Bigger is better.  That’s what most Americans value.  McMansions became the rage throughout the 1990s.  While the average square footage of a single-family home built last year was 10 percent larger than a decade earlier, the average lot size declined by the same percentage according to the U.S. Census Bureau.  Southwest Airlines might have considered using that analogy when it began charging wide-body fliers for two seats if they couldn’t fit into one.

The year 1991 marked the first time when any state reported 15 percent or more of its population as obese.  By 2000, Colorado was the only state where less than 15 percent of the population was obese. 

We’ve all heard it by now.  Americans are fat and getting fatter.  The October 9, 2002 issue of the Journal of the American Medical Association trumpets that 64.5 percent of Americans are now overweight—30.5 percent of them categorized as obese.  Where do you fall in the equation?  Calculate your Body Mass Index (BMI).  The federal government classifies you as overweight if your BMI is between 25.0 and 29.9.  If you reach 30 or more they grant you the title of obese.

 

 Are you a little disturbed by your BMI?  Your dress size hasn’t changed since 1980?  Consider this.  The standard size 6 waist measurement in 1984 was 23 inches.  The Gap’s size 6 waist measurement in 2002 is 29 inches.  Your clothes grew along with you.

This year the Surgeon General declared obesity a national epidemic; the Centers for Disease Control and Prevention said it’s the number two cause of preventable death; and the Internal Revenue Service gave you a tax deduction if you spent money to lose weight.  Why?  The financial costs are staggering. 

Over $117 billion was spent in 2000 related to the economics of obesity--$61 billion in direct costs and $56 billion due to the costs of absenteeism and lost productivity according to the Surgeon General.  Wolf and Colditz reported similar numbers in 1998 (see chart).  And it’s not that people aren’t trying to lose weight. The Surgeon General reports that Americans spent $33 billion on diet products and services in 2000.

Most of the costs of obesity are due to diseases associated with it: type 2 diabetes, coronary heart disease, hypertension, gallbladder disease, certain types of cancer, and osteoarthritis.  Christopher Saudek, director of the diabetes center at John Hopkins University, indicated in the May 15, 2002 issue of JAMA that any nation that increases its body weight is going to increase its diabetes.  In the United States diabetes rates have risen 6 percent a year for the past decade.

 

Annual Direct and Indirect Costs Attributable to Obesity in the United States

(Billions of 1995 Dollars)*

Disease	Direct Costs	Indirect Costs
Type 2 Diabetes Mellitus	$32.4	$30.7
Coronary Heart Disease	$7.0	NA
Hypertension	$3.2	NA
Gallbladder	$2.6	$0.1
Breast Cancer	$0.8	$1.5
Endometrial Cancer	$0.3	$0.5
Colon Cancer	$1.0	$1.8
Osteoarthritis	$4.3	$12.9
Total	$51.6	$47.5

Wolf and Colditz, Obesity Research, 1998

 

A Rand Corporation study released this year in the March/April issue of Health Affairs indicated that obesity  has the same association with chronic health conditions as 20 years of aging and greatly exceeds the associations of smoking or problem drinking.  Obesity increases health care costs 36 percent and medication costs 77 percent, compared with being in a normal weight range.  Compare this with smokers who spend 21 percent more on patient care and 28 percent more on drugs.

C. Everett Koop and his Shape-Up America initiative publicized that the number of workdays lost due to illnesses attributable to obesity rose from 52.5 million in 1988 to 58.5 million in 1995.  The Employers Health Coalition reported a strong relationship between increasing BMI and the number of days lost from work in Tampa.  They recounted in their 2000 health and productivity study that, on average, obese individuals lost 1.4 days more in a 20 day period than non-obese individuals. (The Hidden Competitive Edge: Employee Health and Productivity, Employers Health Coalition, 2000)

The picture is potentially worse for our future employees.  According to the 1976 – 80 National Health and Nutrition Examination Survey (NHANES), 5 percent of adolescents were overweight.  The October 9, 2002 JAMA article indicates that number tripled in 2000 to 15 percent.

The costs of childhood obesity are impacting employers today via dependent health care costs.  Wang and Dietz noted in the May 2002 issue of Pediatrics that hospital costs tripled since 1981, in this population, to $127 million a year.  Hospital discharges for diabetes nearly doubled, obesity and gallbladder diseases tripled, and sleep apnea increased fivefold.  Days spent in the hospital for obesity-related disease more than doubled, from 152,000 over the three years 1979 – 81 to 310,000 days during 1979 – 99.  At a time when hospital stays overall were shortening, obese youngsters’ average stay increased by about a third to 7 days.

How did America grow to this size?  The NHANES studies first noted the problem in 1980.  Gary Taubes, in the July 7^th issue of the New York Times, proposed that this trend coincides with the federal government and medical community’s promotion of the high carbohydrate, low fat diet.  Others blame the food industry.  The US food supply increased from 2220 usable calories per person each day in 1970 to 2680 calories in 1997.  Still others blame the fast food industry.  According to Eric Schlosser in the best seller, Fast Food Nation, Americans spent $6 billion on fast food in 1970 and $110 billion in 2001.  In the late 1950s a soft drink order contained about eight ounces.  Today a child’s order of Coke at McDonald’s is twelve ounces and a large Coke is thirty-two ounces and 310 calories.

On July 24^th Caesar Barber filed a class-action lawsuit against four fast food chains, claiming their food choices contributed to his obesity, diabetes and heart disease.  Mr. Barber stated that he didn’t realize fried food was bad for him until his doctor told him so three years ago.  Steven Anderson, president and CEO of the National Restaurant Association, pointed out in an article by MSNBC staff, “[T]here is a certain amount of personal responsibility we all have.  The issues of obesity and nutrition are much more complicated than this and involve factors such as genetics, medical conditions and the level of physical activity.”

What can we do to change the obesity trend and its associated costs?  A large part of the answer may lie in something as simple as physical activity.  Dr. Steve Blair, an epidemiologist at the Cooper Clinic in Dallas, is famous for his studies on the impact of exercise.  He led an eight-year study of 22,000 men and found that obesity did not increase the mortality risk in fit men.  The unfit lean, whose performance was measured on a treadmill, were nearly twice as likely to die as the fit, including the obese fit.  In other words, fat and fit beat thin and soft.

What can employers do to help their employees?  Encourage physical activity and offer a variety of food choices.  Evaluate what’s in your vending machines.    Consider implementing “standing” meetings; people will be more efficient and they’ll burn more calories.  The Surgeon General’s Call to Action suggests changing workflow patterns, including flexible hours to create opportunities for physical activity during the workday.  Provide meeting-free time for lunch and ensure healthy food options.  Require weight management and physical activity counseling as a member benefit in health insurance contracts.

The bottom-line?  Move more, eat less, and you’ll see your personal “square footage” decrease along with your costs.

 

* Note:  This article appears in the October 2002 issue of "Health & Productivity" The author updated it to reflect the new trend information released in the October 9, 2002 issue of "JAMA".