The High Cost of Self-Inflicted Disease

The role of citizens vs. government in managing health goes beyond the current health reform debate in Washington.

An issue as big as healthcare is the environment. And so, what if there was a way to dramatically improve the health of all Americans while decreasing our consumption of fossil fuels by a billion gallons a year?

Transformational new technology? Innovative legislation from Washington?  The answer is simple. We would achieve these goals by reducing the weight of the average American to what it was in 1962. [1]

Sheldon Jacobson is a computer science professor who has studied the effects of obesity and fuel consumption.  His work points to a simple matter of physics. Heavier drivers increase fuel consumption. Car engines use more energy to move more weight. The added weight Americans have packed on since the sixties costs motorists an estimated $4 billion a year.[2]

Supersizing America

Americans are being “supersized” at an alarming rate as part of a global obesity pandemic that is driven by a variety of lifestyle and environmental factors. Around the world today more people now die from obesity than malnutrition. It has overtaken tobacco as the largest cause of preventable disease.

Obesity is a real disease recognized by the American Medical Association, World Health Organization and others. Like smoking, overreliance on alcohol and drugs, it is a non-communicable disease.

Communicable diseases, like flu, malaria and measles are caused by forces in nature. Most non-communicable diseases may be influenced by things like genetics or exposure to hazardous materials in the environment, but in some manner, are self-inflicted by choices we as consumers and as a society make.[3]

Let’s use obesity to illustrate how self-inflicted diseases impact both our health and our wallet.

Today, more than two-thirds (68 percent) of American adults are either overweight or obese.[4]  Since 1980 adult obesity rates have more than doubled.[5] [6] If nothing changes 42 percent of U.S. adults will be obese by 2030 with more than ten percent of Americans being severely obese. [7] 

And while obesity is an “equal opportunity” disease affecting all walks of society, it is more pervasive and impactful among low income Americans and minorities. [8]

Beyond its direct impact, obesity is also a “gateway disease”. It dramatically increases the prevalence of diabetes, cardiovascular disease, cancer, osteoarthritis, infertility, sleep apnea and other health conditions.[9]   For example, as the prevalence of obesity grows, new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis are on track to increase 10 times between 2010 and 2020 — and then double again by 2030.[10]

Over the next twenty years it is estimated that obesity will be a causal factor in 8 million cases of diabetes, seven million cases of coronary heart disease and stroke and a half million cases of cancer.[11]

A heavy price paid by all

Obesity is not only bad for our health, it’s also very expensive. Worldwide, obesity has the same economic impact as smoking or armed conflict.[12]

Within the United States, obesity-related illness treatments cost Americans an estimated $190.2 billion annually and will add another $550 billion in additional costs between now and 2030. [13] [14]

On average Americans who are obese spend more on medical services and medications than smokers and heavy drinkers. [15]  They incur 40% higher inpatient hospital costs, 27% more physician visits and outpatient costs and consume 80% more prescription drugs.[16]

Beyond direct medical, obesity impacts the productivity and competitiveness of America’s employers and workforce. A study by the Society of Actuaries estimates that U.S. employers are losing $164 billion in productivity each year due to obesity-related issues with employees.[17] The Robert Wood Johnson Foundation predicts that annual economic productivity loss due to obesity is likely to reach $550 billion by 2030.[18]

Without significant change, obesity-related costs will rise dramatically with increases being absorbed by employers and goods and services they provide. Consumers will be increasingly impacted by larger out of pocket expenses as well as higher taxes to support programs such as Medicare and Medicaid which are already teetering on the brink of disaster because of their national price tag. Obesity-related medical expenditures already cost these programs an extra $62 billion annually.[19]

Solving for Obesity is simple and complex

When it comes to understanding what is driving obesity and what can be done to slow or stop this epidemic, the answer is both simple and complex.

At a simple level the obesity epidemic is caused by Americans consuming more calories through food and beverages than they expend.

But the deeper answer to why this is occurring is rooted in a myriad of issues that have unfolded over the past four decades.

Today we live in a world where inactive lifestyles are the norm and inexpensive, high calorie foods and drinks are readily available 24 hours a day.

There are fewer safe places to walk or play. Parts of our communities (especially low-income neighborhoods) lack food outlets offering affordable, healthy foods. We are constantly bombarded by advertisements for unhealthy foods and beverages.

While we are all affected by these trends, our children are at greatest risk. Today, one in three American children is overweight or obese. The prevalence of obesity in children more than tripled since 1971 and is now the Number One health concern among parents in the United States, topping drug abuse and smoking.[20]

If you are a parent and want your child to be healthy, it would seem reasonable that there are simple things to do to ensure that they are not overweight or obese. For example, a study from the American Journal of Preventive Medicine found that eliminating just 41 calories a day could halt rising body weight trends in children and teens.[21]

Unfortunately, a variety of forces make it difficult to achieve such a simple goal.

Today the majority of children in the United States are high in added sugar and fat and too low in fruits and vegetables, whole grains, and low-fat and nonfat dairy products.[22]

Children are less active today than at any point in our history. On average, kids consume 7.5 hours of screen or media time a day.  In 1969, half of all children walked or biked to school. Today about 13 percent walk or bike to school.[23]

Fast food companies are specifically marketing to children and adolescents. In one study by the Robert Wood Johnson Foundation, McDonald’s was found to have the strongest emphasis on the children’s market, with 40 percent of 44,062 ads studied aimed at kids.[24]

Beyond the blitz of airtime focused on children, the fast-food companies use free toys and popular movies to appeal to kids by focusing on promotions, brands, and logos—not on food.[25]  

As a result, on any given day, more than one third of U.S. children eat fast food.[26]  French fries are now the most common “vegetable” that kids eat, making up 25% of American children’s total vegetable intake.[27]

And so, can something like regulating fast food advertising to children (like advertising bans and warning labels for tobacco products) impact the obesity epidemic in children, which in turn, may improve health and lower medical costs?

The province of Quebec banned fast-food advertising to kids in electronic and print ads 34 years ago. And while Canada is seeing as similar explosion in childhood obesity like the United States, Quebec has the lowest childhood obesity rate in Canada.

Researchers from the University of British Columbia who studied the impact of the advertising ban in Quebec concluded two things. First, the ban resulted in a 13 percent reduction in fast food expenditures.  At the same time, they estimate that 4 billion fewer calories were consumed by children in the province.[28]

In the end, childhood obesity has many consequences for our kids and our country. The most dire is that obesity may lead to a shorter life span for our children than that of their parents.[29] Children who are obese are more than twice as likely to die before the age of 55 compared to non-obese children.[30]

Solving for the Obesity epidemic brings us face-to-face with the need to better understand and make decisions as part of the health reform debate. Like other self-inflicted diseases (think smoking/vaping, alcohol/drugs), highlighting the consequences of Obesity illustrates the need to broaden the health reform discussion to include a view towards creating new paradigms and models to prevent or mitigate many of the health issues we now face.   Failure to do this means such medical and health conditions will continue to fill hospitals beds, cost more in dollars and deaths that would otherwise be prevented.


For Consideration:

  • What is your view in how to balance the responsibility of a citizen to manage their own health with the role government plays in legislating or regulating products and services in an attempt to create healthier environments and citizens?
  • Should drinks containing high amounts of sugar be regulated or taxed in an effort to reduce obesity (similar treatment to how alcohol and tobacco are taxed and regulated)?
  • What other actions might be taken by state and local governments to put forward legislation or regulations to create healthier environments which encourage a high level of health status or mitigate the effects of personal choices leading to a growing number of Americans who are destined to have costly health and medical conditions that could be avoided?

Additional Resources:

“Sugar: Consumption at A Crossroads” by the Credit Suisse Research Institute

Get the Facts: Sugar-Sweetened Beverages and Consumption from Centers for Disease Control and Prevention (CDC)

Learn more about Noncommunicable Diseases with news and information from the World Health Organization.


References:

[1] Sheldon Jackson (2006,2008), The Engineering Economist. “The Economic Impact of Obesity on Automobile Fuel Consumption,” published in The Engineering Economist (Volume 51, Number 4, 307-323, October –December 2006)

[2] Ibid

[3] Noncommunicable diseases fact sheet, (2013), World Health Organization, http://www.who.int/mediacentre/factsheets/fs355/en/

[4] Flegal KM, Carroll MD, Ogden CL, et al.  Prevalence and Trends in Obesity among U.S. Adults, 19992008. Journal of the American Medical Association, 303(3): 235-41, 2010.

[5] National Center for Health Statistics.  “Prevalence of Overweight, Obesity and Extreme Obesity among Adults.”

[6] Ogden CL, Carroll MD, Kit BK, Flegal KM.  Prevalence of Obesity in the United States, 2009-2010.  NCHS data brief, no 82.  Hyattsville, MD: National Center for Health Statistics, 2012.

[7] Ibid

[8] Trust for America’s Health and Robert Wood Johnson Foundation.  F as in Fat: How Obesity Threatens America’s Future — 2011.  http://www.tfah.org/report/88/ (accessed July 2012).  Based on data using the previous BRFSS methodology in use from 2008-2010.

[9] Y Claire Wang, Klim McPerhson, Tim Marsh, Steven L. Gortmaker, Martin Brown. Health and economic burden of othe projected obesity trends in the USA and the UK. The Lancet. 2011. 815-827

[10] F as in Fat: How Obesity Threatens America’s Future. Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation. 2012.

[11] Y Claire Wang, Klim McPerhson, Tim Marsh, Steven L. Gortmaker, Martin Brown. Health and economic burden of other projected obesity trends in the USA and the UK. The Lancet. 2011. 815-827

[12] Overcoming Obesity: An Initial Economic Analysis, McKinsey Global Institute, November 2014 http://www.mckinsey.com/Insights/Economic_Studies/How_the_world_could_better_fight_obesity

[13] John Cawley, Chad Meyerhoefer. The medical care costs of obesity: An instrumental variables approach. Journal of Health Economics, 2012; 31 (1): 219 DOI: 10.1016/j.jhealeco.2011.10.003

[14] [14] Ogden CL, Carroll MD, Kit BK, Flegal KM.  Prevalence of Obesity in the United States, 2009-2010.  NCHS data brief, no 82.  Hyattsville, MD: National Center for Health Statistics, 2012.

[15] Sturm R.The Effects of Obesity, Smoking,and Problem Drinking on Chronic Medical Problems and Health Care Costs.Health Affairs.2002;21(2):245–253.

[16] Ibid

[17]  Overweight and obesity study. Society of Actuaries. 2009. https://www.soa.org/Research/Research-At-A-Glance.aspx

[18] Trust for America’s Health and Robert Wood Johnson Foundation.  F as in Fat: How Obesity Threatens America’s Future — 2011. 

[19] Finkelstein, Trogdon, Cohen, et al.  “Annual Medical Spending Attributable to Obesity”.

[20] Overweight in Children, American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/Overweight-in-Children_UCM_304054_Article.jsp#.WGavuWwzWbg

[21] Wang YC, Orleans CT and Gortmaker SL.  Reaching the Healthy People Goals for Reducing Childhood Obesity: Closing the Energy Gap.  Am J Prev Med, doi: 10.1016/j.amepre.2012.01.018, 2012.

[22] Ibid

[23] The National Center for Safe Routes to School, 2011.   http://guide.saferoutesinfo.org/introduction/the_decline_of_walking_and_bicycling.cfm

[24] Fast-Food Television Ads Use Toys, Movies to Target Kids. Robert Wood Johnson Foundation. April 2013. http://www.rwjf.org/en/library/articles-and-news/2013/08/fast-food-television-ads-use-toys–movies-to-target-kids.html

[25] Ibid

[26] Caloric Intake From Fast Food Among Children and Adolescents in the United States, 2011–2012. Centers for Disease Control. September 2015. https://www.cdc.gov/nchs/data/databriefs/db213.htm

[27] Obesity in Infants to Preschoolers. American Heart Association. http://www.heart.org/HEARTORG/HealthyLiving/HealthyKids/ChildhoodObesity/Obesity-in-Infants-and-Preschoolers-Infographic_UCM_467593_SubHomePage.jsp

[28] Fast Food Consumption and the Ban on Advertising Targeting Children: The Quebec Experience. Tirtha Dhar Assistant Professor, Division of Marketing, Sauder School of Business, University of British Columbia. April 2011. http://www.marketingpower.com/aboutama/documents/jmr_forthcoming/fast_food_consumption.pdf

[29] American Heart Association, 2010; Olshansky et al., 2005

[30] Franks PR, Hanson W, Knowler M, et al.  “Childhood Obesity, Other Cardiovascular Risk Factors, and Premature Death.”  New England Journal of Medicine, 362(6):485-93, 2010.

Does Sugar Addiction Impact $1 Trillion in U.S. Healthcare Spending?

This article looks at the explosion of added sugars in our food and drink supply and reports on the health and cost consequences to all.

It is clear that the obesity epidemic is a key issue in the health reform debate as research conclusively shows that it drives significant increases in chronic diseases like coronary heart disease and diabetes.

What is less clear from a science and public policy perspective is the role sugar plays in both obesity and chronic diseases and what, if anything, should be done to regulate or manage its presence in our food and drink supply as part of the health reform debate in the United States.

“Sugar: Consumption at A Crossroads” is a groundbreaking report from the Credit Suisse Research Institute that explores the medical, economic, consumer and public policy implications of global sugar consumption.

Amongst the many data points and in-depth content in the report is this estimate of the economic impact of sugar in the United States:

“30% – 40% of healthcare expenditures in the USA go to help address issues that are closely tied to the excess consumption of sugar.”

The consumption of added sugar (sugar not contained in natural products like fruit or milk) or high-fructose corn syrup (HFCS) has increased dramatically over the last few decades. According to this report:

  • The world daily average consumption of sugar and HFCS per person now averages 17 teaspoons per day, up 46% from 30 years ago. This is the equivalent of 280 calories per day.
  • In comparison, Americans now consume an average of 40 teaspoons per day. As a benchmark, the American Heart Association recommendation for daily sugar intake is six teaspoons for women and nine for men.
  • Added sugars now represent 17% of a normal US diet with 43% of added sugars coming from sweetened beverages.

The report also includes a survey of physicians in the US, Europe and Asia. Key points from the physician view include:

  • 90 percent of the doctors surveyed believe that the sharp growth in type II diabetes and the current obesity epidemic are strongly linked to excess sugar consumption.
  • 82% of the doctors surveyed in the U.S. and Europe believe that sugar calories are handled differently by the body. 
  • On the question “is sugar addictive,” 65% think this is the case.

While medical research has yet to prove conclusively that sugar is the leading cause of obesity, diabetes type II and metabolic syndrome, the balance of recent medical research studies are coalescing around this conclusion. Advances in understanding the negative effects of refined carbohydrates on blood sugar regulation and cholesterol, and the metabolic impacts of fructose, are changing the traditional view that all calories are the same.

From a public policy perspective, governments and regulators have done little to address the impact of sugar consumption. Typical options often discussed, but rarely acted upon, include higher taxation as an attempt to reduce sugar intake while helping to fund healthcare costs related to obesity and diabetes, as well as increased spending on educating and explicit product labeling and warnings.

Worldwide, obesity now kills more people than starvation and malnutrition. The rapid growth of obesity, diabetes and related nutritional issues is arguably America’s top social health concern for which solutions can be devised to slow the growth and improve both health outcomes and costs.

And so, there is an opportunity to bring this social determinant of health into the mainstream of the health reform discussion. It’s a great example of the choices we can make to either continue to spend more money caring for the those medical maladies that come from the over-consumption of added sugars, or investing in a thoughtful response to increasing public awareness to deal with the root causes to slow the trend and improve the health of citizens.


For Consideration:

  • As part of health reform, what role, if any, should government play to address the growing implications in how the rapid rise of sugar impacts health status and eventually health costs?
  • Should sugar be regulated in ways similar to the treatment of other items that impact consumer health such as tobacco products?
  • Do you look at, or monitor, the level of added sugars found in the items you and your family consume? How does personal responsibility come into play when it comes to reducing the impact of sugar becoming a significantly higher portion of the average Americans caloric intake?

Additional Resources:

To go deeper on this topic:

“Sugar: Consumption at A Crossroads” by the Credit Suisse Research Institute

Get the Facts: Sugar-Sweetened Beverages and Consumption from Centers for Disease Control and Prevention (CDC)