Jennifer Lovejoy, PhD, Senior Vice President, Clinical Development & Support
Trust for Americas Health and the Robert Wood Johnson Foundation have just released their annual report on U.S. obesity trends and the news is not good. The number of obese adults, is expected to increase dramatically in every state in the country over the next 20 years, resulting in a large increase in obesity-related disease rates and health care costs.
According to the report, if obesity rates continue on their current trajectories, by 2030, 13 states could have adult obesity rates above 60% and all 50 states could have rates above 44%. This would contribute to more than 6 million additional cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and 400,000 cases of cancer over the next two decades. The costs of the obesity epidemic are already staggering, and clearly this sort of increase in prevalence could seriously jeopardize the fiscal future of this country. As is the case today, the healthcare costs of obesity are increasingly impacting employers and state governments, which is hopefully strong motivation for these entities to take action and implement both policies and clinical weight management programs to prevent and treat obesity.
The news from the report is not all bad, however. According to the analysis, if states could reduce the average body mass index (BMI) of residents by just 5% by 2030, every state could help millions of people avoid obesity-related diseases and save billions of dollars in health care costs. This amount of weight loss is relatively modest - for a six-foot-tall person weighing 200 pounds, a 5% reduction in BMI would mean losing about 10 pounds. Surely this should be a call to action for every state government, school system, and employer to take action now to reduce obesity rates.
Unfortunately, I feel that the recommendations of the report are much too limited to address such a severe problem. They are focused mainly on obesity prevention efforts, and primarily on childhood obesity, even though the report clearly indicates that it is adult obesity that is driving the health care costs. Certainly attention needs to be given to recommendations for prevention of childhood obesity, like implementing healthier school meal and physical activity guidelines. And some prevention strategies have been shown to be effective for adults (at least to halt the upward obesity trend). But to really deal with the problem requires treatment. Prevention is not going to get us any sort of reduction in BMI across the board.
Unlike in decades past, todays cognitive-behavioral weight loss programs have proven to be very effective in helping people lose 5-10% of their body weight and keep it off long term. And these programs can be disseminated: some are now being offered through local YMCAs and other venues. We had two new obesity drugs approved by the FDA in 2012 that could help millions of people lose weight if doctors will prescribe them and health insurance plans will pay for them. It is time to treat obesity for the serious chronic condition that it is. Every American should have access to a free or low-cost weight management program in the worksite that involves intensive counseling or coaching (at least 12 sessions according the U.S. Preventive Services Task Force), is evidence-base