For more than a year, the crisis of uninsured Americans has dominated the talk of the town in Washington. As it should. But now attention is turning to one of the most vexing and costly public health care challenges in the country—the problem of obesity. More than two thirds of adults and one third of children in the U.S. are overweight or obese, and the medical effects will continue to unfold in the decades to come. Will health-care reform help tackle obesity? And what else might happen now that first lady Michelle Obama has adopted it as her bailiwick?
Obesity is, in policy speak, "multifactorial," meaning there are many causes, from how much we move to what we eat and drink. Last year legislators considered a federal tax on sweetened beverages as a way to pay for health-care reform. Public-health advocates, including CDC director Tom Frieden, love this idea. If sodas and sugary sports drinks cost more, the theory goes, people will stop buying them, lose some weight, and get healthier. The beverage industry, unsurprisingly, lobbied the idea out the back door of the Capitol, but it is gaining momentum on the local level.
There are, however, pieces of the legislation that did make it through, and these may help curtail obesity and the expensive chronic illnesses—including heart disease and type 2 diabetes—that come with it. Vending machines and chain restaurants with more than 20 locations will be required to provide consumers with caloric and nutritional information about the items they serve. Most people underestimate the number of calories and amount of fat in foods they eat outside their homes. In one study, 99 percent of consumers surveyed thought a restaurant serving of cheese fries with ranch dressing had fewer calories than it actually did—a whopping 3,101. Will people change what they eat? Too soon to tell, but last week President Bill Clinton told NEWSWEEK's Jon Meacham that after Starbucks started posting calorie counts—required under a 2008 New York City law—he stopped buying his beloved 490-cal raspberry scone.
There's good news on the clinical side, too. Insurance companies will now be required to provide coverage for preventive-health services, which include obesity screening (a doctor's physical exam combined with a measurement of body-mass index, or BMI) and nutritional counseling—a vital part of obesity prevention, says Dr. Joseph Thompson, director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity. The need for this kind of counseling is huge, says Dr. Sarah Armstrong, director of the Duke Children's Healthy Lifestyles Program, but insurance coverage has been spotty at best and otherwise successful programs have had to struggle to remain viable. That may start to change.
Does health-care reform require overweight people to pay more for insurance? No. But there are provisions in the law, predominantly tagged to tobacco, that open the door to charging a premium to people who have lifestyle risk factors like obesity down the line, says Thompson. Stay tuned.
Outside of health-care reform, several other initiatives, including the first lady’s Let’s Move campaign against childhood obesity, may help turn the tide. Earlier this month the U.S. Department of Health and Human Services awarded $372 million in stimulus money to urban and rural communities to fight obesity by upping the availability of nutritious foods and providing safe places for exercise and play. The stimulus will also give money to physicians and hospitals to adopt electronic health records. To be eligible, docs need to demonstrate that they're "meaningful users" of these records; one of the ways they do this is by documenting BMIs at every visit, allowing physicians and patients to watch for weight gain over time and work to prevent it. And Congress is now in the process of reauthorizing the Child Nutrition Act. The Department of Agriculture wants to offer more nutritious foods, like fruits, vegetables, and whole grains, in schools, and it wants authority to set standards on so-called competitive foods, which include vending-machine snacks and sodas.
Of course, none of these efforts will change a thing if we don't overhaul what we eat (too much fat, sugar, and salt) and how we eat it (supersized portions). Take one highly publicized ingredient, high-fructose corn syrup, which is derived from corn and has made its way into a multitude of the foods and drinks we consume—ketchup, sodas, and even the presumably good stuff like salad dressing and yogurt. A formidable contingent of nutritionists believe that agricultural subsidies for corn and other crops have contributed to the obesity crisis by making fattening foods cheap and ubiquitous. They want the subsidies expunged. Others, including USDA economists, argue that the effect is small and that eliminating them won't solve the problem. It's unlikely, given the outsize power of farm states in the Senate, and of Iowa in choosing presidential nominees, that the subsidies will be axed. But you're certain to hear a lot more about this in the run-up to the 2012 farm bill. In the meantime, here's something to chew on: a new study out of Princeton University found that rats who consumed high-fructose corn syrup gained significantly more weight than rats who ate plain old table sugar—even when they took in the same number of calories. Sign them up to testify on the Hill.