America’s progress in arresting its obesity epidemic has been too slow, and the condition continues to erode productivity and cause millions to suffer from potentially debilitating and deadly chronic illnesses, according to a recent report from the Institute of Medicine. Obesity has a human toll of obesity-related chronic disease and disability, with an annual cost of $190.2 billion for treating obesity-related illnesses.
In April 2012, Mayo Clinic released a study that found people who are obese paid more in health care costs than smokers. Mayo Clinic tracked their insured employees and retired employees from 2001 to 2007 to determine how much more smokers and the obese paid in annual health care costs. People who were obese averaged $1,850 more in health care and health insurance costs per year than those who maintained a healthy weight. In comparison, people who smoked averaged $1,275 in additional costs per year. Those who were morbidly obese paid between $5,467 to $5,530 more in additional health care costs per year when compared to other members of the group.
Solving this complex, stubborn problem requires a comprehensive set of solutions that work together to spur across-the-board societal change, according to the committee that wrote the report. It identified strategies with the greatest potential to accelerate success by making healthy foods and beverages and opportunities for physical activity easy, routine and appealing aspects of daily life.
The committee evaluated hundreds of prior strategies for their promise in accelerating obesity prevention over the next decade. It mapped how the most promising interacted with, reinforced, or slowed each other’s progress. This “systems approach” way of thinking allowed the committee to identify recommendations and understand how they would be important individually and, when implemented collectively, would further strengthen efforts to prevent obesity. The result was the series of goals:
- Make physical activity an integral and routine part of life
- Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice
- Transform messages about physical activity and nutrition
- Expand the roles of health care providers, insurers, and employers
- Make schools a national focal point
Specific strategies that the committee noted include requiring at least 60 minutes per day of physical education and activity in schools, industry-wide guidelines on which foods and beverages can be marketed to children and how, expansion of workplace wellness programs, taking full advantage of physicians’ roles to advocate for obesity prevention with patients and in the community and increasing the availability of lower-calorie, healthier children’s meals in restaurants.
“As the trends show, people have a very tough time achieving healthy weights when inactive lifestyles are the norm and inexpensive, high-calorie foods and drinks are readily available 24 hours a day,” committee chair Dan Glickman, executive director of congressional programs, Aspen Institute, Washington, D.C., and former secretary, U.S. Department of Agriculture said in a statement. “Individuals and groups can’t solve this complex problem alone, and that’s why we recommend changes that can work together at the societal level and reinforce one another’s impact to speed our progress.”
The report calls on health insurers to improve coverage of, access to, and incentives for routine obesity prevention, screening, diagnosis, and treatment. It said both public and private health insurers should include access provisions to address obesity prevention, screening, diagnosis, and treatment.
Potential actions include:
- insurers considering the inclusion of incentives in individual and family health plans for maintaining healthy lifestyles
- insurers considering benefit designs and programs that promote obesity screening and prevention, plus innovative approaches to reimbursing for routine screening and obesity prevention services in clinical practice and for monitoring the performance of these services in relation to obesity prevention
- insurers taking full advantage of obesity-related provisions in health care reform legislation.
The report’s proposed strategies and action steps aim to support individuals’ and families’ abilities to make healthy choices where they work, learn, eat, and play. For example, it said healthy food and beverage options should be available at competitive prices everywhere that food is offered and an effort should be made to reduce unhealthy products.
Fast-food and chain restaurants could revise their recipes and menus to ensure that at least half of their children’s meals comply with federal dietary guidelines for moderately active children and charge little or no more for these options, the report said. Shopping centers, convention centers, sports arenas, and other public venues that make meals and snacks available should offer a full variety of foods, including those recommended by the dietary guidelines.
Americans are surrounded by messaging that promotes sedentary activities and high-calorie foods and drinks, the report notes. The food, beverage, restaurant, and media industries should step up their voluntary efforts to develop and implement common nutritional standards for marketing aimed at children and adolescents up to age 17.
The report said government agencies should consider setting mandatory rules if a majority of these industries have not adopted suitable standards within two years. To increase positive messaging about physical activity and nutrition, government agencies, private organizations, and the media could work together to develop a robust and sustained social marketing campaign that encourages people to pursue healthy activities and habits.
Fiscal policies could help increase access to healthy foods and activity, the committee notes. For example, flexible financing or tax credits could be used to encourage developers to build sidewalks near new housing and locate supermarkets in communities without them.
Given that children spend up to half of their waking hours in school and consume a third to half of their daily calories there, schools can be a gateway to healthy habits, the report said. Schools should be given the resources and support to implement federal nutrition standards for meals and for products served in vending machines, concession stands, and other venues.
Students in every grade should have opportunities to engage in at least 60 minutes of physical activity daily through quality physical education and active classroom activities. Schools should make food literacy part of their curricula; USDA could support this by developing age-appropriate nutrition information for lesson guides.
“Obesity is both an individual and societal concern, and it will take action from all of us — individuals, communities, and the nation as a whole — to achieve a healthier society,” IOM President Harvey V. Fineberg said in a statement.
The report’s blueprint for action is being released in conjunction with the new “Weight of the Nation” initiative, which includes an HBO documentary series presented in collaboration with IOM, in association with CDC and the National Institutes of Health, and in partnership with Kaiser Permanente and the Michael and Susan Dell Foundation.
The initiative seeks to spur individuals and groups to get involved in local efforts to promote healthy eating and activity. The IOM report was sponsored by the Robert Wood Johnson Foundation.
