Obesity Action Coalition Blog

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As the “Weight of the Nation” conference comes to an end, I thought I would share a few final thoughts. I really am truly appreciative of the leadership of the Centers for Disease Control and Prevention (CDC) on the obesity prevention issue. It is quite reassuring to know that there is a group looking at some of the social determinants (socioeconomic issues, transportation, food supply, etc.) that lead to our environment where obesity is so prevalent.

With that being said, I still think at the same time we need to have a similar focus on intervening with or treating obesity. Throughout the meetings, I heard great examples of environmental prevention efforts that appear to be working, but we also need to hear about obesity intervention efforts and what is working and not working as well. Hosting a similar meeting on the treatment of obesity with the widespread support of both the CDC and public policy makers will be something I will be encouraging officials to do in the near future.

Thanks to all of you who followed my remarks on the OAC blog and on Facebook. If you would like to see the OAC utilize our blog and Facebook in a similar fashion in the future, please let us know by emailing info@obesityaction.org as we always appreciate feedback and constructive criticism.

Another interesting comment from one of the mayors on the panel, “The wellness/health of citizens should be our elected officials number one priority especially at the local level. Without health, how can a community thrive at any level?”

Can’t find a champion in your community? Try reminding your officials that addressing weight issues among citizens benefits their communities in many ways.

The current session features mayors from cities across the country who are tackling obesity. One of the mayors made an interesting observation. He said, “The obesity epidemic is more about a failure of public policy and vision than any other factor.” A pretty powerful statement from an elected official considering how many believe that the obesity epidemic is solely a failure of individuals.

As the third and final day of the “Weight of the Nation” conference begins, I will be attending tracks looking at working with state and local officials to encourage action around obesity. These topics are very familiar to me personally as working with state and federal officials is a big part of my job description and my personal passion. However, the topics have me thinking about the importance of the members and supporters of the OAC taking action in their own local communities. You may have concerns about childhood obesity, school foods, exercise, treatment or some other obesity focused topic and if you are not acting on them in some way through volunteering with local programs or being a public advocate, we need you to do so.  As I’ve said many times in the past, the OAC will become a true advocacy voice when we are not only representing the interests of our members, but when our members themselves become advocates.

My first session included references to a number of interesting Web resources for those of you interested in actual examples of policy recommendations or legislation that has been considered.

The first is from the Centers for Disease Control and Prevention (CDC) and actually allows you to search state legislation (both passed or defeated) dealing with physical activity, nutrition and obesity for the past several years:

http://apps.nccd.cdc.gov/DNPALeg/Index.asp

Two other great sites include:

• The National Council for State Legislators at www.ncsl.org
• The National Governor’s Association at www.nga.org

Quite frequently I am asked for actual examples of legislation and policies and I think the above resources are great sources for such information.

My final session for today was a very interesting, and at times troubling, panel on using incentives to reduce obesity. One of the presenters specifically spoke on the use of financial incentives in the workplace and what the law allows. She raised several theoretical examples of scenarios and asked the audience whether she thought they were legal or illegal. One of those examples was an employer choosing to fire all of their employees with a body mass index (BMI) more than 25 in an effort to reduce health costs. Her response that while this may be illegal in Michigan and a few cities (who have weight discrimination laws), she believed (admitting that this would obviously be challenged legally under the Americans with Disabilities act by the Equal Employment Opportunities Commission if there were morbidly obese employees at the company) that under recent case law, the employer would likely win legally (although they obviously might face some serious scrutiny and public criticism from the OAC and many others, and I have a strong feeling a number of lawyers would disagree with her as other state/federal laws may intervene).

Whether correct or incorrect in her conclusions, her example really pointed out that we need to proceed with some caution around the topic of employer incentives and penalties to address obesity and that we may need to push for further laws/regulations to ensure fair treatment. Employers offering incentives around urging workers to adopt healthy lifestyles is likely to be encouraged and expanded under healthcare reform and unfortunately I am not so sure we are ready for the potential consequences of such programs. Special care will need to be taken in both the implementation and regulation around any such incentive programs.

This will be my last update for the day. Look for more tomorrow as the inaugural “Weight of the Nation” conference wraps up.

The highlight of the afternoon sessions has been the passionate remarks of Assistance Secretary of Health, Dr. Koh. He reminded the audience of how the World Health Organization defines “health.” They define health (paraphrased) as a state of complete physical, emotional and social wellbeing and not just the absence of disease. A very powerful statement and an important reminder.

My initial blog comments raised the concern that the role of treatment was lacking from the agenda and while I still believe the meetings would benefit from some treatment/intervention topics, I am very impressed by the quality of presentations. The public health participants in this meeting are looking at the very big picture when it comes to obesity and are trying to come to grips with the many social and environmental causes of obesity. The OAC will, of course, continue our focus on helping individuals affected through education and working to improve access to the prevention and treatment of obesity, but I am also very relieved that we have some truly dedicated folks in both the public and private sector evaluating the larger world or macro influencing the obesity epidemic. The CDC and their partners deserve our applause for their efforts.

I attended two very interesting sessions this morning. The first dealing with disparities, and the second with economics.

The disparities talk highlighted the need for additional action in the African-American, Latino and Native American populations. Obesity rates are high among the population as a whole, but are affecting these populations at much higher rates. One of the key points raised was the importance of addressing socioeconomic issues. One survey showed that for every one Caucasian who expressed concern about personal safety for their children while playing outdoors, four Latinos did the same. Another interesting point was raised by one of the presenters as well, the lack of the skill set among providers to address obesity issues. Does your primary care physician understand addressing obesity? Although this was raised in the disparities talk, I think this challenge applies universally and is a significant problem.

The second talk featured a number of economists presenting information on the economics of obesity. A couple of interesting observations/comments:

1. One panelist emphasized that the growing healthcare costs of obesity are not necessarily because people affected are more expensive to treat then they were 10 years ago, just that there are more individuals now affected.
2. The same panelist also raised that peoples decisions regarding their health and behavior are driven by their preferences (which may be genetically set) plus the tradeoffs they face (do I prepare a healthy meal or eat fast food? What’s the cost of the time necessary to prepare such a meal?). He emphasized telling folks that if they behave differently, it will have no effect if we do not incentivize the tradeoffs in favor of more healthy behaviors.
3. It was reported that Caucasian females affected by obesity earn 11.2 percent less than their normal weight counterparts.
4. And that the lifetime societal costs of obesity in today’s dollars are approximately $54,759 more for an obese individual than a normal weight individual and up to $90,000 more for a morbidly obese individual.

I found it very interesting that one of the economists specifically spoke about her motivation to review obesity specific data. She shared the story that she was motivated by a colleague who thought obesity was just a personal problem and that society/government had no role or reason to help address this issue. After she presented her data to her colleague, he changed his mind. If only all members of the public were as understanding as her colleague. We do know that often such economic data is actually used as a mechanism to further punish those already affected by obesity. In fact, I have no doubt today that with reports of the high costs of obesity across the headlines throughout America, we will see plenty of comments urging that individuals affected by obesity be denied healthcare or penalized in some additional way. It is important that we strike the right balance with such economic data. Our sole motivation to address obesity should not be money. It needs to be that everyone deserves the chance at a healthy life.

Kathleen Sebelius, Secretary of HHS, urged a national focus on obesity and focused her remarks on lowering childhood obesity rates by improving food quality, lowering the cost of high quality food, improving exercise/recess and PE requirements and improving neighborhood safety/sidewalks/parks to encourage play.

Secretary Sebelius said that the United States has the best “sick” care system in the nation, but not very good at “health” care. My challenge with this argument is that can we move to a wellness, health model without first addressing those that are struggling with their weight? Obesity like other chronic diseases is not going to just disappear just because we move to a “health” model and frankly one of the reasons we have a “sick” care model is the failure to recognize obesity as one of those “sicknesses.” Will those struggling with their weight be penalized under such a new system? Some discussing such reform are suggesting such penalties.

Secretary Seblius’ remarks reminded me that we have much work to do with our elected and appointed officials understanding the obesity epidemic. It reminded me of the importance in participation in meetings like the Weight of the Nation, but also the importance of the OAC representing the interests of those affected by obesity. Sometimes in looking at an overall epidemic, those affected are lost in the equation. We are more than just excess dollars spent, we are real people who are struggling with a chronic life-long condition. We need to make sure our elected, appointed and public health officials understand this.