Cincinnatus BLOG *** Political Commentary - Social Commentary

More than 60% of adult Americans are overweight and a staggering 33.3% of adult men and 35.3% of women are obese. Even more disturbing 12.4% of children 2-5 years, 17% % of those aged 6-11, and 17.4% of adolescents aged 12 to 19 years are obese.  The Center for Disease Control (CDC) defines overweight in adults as a Body Mass Index (BMI) between 25 and 29.9 and obesity as a BMI 30 or higher. BMI is calculated dividing a persons weight in kilograms by their height in meters squared. To make the calculation simple the Department of Health and Human Services and others provide a simple calculator based on height in feet and inches and weight in pounds on their websites. For children and adolescents the CDC defines overweight as a BMI between the 85^th and 95^th percentile and obesity as being above the 95^th percentile for children of the same age and sex. The CDC provides a simple calculator to help you determine if your child is overweight or obese.

It’s no exaggeration to say the current obesity pandemic threatens to overwhelm the American and Global Health Care System by contributing to illnesses such as diabetes and heart disease. Obesity, which diminishes both the quality of life as well as life expectancy, is the leading risk factor for the most common form of diabetes, Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose). Specifically, type 2 diabetics become resistant to the effects of insulin; the hormone that regulates the absorption of sugar into cells. Type 2 diabetes develops when the production of insulin is insufficient to overcome the underlying problem of insulin resistance.  The early stages of the disease are characterized by an overproduction of insulin. As the disease progresses insulin levels may fall as a result of the partial failure of insulin producing Beta cells in the pancreas.

Type 2 diabetes was traditionally confined to adults and was once called adult-onset diabetes; that is no longer the case. Today some obese children develop type 2 diabetes even before the onset of puberty. A recent study demonstrated that 25% of obese children are already glucose intolerant (pre-diabetic insulin resistance) and at a high risk of developing frank diabetes.

There are 23.6 million diabetics in the United States, roughly 8% of the population and as a result of the obesity pandemic there numbers are growing dramatically. For example, the total prevalence of diabetes increased 13.5% between the years 2005 and 2007. According to the American Diabetes Association one out of every five health care dollars is spent caring for someone with diagnosed diabetes, while one in ten health care dollars is attributed to diabetes per se. This should not be all that surprising given the propensity of diabetics to develop complications. The most life-threatening consequences of diabetes are heart disease and stroke, which strike people with diabetes twice as often as normal individuals. In diabetics these complications occur at an earlier age and are more likely to be fatal. Diabetes is the leading cause of new cases of blindness in people ages 20-74. Diabetes is also the leading cause of end stage renal disease accounting for 43% of new cases and make up the largest group that undergoes dialysis and kidney transplant. More than 60% of non-traumatic lower-limb amputations occur among diabetics. Other complications include impotence, depression and nerve damage. Clearly, weight gain and the resultant rise is diabetes has a devastating impact on the health of Americans.

Weight gain results from an energy imbalance. Simply stated this involves taking in to many calories and not getting enough exercise. The medical solution is at least in theory easy, loose weight and avoid this catastrophic end. Studies have clearly shown that increased physical activity reduces the risk of developing type 2 diabetes regardless of the degree of adiposity (fatness). Exercising to an intensity of 80–90% of age-predicted maximum heart rate for at least 20 minutes, at least five times per week has the potential to substantially enhance insulin sensitivity. Even modest weight loss in the range of 5-10% of initial body weight and regular exercise has been shown to reduce the risk of diabetes by 58% over a three-year period.

Eat less and exercise more has been the mantra for the last several decades but the message seems to have been lost on the 60+% of Americans who are overweight. What will it take to put a halt to this mushrooming health care time bomb - probably nothing less than a no-holds-barred campaign similar to anti-smoking campaign of the last three decades?  At the risk of being unpopular in some circles the following should be at least considered:

1.     Portion Control - After having lived in Europe for more than 15 years the most shocking change I found on my return to the U.S. was the sheer size of portions served in U.S. restaurants. A 400-gram (13.5oz.) steak is more than any adult should eat - do we really need to have 22oz and 24oz steaks on the menu?

2.     It’s all about sugar and fat. A “Big Mac” and a Coke on occasion seems reasonable, but as a steady diet the only thing that will be supersized is the child.

3.     Just walk - do it for your health or to save the planet from global warming but just do it. Who knows tomorrow you might just start to run.

4.     Here is where I get into real trouble - After some reasonable grace period to correct the problem e.g. one-year, overweight and obese people should be charged higher health and life insurance premiums. The rationale is no different than higher premiums for smokers. Just like smoking, the voluntary action of eating to much, eating the wrong foods, and not exercising costs the rest of the population a great deal of money. If we won’t loose weight to improve our health and save our own lives the rest of the population should not be unduly burdened with the excess cost. Hopefully, this will be a concrete incentive to loose weight and exercise. While this may sound punitive, concrete action like this helped to reduce smoking.

5.     Reluctantly, I would recommend a tax on high calorie fast food. Making cigarettes more expensive clearly reduced the number of people who smoked. To be fair and provide a further incentive we should rebate that tax for each portion of “healthy food” that is substituted for the traditional fat meal.

6.     Education at all levels, in schools, at work; in public service advertising we must address the seriousness of this issue.

The only thing we can’t do is continue to do what we are doing because it clearly has not worked.