No vaccine exists for the obesity epidemic. An August report from CDC estimated nationwide medical costs of obesity at $147 billion a year. An obesity journal bravely predicted last year that by 2050, all Americans would be overweight or obese.
According to the Gallup-Healthways Well-Being Index released last month, 23.2% of Californians are obeseÂ — about one in four. In addition to threatening individual health, obesity is threatening the state’s financial health as well, according to the California Center for Public Health Advocacy. Piling on pounds, CCPHA said, costs $41 billion annually, including expenses related to health care services and declining worker productivity. Los Angeles County’s obesity-related costs were shown as a whopping $11.9 billion annually, with $3.3 billion annually for Orange County.
Numbers aside, local health administrators do occasionally lose sleep over the sheer magnitude of obesity. “Every night I lay my head on the pillow, I ask myself these questions,” said registered dietician Suzanne Bogert of the Los Angeles County Department of Public Health’s Division of Chronic Disease and Injury Prevention. “Did I eat enough fruits and vegetables, choose foods low in fat, salt and sugar, honor my hunger and move my body with activity?”
She seeks correct answers for constituents in her role as project director for the federally funded Renew Environments for Nutrition, Exercise and Wellness — or RENEWÂ — managed by the L.A. County Health Department. Bogert said that helping residents lead healthy lives is easier said than done, considering that “being healthy” requires safe parks or trails and a corner store stocked with good food, both often missing in lower socioeconomic areas.
Further problems come in providing healthy foods to school children. “We’re most concerned about obesity prevalence [among] children ages zero to five,” she said.
Bogert cheers the USDA-funded Network for a Healthy California’s Champions for Change program, which aims to empower low-income Californians to increase produce consumption, physical activity and food security. The program’s bilingual billboards don’t mince words: “My kitchen. My rules. Eat more fruits and vegetables.” Families are shown, step-by-step, how to make changes at home and invoke community and school cooperation.
Outreach is paying off. “With nutrition education events, county public health staff touch people where they live, work, shop and pray,” said Bogert.
Nipping Disease in the Bud
Change requires a tactical, multilevel approach. “Insurance doesn’t pay for obesity prevention,” said Anne Peters, director of the clinical diabetes programs at the University of Southern California’s Roybal Comprehensive Health Center, under the umbrella of Los Angeles County’s Department of Health Services. She also treats patients at her Beverly Hills clinic.
“Medicine is a disease-based field, and thus far, we only treat disease. It takes even more resources to prevent disease,” she said. “The more I treat diabetes, the more I want to prevent it, and cost-effectively.”
Obesity can negatively affect all organ systems, and the sinister relationship between obesity and diabetes is clear. According to the American Diabetes Association, “Diabetes is an urgent health problem in the Latino community. Their rates of diabetes are almost double those of non-Latino whites.”
“The community near Roybal is becoming more Latino and has also evolved at a higher risk for diabetes,” said Peters. Her research staff is part of the multicenter NIH LookAHEAD study, which is assessing the benefits of weight loss and exercise on treatment of Type 2 diabetes.
“Community-based initiatives are vitally important,” Peters said.
She and her colleagues also actively promote good nutrition and healthy eating at a grassroots level. A major accomplishment is establishment of the first farmers markets in East and South Los Angeles. “Promotoras or community liaisons work with us in both settings,” she said. Local college nutrition students mentor high school students, who in turn, mentor elementary school students.
Not So Simple
“People don’t realize obesity is a complex, multifactoral problem,” said May Wang, associate professor of community health sciences at UCLA. “It’s much more than helping people control eating or encouraging physical activity behaviors. Latest research shows obesity begins in pregnancy if not before. An overweight mother is more likely to produce an overweight baby.” Chronic stress from living conditions can also contribute to weight problems, she added.
Wang gives high marks to the federally funded Special Supplemental Nutrition Program for Women, Infants and Children. Participants have low to moderate incomes and are at nutritional risk. In California, home to the nation’s largest WIC Program, 81 local agencies serve about 1.2 million participants at 650 local sites.
“WIC makes a remarkable impact, nurturing healthy eating habits, educating mothers and making it all as culturally appropriate as possible,” said Wang. She estimates 70% of infants born in Los Angeles are to WIC moms.
It’s no secret: When wide gaps exist between rich and poor, health outcomes then tend to worsen. “East L.A. has high childhood obesity rates, while Manhattan Beach is 4%,” Wang said.
Improving school lunches is a good effort, but kids go home, often to fast food, because it’s easy. It’s also higher in calories, fat and sugar. “Society moves so quickly, people are tired. What do they do?” Wang asked.
Encouraging Â Healthy Habits
“Obesity is such a major societal problem, we must approach it from every angle,” said Nancy Bowen, chief medical officer for public health at the Orange County Health Care Agency.
Like first lady Michelle Obama, Orange County wants to quash childhood obesity. In May this year, the county’s Grand Jury report on the problem recommended better coordination of programs with a comprehensive plan, dedicated funding — not so reliant upon grants — and more parental involvement.
Even though waistlines may not be trimmed, local budgets certainly are, and the timing could be better.
“We’re making sure our efforts are coordinated and are spending money in the smartest way possible,” said Bowen. A public-private collaborative, the Orange County Nutrition and Physical Activity Collaborative, gracefully encourages healthy eating and lifestyles.
The Orange County Health Care Agency also values its partnerships; NuPAC aligns with the Orange County Obesity Prevention Plan, patterned after the state’s model, as a framework for action for partners from seven key sectors, including local government, families, health care insurers and providers, and schools. NuPAC’s curriculum includes Champions for Change, plus a Rethink Your Drink promotion of smart beverage choices.
Peters in Los Angeles remains encouraged, not discouraged, by what she’s seen patients of all socioeconomic levels accomplish. She said, “It may take five or six tries, or 10 years, but they do it. When the switch turns on in the brain, I’m more impressed than depressed by what people are capable of.”