At Institute of Medicine obesity panel, a coordinated public effort is the doctor’s orders

The obesity epidemic is one of the most pressing problems the health care sector faces. Accounting for $190 billion in health care spending annually, obesity is one of the leading causes of preventable death in the United States.

While the numbers are staggering and the implications of obesity are grave, we are at a potential turning point in the fight.

The Institute of Medicine recently hosted a roundtable panel entitled “The Current State of Obesity Solutions in the United States.” During the discussion, leaders from the private sector, governments and non-profit groups reported on the progress of solutions and the actions being taken to rally against this disease.

Many panel members were optimistic about the state of potential solutions. A heavy emphasis was placed on strengthening patient engagement, expanding a “systems approach” in which obesity registries, data metrics and expanded health teams are used, and bolstering efforts to combat childhood obesity with increased exercise and nutrition standards.

Obesity as a disease needs a joint clinical-community response

The resonating theme from the panel was the need for a strengthened clinical-community relationship in which a larger part of the community participates in promoting a healthy lifestyle. Dr. Howard Koh, assistant secretary for health, spoke about the role society plays as health providers. “Health care goes beyond the doctor’s office; health starts where people live, learn, labor, play and pray.”

Dr. Howard Koh

Instead of stigmatizing obesity as an individual problem, Dr. Koh advocated for the treatment of obesity as a disease, requiring more than a simple diet plan and exercise routine.

The panel concurred that obesity is not just a health problem; it is a social problem that requires a comprehensive social response. Dr. Bill Dietz, chief consultant for the Institute of Medicine, compared the obesity epidemic and potential plateau in obesity rates in children to the rise and fall of tobacco use during the mid-20th century.

Lessons society can learn from anti-smoking campaigns

Smoking was first considered a critical public health issue when the link between smoking and cancer was originally reported in the 1950s. The rate of tobacco use leveled off during that period, but remained high well into the 1990s until rates gradually decreased.

Dr. Dietz explained that this drop off was the result of a very coordinated social campaign to inform the public about the severely negative impacts of smoking, while also providing resources to help users quit. With support from inside and outside the health care community, the campaign brought together doctors, celebrity spokespeople and educators to fundamentally alter perceptions and attitudes about smoking.

While anti-smoking campaigns tend to focus on scare tactics and graphic content to stigmatize smoking, I believe obesity campaigns should focus on providing support structures and promoting the tremendous rewards of living a healthy lifestyle.

Employers role in fighting obesity

One piece of good news is that public policy has recognized the necessity of broadening health care engagement outside of the doctor-patient relationship. A provision within the Affordable Care Act allows employers to charge obese employees an additional thirty to fifty percent in health care contributions to cover the increased cost of being obese, which on average is $1,152 more a year for men and $3,613 more for women.

The goal here is not to punish people for being obese, but rather to encourage individuals and employers alike to recognize the real costs of being obese.

One of those employers is Hy-Vee Inc., a grocery store chain in the Midwest. Speaking at the panel on behalf of Hy-Vee was assistant vice president of health and wellness Helen Eddy. Eddy explained how Hy-Vee uses a comprehensive method to promote the health of its employees; from healthy food choices in the work place, to an exercise-friendly work environment and behavior modification designed to address unhealthy choices.

The results are impressive. The cost of employer health care contributions is $6,400 per employee, nearly half the national average of $10,000 to $12,000 per employee. Hy-Vee has been able to give its employees a one month premium holiday five of the last six years.

There are some exciting things happening in the fight against this disease, but one big obstacle remains. Obesity needs to be recognized as a widespread social crisis, not just an individual problem. Increased social awareness and engagement can change that.

With obesity rates in children decreasing in many states, there is a glimmer of hope. Something is working. The question is will obesity rates plateau for decades to come just as tobacco use has in the past? Is stagnation good enough? What is your opinion?