Shoes, Ships, and Sealing Wax

Nic's soapbox

Heather has a post up this morning on obesity laws which dovetails rather nicely with an article in this morning's Washington Post on the new gym classes in local schools.

Now I'm going to apparently contradict something I said earlier: I actually do care about the "obesity epidemic."

I work in the public health sector. In a way, I think it would be unprofessional of me if I didn't care about obesity the same way I care about AIDS, or cancer, or seatbelts, or antibiotic resistance.

From a May speech by Secretary of Health & Human Services Tommy Thompson:

Now I want to talk with you about an epidemic that is slowing our nation down: obesity. Today, nearly 2 out of 3 American adults and about 15% of children are overweight or obese. And minorities are faring worse than the overall population: 23% of Hispanic Americans are obese. And 30% of African Americans are obese.

At least 17 million Americans have Type 2 diabetes. That's about one out of every 20 people. At least 16 million more have pre-diabetes. Poor nutrition, overweight, and inactivity cause at least a third of all cancers. And obesity aggravates hypertension, which contributes to the number one cause of death in this country: heart disease.

Every day, there's new evidence about the harmful health effects of obesity. The CDC reported this week that obese and overweight women face significantly increased risks of having babies with birth defects.

We must increase the number of women who are at a healthy weight before they become pregnant.

We should also be particularly concerned about America's children. Think of this: Type 2 Diabetes was once a disease of adults 40 and older. Now it's found in children as young as 8.

Why? Because our children are more sedentary and overweight than ever before. In fact, the number of overweight children has tripled in the past two decades. We need to get serious about our children's lifestyles and get them active for at least an hour every day.

This is where I get on my prevention soapbox. I can't help it! So many of our chronic, debilitating illnesses can be prevented through lifestyle choices.

I actually think that most of what the government is doing...massive outreach and education...is appropriate. I appreciate the goals of legislation like the proposed Menu Education and Labeling Act, which would require nutritional labeling in restaurants. (N.B., this doesn't mean the mom & pop deli down the street, it applies to chains with 20 or more outlets. They have an idea of how much food they are using and what goes into the menu items...those corporate test kitchens are labs.) I've been reading with great interest the meeting transcripts from the FDA Obesity Working Group.

Personal bias disclosure: I live in the Washington area. Many members of my family are or were career government workers. I personally have worked for government contractors most of my career and I have worked with doctors, nurses, and scientists from FDA and NIH. Most of them are dedicated health professionals who think of the citizens as their patients, and their interest is not in getting grants or publishing their own research, it is in the public health. So I don't laugh when someone says "I'm from the government and I'm here to help."

Beyond the public health is the economic need. Obesity-related medical conditions hurt productivity and treating the obesity-related conditions costs money. From the Surgeon General:

Overweight and obesity and their associated health problems have substantial economic consequences for the U.S. health care system. The increasing prevalence of overweight and obesity is associated with both direct and indirect costs. Direct health care costs refer to preventive, diagnostic, and treatment services related to overweight and obesity (for example, physician visits and hospital and nursing home care). Indirect costs refer to the value of wages lost by people unable to work because of illness or disability, as well as the value of future earnings lost by premature death.

In 1995, the total (direct and indirect) costs attributable to obesity amounted to an estimated $99 billion. In 2000, the total cost of obesity was estimated to be $117 billion ($61 billion direct and $56 billion indirect). Most of the cost associated with obesity is due to type 2 diabetes, coronary heart disease, and hypertension.

I favor the education, as I've said before, and maybe some economic incentives for people to improve their health. (We're going to pay the costs one way or another, so why not put the money on the prevention side?)

I cleaned up my act, after years of eating poorly, being sedentary, and smoking, after watching family members get diabetes and cancer and have heart attacks and stokes. I am not going to have kids to take care of me and I'm not rich enough to afford the nice nursing homes, so I figure it's in my best interest, economically and otherwise, to do what I can to remain as healthy as possible.

But that's just personal. You shouldn't care about my health any more than I care about yours. But when it is the health of 2/3 of the productive population, the economics of it should make the issue of interest to all of us.

Posted by Nic at December 23, 2003 11:32 AM | TrackBack