks.

“Some communities don’t have accessible sidewalks,” Sutton said. “There are no walking paths or bike paths. You have to get in the car to go from point A to point B. I think that is one area we can work on in this state. There are lots of studies that show if you build parks or walking trails, they will come.”

Sutton also highly encourages worksite wellness, providing opportunities for physical activity in the worksite that can have beneficial impact on the bottom line. Studies have shown such centers result in healthier workers who take fewer sick days.

“It doesn’t take much,” Sutton said. “A stationary bike or a few weights can have a really good impact on the worksite. Promoting physical activity at the worksite can have a tremendous impact on the bottom line.”

Dr. Alan Penman, epidemiologist for the MSDH, agrees that promoting physical activity is one of the most important ways to address the obesity epidemic.

“You shouldn’t discuss overweight problems without addressing people not being active enough,” Penman said. “If I had to choose, I’d wish for more people slightly overweight but very active, as opposed to normal weight but couch potatoes. I think more and more now it is very, very important that people get back to being physically active, whatever it takes. We have engineered out all the opportunities for being active during the day.”

It is difficult to lose weight, and even more difficult to keep it off permanently.

“A lot of these programs, if you go back and check in a year or two years, people have regained the weight,” Penman said. “Because it is so difficult to lose weight and keep it off permanently, that argues very strongly for preventing weight gain in the first place.”

Being surrounded by a sea of food makes keeping body weight at ideal levels difficult.

“We’re encouraged to eat all the time with television advertising especially, but also print and billboard advertising,” he said. “A lot of our social functions involve food. We’re constantly eating. It is really not a surprise. It should not be a shock to anyone that this is happening. In fact, if you wanted to design an experiment to make everyone in America fat, you couldn’t do anything better than what we have done in the past 50 to 60 years. So that is our society. That is our culture. That must change if we are going to make meaningful, large-scale, permanent changes to get back to the way things were before. But if people want that, we can do it.

“This is America. I am British. We have always thought of America as the ‘can do’ society. I believe America could do it if it wanted to. You can’t legislate eating and drinking behavior. It is going to be difficult because a radical change is involved, whether you are a little overweight or a lot overweight.”

Penman said up to a certain age, children don’t make their own food choices. They eat what is put before them.

“If we are raising generations of overweight children, then we are to blame,” he said. “Most overweight kids will become overweight adults. It tracks through the years. They are set up from the start for an unhealthy life. The adverse health consequences of being overweight are well established. Just last week there was a big media splash about a study that just came out showing the relationship between obesity and various types of cancer. Whether cancer, heart disease or diabetes, these are serious personal health consequences with serious financial implications for the person and our health care system.

“Arguably this has emerged as our most important health problem. It is right up there with smoking as a health problem. We are on track to have the fattest generation of kids ever. It is going to get worse before it gets better. There is no indication yet that it has reached a plateau.”

With a large percentage of overweight people and all the health consequences, obesity can’t help but raise employee health care costs particularly for small employers, resulting in higher insurance premiums or even small employers not being able to offer health benefits at all.

“Nationally health care costs for treating problems that result from excess weight are enormous, billions of dollars,” Penman said. “That affects the general economy. And it is not just an American problem. It is a global thing. Europe, Japan, Africa and even places like India are seeing similar problems.”

Penman warns that the number of people with diabetes could overwhelm an already overloaded health care system, particularly in rura
l and medically-underserved areas where primary care providers are in short supply and specialists non-existent. In addition, health care costs will increase dramatically — particularly in

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