In spite of media coverage and doctors' advice, millions of Americans are still overweight. Why can't state and federal policies control help?
Despite the many public efforts to promote physical activity and good nutrition in recent years, despite the constant warnings about the obesity crisis, Americans just keep getting fatter. According to an annual state-by-state look at the problem, adult obesity rates increased in 37 states in the past year, and only the District of Columbia saw a decrease—down a mere 0.1%. More than 25% of adults are now obese in 28 states, up from 19 states last year.
In 1991 no state had an obesity rate above 20%. Today more than 20% of adults are obese in every state except Colorado, where the number stands at 18.4%, according to the survey by two nonprofits, the Robert Wood Johnson Foundation and Trust for America's Health. Mississippi, the worst performer of all 51 on the list (which includes the District of Columbia), stands at 31.7%. Similarly disturbing increases were found in the percentage of adults with Type 2 diabetes, a weight-related disease. The survey found higher incidence of diabetes in 26 states. Four states are above 10%.
No Magic Pill
Overall, adult obesity rates have doubled since 1980, from 15% to 30%, and two-thirds of U.S. adults are now considered overweight or obese. The national rate for diabetes in adults has grown from 5.2% in 1980 to more than 8% now, and one in three Americans has hypertension—often weight-related. The report estimates that the direct health-care costs of obesity exceed $61 billion annually.
The U.S. "is not treating the obesity crisis with the seriousness it deserves," said Jeff Levi, executive director of Trust for America's Health at a press conference. He complained that while obesity rates keep climbing, federal funding for programs to address the problem has been steadily reduced over the last several years. "The only thing going down is the money spent to prevent this epidemic."
Plenty of money is also spent by individuals attempting to lose weight, apparently to little avail. The market for weight-loss treatments in the U.S., including diet programs, herbal products, and the like, is worth some $33 billion a year. About $200 million of that comes from prescription products (BusinessWeek.com, 3/8/08) such as Roche's (RHHBY) Xenical and Abbott Laboratories' (ABT) Meridia, none of which work especially well, say obesity experts.
Obesity Policies Receive Failing Grades
The survey found a correlation between poverty and obesity, with 7 of the 10 states with the highest obesity rates also in the top 10 for poverty rates. But wealthy states such as Connecticut, with an obesity rate of 20.8%, have not escaped the problem. There is also a geographic correlation—11 of the 15 states with the highest obesity rates are in the South, while Northeastern and Western states have the lowest rates.
The survey, published in the report F As In Fat: How Obesity Policies Are Failing In America 2008, combines three years of surveillance data spanning 2005-2007 from the U.S. Centers for Disease Control & Prevention. Individuals with a body-mass index of 30 or above, a calculation based on height and weight, are considered obese. For instance, a person who is 5 ft. 8 in. and weighs 200 pounds has a BMI of 30.4.
The two foundations also reviewed state and federal policies aimed at reducing obesity in children and adults and found that, while all 50 states have some sort of law addressing the issue on the books, only 13 back up these regulations with enforcement language, and of those, only four call for sanctions or penalties if the laws are not implemented.
Medicaid Guidelines on Obesity
Only Georgia and Vermont have specific guidelines for treating obese adults in their Medicaid programs. On the other hand, 20 states do not cover nutritional assessments for obese adults under Medicaid, and in Nebraska and South Carolina the Medicaid programs specifically state that obesity is not a disease and treatment cannot be covered.
"There needs to be a sense of urgency and outright alarm," said Dr. James Marks, senior vice-president of the Robert Wood Johnson Foundation. "This is the fifth F As In Fat report and each year we see more evidence that our nation's obesity epidemic continues to gain speed and destructive force." Marks and Levi attributed the steady rise in overweight Americans to large serving-sizes in restaurants, the high cost of nutritional food, and more time spent in front of TVs and computer screens. "No single action or effort led to this change," said Levi, and in the same way no single action will solve it.
Levi and Marks called on governments, parents, schools, and corporations to come up with ways to reverse the fat trend, particularly in children. But leadership, they say, must come from the federal government, which they say has put few resources into fighting obesity. Although they support in principle the Federal Obesity Prevention Act legislation introduced in July by Senators Chris Dodd (D-Conn.), Tom Harkin (D-Ind.), and Jeff Bingaman (D-N.M.), calling for a national strategy for combating obesity, they worry the funding won't be there. "A strategy alone is insufficient if resources are not placed behind it," said Levi.