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. Nurses General Nursing Article

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.

I don't disagree one bit about poverty affecting nutrition, but in my personal circles I don't know anyone that lives in poverty or anything close to it (a couple are on modest incomes) but I know a lot of people who are obese and/or morbidly obese. We're about 50-50 at work. 25% make professional salaries with a health science degree, in an affordable area of sunny California.

And then there's my significant other who lives in San Francisco, he and several of his friends had sustained hard times during the recession, none of them are overweight.

Flat broke or financially comfortable, food culture is pervasive.

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.

Amen. CHO restricted diets are probably the only effective way to deal with weight gain in certain individuals who lean towards diabetes/metabolic syndrome. That's the only way I can keep my weight down, though even up to my late 30s I could eat anything I wanted as long as I worked out faithfully. It's unreal how difficult it is to find products without added sugar at the grocery store. Pasta sauce, peanut butter, and salad dressings come to mind as products which are perfectly fine without added sweeteners, yet nevertheless are loaded with the stuff.

We have a favorite restaurant we have been going to for years. One day, they had braised cabbage with little bits of goat cheese on it as their vegetable special. It was pretty good. Later, I realized what that ? ingredient was that I'd been trying to figure out. Next time we went, they had it again and I asked how it was prepared. Answer: olive oil, spices, and brown sugar! Stated by the waiter as if that was a good thing. It really irritated me that this had not been communicated. Think of all the diabetics who are trying to do the right thing by getting veggies. I asked him, "how about your Brussels sprouts? Are those prepared with brown sugar?" "Oh, no," he replied, "those are braised with turbinado sugar!"

We are in a really bad place as a society when we feel like it's necessary to drown our veggies in sugar.

So frustrating when you are trying to do the healthy thing.

I don't disagree one bit about poverty affecting nutrition, but in my personal circles I don't know anyone that lives in poverty or anything close to it (a couple are on modest incomes) but I know a lot of people who are obese and/or morbidly obese. We're about 50-50 at work. 25% make professional salaries with a health science degree, in an affordable area of sunny California.

And then there's my significant other who lives in San Francisco, he and several of his friends had sustained hard times during the recession, none of them are overweight.

Flat broke or financially comfortable, food culture is pervasive.

I agree with you. Just looking around my workplace, the rate of folks who are overweight is probably 80 %. And we all make a decent living, live in an area where access to outdoor exercise is abundant.

It is definitely not related to "being poor". People are making poor choices.

My own BMI is 26 so I need to lose some weight as well. My own choice has been to ratchet down my exercise when a year ago I was training and ran a half-marathon. I do the low carb thing most of the time but fall off that wagon occasionally.

It is all choices I make that determine my health.

Eating out is tough too when you are looking to do low carb but I've looked online at restaurants "ingredients" list and that is helpful. But it takes commitment to do so.

I love pasta but rarely eat it. I did find a low-carb pasta that tastes good though. Look up the "Dreamfields - Healthy Carb Living" label.

Specializes in Pharmaceutical Research, Operating Room.
I have to agree with you. Crime rates influencing exercise? It's more like, TV influencing paranoia. True the creepers are out there, like they've always been, but sensationalism is to blame when a guy is scared to chat with the neighborhood children for fear of some accusation.

Off topic, but all the advertising, and the sensationalism, and the constant, unwavering national paranoia and negativity were the main reasons we ditched our cable, got a Roku, and stopped watching nearly as much TV as we used to. I'm only 32, but it completely disgusts me what "entertainment" and the "news" have become in our society.

Crime rates are about as low as they've ever been. Such a fallacy about modern safety that's repeated over and over.

There are many parts of Southern California, especially in the Greater Los Angeles area that have a very high population and are not very safe for kids to run around alone. Regardless of what the crime rate is, I would not want my kid to be playing outside alone in an area where all the houses have bars on the windows.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
CHO restricted diets are probably the only effective way to deal with weight gain in certain individuals who lean towards diabetes/metabolic syndrome.
Yep...I had metabolic syndrome as recently as a year ago: total cholesterol of 254, a hemoglobin A1C of 5.7%, excessive waist circumference, and slightly elevated blood pressure. I was going to become a diabetic if I didn't make changes. After all, my mother, father, at least three grandparents, several aunts and cousins were/are all diabetics, so I have the genetic propensity to develop diabetes as well.

Despite an 82-pound weight loss, a normal body weight, and adherence to a CHO-controlled diet, that pesky A1C only dropped to 5.6%. Regardless of what anyone says, weight control is not a simple matter of balancing calories in with calories out for certain susceptible people.

and for those that DO attempt everything for weight loss, facing surgery as a last resort, even that is not a financial answer. My insurance charges a 50% copay on top of my $1500 per year deductible! How is that feasible?

Specializes in Psych, Addictions, SOL (Student of Life).
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

I am very against e government getting to involved in the rights and business of private citizens. At one public school near me the district wanted to ban sack lunches all together among other silly rules which is why my son get to private school. He can eat the food I make for him and no common core math! "

hppy

Specializes in geriatrics.

Making healthy food choices can be so confusing, especially for those who don't really understand what they're eating.

Aside from all the junk and convenience foods, all the hidden fats and sugars complicate matters. As a result, you may be able to afford the healthier alternatives but for various reasons choose not to buy them, or perhaps you desire healthier alternatives and cannot afford them.

Regardless, portion sizes have increased approximately 30 percent in the last 30 years. We have so many choices now, and food is addictive.

I was raised with a single parent, and we ate poorly because there was no money. This is the case for many households. However, the other side of this are the families who have the financial means to eat healthy and choose not to.

There are many factors at play.

I am very against e government getting to involved in the rights and business of private citizens. At one public school near me the district wanted to ban sack lunches all together among other silly rules which is why my son get to private school. He can eat the food I make for him and no common core math! "

hppy

I didn't mean that kind of government intervention. I'm talking about the schools having quality food available for the kids whose parents don't send them with anything or perhaps don't or aren't able to provide nutrient dense/adequate protein at home.

I have a teenage son who is so appreciative that I make him hummus and turkey sandwiches so he doesn't have to buy the food at school, it's pretty bad when a teenager says the food is crap.

If we're gonna spend billions why not do it at the front end?

Specializes in Psych, Addictions, SOL (Student of Life).
I didn't mean that kind of government intervention. I'm talking about the schools having quality food available for the kids whose parents don't send them with anything or perhaps don't or aren't able to provide nutrient dense/adequate protein at home.

I have a teenage son who is so appreciative that I make him hummus and turkey sandwiches so he doesn't have to buy the food at school, it's pretty bad when a teenager says the food is crap.

If we're gonna spend billions why not do it at the front end?

I agree that we can all do better - I am an hour shifter so I work 5 days a week. When I cook it's always pretty healthy stuff, But when hubby is in charge it's fast food mostly. I make sacklunches with my kid every morning: Sanwich, fruit , a cookie or snack and a bottle of water. Every thing I cook is from fresh seasonal locally sorced fruits veggies and meats and I grow a garden. my son eats every thing I put on the table. it's really not more expensive than fast food but it requires planning and effort. Plus every meal we plan together is a lesson in math,nutrtion, and healthy bodies. I am fat always have been no sure why because I eat pretty healthy - I woud guess that my higher power likes me this way.

Peace and Namaste

Hppy

You can live without smoking, drinking and drugs. You must eat to live. There is no irony here. Smoking, drugs, and alcohol are all addictive choices people make because they decided they wanted to look cool, numb the pain, or just feel good. The were not forced to start doing it, they will not die if they stop "cold turkey" (well, severe alcoholics and some drug users could). You can't just quit eating.

Food is an addiction for many. Poor eating choices occur for many reason, education, poverty, laziness or just not caring. Lack of exercise is a huge contributor for children/young adults. There are also metabolic issues that come in to play for some (but not all).

Yes healthier choices need to be made, people need to exercise more. We are getting fatter as a nation, but comparing obese people to other addictions is not the same.

And yes, I am obese (morbidly at that).

Now me being a morbidly obese nurse telling people to eat better and exercise more, that is irony.

I guarantee that if people stopped eating processed foods and ridiculous amounts of sugar - even cold turkey - they will not die.

So, yes, I see the irony the PP spoke of.

I grew up in a poor family with limited food choices as well, however I CHOOSE now what I buy. Just like a smoker CHOSE to start smoking. "Back in the day", it was the cultural norm to eat these kinds of diets due to finances, or familiarity, but so was smoking.

Both are incredibly hard habits to break and its a shame that smokers are crusified while obese people ate coddled. Why can't we be supportive of both? I say this as a smoker and someone who has a BMI of 30 (read: obese).