We Can’t Hide from the Hidden Costs of Obesity

By Vincent Ferriero   Whatever is said here about the hidden costs of obesity to the nation and individuals, it is not intended to demonize the obese in any way. They are the victims, not the perpetrators. In fact, many of the hidden costs are paid in ways that can’t be counted in dollars, everyday human costs paid by the obese individual. Life is simply more difficult and painful for them. So no one has more to gain from seizing control of their lives. Obesity is a disease and those who suffer from it should have the right to get well. The hidden costs of obesity appear all over the economic spectrum. They include home modifications and longer hospital stays. In some cases the added cost falls financially on the already struggling individual, but often it is paid by insurers or by state and federal programs, including housing agency grants, Medicare and Medicaid. Bathroom and kitchen modifications, grab bars, wider entrances, and entry ramps are just some of the home modifications often required in response to obesity. On the medical side, since diabetes is so closely tied to obesity, the real cause of many hospital admissions is often obscured. For instance, a recent report by the U.S. Agency for Healthcare Research and Quality shows that diabetics make up less than eight percent of the population, but they comprised almost twenty percent of hospitalizations in 2008. The majority of these hospitalizations involving diabetics had nothing to do with their diabetes. They were for other conditions. The report said that diabetes increases the amount of time patients spend in the hospital, thereby increasing the costs—whether the patient is there because of diabetes or a separate medical issue. And in ninety percent of the ever-increasing cases of type 2 diabetes, obesity is the cause. A short list of hidden costs of obesity passed on the public as a whole: • Hospitals in the U.S. are replacing wall-mounted toilets with floor models to better support obese patients. • Vehicles burns more gasoline carrying heavier passengers than lighter ones. An additional 938 million gallons of gasoline are used each year due to overweight and obesity in the United States, or 0.8 percent. The driver pays for the extra gas, but when demand goes up, cost goes up for everyone. • Blue Bird, the school bus company, is widening its front doors so wider kids can fit. • Ordering oversized coffins to accommodate their obese clients in death has become common practice at funeral homes. • The most obese men take 5.9 more sick days each year; for the most obese women it’s 9.4 days additional days. Obesity-related absenteeism costs employers as much as $6.4 billion a year. Even when obese workers do come to work, poor health can cut into productivity, as they encounter pain or shortness of breath or other obstacles. • The average airline flight is now carries an additional 1960 pounds in passenger weight than a few decades ago. It has become increasingly clear that while the cost of obesity is shared by many parts of the economy, the story always begins with marketing. The marketing of America is the door that shrewdly opens the nation to pervasive bad health. In a sense, Americans are denied personal ownership of our bodies and made vessels for new products which must be consumed. This is doubly true for the obese. Products are idealized and glorified, linked to exciting life styles—more fun than you are having now—to lure consumers down their path. And when the path to chronic bad health is followed far enough, another marketing path emerges and this one leads to all the medications needed to keep the unfortunate consumer limping along. Paula Deen, the Southern cooking queen famous for her deep-fried Twinkies, is a perfect example of how the American Marketing Machine captures consumers both coming and going. Ms. Deen built an empire on bountiful buffet tables and dishes like cheesy meatloaf that explode body mass index charts. She herself became obese and a diabetic. So what did this teach the American public? Ms. Deen’s response was not to advocate for controlling or curing diabetes by changing dietary habits; it was to promote a pharmaceutical answer to a lifestyle problem she helped create. In fact, she became the paid spokesperson for one of the leading medications designed to manage diabetes. So while Americans became obese and diabetic, Paula Deen became rich. Of course, even though prescription drugs are the chief source of obesity-related excess medical costs, Paula Deen is just a symptom of a broken system. When she launched her first restaurant, she wasn’t out to make people sick; she just wanted to make money providing the kind of food people would buy. Marketers will make the same claim—that they are just giving Americans choices among the kinds of products they already want. But the facts remain: Among the obese population prescription drug costs to Medicare average about $1,300 a year, an eighty percent increase measured against the “average weight” population. Overall, expenses for a normal-weight person on Medicare average $4,700 a year, while costs for an obese person range about $6,400 annually. The percentage of obese Americans—those with a Body Mass Index of thirty or higher—has tripled since 1960, now standing at thirty-four percent. The incidence of extreme or ‘morbid’ obesity (above 40 BMI) has risen by six hundred percent to six percent of the population. Some experts hope these changes and disparities, along with the stunning economic costs of obesity so often spread through the entire economy, could become the obesity epidemic's second-hand smoke. When scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air, policymakers finally got serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also motivated action. But many people want it both ways, and want someone else to pay. They recognize the harm—even if they don’t see the hidden costs—but don’t want to give up “freedom” of choice. Food, even excesses of food, plays such a central part in cultural rituals like holiday dinners that resistance seems instinctive. Laws mandating seatbelts or imposing tax penalties on cigarettes find ready acceptance from the public, but food is different, and therefore obesity is different. And, of course, political elements predictably rise up with cries of “nanny state” when anyone in the government—even Michelle Obama—suggests healthier dietary habits. Despite the political blowback, the effort continues. New York City recently announced a plan for a far-reaching ban on the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts. The proposed ban would affect most popular sugary drinks found in delis, fast-food franchises and even sports arenas, from energy drinks to pre-sweetened iced teas, limiting them to sixteen fluid ounces. In announcing the new measure, Mayor Bloomberg said, “Obesity is a nationwide problem, and all over the United States, public health officials are wringing their hands saying, ‘Oh, this is terrible.’ New York City is not about wringing your hands; it’s about doing something,” he said. “I think that’s what the public wants the mayor to do.” Hoping to turn the tide of the obesity epidemic, the federal Center for Disease Control (CDC) is promoting strategies it hopes will highlight the problem and encourage Americans to make changes to reduce obesity. The CDC plan calls for making healthy food more available, promoting more choices of healthy foods, promoting breast-feeding, encouraging physical activity and creating sites in communities that support physical activity, Dr. William H. Dietz, director of CDC's Division of Nutrition, Physical Activity, and Obesity, said during a recent press conference. "These recommendations, I believe, set the foundation for the community interventions necessary to reverse this problem in the United States." As we move toward a more responsive health care system and a healthier population, no one’s goal should be laying blame at the feet of any one group. The facts speak for themselves, but the response should be predicated on compassion and a better outcome for all of us.