Obesity

This made our day yesterday. Many thanks to the astute reader who sent it in.

Shannon Brownlee's recent piece on TIME Ideas is sure to provoke some vehement reactions. Here's her conclusion:

"Maybe it’s time to be at least a little more willing to similarly demonize excess poundage. Our rapidly rising rate of obesity harms us financially, because we pay for health care collectively. Insurance premiums paid by the healthy subsidize the care of the sick. That means we are all paying for the costs of treating obesity and that treatment is one of the things that is helping to send health care spending through the roof. The war on smoking worked because it made smoking shameful and the public health measures needed to fight it permissible. It may take an even tougher approach to combat obesity, beginning with the recognition that it’s bad for all of us."

We definitely see the value of social pressure as a means of changing behavior. Brownlee is right that the social pressures are an important reason why people stopped smoking, and why more people don't start now. UCLA professor Mark Kleiman commented earlier this month on The Reality-Based Community that a similar. more severe transition has happened for any number of other activities. However, it's crucial that such social pressure is directed at behaviors, not at people. Berating fat people and promulgating the idea that the obese are morally inferior is not the goal. Rather, public health advocates should focus on curbing unhealthy behaviors like overeating and inactivity.

Everybody knows obesity is a massive problem in the U.S. It rivals smoking in terms of its health hazards, according to a report in the February 2010 American Journal of Preventative Medicine. As a society, we’ve made great strides, giant leaps even, in reducing rates of smoking. Smoking bans on airplanes, in public buildings, in restaurants, have helped. So have negative ad campaigns aimed at teenagers, higher insurance premiums for smokers and higher taxes on cigarettes.

We've talked before on the blog about how where you live can have a huge effect on the kind of medical care you get. Unsurprisingly, it also affects how healthy you are to begin with.

A new study from the New England Journal of Medicine reports the results of a three-year randomized trial performed by the US Department of Housing and Urban Development (HUD). According to the study, people who live in lower-poverty areas are somewhat less likely to become obese or develop diabetes than those in higher-poverty areas.

The study was most notable for its methodology. The families in the study were all headed by women, with children under 18 in the household, and were drawn from public housing in cities across the country. Eligible families who applied were randomly selected to receive a standard housing voucher, a voucher that was only usable if they moved to a low-poverty area (a census tract with a poverty rate of 10 percent or lower), or no voucher. Because the families were drawn from comparable populations and randomly assigned vouchers for low-poverty areas or not, it's unlikely that the obesity effects of living in lower-poverty areas were the result of pre-exisitng motivation to leave their area or to stay fit.* That design allows the researchers to look at health differences based on where the participants in the study lived separately from the health effects of additional income from the voucher.

We don't often post raw links or pictures without commentary, but the last few weeks have involved a few great ones that we couldn't pass up.

First: via the new Washington Post Wonkblog (congrats on the new site, guys!), Dr Seuss explains the medical arms race in the video to the right! (Watch it fullscreen--it's worth it!)

Two weeks ago, American Beverage Association President Susan Neely took issue with Mark Bittman’s New York Times Magazine article, in which he advocated taxes on soda and other unhealthy foods. Bittman’s justification was that raising the prices of those unhealthy foods relative to more nutritious foods would encourage people to eat more healthfully, and so help combat the national obesity epidemic. Neely said in her response, “Obesity isn’t about “good” and “bad” foods. It’s about an imbalance between calories consumed — from all foods and beverages — and those burned through physical activity.”

She’s right, of course: many factors contribute to obesity, but the problem isn’t as simple as “eating bad foods makes you obese.” The thing is, that’s not what Bittman was saying, either. The ultimate goal of his tax proposal is to change the food environment in which we live.

Public health advocates believe that Americans live in an obesogenic environment: not one where anyone is forced to eat unhealthily and become obese, but an environment with forces that encourage overconsumption of calorie-dense, low-nutrition foods.

If you’re an average American, you drink 44.7 gallons of pop (“soda” for the coastal readers out there) every year.  Adding in sports and energy drinks, the average American consumes about 50 gallons of sugary beverages a year.

Assuming you are drinking non-diet beverages, you would ingest 46 pounds of sugar, or about 7.3 gallons.

If you need help visualizing that, this picture shows how much sugar you would consume if you drank one 12oz soft drink a day for a year (5 gallons):

NUMBER OF THE DAY: 27.6%

27.6% of American adults are obese -- a new record high, and almost 12 percentage points higher than fifteen years ago. This indicator is only one of many in a disturbing trend worrying public health advocates.

Also troubling is the adult obesity rate in Colorado -- the slimmest state in the country. Until last year, Colorado had never had adult obesity over twenty percent. In 2010, it finally crossed the line to 21.4 percent.

The thinnest state in 2010 would have been the fattest in 1995.

In 1995, Indiana was the most obese state, at 20.1 percent. It was the only state above twenty percent. The fittest states had obesity rates barely above 10 percent.

Perhaps the most upsetting statistics come from Alabama and West Virginia, where obese adults outnumber their normal-weight counterparts. In Alabama, 33% of adults are obese compared to only 30.1% of normal weight. In West Virginia, it’s 32.9% obese and 32.1% normal. The public health implications of such widespread obesity are significant, and we don’t even know what the effects of long-term obesity are. As childhood obesity rates climb, we need to be thinking about and enacting solutions. A significant body of research suggests severe long-term health problems result from an overweight youth:

A number of long term adverse effects of childhood obesity are now well established. The socioeconomic impact of obesity in adolescence/young adulthood is considerable, but little known. Obesity in childhood tends to persist into adulthood. Cardiovascular effects of obesity in childhood persist and this predicts a strong link between childhood obesity and morbidity/mortality in adulthood, which should be  reflected in increased cardiovascular morbidity in future, as the current generation of obese children become adults. Taken together, this evidence makes a strong case for greater efforts directed at the prevention and treatment of childhood obesity. (J J Reilly, et al., Systematic Review: Health consequences of obesity)

We’re going to be looking at obesity a lot in upcoming blog posts. We’ll look at the way it fits into our health care delivery system and what insights might be gleaned from thinking about it. Understanding how to deal with behavioral health issues is going to be crucially important to fixing our cost growth and designing a more holistic, integrated, cost-effective delivery system.

Be sure to follow us on Twitter to hear about our blog updates, get our take on health policy news, and learn of events in DC!

Should people be able to use food stamps to buy sodas and other sugary beverages? New York City thinks not.

As we’ve often noted, food policy will increasingly play a large role in health policy, as we institute programs and policies to curtail the obesity epidemic threatening the health of our nation. New York City, a city always at the top of fashion and food, has already begun a public education campaign about sugary beverages. It is now contemplating further action.

Nearly 57 percent of adults in New York City and 40 percent of children in New York City public schools are either overweight or obese. The potential health consequences are frightening, and obesity rates are particularly alarming in New York's low income neighborhoods (30 percent in the poorest neighborhoods versus 17 percent in the richest). Obesity-related health care conditions cost New Yorkers nearly $8 billion a year in tax dollars, or $770 per household. (That's one reason that the city was at the vanguard of the move to require menus to display calorie counts, now a part of the national health care law.)

Watch out strip mall drugstore. You may have some competition. Natasha Singer reported recently in the New York Times, “The farm stand is becoming the new apothecary, dispensing apples—not to mention artichokes, asparagus and arugula—to fill a novel kind of prescription.”

Wholesome Wave, a nonprofit dedicated to increasing access to healthy foods, announced its “Fruit and Veggie Prescription Program" pilot program where physicians at community clinics can prescribe vouchers for local farmers markets and then monitor the impact of increased fruit and vegetable consumption on a patients’ health. (Watch Dr. Shikha Anand on CNN talk about the program here.) It's being tested in Holyoke, Lawrence and Boston, Mass., and in Portland, Maine.