12/01/2010 01:49 pm ET | Updated May 25, 2011

US Health Care Reform: As Seen From the Trenches: Part 3 of a 6-Part Series

The obesity epidemic is putting ever-increasing strain on the U.S. health care system. The United States leads the world in obesity, thus qualifying our population as the world's unhealthiest. Obesity rates are about 30 percent of the population (defined as a body mass index of over 30- (weight in kg)/(height in meters squared)). Rising obesity, which is responsible for pervasive disease processes manifest in all areas of medicine, increases health care cost exponentially.

Every pound an individual gains in fat causes their cells to respond less and less effectively to insulin, putting pancreatic beta cells into overdrive for insulin production. Beta cells eventually become nonviable due to excess strain from chronic insulin resistance, leading to type two, "adult diabetes." This pathology is also beginning to affect the growing number of obese adolescents in the United States.

Diabetes leads to cardiovascular disease on the macro and microvascular level. Macrovascular diseases include heart attacks, cerebrovascular accidents (embolic/ischemic strokes), end stage kidney disease (with renal artery disease), and blindness (through retinal artery disease). Microvascular diseases include neuropathy, (with loss of distal sensation initially -- fingers and toes -- predisposing to infections due to poor blood supply, leading to amputations starting in the toes and working up the feet and legs to viable tissue), as well as further insult to kidney and retinal disease.

Aside from diabetes, obesity is associated with hypertension, arthritis (from the stress created on joints through carrying around an unnatural amount of human weight), asthma/pulmonary conditions (secondary to the muscles of respiration being unable to fully expand the chest underneath an overbearing load -- the so called Pickwickian syndrome from Charles Dickens, "The Posthumous Papers of the Pickwick Club"), and obstructive sleep apnea (resulting from too much soft tissue laxity in the upper airway during sleep, creating momentary asphyxiation until arousal occurs), which itself causes a constant fatigued feeling, non-productivity during the workday, pulmonary hypertension leading to right sided heart failure, and fatal car crashes from chronic exhaustion. The morbidity and mortality linked with obesity is extensive. The cost of managing patients with obesity-related disease is colossal.

Calculations of obesity's economic impact, through tabulating aggregate direct health care costs and lost human productivity, demonstrate dollar ranges in the 100's of billions. These calculations are daunting and complex, given the wide-ranging impact of obesity. One gains an appreciation of the magnitude of obesity's cost, and the challenge in accurately portraying it, through considering medication costs for diabetes and its numerous associated pathologies (hypercholesterolemia, hypertension, retinal disease, etc.), dialysis costs for chronic renal failure, inpatient medical and outpatient rehabilitation costs for stroke patients, and the opportunity costs of losing great numbers of viable, working-aged individuals to disease processes, accounted across all areas of the health care system.

The Italian Renaissance notions of beauty revolved around voluptuous, thickened flesh, which symbolized wealth during the early 1500's, a historical era where diseases of starvation and malnutrition plagued society's poorest populations. Ironically, we are now in a historic era where our indigent populations are affected by diseases of excess (obesity), which is coupled with the modern post World War II idea of the social welfare state taking responsibility for its citizens from "cradle to grave." Progress and modernity have created food surpluses so abundant that all levels of society have access to plentiful nutrition. Population studies and empirical measures have delineated that poorer segments of the U.S. population are disproportionately affected by obesity. Various social and economic reasons may account for this fact, such as a lack of understanding and education about nutritional value or unavailable balanced and healthy food supplies. This population in particular faces tough challenges in dealing with obesity and its costs. Since the poorest populations are dependent on the social welfare institutions of Medicare and Medicaid, a disproportionately obese, underprivileged population places excessive pressure on the U.S. health care system and Federal Government.

Preventive care is the essential, cost-effective fix for the obesity epidemic. While awareness of the obesity epidemic in the United States seems to be present from health care workers to politicians, the results of a thinner society are lagging. Discipline and personal accountability are paramount in combating obesity. Eating less and exercising more are complex individual decisions that can be aided with strong societal/cultural pledges to healthier living. Educational programs, community events, and social institutions will be integral components in creating the collective willpower and changes necessary to beat obesity. As it stands, there are no signs of the trend toward an ever-obese society reversing.

Debilitating strain on the system is easy to contemplate when the voluminous health problems resulting from obesity are extrapolated across an increasingly obese society. Sustaining such a system implicates drawing more money from an ever-shrinking tax base (with unemployment hovering at nearly 10 percent in the United States and nearly 50 percent of the population currently not paying federal taxes) in order to support social welfare institutions. The ramifications for health care costs are in my opinion deleterious and the sustainability of such a system is impossible.