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Monday, August 17, 2009

Obesity and health care

On Sunday, the San Francisco Chronicle published "Obesity a Crushing Weight on U.S. Health Care," which points to the obesity epidemic as a driving force behind the high cost of health care.

Duh.

Seriously, it's taken this long for a reporter to make such a conclusion? And I thought us journalist types were supposed to ahead of the curve.

Obesity is linked to a variety of nasty life-threatening conditions: Type II diabetes, high blood pressure, congestive heart failure, certain types of cancer. Diseases -- especially ones like diabetes and cancer -- are expensive to treat. Therefore, it stands to reason that obesity is linked to high health-care costs.

I remember when I was originally researching surgical weight loss. There was a lot of controversy at the time over the BMI requirement most insurers had for patients to qualify as having a medical necessity to lose weight.

WLS experts and obesity researchers talked about the cost benefit of covering weight-loss surgery for people with BMIs of 35-40 because they thought it was easier for a smaller patient to physically withstand the rigors and trauma of major surgery. They also believed that patients who were able to drop a large amount of weight BEFORE their bodies sustained irreparable damage from excess weight would be more successful in the long run. Insurance companies, on the other hand, viewed weight loss as a vanity measure and didn't want to cover it until it had already caused life-threatening diseases. Only then did the cost of the surgery win out over the cost of managing a long-term disease.

I also remember being very angry back then that WLS was my only option for insurer-covered weight management. I couldn't understand why an insurance company wouldn't pay for a year of intensive nutritional counseling and personal fitness training in an effort to prevent a patient from ever needing surgery.

At that point, I was able to speak to someone in the insurance industry. She was blunt and to the point: Insurance companies could not justify the expense of an obesity treatment that depended too much on an individual's compliance. People are fickle, and they sabotage themselves, she said. Paying for a year of nutritional and fitness counseling offered the insurance company no guarantee. However, surgery did. At least with surgery, there was a higher chance of immediate and long-term results.

My, how the pendulum has swung in the last five years. Now, many insurance companies require potential WLS candidates to undergo six to 12 months of medically supervised weight management before surgery can be approved. Some programs are hosted in hospitals by third-party groups. Others are offered by bariatric surgery centers. And others are semi-private. The motivation behind the programs are as varied as their sponsors. Some are merely there to prepare patients for life after WLS, which is the patient's ultimate goal anyway. Others are focused on getting patients on the track to better health so they abandon their desire for WLS. And others fancy themselves to be objective, saying they don't promote or condone WLS procedures but that they don't discourage their participants from pursuing surgical weight loss either.

One thing is certain, despite the increase in WLS over the last five years, obesity is still an epidemic and those afflicted are getting younger and younger.

Solutions mentioned in the Chronicle article include limiting fast-food establishments, creating public gardens and taxing junk food. Making healthy living more convenient and affordable sounds like an easy answer. I wish it were.

But the reality is that humans are human, and we've created this conveniently unhealthy culture we live in. If there were a public garden in every neighborhood, how many people would truly take the time to tend it so that it reaped a harvest that everyone could benefit from? And would that truly reduce the amount of processed foods each family consumes?

And as far as taxing junk food goes, I think that will have a marginal effect on consumption as well. I remember when cigarettes were first taxed in the 1980s. My mother, a longtime smoker, was not about to pay an extra 25 cents a pack for cigarettes and she quit cold turkey. But you know what? Her friends didn't. They all complained about the tax, but they kept smoking. Some still smoke today, and I don't think they've cut back. I imagine a junk food tax would have the same effect. Some may quit fast food altogether, others might cut back on trips to drive-thrus and soda/candy purchases, but many will cut other expenses just so they don't have to be inconvenienced.

Looking at my own situation, I can honestly say I hope my children never know what fast food is. I don't want a drop of McDonald's, Jack in the Box, Taco Bell, etc., to ever touch their lips. But is that anything more than a pipe dream? Fast-food advertising is everywhere: TV, billboards, radio, vehicles, clothing, the list goes on. How do I shield my children from that when I can't even shield myself?

I don't want my children to suffer my fate. I don't want them plagued by the social stigma and physical limitations of obesity, but I also know I can't raise them in a bubble. I am glad that obesity is back in the spotlight as a public health issue -- because it really does affect the entire population. At the same time, though, I realize that it is my job to ensure my children develop a healthy relationship with food and that they maintain a healthy level of activity. It may not be easy for me to cook dinner every night and take the time to play outside with my children, but if I don't, who will? And if I don't take the time to ensure my children are active, who will I have to blame when they develop sedentary habits?