America's Greatest Health Threat: Obesity

No matter where you live in America, obesity threatens to unleash a wave of chronic disease in the next few years that will swamp the health-care system and add an economically crippling $344 billion a year to total health spending by 2018. This is the message of the 20th annual survey of the health of all 50 states, undertaken by the nonprofit group America's Health Rankings. Although the survey found that the U.S. has made big strides in treating cancer, cardiovascular disease, and other critical illnesses over the past two decades, there has been little to no progress in preventing disease in the first place. And while smoking has been the greatest challenge of the past 20 years, it will soon be overtaken by obesity, which the report identifies as the fastest-growing and most significant risk factor for chronic disease the nation has ever faced. The survey also ranked the U.S. against other industrialized nations, and the results were equally grim. Although the U.S. spends far more per capita on health care than any other country, 30 nations surpass it in life expectancy, and it has the highest death rate from treatable conditions of 19 industrialized countries. The American health-care system was ranked last when compared with those of Australia, Canada, Germany, New Zealand, and Britain on a number of measures. a tsunami of preventable illnessDomestically, the measure that is the most worrisome is weight. More than one in four Americans are considered obese, as measured by a formula called the body-mass index, and if current trends continue, 43% of the adult population will be considered obese in just eight years—that's 103 million Americans. No state has experienced a drop in obesity over the past five years; instead, 80% of all states have seen significant increases. The prevalence of obesity ranges from a low of 19.1% of state residents in Colorado to over 30% of the population in six Southern states. "We have identified obesity as an absolute crisis condition," says Dr. Reed Tuckson, chief of medical affairs for UnitedHealth Group (UNH) and a board member of United Health Foundation, which partly funded the survey."Unless we work at many different levels, immediately and urgently, there is going to be a tsunami of preventable chronic illness pouring through the medical-care system that will escalate costs well beyond anything people are now planning for." The report did find some improvement on the smoking front—the other huge preventable health risk in the U.S. Smoking prevalence declined 38% from 1990 to 2009 and dropped from 19.8% to 18.3% of the population over the past year. One in five Americans continues to smoke, however, and smoking remains the leading cause of preventable disease and death, causing some 440,000 people to die prematurely each year. The proportion of the population that smokes ranges from a low of 9.3% in Utah to over 25% in Kentucky, Indiana, and West Virginia. problem no. 2: the uninsuredOther health risk factors also declined over the two decades that the survey has been published, including lower rates of crime, infectious disease, and infant mortality. Those gains have been offset, however, by a rising rate of the uninsured, lack of progress in hiking the high school graduation rate, and lack of access to adequate prenatal care for pregnant women. The survey, which is also sponsored by the American Public Health Assn. and the Partnership for Prevention, a public-private coalition, measures 22 health indicators, among them alcohol consumption, the number of primary-care physicians per 1,000 people, prevalence of diabetes, crime, and infant mortality. It found that New York has shown the most improvement in the overall health of its residents since 1990, thanks to a reduction of violent crime, infant mortality, and smoking, and an increase in immunizations. Oklahoma was the only state where health measurements are worse than in 1990, in part because of sharp increases in violent crime, obesity, and children living in poverty. Vermont was rated the healthiest state for the third year in a row, while Mississippi replaced 2008's Louisiana as the last-place finisher. Click here to see the healthiest and sickest states in the U.S.

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