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.

Specializes in LTC.

Can I make a request? Can I ask that we specify Type 2 diabetes when discussing obesity and diabetes. 1 in 3 type 1 women suffers at some point from an eating disorder (Joslin). Part of this is due to a constant food consciousness required, but part of it comes back to being treated in healthcare and in society as if they have a disease of obesity. Please end the stigma around diabetes as a whole, but especially be aware of how clinical language effects the individuals afflicted. Please specific type, and please note the genetic link in type 2 when speaking about diabetes.

Specializes in Med-Surg Nursing.

I'm obese..Still am after weight loss surgery in 2009. I was lucky then because my then-health insurance covered WLS except I had to pay a $2000 copay...fine by me! Now, I have a WLS exclusion on my new insurance policy that came with my new job. A state job, to be exact. I had WLS related blood work last year and since it was coded Bariatric Surgery follow-up, I was charged for the full amt of the tests...over 3k! Well, I wrote my insurance company a letter stating other reasons that they should approve my lab work. Like my Hashimotos Thyroiditis, my history of kidney cancer (of which I'm now OK just minus 1 kidney) to name a few...and they approved it.

So why am I still obese after WLS? Well, I also have a herniated disc and 2 bulged discs in my lower back which make anything but walking painful and exacerbates my back pain. I live in the snowbelt and it's impossible to walk during the winter months. Secondly, I also started taking Neurontin for the nerve pain that runs down my left leg. It's made me gain 30 lbs in the last year. On top of 3 epidurals and one spinal nerve block, all with steroids in them. Well the last spinal nerve block has worn off and I'm seeing a new pain management Dr next month.

I do try to eat mostly protein but as we all know it's very expensive. I've kept my high cholesterol WNL as well as my Hgb A1c levels. Now my mother also had WLS the same year I did and she was once off her diabetic meds but her A1C went up to 6.5 so her Dr put her back on metformin and that was with NO weight gain :/ So diabetes is definitely in my family tree.

I need to go back to the WLS Dr's to see if he'll put me back on phentermine/Topamax again...it did help the last time I took it I lost about 25lbs! Hopefully my husbands insurance policy will cover it since mine will not. :(

Specializes in orthopedic/trauma, Informatics, diabetes.

One thing about school lunches: they are in the same category as prison food, so kids that are free/reduced lunch, which is pushing 50% of the population here in the South where I live, are fed CRAP. I have two type 1 children and I pack their lunches because the carb counts fora school lunch is >150 g PER meal. If they eat breakfast and lunch at school, it adds up. I have had WLS sx to try and reverse my T2, I am at the gym 2-3 hours 3-4 days a week and need 60-90 g protein/day-my kids needs a lot of protein to reduce insulin needs. It is expensive to eat high quality protein and fresh fruit/veggies.

What do you think started it then?...factory farmed meat with steroids and antibiotics in their feed grains?...pesticide laden seed crops where scientists writing to the W.H.O. specify that the chemicals in them lead to a hormonal imbalance to any animal that consumes them - one such hormone is cortisol that most everyone here knows is the biggest contributor towards the deep fat tissue accumulation we know is the worst fatty tissue to have?

Where are the stops to the food advertisers the marketers the food conglomerates that provide what they call "food" to our schools? The food lobbying industry, yes INDUSTRY. I remember visiting farmers selling their produce and eggs and cheese off their trucks in the city - a sight my two children will sadly never see. A trip to the farmers market in a car is the best I can do. Yet I pass 4 grocery stores selling their sugar fested chemically processed cheaper foods as I do.

nonsense! Obeseity & 2nd handsmoke (have not heard that term fora LONG time). Obeseity is self indulgence, you are your own worst enemy. Oh but that couch and the McD burger with double cheese looks soo rude and good. but the trick is, to get off the couch and go for a walk at least once a week. Get the point?

As for smoke..Up here you have to go across the street (100') to enjoy a smoke. Why? Becasue smokers are rude & stand by the door way to get their fix.

Here's another contributor, we have health care providers who lack the knowledge about the topic to speak about it but they do anyway.

I'm a former nutritionist turned nurse. It isn't just fast/junk food that is causing this problem. The problem is that the field of nutrition (based in biochemistry and not fully understood without such knowledge) has become political fodder for government organizations wanting to push particular foods/ideas down our throats (literally). What am I talking about? You know that nutrition course you took for nursing prerequisite? Politics. Even the basic chemistry used is not enough to understand the way nutrition works.

Myth Number One, the lie going on for almost two full decades now is that dietary fat makes you fat. Nope, nada, CAN'T do that. It is and has always been starch/sugar/carbohydrates. And with the million and one "health professionals" recommending "whole grains" and a diet of "complex carbohydrates" (that mainly come from starch), people can't figure it out. Swapping out puffy white starches and sugars for "whole grain" versions are not going to cut it. They all break down into the same glucose molecules in the end. Sure, you can get them through the system faster (fiber) but you'll still break most of them down because they're SO EASY to break down, even with the fiber. And you don't need even HALF of what you're eating of them.

I always tell people when they remark on how I am able to keep my weight down in my 40s, "Well, if you had any idea of how much fat I eat!" Blood lipids? Fabulous. All of my vital stats are great. NO HEALTH ISSUES. My younger siblings? Not so great. So no, it isn't just genetics. If you want to get rid of the obesity epidemic, you'll have to pay the real cost of food, tell people the truth about their food, recognize that nutrition professionals are just as propagandized to about how health studies work as any other health care worker (the main reason I left the field), stop talking to doctors about nutrition (because they have NO IDEA; they don't have the background) and start doing some research yourself.

You have been duped long enough and I've only brought up ONE issue. If I tried, I could go on all.........day.........long.

Main rules (with REAL science behind them): avoid sugar, limit starch, if you're sensitive to a food stay away from it (and find out what you're sensitive to), stop eating food out of BPA lined cans and bottles or out of shrink-wrapped plastic whenever possible, buy organic (that's poison-free, GMO-free food with lots of soil organisms that you NEED), don't wash the dirt completely off of your organic produce (root vegies, etc), eat cultured and fermented foods whenever possible (daily), grass-fed free range meat/dairy/eggs OR NOT AT ALL, I personally would not eat as much seafood as recommended if you want to avoid some really huge toxins that are totally unavoidable otherwise (yep, it's a bummer), eat coconut oil, grass-fed butter and olive oil but fats from grass-fed meats are also good. An avocado a day would benefit anyone, nuts make the best snack ever (forget about all of those calories they have- that's another topic entirely). Throw away all of those soy/canola/corn oils but cold pressed nut oils are fine. Grain in serious moderation, depending on sensitivity. And remember, you don't have to eat any particular food. That's right, you can live without it. There is no 100% rule for all.

I'm sorry that I can't explain all of this but it would be enormous.

Well, you did a pretty good job right here. Well said.

I'm a former nutritionist turned nurse. It isn't just fast/junk food that is causing this problem. The problem is that the field of nutrition (based in biochemistry and not fully understood without such knowledge) has become political fodder for government organizations wanting to push particular foods/ideas down our throats (literally). What am I talking about? You know that nutrition course you took for nursing prerequisite? Politics. Even the basic chemistry used is not enough to understand the way nutrition works.

Myth Number One, the lie going on for almost two full decades now is that dietary fat makes you fat. Nope, nada, CAN'T do that. It is and has always been starch/sugar/carbohydrates. And with the million and one "health professionals" recommending "whole grains" and a diet of "complex carbohydrates" (that mainly come from starch), people can't figure it out. Swapping out puffy white starches and sugars for "whole grain" versions are not going to cut it. They all break down into the same glucose molecules in the end. Sure, you can get them through the system faster (fiber) but you'll still break most of them down because they're SO EASY to break down, even with the fiber. And you don't need even HALF of what you're eating of them.

I always tell people when they remark on how I am able to keep my weight down in my 40s, "Well, if you had any idea of how much fat I eat!" Blood lipids? Fabulous. All of my vital stats are great. NO HEALTH ISSUES. My younger siblings? Not so great. So no, it isn't just genetics. If you want to get rid of the obesity epidemic, you'll have to pay the real cost of food, tell people the truth about their food, recognize that nutrition professionals are just as propagandized to about how health studies work as any other health care worker (the main reason I left the field), stop talking to doctors about nutrition (because they have NO IDEA; they don't have the background) and start doing some research yourself.

You have been duped long enough and I've only brought up ONE issue. If I tried, I could go on all.........day.........long.

Main rules (with REAL science behind them): avoid sugar, limit starch, if you're sensitive to a food stay away from it (and find out what you're sensitive to), stop eating food out of BPA lined cans and bottles or out of shrink-wrapped plastic whenever possible, buy organic (that's poison-free, GMO-free food with lots of soil organisms that you NEED), don't wash the dirt completely off of your organic produce (root vegies, etc), eat cultured and fermented foods whenever possible (daily), grass-fed free range meat/dairy/eggs OR NOT AT ALL, I personally would not eat as much seafood as recommended if you want to avoid some really huge toxins that are totally unavoidable otherwise (yep, it's a bummer), eat coconut oil, grass-fed butter and olive oil but fats from grass-fed meats are also good. An avocado a day would benefit anyone, nuts make the best snack ever (forget about all of those calories they have- that's another topic entirely). Throw away all of those soy/canola/corn oils but cold pressed nut oils are fine. Grain in serious moderation, depending on sensitivity. And remember, you don't have to eat any particular food. That's right, you can live without it. There is no 100% rule for all.

I'm sorry that I can't explain all of this but it would be enormous.

Organic grass fed is ideal but i think pushing this ideal can discourage people who can't afford it. Even entry level will still have its benefits.

Specializes in Critical Care; Cardiac; Professional Development.
Organic grass fed is ideal but i think pushing this ideal can discourage people who can't afford it. Even entry level will still have its benefits.

Exactly. The vehemence of the GMO grassfed orhanic bandwagon is causing harm due to the overwhelming polarizing message from its followers. It is all good stuff but when a patient is trying to wade through the emotional and conflicted journey of trying to yet again tackle this beast, such standards are near impossible to assimilate.

I advise my patients to start slowly. Make the change just to whole foods first. Then tweak it out as new habits are built. There is nothing like a slip up within a history of failure to engage all or nothing thinking and leads swiftly to giving up. First and foremost the little changes must be sustainable. Then one can start moving toward more idealized versions that incorporate organic local grassfed etc

Specializes in geriatrics.

Just learning to minimize processed foods, fast food and added sugar will do wonders for your overall physical and mental health. Organic is not always better and it's expensive.

Just learning to minimize processed foods, fast food and added sugar will do wonders for your overall physical and mental health. Organic is not always better and it's expensive.

Organic is definitely not better when it comes to nutrition. And yes, much pricier.

Moderation is most likely the key for most people although I do low-carb most of the time. Too many carbs make me feel sluggish so if I eat a sandwich - even a healthy sandwich - the carbs in the bread make me feel bad the rest of the afternoon. I do something protein at lunch. Either a low-carb Costco shake or maybe a boiled egg, chicken breast, cheese stick.

Specializes in geriatrics.

Same. I don't eat bread at all. Maybe 3-4 times a month I'll indulge with a whole grain wrap. I find bread makes me feel very lethargic.

Curious what did u find that worked for u?