Think Tank

Fat Californians Putting Strain on Health Economy

A lot of Californians are fat, and they’re putting a strain on their own health, as well as the state’s economic health.

More adults in California are obese or overweight than those who aren’t, according to a new study.  Almost 40% of children in public schools in California are overweight or obese, according to another study.

A UCLA Center for Health Policy Research study released this month found that almost 60% of California adults are overweight or obese and that almost 8% of the state’s adults have diabetes.

A study released last month in the journal Pediatrics found that between 2001 and 2008, 38% of California’s fifth-, seventh- and ninth-graders were overweight, 19.8% were obese and 3.6% were severely obese.

Rates of obesity and diabetes in California are considerably higher than national goals and both appear to be rising. Extra pounds make it harder for people to stay healthy and they take a financial toll on the state, as well. According to California Health Interview Survey, California’s costs related to obesity are reported to be $21 billion a year. California’s total annual cost of diabetes is estimated to be $24 billion — about $17 billion spent on direct medical care and $7 billion on indirect costs associated with the disease.

We asked stakeholders how policy makers and insurers should combat obesity in California.

We got responses from:

Think Before You Build

Our neighborhoods are making us fat.  And not just fat — sick, and in ever-increasing numbers.  In a new study by the UCLA Center for Health Policy Research, we found that both obesity and diabetes are increasing steadily in California, with persistent and worsening disparities among communities of color, as well as lower-income and less-educated California adults.  Both conditions are related to each other, as well as to heart disease; both will cost California millions in health care in coming years; and both are related to the way we live.

Today in California, our environment is dominated by the automobile.  There are plenty of parking lots, but often no sidewalks or bike lanes in the neighborhoods we live in.  Many Californians have to drive out of their communities to get to a supermarket, rather than having grocery stores and farmers markets within walking distance.   In many areas, fast food venues provide the majority of restaurant options, leaving residents without the opportunity to purchase more nutritious food options.  Additionally, in many areas there is a shortage of parks where children can play, especially in urban areas, and those that exist are often unsafe.

The result is an unhealthy and sedentary lifestyle.  Although policymakers have started to think about how the structure of neighborhoods affects health, there is more that can be done.  For example, California wisely banned sugary drinks from the vending machines on school campuses.  But why not have “nutrition zones” around schools that serve the same purpose as “Drug-Free School Zones”?  That means no fast food restaurants or trucks within a mile or half mile of a school.  However, stores and trucks that sell healthy snacks, such as yogurt, salads, fruits and vegetables, would be welcome.

We also need to think carefully about both existing and future construction.  In poor areas, there are often vacant lots that are overgrown and unused.  Those kinds of spaces can be repurposed into parks and playgrounds, or they can provide a space for farmers markets. There’s also a lot of effort right now to work with schools to make school grounds and playgrounds available after hours for community use.  Utilizing these areas can make the neighborhood safer overall. 

Sidewalks are important places for children and community members to exercise, as well as get to schools and stores.  In terms of infrastructure projects, cities and counties should consider tapping federal monies available through the “Safe Routes to School Program” from the U.S. Department of Transportation.  The goal is to provide kids with safe avenues to walk or ride their bikes to school — sidewalks, crosswalks, crossing guards, traffic lights and other “traffic calming” techniques.  The development and implementation of a system of bike paths and routes can also provide a more active means of commuting for adults, for work and leisure time travel.

Ultimately, we need to think carefully about how we construct our neighborhoods — ensuring that even as we green light a construction project, we think holistically about how it relates to the things that make a community healthier: sidewalks,public space, trees, grocery stores,  farmers markets, traditional and non-traditional physical activity venues.  Historically, public health professionals have not been part of the discussion when city and county construction planning decisions are made.  They should be, as should representatives from local communities.  There’s also a great CDC resource for policymakers, planners and communities called “Designing and Building Healthy Places” — it’s something all policymakers should use as a resource as they consider current and future projects for their constituents.

Insurers Work To Prevent, Reverse Obesity

The news about our country’s obesity epidemic is not getting any better. 

As we have seen the rise of obesity over the past two decades, associated health care costs are rising as well.

The Congressional Budget Office released a report mid-September revealing that from 1987 to 2007, overweight or obese adults went from 44% of our population to 63%. During the same period, health care spending per adult rose 80% ($2,650 to $4,550).

While the CBO noted that all groups experienced a significant increase, those who were obese saw a much more rapid rate of growth of health care costs. Average spending increase for adults with a healthy weight was 65%. Obese adults, who comprise about 28% of the population, saw a 111% increase.

Looking forward, the CBO estimated that if obesity rates continue to increase at the same rate, 37% of the population would be obese by 2020 and per capita spending would grow to $7,760. If we can reverse this trend and see a 20% decline in obesity rates, the CBO projects spending would slow to $7,230.

This latest data just reinforce the importance of societal response to help change the course on our obesity epidemic.

Individuals play a role in making changes that will improve health. The public sector plays an important role in ensuring people have access to affordable healthy food and making sure our communities are safe enough for people to walk, bike and play.

And, our health care community plays a big role in helping to prevent or reverse obesity.  Health plans were at the forefront of creating prevention and wellness programs for our members. Health plans work with physicians, patients and employers to encourage obesity prevention.

For instance, Health Net offers members, health care providers and the community its innovative Fit Families for Life — Be in Charge! weight management program. It’s a comprehensive offering that includes a breastfeeding and nutrition support hotline, a home-based family fitness and nutrition program, personalized telephonic coaching, worksite wellness, and community workshops on nutrition and physical activity.

Partnership HealthPlan of CA, providing health coverage through public programs in Solano, Napa, Sonoma and Yolo counties, offers a voluntary program for individuals with two or more complex health issues (including diabetes, chronic obstructive pulmonary disease and obesity). The program, which provides intensive and education telephone and in-home support for enrollees, has changed lives and reduced health care costs.

Blue Shield has an innovative, award-winning employee program called “Wellvolution” that takes a new approach to wellness.  It offers employees free on-site biometric screenings, health coaches to help set goals, and a variety of wellness programs — including classes on weight management, smoking cessation, nutrition and emotional well-being. Blue Shield is also testing out “walk stations” in some of their customer service departments. These stations allow employees to call customers while walking on a treadmill — incorporating exercise into their workday. Employees are also offered incentives to get moving, including medical contribution discounts and a health day off.

We have also addressed obesity prevention as an industry.  Our Association partnered with the California Medical Foundation to create a four-volume set of comprehensive obesity guidelines for providers to improve the care and outcomes for adults, children and adolescents and pre/post bariatric surgery patients.  With an expert panel of more than  60 physicians, this was the first time the health care community collaborated on a single set of guidelines for a health condition.

This is just a sampling of a variety of unique programs health plans offer.  We will continue to innovate and test new strategies as we work to reverse course on this epidemic.

Policymakers Need to Consider Health in All Decisions

Obesity is an epidemic, here in California and across the nation. It strains our health care system, diminishes economic competitiveness, and is one of the leading causes of preventable disease in California. In fact, some researchers warn that if the obesity epidemic continues to grow unchecked, the current generation of young people may be the first in American history to have a shorter life expectancy than their parents.

Traditional obesity prevention programs have bypassed policymakers, instead relying solely on public education to make a difference. At The California Endowment, we think that’s an incomplete strategy. While direct public outreach is essential, it’s just as important to craft public policies that make our communities healthy places to live, learn, and work.

The evidence is crystal clear. When communities are healthy, people are healthy. When schools offer quality PE classes, students are more active. When they offer healthy food in the cafeteria and banish soda and other sugary drinks from school grounds, kids eat better. Similar benefits extend to local neighborhoods. For every park and playground in a community, obesity risk declines.  And a growing body of evidence suggests that farmers’ markets, produce stands, and quality grocery stores are essential for helping parents to prepare healthy meals for their families.

For the greatest impact, policymakers need to consider the health impact of every decision they make. Even seemingly unrelated issues—like zoning, economic development, and transportation—can have a major impact on the health of local communities. For example, transportation planners should include sidewalks and bike lanes on new construction projects, so residents have real alternatives to driving. And when setting zoning priorities, why not emphasize healthy retail food outlets over fast food joints?

At The California Endowment, we believe strongly that if Californians are given the opportunity to make healthy decisions, they’ll leap at the chance. But it’s up to policymakers and other community leaders to make sure those healthy choices are possible.

To learn more about how the communities we support have created healthier environments , visit the Success Stories section of The California Endowment’s web site.

Establish Marketing Guidelines

Walking down the cereal aisle with my young child, it’s easy to see advertising and marketing’s power to influence kids’ food preferences, purchase requests and diet. Science also backs this up. A recent report by the Institute of Medicine found, based on its review of all existing scientific studies, that the “food and beverage marketing practices geared to children and youth are out of balance with healthful diets, and contribute to an environment that puts their health at risk.”

Marketing is not just feeding childhood obesity, it’s also undermining children’s oral health.

While California has moved aggressively to pass legislation improving the nutritional quality of foods and beverages sold in schools, children are still bombarded with unhealthy products in the media. Given that children are spending more time with media — and its ever-evolving new interactive characteristics — more attention must be paid to the nutritional messages children are receiving outside of school.

The industry has claimed that its marketing to children will be limited to healthier products and messages through a self-regulatory initiative. But, more than two-thirds (68.5%) of all advertising by participating companies continues to be for products of the lowest nutritional quality that “should only be consumed on special occasions,” according to the U.S. Department of Health and Human Services. Ads for healthy products, such as vegetables, fruits, whole grain breads and others, account for less than 1% of all advertising from participating companies.

So, a key step toward improving the nutritional messages children receive that is strongly supported by children’s health advocates, the scientific community and policymakers is establishing a uniform nutritional standard that determines which food and beverage products can be marketed to children. An interagency working group, led by the Federal Trade Commission, was scheduled to release this standard for public comment in July 2010.

However, it has been indefinitely delayed due to the influence of industry interest groups. California’s federal representatives, especially those who sit on relevant Senate and House committees and have expressed interest in childhood obesity (including Reps. Mary Bono and Henry Waxman, and Sen. Barbara Boxer), must now pressure federal policymakers to release the draft nutritional standard.

State-level representatives also must take steps to put additional pressure on federal policymakers to address children’s unhealthy advertising environment.

Prevention Trumps Intervention

It is expected that increasingly widespread diabetes, cardiovascular disease and other weight-related conditions will require an extraordinary share of state and national budgets.  To prevent this untenable situation, the prevalence of obesity must be reduced.

Why is it that despite widespread knowledge of the health consequences of obesity and people’s insatiable desire to lose weight — an estimated $40 billion is spent annually on weight-loss programs and products — people not only fail to lose, but continue to gain weight?

The answer is that weight-loss treatment is woefully ineffective and even successful weight loss is rarely sustained.  How then can the prevalence of obesity ever be reduced?

There is a way to reduce the prevalence of obesity without one person losing one pound and the answer lies right before our eyes.  If we can reduce the incidence of obesity, i.e. reduce the number of new cases of obesity, we can significantly reduce the prevalence. Prevention of obesity in the general population, rather than a narrower focus on intervention with individuals who are already obese or overweight, would be both cost effective and protective of the future physical health of our population.  If we begin to slow the number of new cases, we will slowly, but surely, reduce the population prevalence of obesity.

Prevention of obesity will be more effective than treatment.  Prevention efforts focus on creating healthful food and activity choices.  Weight-loss treatment efforts focus on deprivation and work against biology.  Prevention efforts can be implemented community-wide — such things as zoning to encourage availability of healthy food options or safe spaces for walking or school policy changes. These changes can be a much more cost-effective way to impact the population’s health than individual treatments.

The benefits from community-based changes to promote health extend beyond those who are already overweight.  While almost 40% of California school children are overweight or obese, 98% of children have diets that do not meet the current dietary recommendations.  Strategies that facilitate healthy eating and activity behaviors will protect all children against later development of cardiovascular disease, cancer and osteoporosis.

Creative approaches to funnel funding into strategic community initiatives to prevent obesity, if successful, will lower the incidence of obesity and thus its prevalence and, ultimately, reduce health care costs associated with the burden of chronic disease.  While we attempt to improve our treatment efforts, we must recognize the substantial savings associated with preventing obesity and employ our health care industry to help the public understand the high cost of not mobilizing funding to create healthy communities where the healthiest choices are also the easiest choices.