Obesity is the new smoking. While states are increasingly outlawing public smoking, no one is ready to initiate similar measures targeted at people who are obese. It's just not polite.
Many states have adopted public smoking bans in the past couple of years—not surprisingly—but I was completely stunned when I saw the announcement that New York City is now going to ban its restaurants from using all trans fats because they're unhealthy. Does this foreshadow the complete demise of the dessert menu, too? Americans are overweight, so now none of us can have cheesecake? There are so few methods to encourage healthy weight, healthy eating and physical activity, I think we're ready to consider almost anything.
Healthcare payers I've talked to recently tell me they want to create obesity programs but don't know how to do it in a sensitive yet effective manner. For most DM or wellness programs, the first step is identifying the population that needs immediate intervention and possibly predicting who in the population could use some preventive steps. For obesity, that might mean asking people to step on a scale, or asking physicians to identify their overweight patients.
One colleague mentioned that there are plenty of physicians who themselves are overweight and are reluctant to discuss weight and eating habits with patients because they believe they lack credibility.
PricewaterhouseCoopers identified obesity as the next major health hurdle for America in 2007 and polled consumers on their attitudes about it. According to the survey, 40% of consumers believe insurance premiums should be higher for people who are obese because of poor lifestyle. For comparison, 61% believe premiums should be higher for smokers. The research also indicates that there are far more obese people than smokers, and they have 30% to 50% more chronic conditions than those who smoke.
AHRQ reported last month that hospital stays of obese patients increased by 112% between 1996 and 2004 to 1.7 million. Granted, most of the stays were for weight reduction surgeries, which have become more available in recent years, but let's not lose sight of the fact that both supply of and demand for weight reduction surgery have increased for a reason. According to AHRQ, almost all the patients in the study were morbidly obese (at least two times their ideal weight). Hospital costs averaged $11,700 per day.
It was 40 years ago when we started telling kids the best way to quit smoking is never to start. As we try to engineer programs and coordinated efforts to stop the obesity epidemic, we can learn from our past experience with reducing smoking. One of the reasons why smoking rates are down today is because we've been educating an entire generation about the health risks—a generation that has now grown up mostly smoke-free.
For obesity, we've just now gotten serious about educating—earnestly educating—kids about their weight. I don't just mean the four food groups and 20 minutes of physical education a week. Today, it's serious. It might very well take us 40 years to finally see the outcomes, but for now, it's our most logical approach.
Besides, outlawing dessert menus would just be impolite.
Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at [email protected]