STOP Obesity Alliance Recommendations for Addressing Obesity within Health Reform
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(HealthNewsDigest.com) – As Congress and the Administration refine the specifics of health reform and other health-related initiatives in the coming months, the Strategies to Overcome and Prevent (STOP) Obesity Alliance believes that addressing obesity through meaningful, evidence-based approaches must be a top priority.
Overweight and obesity are associated with significantly increased risk of more than 20 different diseases, including type 2 diabetes, heart disease, hypertension, certain cancers, and osteoarthritis.1 Rising obesity rates across the nation have led to worsening health outcomes.2 Beyond these debilitating health outcomes, most recent economists agree that obesity is a major driver of health care utilization and spending, and contributes to escalating health care costs. As a recent study published in Health Affairs makes clear, obesity accounts for an estimated 9.1 percent of annual health care spending in the United States, amount to $147 billion in 2008.3 The projections for increases in obesity prevalence and related costs are even more alarming.
Bottom line: Obesity stands at the center of the cost and quality equation. As the “chronic disease gateway,” obesity leads to crippling health and economic consequences for individuals, families, employers, the health system and the nation as a whole. America can greatly improve health outcomes and take steps to reform the health care system by directly addressing this issue. Obesity is too often characterized as a failure of individual willpower and a lack of personal responsibility, when in reality there are also complex biological, environmental, and social factors at work. Just as there were many factors that brought America to this point, it will take a multifactorial approach to help us reverse the obesity epidemic.
The mounting evidence of the negative health outcomes and increasing costs due to obesity lead us to the conclusion that as a nation we are at the “tipping point.” Policymakers have a responsibility to acknowledge the facts and act on them. We cannot allow the two-thirds of adult Americans who are overweight or obese—the majority of the population—to be ignored, and more importantly, we cannot solve this issue among our children without addressing the problems faced by the adults who are their parents, teachers, and role models. Without their help, today’s generation of children may live in worse health and have shorter life spans than their parents.4
While the pervasiveness of obesity in America is grave, the goal of improving health and decreasing chronic disease is attainable if we approach the problem from the perspective of better health rather than promoting unrealistic weight-loss goals. According to the National Heart, Lung and Blood Institute (NHLBI), modest weight loss, such as losing five to ten percent of baseline weight and maintaining it, is associated with reducing the risk of developing type 2 diabetes and cardiovascular disease. 5,6
In accordance with the principles set forth by our member organizations and after review of the current health reform proposals, we believe that health reform must include these four elements, reflecting the existing evidence for clinical and community approaches:
Standardized and effective clinical interventions, flowing from evidence-based guidelines, such as those approved by the National Heart, Lung and Blood Institute (NHLBI), that include acknowledging the health benefits of five to ten percent sustained weight loss to aid and support those individuals who are currently overweight or obese achieve improved health.
Enhanced use of clinical preventive services to monitor health status and help prevent weight gain, especially for individuals who are already overweight and are at risk of becoming obese.
Effective, evidence-based community programs and policies that encourage and support healthy lifestyles, focus on health literacy, address health disparities, and represent a significant investment in population-based prevention of obesity.
Coordinated research efforts to build the evidence for all three of the above elements, continuously improving quality of care, bolstering our understanding of what does and does not work in various settings, and helping to translate the scientific research into practice recommendations for real-world clinical settings and communities.
Conclusion
Halting the obesity epidemic in the United States requires determination and immediate action. Greater efforts in basic and clinical research, prevention strategies, and the relevant education and training of health care professionals will be needed to tackle this epidemic, in addition to expanding the commitment of policymakers, community groups, schools, employers, and faith-based organizations. Though the burden of obesity is great, the price of inaction is even greater, both for those affected and for society as a whole. We must embrace the evolving, evidence-based interventions for both the clinical and community settings that will show us the way forward.
Christine C. Ferguson, J.D.
Director, STOP Obesity Alliance
Research Professor, The George Washington University School of Public Health and Health Services
Christine C. Ferguson, J.D. is charged with coordinating the day to day activities of the STOP Obesity Alliance. In addition to this role, Ms. Ferguson is a member of the faculty at the School of Public Health and Health Services at The George Washington University.
1 National Heart Lung and Blood Institute. (1998) Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Available at: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm.
2 Trust for America’s Health. (2009). F as in fat: how obesity policies are failing America. Washington, D.C.: Jeffrey Levi et al.
3 Finkelstein E.A., Trogdon J.G., Cohen J.W., Dietz W. (2009) Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs, 28, w822-w831.
4 Olshansky S.J., Passaro D.J., Hershow R.C., Layden J., Carnes B.A., Brody J. et al. (2005). A potential decline in life expectancy in the United States in the 21st century. New England Journal of Medicine, 352, 1138-1145.
5 Aucott L., Rothnie H., McIntyre L., Thapa M., Waweru C., Gray D. (2009). Long-term weight loss from lifestyle intervention benefits blood pressure? A systematic review. Hypertension, available at: http://hyper.ahajournals.org/cgi/content/abstract/HYPERTENSIONAHA.109.135178v1. see also Lavie C.J., Milani R.V., Artham S.M., Patel D.A., Ventura H.O. (2009). The obesity paradox, weight loss, and coronary disease. American Journal of Medicine, available at: http://www.amjmed.com/article/S0002-9343%2809%2900500-2/abstract
6 Facts about healthy weight. n.d. Retrieved August 10, 2009, from: http://www.nhlbi.nih.gov/health/prof/heart/obesity/aim_kit/healthy_wt_facts.htm
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