The Skinny on Obesity: Is There a Cure?

    It is not a secret that America is getting fatter.  According to the CDC, more than 1/3 of Americans are obese.  You’ve probably heard it before, and have read it once or twice.  But what does that mean?  What’s the significance to the average, normal person?

    To be an obese adult American means to have a BMI of 30 or higher.  But what does that mean and why should we care?  Well, imagine a male who is 5’9.  If this man is between 125lbs – 168lbs, he has a BMI of 18.5 – 24.9, meaning he has a healthy weight.  However, if he has a BMI of 30, that would mean his weight is 203lbs or greater.  Another way of identifying unhealthy weight is by measuring the waistline.  The American Heart Association recommends a woman’s waist to be 35 inches or less, and 40 inches or less for men.  Why just measure the waist?  Because the fat that accumulates between our abdominal organs is most damaging, thus, it is highly relevant to our health.

    Obesity and its health implications may not mean much to us anymore.  We have all heard the staggering statistics so much that it has lost its shock value.  We have become rather accustomed to our lifestyle and don’t really seem to care that not one state in the U.S. has less than 20% of obese inhabitants.  So perhaps we have lost our ability to be shocked into submitting to healthy habits and have no real problem with our weight knocking off a decade or two of our life span.  Perhaps hitting us where it hurts would get our attention.

    “In 2008, medical costs associated with obesity were around $147 BILLION dollars, and insurance companies paid about $1,500 more in claims for obese people than people within a healthy weight range.”  Still not impressed?  Still feel this is an “individual responsibility” that doesn’t impact you?  In 2007, the total Medicaid outlays in fiscal year 2007 were $333 billion (57% was federal spending while 43% was state spending).  In 2006, Medicaid outlays represented 15% of all U.S. health care spending.   Medicaid represents 40% of Federal government general revenue spending on health care and 41% of such spending by states” (Truffer, Klemm, Hoffman, & Wolfe 2008).

    Still not impressed?  Where do Medicaid funds come from?  Medicaid isn’t financed through trust funds like Medicare.  The costs are met by Federal and State general revenues on an as-needed basis (Truffer, Klemm, Hoffman, & Wolfe 2008).  Congress provides an annual appropriation, which are spent through daily draws from the general fund of the Treasury in the amount needed to match that state’s program expenditure.  The states have guidelines set by the Federal government, but have the ability to choose who can qualify for services.  Basically, these dollars come from the working man.  It comes from your taxes.  This still may not rock your boat depending on how you view spending your tax money to help those who need it, most of us are happy to help those who cannot help themselves.  But this has its limits.

    Just how many people on Medicaid are obese?  If insurance companies pay about $1,500 more in claims for obese people than for people of a healthy weight, it is theoretically possible that even more money is being spent on obesity related illness on the Medicaid system.

    According to Lee, Sheer, Lopez, and Rosenbaum, 2010, “Our findings suggest that most states are not ensuring recommended screening and treatment of adults and children for obesity through Medicaid, the EPSDT program, or private insurance. Additionally, most states are not regulating the insurance market with regard to use of obesity in medical underwriting. With the current economic downturn, many states are experiencing budget deficits and are unlikely to expand coverage of obesity treatments or enact coverage mandates in the near future.”  Each state has various requirements related to coverage of obesity and obesity-related illnesses.    What’s more noteworthy is Lee, ET. al., 2010, also states, “Through Medicare and Medicaid, federal and state governments finance approximately half of direct medical expenditures attributable to overweight and obesity in the U.S.11 Medicaid enrollees have the highest prevalence of obesity compared with those who are uninsured, privately insured, or in Medicare” (Lee, et. al., 2010).  So one can logically assume that Medicaid recipients are seeking treatment for obesity related illnesses including Diabetes and heart disease.  In this same study, it is reported that, “In 2000, the total cost of obesity in the United States was an estimated $117 billion—$61 billion in direct costs and $56 billion in indirect costs. This is astronomical considering this piece of information is 12 years old!

    So, obesity impacts anyone who has employment because your money is used to treat “a high prevalence of obesity” when compared to uninsured, privately insurance or Medicare recipients (Lee, Sheer, Lopez, and Rosenbaum, 2010).  Even if you have a healthy BMI and are in generally good health, you are financially contributing to treat those who do not.  Many of these states are in somewhat of a conundrum.  They have to conserve dollars to treat those on Medicaid, so most states will not cover medication to reduce weight.  “Despite these recommendations, public and private insurance coverage for treatment of obesity as a primary disease still appears very limited” (Lee, et. al., 2010).  Also interesting, 26 states cover nutritional counseling, 20 do not.  Only 10 states cover medication therapy.  Two states explicitly will not cover bariatric surgery, while most will.  Sadly, three states will not cover nutritional education/counseling OR drug therapy, but will cover bariatric surgery!  This is in direct conflict with the clinical practice of offering intensive counseling and behavioral therapies, which has been found to be more effective than drug therapy and just as cost-effective.  The bottom line is Medicaid, for the most part, does not treat obesity as a disease.  If Medicaid isn’t getting on board, then it’s a safe bet that neither will Medicare or private insurance companies, and the problem continues to grow as rapidly as America’s mid-section.

    I have heard it said that it is far more expensive to eat healthy than to eat a diet high in fat and sugar.  Let’s see if this holds true.  The New York Times states, “Energy-dense munchies cost on average $1.76 per 1,000 calories, compared with $18.16 per 1,000 calories for low-energy but nutritious foods” (Pope, 2007).  Further, “Based on his findings, a 2,000-calorie diet would cost just $3.52 a day if it consisted of junk food, compared with $36.32 a day for a diet of low-energy dense foods. However, most people eat a mix of foods. The average American spends about $7 a day on food, although low-income people spend about $4, says Dr. Drewnowski” (Pope, 2007).  The cost of healthy food such as fruits and vegetables has increased almost 200% since 1983.  Sweets and sugars went up 65% and sodas went up just 30% since 1983.  See a huge difference?  “According to a 2004 study published in the “Annual Review of Public Health,” obesity is closely linked to financial hardship. Since unhealthy food is cheaper, it makes sense for people who are poorer to focus on them as a primary source of nourishment. However, the list of cheaper foods includes fats and oils, sugars and sweets, all of which are higher in calories than healthier foods” (Pope, 2007).

    So, will Disney make a huge impact on our obesity problem by removing ads for unhealthy foods from its television networks?  It’s anyone’s guess, but judging from their recent blunder of promoting fat villains in their parks, the general public is just not ready to be singled out on its over-indulgent behaviors that are leading to serious health problems for our nation, including our children.  Does the city of New York have their finger on the pulse of the nation’s need by limiting the ability to buy sodas larger than 16 ounces and limiting the selling of sugary goodness?  It doesn’t seem to be greeted with open arms.

    What is the solution?  It’s a slippery slope.  You cannot deny the statistics.  We are eating ourselves to death as a nation, and we could easily be characterized as the morbidly obese person locking ourselves into our dark closet to scarf down a few Twinkies and refusing to see ourselves in the mirror.  And when the hand of reason taps our shoulder and tries to point out the err of our ways, we scoff, become offended, and strengthen our hold on the Twinkie AND our resolve to keep the evil hand at bay.  Should we be FORCED into submission?  Many people hold parents responsible for their obese children and make comments that degrade the parents for ever allowing the child to reach such a state.  But when our entire nation is busting at the waistline, we all grumble under our breath and complain that no one has the right to tell us how or what to eat.  It’s as if we are becoming that unruly child.

    True enough.  We should have the right to eat as we want, and if you want to put yourself into an early grave, it’s your prerogative.  This is America after all.  No doubt, eventually graveyards will get in on the action and start charging a higher premium to bury the obese in the extra-large casket.  Is there an alternative?

    What about re-vamping the food stamp program?  Fifty million Americans are on Medicaid, and 40 million are on food stamps (Duclos, 2010).  Currently, the food stamp program in Texas allows the purchase of just about anything you can safely consume orally with the exception of alcohol and tobacco.  There is no restriction on the types of foods that can be purchased.  These individuals are already financially struggling, and are likely trying to stretch their food dollar.  As has already been mentioned, it is considerably cheaper to buy some ground beef and Hamburger Helper than to buy a few apples.  Ramen noodles can feed one person for far less than a dollar, but with considerable impact on the waistline.  Many arguments are made that these people should not be allowed to purchase the Doritos and the Oreos since they are on a government assistance program.  Maybe there should be restrictions imposed on the food types that can be purchased by food stamps.  However, if that is the route we are to take, we should be prepared to pay a family of four far more if we are to cover the expenses of fresh vegetables, fruits, skim milk, and lean meat.

    Should we make more stringent requirements on the Medicaid recipients?  Perhaps instead of throwing the least at the obesity problem, we should invest (and enforce) weight loss programs, nutritional education, and access to exercise programs.  The hopes would be to take the initial hit up front (by providing more services to reduce obesity) and then see the decrease in expenses as people drop weight and improve health.  Yes, this could be another option.  Plus, paying for bariatric surgery while negating other options violates most if not all clinical protocol and increases health risks for these patients.

    Perhaps we could offer rewards for those that have a healthy BMI or who have limited or no medical claims in a certain time period?  Could that make people reflect on what they are putting in their body?

    Wake up, America.  Many of us are obese, and as we age, our health will continue to decline.  Our longevity is actually now on the decline, and our average life expectancy is decreasing.  We seem to have become a country of whiners.  We whine about words (always trying to be PC instead of forthright).  We whine about inequity between the classes.  We whine about inadequate healthcare.  We whine about foreign and domestic policies, and we blame everything but ourselves.  So are we really shocked to see Disney pulling ads, NYC cracking down on the sugar and sodas, and our First Lady imposing dietary restrictions in our schools?  For an example, my son in high school noticed there are no more cola machines, but they have been replaced by Gatorade and bottled water, and both of which were more expensive than the sodas!  The cost of an average lunch in our schools has gone up 65 cents in one year, which is rather noteworthy when I have 5 children in school.

    Here’s a concept I wonder if we’ve thought about.  The ads aren’t making you fat.  The McDonald’s dollar menu had no hand in your weight gain.  New York City selling Big Gulps at the gas stations had no input in your need for insulin injections for your Type 2 Diabetes.  Maybe, just maybe, it was on us.  Just MAYBE, you should listen when your body is telling you it is full regardless of how yummy it tastes.  Is it possible that you kept eating to fill that void after that break-up, divorce, or loss?  Are you honestly and truly “addicted” to food?  It seems like the latest attempt to place blame on something other than our own will power.  You are not addicted to food, you are simply out of control and unable to restrict yourself.  I mean, when did it become so accept to actually surgically alter your GI tract to restrict your intake?  Did you know that’s not always a good thing?  People who overeat do not wake up after that surgery with no urge to overeat.  Most of them will, and most will suffer dumping syndromes at a minimum while some will rupture their reduced stomach and die of sepsis.  It’s hardly a “cure” to obesity.

    Years ago, it was considered sexy to be curvaceous, like Marilyn Monroe.  It was incredibly sexy and was a sign of living well and having abundance.  Now, we wonder why women who appear as nipple and skin on ribs are considered the new version of sexy.  Maybe it’s not all that hot, but more symbolic of having self-control in a world of over-abundance.  It doesn’t really matter, because we can abuse our bodies in either direction, and neither is healthy or beneficial.  The bottom line is it is time to accept responsibility for what we put in our mouth.  The burden should lie on the individual.  If you are fat, you pay higher insurance premiums while those in a healthy weight range pay less.  Just like bad drivers pay higher premiums and good drivers get the break.  If you are receiving government money to eat, then you should have to eat within the guidelines of the food pyramid set by that same government (  If you receive Medicaid, then you should be required (and it should be covered) to attend a wellness program to reduce your weight and thus reduce the cost of your care that is paid for by our tax dollars.  If you are obese, then pay for the second airline ticket.

    Being obese sucks, and surely these restrictions and expenses are burdensome, and if they don’t motivate you, then nothing else can or will.  It’s time we revert back to the concept of personal responsibility and stop blaming the marketing, the depression, the addiction, and the spoon itself.  Our great-great-grandparents are rolling their eyes wondering how we got this far.  Take the stairs, go for a walk, try eating the suggested serving size on the carton (preferably not the Twinkies box), or opt for water.  You do not need to look far for some common sense eating plans and exercise options.  It’s not Big Brother’s job to come in and spoon feed us.  So please, work together to own our decisions and work within the confines of personal responsibility before Big Brother steps in and takes away all of our little joys!  They will start looking at other things besides soda – like our BEER (which is far freakin’ worse than soda), cigarettes, Twinkies, Chips Ahoy, Oreos, and the WINE!  It will be prohibition all over again, except with the junk food alongside the alcohol this time!


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