A Hefty Price Tag

Heather N. Kolich

According to the Centers for Disease Control and Prevention, overweight and obesity are defined by a mathematical calculation that uses a person’s height and weight to determine his or her body fat. This number is called body mass index, or BMI.
A number, however, can’t capture the true meaning of excess weight. Heaviness exacts a toll on physical and mental health, personal and national economics, social standing and life opportunities. Yet, as detrimental as overweight and obesity are, the population of overweight Americans is soaring. One third of American adults are overweight, and another 35.7 percent are obese. The number of overweight and obese children—12.5 million kids age 2-19—is triple what it was in 1980.

It’s Not a Small World After All

Medical and media reports often refer to the “obesity epidemic” in America. When we hear “epidemic,” images of a rapidly moving, devastating contagious disease that sickens and kills millions of people come to mind. That’s not how accumulation of excess body weight works, though. It creeps up gradually, year upon year. Heaviness isn’t communicable, either. It doesn’t spread from person to person through a virus as do colds and flu. And it isn’t limited to the United States. Research to find a genetic cause for excessive, progressive weight gain has uncovered a few rare, genetic abnormalities, but these don’t explain the near-simultaneous rise in body weight around the world. With a global presence, the problem is more recently and more appropriately termed “obesity pandemic.”

After ruling out physiological causes for the international increase in overweight individuals, researchers focused on environmental causes. The basic premise is that overweight and obesity are health conditions we’ve created by altering our living and working environments to demand less physical activity. At the same time, food is more available than it was in past generations, so we’re eating more—more often, more sugar, larger portions, and vast quantities of high-calorie convenience foods. In essence, we’re living in an “obesogenic” world, an environment that fattens us up.

The Cost of Increased Disease Risk

Unfortunately, carrying around excess body weight isn’t a stand-alone health concern. Heaviness opens the door for numerous serious chronic diseases and debilitating events:

Heart disease is the number one cause of death in the United States. Excess weight is a prime risk factor in developing cardiovascular disease and experiencing a cardiac arrest event. While CPR can save the life of a heart attack patient, extra poundage makes it difficult for rescue responders to position the patient for CPR, locate the proper compression point, and perform effective chest compressions.

Cancer is the second leading cause of death. In 2007, 84,500 new cases of cancer in the U.S. were linked directly to obesity. Fat cells increase estrogen, raise insulin levels, and secrete hormones that stimulate cells to grow. These body conditions are associated with cancer of the esophagus, pancreas, colon and rectum, breast (postmenopausal), uterine lining, kidneys, thyroid, and gallbladder.

The explosion in type 2 diabetes closely parallels rising weight trends. Diabetes is the seventh deadliest disease in America, and it causes a host of life-changing problems, including organ damage, blindness, and loss of limbs.

Hypertension is often a byproduct of being overweight. So are gallstones and asthma.

Overweight and obesity increase the chance of having a stroke, the number four cause of death in the U.S.

Being overweight is deadly. Weight-related chronic diseases are the cause of seven out of every 10 deaths each year. While we’re still up and kicking though, heaviness puts a tremendous burden on our joints and spine. Excess weight is a significant factor for developing osteoarthritis. According to the Johns Hopkins Arthritis Center, just 10 extra pounds causes an additional 30-60 pounds of force to land on our knees with each step. Knee osteoarthritis makes walking painful, encouraging sufferers to adopt a more sedentary lifestyle, which starts a downward spiral of effects: muscles atrophy, strength and balance decrease, and the risk of injury from falls increases.

Social and Emotional Costs

If you or a loved one is struggling with excess weight, you know it’s much more than an appearance issue. The stigma of being fat is very real, and it isn’t diminishing, despite the fact that overweight people now constitute a majority of American adults. Active and passive discrimination against heavy people is found in entertainment media, health-care facilities, schools, and places of work—and even in safety design. Although two thirds of U.S. adults are overweight or obese, the automobile industry designs car cabin safety features based on crash tests that use crash-test dummies representing healthy-weight people. Two recent studies combining actual motor vehicle crash data and reported injuries indicate that overweight people suffer more severe injuries than average-weight people, and obese people are more likely to die in car crashes.

As a society we tend to blame overweight people for their condition, ascribing traits such as laziness and lack of willpower to explain their size. This mind-set develops as early as age 3. Researchers found that children would explore every other playmate option before inviting an overweight peer to play. One third of overweight kids receive no return on their offers of friendship.

Because overweight people are often viewed—or portrayed—as lazy, undisciplined, and unsuccessful, opportunities for advancement in careers and social circles are less forthcoming than for average-weight people. When overweight people accept and internalize this view, self-esteem falls while the perception of poor health rises.

Living with a socially unwelcome trait increases stress levels, which has adverse effects on both mental and physical health. Stress can telegraph to other members of the family. Children react to their parents’ stress as well as their own, and many use food and sleep to relieve escalated stress, further fueling a cycle of weight gain.

Economic Costs

The rise in medical care spending in the United States since the 1980s roughly correlates with increasing rates of overweight and obesity. With nearly half of the U.S. population afflicted with one or more chronic disease, treating these serious health conditions consumes 75 cents of every dollar we spend on health care. In Medicare and Medicaid dollars, the cost is even higher: 99 cents of every Medicare dollar and 83 cents of every Medicaid dollar are spent on patients with chronic diseases.

The diseases themselves have a compounding effect: having one condition increases the chance of developing another. Yet a critical point that’s often lost in discussions of chronic disease is that many of them are preventable. Maintaining a healthy weight through sensible food choices and moderate exercise is the first line of defense and recovery.

From a business perspective, weight-related diseases present an economic loss through higher health insurance costs and lost productivity. Workers with chronic diseases are less productive than healthy workers in two measurable ways: absenteeism and presenteeism. One study puts the national business loss from obesity-related absenteeism between $3.38 billion and $6.38 billion. Presenteeism is sick employees showing up for work but performing below standards because of illness. Combined, weight-related absenteeism and presenteeism represent an annual national productivity loss of $11.7 billion.

Lost workdays translate into lost wages for many workers, but heavy people have higher health-care costs than healthy-weight people. Individually, obese people spend 37 percent more on health care each year, including prescription costs that are 105 percent higher. For overweight people the increase in health-care spending is less, but still substantial: 13 percent higher primary-care costs and 37 percent higher prescription costs. These two elements—loss of wages and higher health-care costs—can collide and result in the personal tragedy of medical bankruptcy.

Even with medical treatment, weight-linked illnesses are progressive, resulting in disabilities that prevent overweight and obese people from working. Adding disability payments for these workers on top of high Medicare and Medicaid costs puts a heavy economic burden on taxpayers.

Overcoming Obesity

Overweight and obesity result from consuming more calories than we burn through daily activity. But that doesn’t make food the enemy. Food is only one factor in progressive weight gain. Contributing factors include stress, long work hours, poor food choices (i.e., processed and fast foods), too much time sitting at computer and television screens, too little exercise, and too little sleep—in short, an unhealthful lifestyle.

Fortunately, overweight and obesity are curable, and losing excess weight reduces the pain and negative effects of weight-associated chronic diseases. Despite government and media calls to confront this debilitating health issue as a community, in the end weight loss is an individual achievement. It requires the motivation, dedication, and tenacity to change comfortable routines and habits. Since most of us resist change, especially drastic change, it helps to develop a plan. To get started, identify unhealthful habits. Target and extinguish personal health-busters one at a time, while adopting a healthful replacement habit. For example, replace a daily designer-blend coffee drink with cool, refreshing water. When that routine feels normal, exchange the mid-afternoon bag of chips for a crisp apple.

Just as food isn’t the enemy, it isn’t the answer either. Exercise is a critical element in weight loss. Work with a physician to establish a long-term plan with a series of reasonable goals and a safe exercise regimen. Adding daily exercise is another disruption of our comfortable—or not so comfortable—routines, but no one can lose weight and regain health without it. If knee pain is a factor, discuss pain-control options with your doctor. As weight goes down, so will joint pain.

Exercise must become a priority, even if that means cutting down on overtime hours or saying no to requests from family, friends, coworkers, and others who claim our time. Instead of feeling guilty, build a cheering team out of those very people. Having a support network is another important factor in weight-loss success.

Heather N. Kolich is a writer, editor, and photographer who lives in Cumming, Georgia.

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