Sunday, December 6, 2009

Fat Pride and Cost of Health Care

Obesity is nothing to laugh about when we're talking about shortened life spans, but also means $$$ for our country's health care costs.

According to this study from November by the United Health Foundation, the American Public Health Association and Partnership for Prevention via America's Health Rankings, we're looking at $344 billion in 2018, or more than one in five dollars spent on health care if trends continue. This means spending attributable to obesity will quadruple. And if we held the obesity rate to its current level, the country would save nearly $200 billion a year by 2018, which is $800 per adult.


By 2018 Colorado would be the only state where less than 30 percent of adults would be obese. But in Kentucky, Maryland, Mississippi, Ohio, Oklahoma and South Dakota, more than 50 percent of adults would be obese.

(What's most tragic is that, according to AMR again, the United States has the highest death rate from treatable conditions of 19 industrialized countries.)

This is why I was so surprised to read about Fat Pride Communities about a month ago, who are saying healthy should be the goal, and not thin. A lot of these ideas are also advocated in The Obesity Myth, a book written last year by U. Colorado law professor Paul Campos (something I find interesting as Colorado is the only state with an obesity rate-18.5%-under 20% in the entire US).

Campos writes the following:

First, it's a fake problem. Second, the solutions for the problem are non-existent, even assuming the problem existed. Third, focusing on making Americans thinner diverts resources from real public health issues....The correlations between higher weight and greater health risk are weak except at statistical extremes. The extent to which those correlations are causal is poorly established. There is literally not a shred of evidence that turning fat people into thin people improves their health. And the reason there's no evidence is that there's no way to do it.

Which is pretty much what the Fat Pride Community is saying. But I don't understand how an obese person losing weight-the healthy way, not the liposuction way (which has shown to not make a difference on LDL/bad cholesterol, blood pressure, among other things)-has not been shown to be healthy. Now WebMD isn't the final arbiter on this, obviously, but I challenge you to find someone who will tell you an obese person who loses weight via a healthy diet and exercise regimen is worse off.

And then while Campos may be right that it's hard to lose weight (make a fat person thinner), that doesn't mean our latest efforts of prevention are for nothing. From requiring restaurants to post calorie-content to schools banning junk food, well, I completely support these efforts.

Then you look at how 77% of obesity is due to genetics, and the rate at which we've seen obesity spread, and Fat Pride is saying size discrimination is the same as race discrimination?

In the last few decades we've managed to turn this many people fat. I don't see why we can't do anything to reverse ourselves or prevent more damage.

Saturday, December 5, 2009

Obesity is the new lung cancer

Eating more than you burn is worse than smoking, according to a study published in The New England Journal of Medicine Wednesday.

Declines in smoking in the last 15 years increases today's 18-year-old's life expectancy by 0.31 years, while rising obesity reduces that expectancy by 1.02. So we're looking at a net loss of 0.71 years.

According to the lead author of the study, Susan T. Stewart, in the last 15 years smoking rates declined 20%, but obesity rates increased 48%. So if this continues, nearly half of our population will be obese by 2020.

Her 48% number corresponds with the CDC, which also breaks it down into race groups as well.



Well my free trial to NEJM expired months ago and for some reason NYU will only give the abstract summary of the study, so I've yet to figure out how to get my hands on the entire thing. What I'd like to know if the study takes into account the diminished life expectancy of those who get secondhand smoke, which would be an obvious factor. After all, you don't get fatter by breathing next to fat people. But whatever the accurate number is, I'm sure it wouldn't change the overall message, which is a message we've been hearing for a long time now.

But according to another study last year published in the American Journal of Clinical Nutrition, why obesity happens is attributed 77% to genetics as opposed to environmental factors (prevalence of fast food and poor exercise habits). Which you can take it to mean that obese people are only marrying other obese people, adverse selection ("moderately overweight" women are more fertile), or our environment of cheap transfat calories (read Michael Pollan's books for convincing info on this, or Fast Food Nation, although it was written 5 years ago) has truly become horrendous for your health. This question is unanswered by the researchers themselves.

Hopefully we'll get closer to genome therapy for an "obesity cure" and keep away from the olestra and oily stools (here too). But considering most diseases as far as we know are multi-gene disorders and following the death of 18-year-old gene therapy patient Jesse Gelsinger caused by a massive immune response to the virus vector used to transport the gene into his cells, continue your healthy habits and don't bet on a magic pill just yet.