THE DETAILS: In an address given to the U.S. Centers for Disease Control and Prevention’s first ever conference on obesity at the end of July, Health and Human Services secretary Kathleen Sebelius said that ending obesity would save the healthcare system 50 percent more money than curing cancer. Sebelius’s comments came on the heels of a CDC report finding that obesity costs the U.S. a mind-boggling $147 billion each year, and that obese people spend 42 percent more money on medical bills than healthy people do. Obesity leads to a seemingly endless list of chronic diseases—including heart disease, diabetes, stroke, and high blood pressure. And it’s those chronic diseases that are most likely to bankrupt you and drain whatever insurance plan you may be enrolled in. According to another study released in July, 62 percent of the bankruptcies filed in 2007 were due to medical bills. “Chronic illnesses are the most common and enormous of medical expenses,” says Meg Gaines, JD, director of the Center for Patient Partnerships at the University of Wisconsin, Madison, an independent agency that helps people navigate and understand the healthcare system. “Heart diseases are by far the most expensive and medically intense,” she says.
Given all that, it would seem logical that ending obesity should be a key strategy in any healthcare reform proposal. However, in the entire 1,000-page version of the healthcare reform bill presented recently by the House of Representatives, the words “obese” and “obesity” don’t appear once. Instead, legislators have endorsed funding for screenings and tests for cancer, diabetes, heart disease, and other conditions that are often caused by obesity. But these tests don’t prevent anything, says Erika Schwartz, MD, medical director for Cinergy Health, an insurance company that provides low-cost health insurance and one that is trying to redirect its focus to preventive care; they just catch those diseases in their earliest stages.
WHAT IT MEANS: If we want an affordable healthcare system that reduces the incidence of heart disease and other major illnesses, prevention has to be part of the plan. And that means real prevention, not expensive tests that detect disease that’s already begun. “There is huge confusion over the distinction between preventive medicine and true prevention, and not just in the public but among physicians and the medical community too,” says Dr. Schwartz, who’s also an internist with a private practice. True prevention, she says, has to do with eating right, exercising, sleeping right—the things that keep you healthy. “The healthcare bill in the House doesn’t address what Americans are looking for,” she adds, noting that most of the money people spend on truly preventive care goes towards gym memberships, organic food, supplements, and yoga classes.
“We know that people need to take better care of themselves,” says Gaines. “You want to save a lot of money? Get people to walk to the corner store rather than drive. Stop eating things that come in boxes and packages. Eat things that come from the produce bin and the fruit section.” Promoting and supporting these kinds of healthy behaviors would be a true reform of our healthcare system.
Whether you’re talking with friends or shouting at a town hall meeting, start a conversation about the central role that true prevention must play in our healthcare system. Here are three ideas to start with:
#1: More subsidies for organic food. Legislation about food shouldn’t be limited to the U.S. Farm Bill, when food has such a wide-ranging impact on long-term health. The pesticides used on conventional produce have been linked to a laundry list of diseases and conditions, from Parkinson’s to hormone-system interference, and it’s particularly unhealthy for pregnant women. A study published in March by the nonprofit Organic Center found that 180 pesticides used on foods interfere with the endocrine system. Infants and fetuses who are exposed to these chemicals are at a greater risk for developing obesity later in life. Chemically based agriculture is already subsidized by the government; let’s support organic agriculture so more people can enjoy the benefits of chemical-free food.
#2: Required menu labeling at restaurants. When it comes to avoiding obesity, the deck is often stacked against us. One example is the way restaurants load their menus down with sugar, fat, and salt, making it all too easy to take in way too many calories. Yet the gap between how much we eat and how much we should eat can be smaller than you’d think. According to a study in the most recent issue of the American Journal of Health Promotion, researchers found that a reduction of 100 calories per day would eliminate 71.2 million cases of overweight and obesity, which would reduce medical costs by $58 billion annually. Reducing sodium by 400 milligrams per day in people with high blood pressure could eliminate 1.5 million cases of the disease, reducing medical costs by $2.3 billion per year. A slight five-gram per day reduction in saturated fats in people with elevated cholesterol could eliminate 3.9 million cases of elevated cholesterol, which would save $2 billion each year. To tilt us all towards the healthier end of those numbers, let’s start by requiring restaurants to make it obvious how many calories they’re loading onto our plates.
#3: Funding for sidewalks. The American Heart Association has said time and again that walking is the best way to prevent chronic diseases, and walking for a mere 15 minutes a day is enough for most people to burn off 100 extra calories, which as the aforementioned study found, could eliminate $58 billion in medical costs. People won’t walk if they don’t feel safe, and the best way to ensure safety is to require sidewalks along every street. That’s just the beginning, though. How about tax rebates for people who walk to work?