The Growing Obesity Challenge

Obesity is a disease, just like cancer, heart disease, mental illness, and addiction.  That’s the message of experts at a recent Future of Medicine summit on the subject.

And there are missing pieces in the way states with some of the largest concentrations of obese residents, like Florida, Connecticut, Texas, California, New York, and New Jersey, approach the epidemic.

As recently as 25 years ago, obesity was uncommon in America.  Most states didn’t even collect data on it, and not a single state reported obesity in more than 15% of its population.  Connecticut and Florida both reported rates under 10%.

The CDC map at that link shows what has happened since.  Every state in the country quickly grew bigger. 

By 2010, in 12 states, including Connecticut, between 20% and 25% of the population was obese.  In 24 states, including Florida, between 25% and 30% of the population was obese.  In the remaining 12 states, including Texas, over 30% of the population was obese.

Why has this happened at a time when people arguably have become more health conscious than ever before?   

The reasons that are emerging from research are changing the way experts think about obesity.  If policy makers listen to the experts, then this will change the way they attack the problem, too.

According to the research, obesity is not the result of an exercise of free will to overeat, any more than drug dependence is the result of a desire to overmedicate.  Dr. Paul Kenny of the Scripps Research Institute, a member of the expert panel convened by the Palm Beach County, FL Medical Society, argued that low-quality, high calorie food is proving in laboratory studies to be nearly as addicting as cocaine.

He and others say that we must use a disease model to attack obesity.  We must prevent it whenever we can, and treat it aggressively when it is present.

Unfortunately, identifying a single cause of obesity is elusive.  Dr. Kenny suggested that no single obesity gene will be found.  Dr.Ronald Romear, a practicing pediatrician, said that “in eighteen years, I haven’t seen the thyroid as a cause” for any of the obesity in the children he treats.

Investing in prevention, therefore, is imperative, and this has become the first line of attack against obesity in the public policy arena.

The American Academy of Pediatrics and public health professionals both favor the 5-2-1-0 campaign.  Children and adults are urged:

*  to eat five servings of fruits and vegetables a day,

*  to limit television, computer, and video game play to no more than two hours a day,

*  to exercise at least one hour a day, and

*  to drink zero beverages sweetened with sugar. 

Focusing on individual behavior is important.  As I wrote in an earlier column, there are also broader, community prevention strategies for states to consider.  They could regulate the amount of sugars added to foods and drinks.  They could make an hour of physical education a mandatory part of the school day, and they could offer safe outdoor play areas in all neighborhoods.   

Aggressive treatment is also part of the arsenal against obesity when it has progressed to critical stages.

Bariatric surgeries, such as lap band and gastric bypass, are becoming more common.  Dr. Andrew Larson, a bariatric surgeon on the panel, noted that 45 state Medicaid programs pay for bariatric surgeries.

But, in the disease treatment model, what are largely being ignored by states are the treatment options between prevention and end-stage obesity surgery – primary care integration and behavioral health intervention.

Some argue that primary care providers must play a bigger role in treating obesity in its early stages.  However, primary care providers need tools and resources – including adequate reimbursement for their time – to identify and treat those at risk, and they don’t currently have them as a matter of policy.  

And with addiction at the heart of obesity, states should recognize the importance of mental health services like counseling.  They should make Medicaid coverage for counseling part of the anti-obesity campaign.   

According to a recent George Washington University publication entitled Coverage of Obesity Treatment, neither Florida nor Connecticut (nor most of the high-concentration states) does.

Some of us undoubtedly shake our heads, wondering why government should address what we see as personal choice and weakness. 

But if the experts are correct, then obesity today is no more the result of human weakness than cancer or heart disease, and it is in the public interest that we do more about it.