Obesity: Who Should Bear the Cost

Editor’s note: The answer to reducing medical expense in a sustainable way for lifestyle choices, is NOT to provide more health care at lower cost to people. While environmental changes could assist, fundamentally we should all be responsible for our own actions and pay for the consequences of those actions. Some things are beyond our control such as genetics, but researchers suggest that 60-70% of health care costs are a result of lifestyle choices. So rather than rationing end of life care, people should pay for their lifestyle choices early on.

In this story, I suggest the phrase  ‘people who are obese spent $1,429 more on medical care…’ is really a misstatement. It is more likely that insurance paid the incremental amount and that amount was spread among all insured parties.

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The medical costs of obesity are estimated to be $147 billion a year, economists at RTI International announced today.

The report, issued two days before President Barack Obama visits the Triangle to press his message for health care reform, suggests that “policy and environmental changes” are necessary to help people eat healthier and get more exercise.

Health advocates have long pressed for more nutritious food in schools, better neighborhood development plans that include sidewalks and trails, and financial incentives from insurers to promote gym memberships and exercise.

When people become excessively heavy, they can develop diabetes, cardiovascular disease, arthritis, bone and joint problems, and increased cancer risks.

According to the study, people who are obese spent $1,429 more on medical care than normal weight people. As a result, public and private insurers pay more.

http://www.newsobserver.com/news/health_science/story/1623182.html

Two-thirds of American adults are either obese or overweight

According to a new report published by Trust for America’s Health, Mississippi had the highest rate of adult obesity at 32.5 percent, making it the fifth year in a row that the state topped the list. Four states now have rates above 30 percent, including:

• Mississippi (31.2 percent)
• Alabama (31.2 percent)
• West Virginia (31.1 percent)
• Tennessee (30.2 percent).

Eight of the 10 states with the highest percentage of obese adults are in the South. Colorado continued to have the lowest percentage of obese adults at 18.9 percent.

Adult obesity rates now exceed 25% in 31 states and exceed 20% in 49 states and Washington, D.C. Two-thirds of American adults are either obese or overweight. In 1991, no state had an obesity rate above 20 percent. In 1980, the national average for adult obesity was 15 percent. Sixteen states experienced an increase for the second year in a row, and 11 states experienced an increase for the third straight year.

Source: F as in Fat: How Obesity Policies Are Failing in America 2009, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). July 2009.http://healthyamericans.org/reports/obesity2009/

Who do you want to pay for your health care?

A March 2009 survey of how workers perceive employer health programs found:

• 74% say employers should be able to give lower health care premiums to employees who participate in wellness programs
• 47% favored charging smokers extra for health insurance 
• 43% favored charging alcohol abusers more. 
• Only 26% favored charging the very overweight higher health care premiums. 
• More than 90% of workers were against charging more for older workers, those with emotional problems or genetic conditions 
  predisposing them to a major disease.

Source: “Healthy at Work? Unequal Access to Employer Wellness Programs,” Rutgers University, John J. Heldrich Center for Workforce Development, May 2009,http://www.heldrich.rutgers.edu/uploadedFiles/Publications/Heldrich_Center_WT18.pdf

Virus caused high blood pressure

  Study links common virus to hypertension
Harvard scientists found that mice infected with a common virus, called cytomegalovirus, had higher blood pressures compared with those that were uninfected. They found that CMV stimulates the production of renin, an enzyme that activates a molecular pathway associated with high blood pressure. The study suggests that high blood pressure may be caused by persistent infection of blood vessels. The Washington Post/The Associated Press 

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/14/AR2009051403849.html

High Blood Pressure — a Window into Health Care Reform

As one community, our community thinks about how to reduce the rate of increase in health care costs, focusing on life style choices and addressing factors that affect chronic disease is the first place to focus. 

 

Chronic medical conditions, like hypertension, diabetes, and obesity drive 75% of all health care costs, along with significant workplace costs due to decreased productivity and increased disability claims. These chronic medical conditions are typically the result of lifestyle choices (physical inactivity, poor nutrition, tobacco use, etc.) that people make and are, therefore, preventable.

 

This white paper proposes that we focus our efforts on strategies to reduce the prevalence and cost of preventable diseases. This will enable our best chance to stem unsustainable health care trend increases. For the business community our potentially greatest opportunity is to assist in driving awareness. Throughout the community, starting with employees, their dependents and encompassing underserved communities, we would seek to develop programs that engage individuals in both the identification and self management of hypertension so that an optimal handoff to the medical community is encouraged and facilitated. There is good news –  effective strategies and measures already exist to prevent or delay the devastating impact of chronic medical conditions, but where do we start?

 

A logical place to begin would be 1) with a preventive service that would have a high impact and has proven to be an effective intervention, and 2) to build on the success we have realized with our existing strategies (e.g. Eat Well Live Well, RHIO, and increasing the use of generics). We are convinced that our initial efforts should focus on hypertension (high blood pressure), a very prevalent chronic and often undetected condition that is often a comorbidity with other chronic conditions, like diabetes, stroke, heart attack, kidney disease and obesity.

 

Approximately 1 in 3 adults has hypertension making it the most common primary diagnosis in the United States. African Americans have a 1.5 times higher prevalence of hypertension. Latinos have a higher incidence rate than whites. Seventy percent (70%) of people with Type 2 diabetes have concurrent hypertension.

 

Can we make an impact? Absolutely! Hypertension is easily detectable and can be controlled by lifestyle changes (diet and physical activity) and, if necessary, generic medication. Screening, detection and early treatment can significantly decrease the costs associated with hypertension and the other medical conditions (e.g. strokes, heart attacks, heart failure, etc.) for which people with hypertension are at greater risk. The U.S. Preventive Services Task Force (USPSTF) has determined that the benefits associated with hypertension screening outweigh the risks and recommends that all adults 18 and older be screened for hypertension.

 

Our proposal is to expand the highly successful Eat Well Live Well initiative to include the reporting of blood pressure by all program participants. The RHIO can facilitate the exchange of blood pressure readings among patients and providers and might be able to serve as a patient registry that can facilitate measuring process and outcomes.

 

A logical next step after successfully implementing the hypertension initiative would be to address the burgeoning type 2 diabetes epidemic. In fact, we can begin to address diabetes during the hypertension initiative by following the USPSTF’s recommendation and engaging our medical community to screen adults with hypertension for type 2 diabetes.

 

Community resources should be mobilized in a comprehensive, coordinated, and focused effort by engaging medical providers, pharmacies, and community organizations, including the Public Health Agencies, in the hypertension initiative.

 

Controlling high blood pressure not only saves money, it prolongs lives. Our goal would be to deliver an extensive public relations campaign to get all members of our community to measure and report their blood pressure through EWLW or directly to their physicians at least twice per year.