The Obesity Epidemic and Health Care Reform

09/27/2008 05:12 am ET | Updated Nov 17, 2011

The obesity crisis is getting worse. This past week, we at the Trust for America's Health along with the Robert Wood Johnson Foundation released our annual report F as in Fat: How Obesity Policies Are Failing in America. We found that obesity increased in 37 states in the past year and did not decrease in a single state. Adult obesity rates have doubled in the past three decades, and childhood rates have tripled during this time. Overall two-thirds of adults and 23 million children are overweight or obese. Our national weight gain is costing the country billions in preventable health care costs and lost productivity.

To find out where your state ranks in the national weigh in, you can check out our website. (For those who can't take the suspense, Mississippi was the heaviest and Colorado was the leanest.)

It's not just obesity that's the problem - it's what follows. Our report shows that the rates are off the charts for numerous diseases related to obesity, ranging from type 2 diabetes to heart disease.

This crisis needs to become part of our national conversation on health care. Health reform has long focused on access to care, and increasingly on quality of care, because those issues are central to improving the health of Americans. But for too long, we've neglected to put a priority on preventing people from getting sick in the first place. Instead, we've sat back and watched poor nutrition and physical inactivity become the norm, while preventable diseases have skyrocketed.

We've all witnessed the trends. Kids today aren't getting enough physical activity in schools. They are bombarded with ads for junk food, and at the same time fruits and vegetables are increasingly unaffordable. Many communities don't have enough sidewalks or safe parks. People in lower-income urban and rural neighborhoods often have to travel miles just to get to the nearest grocery store.

Our study looks at many promising approaches to curbing the epidemics of poor nutrition and physical inactivity. These efforts make dollars and sense. There are many ways that we can improve our nation's health by promoting good nutrition and increased physical activity outside of the direct medical system. In addition, Americans need access to nutrition counseling and care that helps prevent conditions from getting worse.

We have a long way to go before this is a reality. Right now, people who need care most have the hardest time getting the care they need. Insurance companies are realizing the staggering expenses associated with obesity faster than policy makers. Unfortunately, the consequence is that some are revising policies to pass costs onto the public. Forty-five states allow using obesity or health status as a risk factor to deny coverage or raise premiums, while only five have a law against this practice. Just this week we learned that the state of Alabama is going to place a surcharge on the insurance premiums of state employees who don't follow a prescribed weight loss plan.

This is where health reform comes in. Every American should have the right and opportunity to be as healthy as he or she can be. As we move to expanded insurance coverage, we need to make sure that all plans cover obesity prevention and treatment benefits without penalty. We can start by providing better Medicaid benefits.

This is especially important since there is a relationship between poverty and obesity. We found 10 states do not include specific coverage for nutrition assessment and counseling for obese or overweight children in their Medicaid programs. And 20 states explicitly do not cover nutritional assessment and consultation for obese adults under Medicaid. Only Georgia and Vermont have specific guidelines for treating obese adults in their Medicaid programs. In Nebraska and South Carolina, the Medicaid programs specifically state that obesity is not an illness and is therefore not covered. In the current economic crunch, states are struggling with Medicaid costs. Few have looked at improving prevention services to keep costs down by keeping people healthier.

As we look forward to entering into season of health care reform debates, it's key we demand that the debate doesn't revolve only around managing costs, because it's also about improving the country's health. By making prevention a centerpiece of reform, we are guaranteed to make progress on both fronts.