How Do You Solve A Problem Like Obesity?

It's time again for the annual ranking of states by percentage of the population that's obese. Typically, this is reported with breathless headlines like "Fattest State!" or "Is It Time for (insert state name here) to Go on a Diet?" The story dominates the news cycle for a day, as horrified newscasters show disturbing images of overweight people (zooming in on their midsections, of course). The concern lasts all of 24 hours before we all move on to the next looming crisis.

Here's what I'm wondering, though: if the statistics are so disturbing (and yes, I think they really are), shouldn't we focus our time and energy on trying to do something about the problem instead of wringing our hands and shrugging our shoulders helplessly? I need to add a disclaimer here: I'm one of the statistics, because I'm overweight, too. So I say these things as someone who is fully aware of the problem, because the problem is me. Still, the numbers I'm reading are certainly something to be concerned about. My home state of North Carolina, for example, reports that 28.3% of the adults are obese, and 33.5% of the children are either obese or overweight. Those stats represent a rank of 12 and 14 in their respective categories. I'm struck by the fact that 1/3 of our children are overweight or obese, and nearly as many adults are obese. That, by any definition, is a lot.

The study outlines a number of areas for concern, and several are worthy of note. Anytime we talk about obesity, we tend to quickly focus on weight, and particularly diet. A study like this has the potential to serve as a wake-up call, but only if we look at all the pieces. What I mean, I guess, is that the solution to a problem like obesity, particularly where children are concerned, is bound to be complicated. We won't be able to decrease obesity levels quickly or easily. That's not to say it can't be done, however, or that we shouldn't try. Anyone who's been successful at losing weight can attest to the fact that it's possible, and that it's worth it. But if we really want to do something about our national obesity problem - and it really is a national issue - we have to think broadly. Obesity isn't just about the food we put in our mouths. It's about how we take care of our bodies; how we think about health care. Are doctors the people we go to in a crisis, with whom we rarely interact otherwise, or are they the ones we collaborate with in order to reach a better, healthier lifestyle? At a time when the economy is suffering, how do we think about where and how we spend our time and our money? Do we go for the easy, cheap options, or do we think beyond the processed food choices so readily available to us and search out other possibilities, such as buying from local farms? Instead of spending inordinate amounts of time glued to our TVs, computers, and video games, or riding in cars to destinations we could easily walk to, do we make an effort to spend time being physically active each day - and trying to set an example for our kids and families?

We didn't get to this point in our lives quickly, but through a long history of choices we make individually and corporately. That also means we won't make changes easily, nor without a concerted effort. But it is possible; I truly believe that. I think it starts with 2 important steps: first, by the choices I make as an individual to lead a healthier, more active life; and second, by talking about those choices with the people around me, in an open conversation about what our shared goals are and what we can do together to make things better for all of us. That's how we can begin to solve our obesity problem, with small steps made consciously.

Paying Our Way to Better Health?

The state of North Carolina announced recently that it was considering a change to how much its employees will pay for health insurance premiums, and the potential change has caused quite an outcry. The basic problem with the state employees' health insurance plan is that it's losing money, and the primary reason is that it is insuring too many sick employees. The costs are high enough that younger, healthy employees can often find cheaper insurance for themselves and their dependents by opting for private insurance.

The solution, according to the state: charge higher premiums for those employees who are smokers and those who are overweight. Not surprisingly, the suggestion met with almost immediate opposition. How could the state know which employees smoke on their own time? And how would they determine if an employee was overweight, without raising enormous privacy concerns? I'll leave the debate about insurance costs for smokers for others, but I am curious about the notion of making people pay more for insurance because they weigh too much.

Obviously, I've had my own struggles with my weight, and my bias would generally be in sympathy with the overweight. It is an interesting conundrum, though. The reality is that for the most part, people who weigh more also have more health problems, including issues like diabetes, heart disease, and breathing problems. Those health issues often translate into higher health costs, so the insurance companies and those who provide insurance (both government agencies and private employers) have a vested interest in how the health of their employees translates to the bottom line. At the same time, it's hard to avoid the sense that people are being punished for something that may or may not be within their control. In this particular case, the standard for being "overweight" which would trigger higher premiums equated to weighing 35% more than normal (and I recognize that "normal" can be difficult to define). The state would also provide a method of exemption for those who are medically unable to lose weight. Still, it does raise the specter of a clash between our public and private lives, where our employers would be interested in the number on the scale, and would be able to, in essence, reach into our pocketbooks to make us pay the price for our unhealthy choices.

And that right there is the main issue, as far as I'm concerned. What is the right approach to encourage people to strive for a healthy, active lifestyle? It seems to me like this is basically a "stick" approach; in other words, punishing people for not eating good things or being physically fit by making them pay more money for health insurance. But I have to wonder whether a "carrot" approach might be more helpful. I'm not sure if I want to advocate for paying people for good behavior. But I also might be more motivated to lose weight if I knew that doing so meant a financial payoff in the form of perhaps a cash bonus or a rebate on my health care expenses. Maybe that's greedy or mercenary of me, but I'd prefer to think of it as being practical. If there's a tangible benefit to staying on the straight and narrow when it comes to eating healthy - money, in this case - then I'm much more likely to stick with it. The end result is the same: I'm healthier and don't need to visit the doctor as often, and that's what will make me and my health insurance provider happier - and maybe even for some of the same reasons.

Obesity in the U.S.

A report was released recently about what is being increasingly called the "epidemic of obesity" in the United States. It's not exactly big news, in the sense that it's probably not surprising to most people. Like many, I've had my own struggles with obesity. I've finally moved off the "obese" part of the BMI rankings, but I'm still officially "overweight," so this is something I think about a lot.

What I wonder about most of all, though, is what can be done about this epidemic. The folks who released the study have proposals of their own, including increasing government spending and focusing resources on healthy programs. That's all well and good, and obviously with a problem this large and affecting so many people, it needs as much attention as it can get. But what to do on a much smaller level: individuals, families, friends and workplaces? I know that my company occasionally talks about issues of health and fitness, but what does that really mean? If they were truly committed to encouraging their employees to follow or pursue a healthy lifestyle, I have to wonder if they would do more - like remove the junk good from the vending machines, or at least provide some healthy options. They could provide showers for those who bike or walk to work. Or (gasp!) provide financial incentives to those who lose weight or take other steps to be healthy.

But the responsibility isn't just corporate, it's personal. So what's a family or an individual to do? Parents can strive to set a good example for their kids by eating more fruits and vegetables, and foods rich in whole grains. We can choose active options for family get-togethers: going for a walk or a bike ride. But I also know that there's a place here for personal responsibility. I was at a seriously unhealthy weight for a long time before I finally decided to do something about it. I made my own choices, and I paid the prices for the bad ones. I had to get to the point where I wanted to lose weight for me, to make the effort to live a healthier life because it was what I wanted. And there's no government program that could make me do that; I had to do it for myself.