In an article in the January 11, 2010, issue of The Mountaineer (Haywood County, NC), Garland Scott addresses concerns about obesity, its effect on health care, and the rising statistics of both adult and childhood obesity. For the record, Scott is president and CEO of UnitedHealthcare of North Carolina. Among the statistics Scott presents are the report that 27% of Americans are obese, the projection that 47.9% of North Carolinians will be obese within a decade, and the observation that childhood obesity rates have doubled in the past three decades. He is promoting education as the means to avert this “epidemic.”
While education is important (ask anyone who’s got one — or anyone who doesn’t), it appears to be a very slow route to achieving the goal of a healthy America. If eating/activity education is a success, it will take generations of it to turn the tide. There are many causes of obesity and overweight, and many of them are not included in curricula.
What is the difference between “overweight” and “obese”? According to the Centers for Disease Control and Prevention (CDC), both terms refer to “ranges of weight that are greater than what is generally considered healthy…also…ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems.” Overweight is defined, for an adult, as a “body mass index” (BMI) between 25 and 29.9; 30.0 or higher indicates obesity. Here is the formula, provided by the National Institutes of Health, to determine your BMI: multiply your weight in pounds by 703; divide that answer by your height in inches; divide that answer by your height in inches again. A 5’5”, 135-pound individual would have a BMI of 22.4 (18.5-24.9 is considered “healthy”), a 5’8”, 270-pound individual would have a BMI of 41.0 (morbidly obese).
According to the World Health Organization (WHO), one billion people are overweight, 300 million of them are clinically obese. WHO declares obesity “a worldwide epidemic.” Epidemic is not the proper term for this problem since an epidemic is a widespread outbreak of an infectious disease; the emphasis here is on infection and contagion. There are many causes of obesity, but so far no one has proven it’s caused by a germ.
One of the major concerns, besides health and mortality, is the skyrocketing cost of medical care. There are a host of diseases and disease conditions that are caused or exacerbated by excess weight, besides the well publicized diabetes and heart disease. Scott, in his article Obesity a statewide concern, cites projections that the cost to the State of North Carolina within ten years will be $11.14 billion dollars ($1473 per every adult). Educating children about healthful eating and the importance of physical activity cannot do much to alleviate that now. And the fix is needed now.
The government has not yet tried to put us all on crash diets; politicians can’t afford to do that to us. So how does America save itself from the obesity beast? Diets, diet plans, diet clubs, diet books, diet pills, and diet gurus are not the answer. The problem with all of these is that once the results are achieved the former fatty wants to return to satisfying, not healthful, food. Satisfaction here is not based on physical needs so much as emotional needs. Although some authors and diet designers address the issue of emotional needs, the solutions offered usually concentrate on a fast fix, because dieters are results-oriented.
The health insurance companies should take a much more active role in defeating the fat monster. It does not have just one cause—lazy people with no self-control—there are many causes (even our DNA is being blamed) and they require more than one solution. Insurers should aggressively promote the most successful weight loss method currently in use, bariatric surgery. Bariatric surgery is not for everyone, but it is for those at least 80-100 pounds overweight. For the uninsured, the cost ranges from $15,000 to $35,000, and there are several types of surgery, including stapling and banding. Insurance companies do not pay providers what an uninsured person pays — $15,000 is a lot of money, but the cost of health care for a morbidly obese individual over a lifetime is considerably more. Consider the cost of diabetic care or heart surgery. As in all weight-loss methods, there is some obesity recidivism; however the rate with bariatric surgery is extremely low. The health insurers have an awful lot to gain, if an awful lot of us lose weight. By promoting weight-loss surgery and making it accessible to those who need it, they will be doing a service not only to America but also to themselves. And isn’t that what health insurance companies are all about?
Bariatric surgery is not elective or cosmetic surgery; it is a life-saving procedure. It is also a quality-of-life-improving procedure. It’s not fun to be fat. There are some morbidly obese people who profess to enjoy being fat, and I am always astounded to hear this. Fat people’s lives are more difficult physically, socially, and emotionally. They are discriminated against and the target of jokes. Climbing stairs is difficult, running can be impossible. Compliments are scarce, “well meaning” advice plentiful, mirrors depressing, and dieting disheartening. I would not promote vanity surgery. If someone is 100 or more pounds overweight, vanity may play a part, but this surgery is necessary.
The terms “fat” and “fatty” may seem harsh in this land of political correctness, but as a “recovered” fatty, I stand by them. Ten years ago, on March 8, 2000, I underwent bariatric surgery. I went from being obese (BMI 37.9) to healthy (BMI 22.4) and have maintained this for ten years, with little effort. I have changed from being a draw on my communities to being a contributor. As an asthmatic who couldn’t roll over in bed without having an attack from the effort, I have experienced through the combination of weight loss and preventive medicine a reduction from my four or five daily attacks to five or six a year. There have been a number of other health and emotional benefits as well. My life has improved to the point where I want to go up to obese people and beg, “Please. You’re killing yourself. Have this surgery.”
I am not disparaging education, but I question its value in a health care crisis. An awful lot of time and money has been expended on tobacco education, but we are still dying from smoking- and chewing-related disease. Sometimes it’s imperative to take more than one approach, and this is one of them. Please, yes, educate our youth on the importance of fitness and healthful choices, but please also eliminate the threat that obesity poses to adults by eliminating it.