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Health Costs of Obesity Near Those of Smoking: HHS Secretary Presses Fast-Food Industry
By Ceci Connolly, Washington Post Staff Writer
Wednesday, May 14, 2003; Page A09

The treatment of illnesses related to obesity costs America $93 billion a year, rivaling the financial toll of smoking-related disease, according to an analysis being published today.

Health care for overweight and obese individuals costs an average of 37 percent more than for people of normal weight, adding an average of $732 to the annual medical bills of every American, the study found.

The analysis, underwritten by the U.S. Centers for Disease Control and Prevention, affirms what many doctors have long asserted -- that obesity is a major factor in America's rising health care costs -- and makes the case that obesity should be targeted as aggressively as smoking, the authors conclude. Medical costs connected to obesity and smoking each account for about 9 percent of all health expenditures.

In television interviews yesterday on the subject of obesity, Health and Human Services Secretary Tommy G. Thompson pressed the fast-food industry "to do what is right for Americans," such as offering low-calorie meals and tips on healthier living. "We're asking them to step up and see if they can do innovative things, like encouraging their customers to eat properly and to exercise," he said on CNN.

The findings, which will appear on the Web site of the magazine Health Affairs, could have broad implications for how the public and private sectors approach the challenge of caring for a population that is living longer, exercising less and eating poorly. Obesity is a major risk factor for diabetes, hypertension and heart disease, and the economic burden is heaviest on Medicaid and Medicare, the government health programs for the poor, disabled and elderly.

"Obesity is something as costly to society as smoking, yet the government and private health insurers have done very little to reduce obesity rates," said Eric Finkelstein, one of the lead authors and a researcher at RTI International, a nonprofit think tank in North Carolina.

Over the past two decades, as scientists and economists detailed the impacts of tobacco use, policymakers and private insurers responded with a combination of incentives such as discounted medical premiums and punitive measures such as higher tobacco taxes. Now, with more than half the nation's population overweight or obese, the study's authors argue, it makes sense to tackle America's weight problem.

Obesity is defined as having a body mass index (BMI) of at least 30. Being overweight is defined as having a BMI of 25. BMI is a formula in which a person's body weight in kilograms is divided by the square of his or her height in meters. Using American units of measurement, an adult who is 5 feet 5 inches tall and weighs 150 pounds would have a BMI of 25.

"There has been a debate about whether obesity is a personal or societal issue and whether the government has any business being involved," Finkelstein said "The fact that the government, and ultimately the taxpayer, is financing half the economic burden of obesity suggests that the government has a clear justification to try to reduce obesity rates."

Among the approaches that have been suggested by Thompson and others are advertising campaigns, a tax on fatty foods, subsidies for fruit and vegetable purchases and discounted health insurance for people who participate in weight loss programs.

"McDonald's, by the way, is putting more salads on their menus and diversifying," Thompson said. "And I think that's a wonderful sign."

As lawmakers face rising federal deficits, the study shines a light on where more and more tax dollars are going. An obese Medicare recipient spends on average $1,500 more on medical care each year than non-obese seniors. Medicaid recipients, who are mostly poor, may have a higher prevalence of obesity because they engaged in "riskier behaviors" such as poor diet, lack of exercise or alcohol consumption, Finkelstein speculated.

The analysis was based on a representative sample of more than 9,800 adults. Because the survey relied on individuals to report their own height and weight, Finkelstein said, it likely underestimates the problem. The analysis calculated only direct medical expenditures, not indirect costs such as lost productivity. Thompson said recent data put those costs at $56 billion.

Given that smoking and obesity now exact comparable financial tolls, the study concludes, "it may be increasingly difficult to justify the disparity between the many interventions that have been implemented to reduce smoking rates and the paucity of interventions aimed at reducing obesity rates."

2003 The Washington Post Company

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