Obesity; The "Second Hand Smoke" of Modern American Society

It’s no surprise when we hear on the news that America has an obesity problem. Nurses are acutely aware that more of our patients are so obese that it is beyond our ability to help them with rolling over in bed and mobility. I work in a GI setting where we do EGD’s and Colonoscopies and I see the problems severe obesity causes for anesthesia such as airway issues. That is what spurred me to look into how obesity affects the cost of healthcare. In three articles, I will explore the basic question of cost, the second will look at the added risks for rural patients, and the final article will address childhood obesity.

Obesity; The "Second Hand Smoke" of Modern American Society

Our country's rising trend over the past few decades of eating processed food and dining at fast food restaurants has added to the obesity problem according to the article, "Obesity is bankrupting America, disease costs soar," by J.D. Heyes. Convenience and lower cost of these high calorie foods can be appealing to some consumers.

Obesity is addressed in the 2010 healthcare reform law, allowing employers to charge more to their overweight employees for health insurance. In fact, they can charge 30 to 50 percent more to employees who refuse to participate in a weight loss and health/ wellness programs. Additionally, in the article, "Obesity Now Costs Americans More In Health Care Spending Than Smoking," by Rick Unger tells us that Obamacare "funds community programs designed to help people take off the extra pounds." Medicare and Medicaid receive incentives to help recipients get into a weight loss program.

There is growing concern among Federal and state officials over the growing amount of federally funded health care towards treating obesity. Lucas Jackson states in his article, "How the Obesity Epidemic Drains Medicare and Medicaid," that one third of Americans are obese. The annual cost of obesity is estimated to be 305.1 billion dollars according to an analysis by the George Washington University. That number includes not only direct medical care, but indirect as well such as worker productivity loss and disability issues. Some officials believe that funding to treat and prevent obesity should be a private sector rather than federally funded.

It remains to be seen whether pumping so much money into federally funded weight loss programs actually will decrease our nation's obesity problem while the temptations on every street corner remain.

Some of the risks of obesity are; diabetes, heart disease, some cancers, and osteoarthritis. It's the "second hand smoke" of our generation in American society (Heyes). A BMI of 30 percent or higher is considered obese, while 40 or higher is morbidly obese. Since 1960, the percent of obese people has tripled to 34 percent and morbidly obese has increased by six times. Those with a BMI of 25-29 or "overweight" has stayed pretty much the same.

In the article, "Economic Costs," they estimate the cost of obesity related health care in 2005 to be $190 billion (This number is different than the above mentioned one, but they are estimates from different sources). Indirectly, there are costs such as higher life insurance premiums and more in worker's compensation for obese employees over those who are not. Also, the days employees are not at work are a cost to the employer due to short term absences and long term disability. The article also mentions the word, "presenteeism" which means that these obese employees may not work at full potential. It is estimated that the obesity related health care costs will increase by $66 Billion by the year 2030 if obesity in America continues to grow at today's current rate.

Breaking that down a bit, for each obese individual, the cost (in 2006) was an added $1429 per individual, a 42 percent hike over the average weight person. "Economic Costs," reports that " In middle-aged men, treatment of five common obesity related conditions . . . resulted in roughly $9,000 to $17,000 higher costs compared to normal weight adults".

There are several ways America's growing waistline has affected shrinking wallets - through increased insurance premiums and higher energy costs. Yes, one billion dollars of additional gasoline is used due to the extra strain on cars because of obese drivers and obese passengers (Unger).

Obesity has taken the top spot from smoking as the highest costing health risk. As Unger tells us, "smokers die early enough that they save Social Security, private pensions, and Medicare trillions of dollars," but obese people live just about as long as those who maintain a normal weight.

Caring for the severely obese poses problems for the patient themselves as well as healthcare workers. Hopefully, as smoking has decreased, obesity will one day too. Please share your insight into this issue and I look forward to sharing my next article that will look into how obese patients who live in rural areas face additional health care problems.

References

"Economic Costs." N.d. Obesity Prevention Source. 25 January, 2015. Web.

Heyes, J.D. "Obesity is Bankrupting America, Disease Costs Soar." Sunday 6 May, 2012. Natural News. 26 January, 2015. Web.

Jackson, Lucas. "How the Obesity Epidemic Drains Medicare and Medicaid." 15 December, 2014. The Fiscal Times. 26 January, 2015. Web.

"The Healthcare Costs of Obesity." N.d. State of Obesity. 25 January, 2015. Web.

Unger, Rick. "Obesity Now Costs Americans More In Health Care Spending Than Smoking." 30 April, 2012. Forbes. 26 January, 2015. Web.

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Brenda F. Johnson

About Brenda F. Johnson, MSN

Gastrointestinal Columnist
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Specializes in LTC, assisted living, med-surg, psych.

Thank you for this non-biased, non-judgmental piece on obesity. I look forward to reading the entire series.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

As a now normal-weight person who had reached the morbid obesity category multiple times during my life (highest BMI 42.5), my perspective on this issue is somewhat skewed and biased.

Obesity is prevalent on my mother's side of the family. My mother is 5'3" and nearly 300 pounds, and my grandmother died at 77 years old in 2002 weighing 411 pounds. Most of my aunts and female cousins have weight problems.

People will suggest lifestyle changes...I've been there and done that. I've been on some type of restrictive diet since puberty and my weight has massively increased and decreased in a yo-yo pattern. I've lost and regained the same 75 to 100 pounds at least five times in my lifetime. Weight gain is rapid for me.

I'm now at a normal body weight and wear a size 6 to 8 pants size. The key to my weight maintenance is limiting my CHO intake to less than 120 grams per day. Carbs keep my body in constant fat storage mode due to constant insulin production. To limit the insulin levels in my body, I must stick to a high-protein moderate fat diet.

Obesity is a lifelong disease process...it cannot be 'cured,' but it can be kept in remission through lifelong weight control and constant vigilance. Good luck to everyone who is fighting the battle of the bulge. I understand your struggles.

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Thank you for the article.

I think that the focus on obesity is classic * the horse is already out of the barn*. Just because one is thin doesn't mean the same damage isn't occurring.

We want to keep allowing the sale of crap non food, even in our schools and healthcare facilities because we don't want to be the food police but we expect people to not become addicted to these foods that focus groups intentionally formulate to do just that. It's up to the parents to teach their kids how to eat in moderation bla bla bla..

And how's that working out for us?

I think crap should only be allowed to be consumed by adults, just like alcohol and cigarettes. At least let's make sure the kids get a first good 12-17 yrs (obviously going to be hard to control a teen but we don't have to sell it at the school snack bar).

I also think we need to make junk food uncool. No dressing it up. Manufacturers want to sell crap to our kids, fine, but it can't be marketed in a colorful package nor advertised in the media.

On the flip side, incentives for selling whole foods. Not the processed crap trying to be whole foods, but real whole foods.

Trying to help the already obese is of course something we need to do, but there's a futility to it. Got to get them as kids.

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Specializes in geriatrics.

Agreed. The ability to lose or gain weight varies for all of us and it's so complex. It doesn't help that fast food and convenience food is EVERYWHERE.

Also, healthy food is expensive and rising. The cost of groceries over the last year is outrageous, at least where I live. I consume less meat now simply because I refuse to pay 8.00 for one chicken breast, or worse yet 20.00 for an average cut of beef.

It's very unfortunate, but obesity will only get worse due to the high cost of living.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
At least let's make sure the kids get a first good 12-17 yrs
This is easier said than done for kids who grow up in less advantaged households. I grew up in a financially stressed household. My parents frequently paid the rent late, utilities were occasionally disconnected, and at times there was only $20 left for groceries.

What types of foods do people purchase with $20 that must be stretched for two weeks to feed a family of three until the next paycheck arrives? Processed carbs will ensure the family is fed for those two weeks. Kraft boxed macaroni & cheese was $0.50 per box and served as meatless dinners. Top Ramen noodles were 10 for $1.00. A 10-pound sack of potatoes was $2.00 and a 5-pound bag of white rice was $1.50. Sources of protein included hot dogs ($0.99 per 10-pack), eggs ($0.99 per dozen) and bologna cold cuts ($0.99 per 16 slices).

Society shames families for buying processed junk foods. However, produce and lean meats are somewhat pricey outside the major agricultural states. On the other hand, simple carbs and processed foods are dirt cheap due to subsidies. Somethings gotta give...

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Specializes in geriatrics.

My grocery bills are on average 100/ week (just me). This includes no condiments or butter either (I don't like the taste), no treats, and maybe 2 pieces of fresh fish.

Fish is cheaper than beef where I live now, and it doesn't matter where I shop anymore. One store is more or less the same cost.

My friend feeds one child and her grocery bills are 150/ week for a family of 3. We make good money, but imagine the working poor. These families are eating cheap foods simply out of necessity.

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This is easier said than done for kids who grow up in less advantaged households. I grew up in a financially stressed household. My parents frequently paid the rent late, utilities were occasionally disconnected, and at times there was only $20 left for groceries.

What types of foods do people purchase with $20 that must be stretched for two weeks to feed a family of three until the next paycheck arrives? Processed carbs will ensure the family is fed for those two weeks. Kraft boxed macaroni & cheese was $0.50 per box and served as meatless dinners. Top Ramen noodles were 10 for $1.00. A 10-pound sack of potatoes was $2.00 and a 5-pound bag of white rice was $1.50. Sources of protein included hot dogs ($0.99 per 10-pack), eggs ($0.99 per dozen) and bologna cold cuts ($0.99 per 16 slices).

Society shames families for buying processed junk foods. However, produce and lean meats are somewhat pricey outside the major agricultural states. On the other hand, simple carbs and processed foods are dirt cheap due to subsidies. Somethings gotta give...

That's what I meant by people will say it's up to the parents instead of govt intervention. Many parents don't or are unable for a variety reasons. The schools and healthcare facilities on the other hand don't have to allow crap on their campuses. And there could be subsidies and incentives for real food.

That said, I doubt it'll ever be easy. But it doesn't make sense to me to spend a significant amount of our budget on trying to make people un-obese if you're not going to try to prevent it in the first place

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I think we've all seen families spend more on crap than they would on real food, even those who would appear to be disadvantaged. And much of the cause of that are those focus groups making sure those foods are addictive. Why buy plain generic Cheerios when you can buy generic pink crap. Price is the same but the plain stuff isn't as addictive or appealing.

Not that plain Cheerios is great but our obesity epidemic didn't start with low sugar bland foods that have always been around.

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Specializes in OR.

I agree with all of what has been said thus far. I find it rather interesting that with all the governmental programs regarding healthy eating, the gripe that people should eat better in spite of there being too much month left at the end of the money and the insurance whine that obesity cranks up health care costs, few insurance companies are will to pay for weight loss measures that actually work. This thought is aimed at what the first poster said about having crummy genetics combined with the human tendency to conserve energy/calories for in a time of need. I for one am like said poster. I have fought my weight for nearly my entire adult life. i can exercise until i drop and diet until I starve, not lose a pound and yet seem to be hungry and can gain weight with a vengeance. i have done the weight loss surgery thing and had health issues that necessitated a reversal of said surgery i have had doctors tell me it is a matter of calories in/calories out and i just need to exercise more and eat less. Uh...they of all people should know that metabolic weirdness plays a part in that too.

Anyhow, i digress. i have found a medication that helps the metabolic issues and addresses the hunger issue. I have actually lost weight The problem is that it is horrendously expensive and the majority of insurance policies outright exclude it, including all policies bought through Obamacare. So essentially my insurance (ironically through my hospital employer who has a thriving weight loss surgery program) will bellow at me about non viable so called solutions and threaten to charge me more for the crime of having a low metabolic rate yet will refuse to cover, even at a premium copay the very medication that will fix the issue. additionally i question the manufacturer who merely increased the dose and repackaged a medication that has been on the market for years then put it out as an obesity fix. This is because of an incidental finding that a side effect was weight loss. Research and development, my tuchas. Just some food for thought, heh!

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Specializes in ED.

Seems like much allowance and sympathy for obese people here, but cigarette smokers are still the scapegoat for society... oh the irony. Obese people should be beaten upon just like smokers, alcoholics, drug addicts. Or perhaps, no one should be beaten upon? Tax each individual according to their sins? Smokers need a reprieve though, they have been taxed unfairly long enough, and no, I'm not a smoker...

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Specializes in Cardiology, Cardiothoracic Surgical.

Love this article! I think it's all interconnected honestly...we don't make it a priority currently in our health care system, so it's not. When I get tired of the hospital, I'll probably go to community/public health and devote my time to these very issues.

I want to see:

1) real financial incentives for employees to get healthy, lose weight (free gym memberships, access to affordable healthy food in cafeterias, reduced health insurance premiums)

2) children eating better (real nutritious food in school lunch programs, community gardens, kids allowed to be kids and go outside and play, parents involved in learning how to cook actual food at home)

3) better designed cities and suburbs where one can actually walk, bike or have access to public transportation (not driving everywhere nonsense)

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