Obesity could cost Texas $15.6 billion next year

By CAROLYN LOCHHEAD and AMY D'ONOFRIO
Copyright 2009 Houston Chronicle Washington Bureau

Aug. 15, 2009, 8:46PM

WASHINGTON — Obesity is the elephant in the room of health care reform, a public health catastrophe that kills well over 100,000 Americans a year, may cost Texas $15.6 billion next year in health care costs and lost productivity, and promises to shorten U.S. life expectancy for the first time since the Civil War.

Whatever Washington does this year to try to lower medical spending almost certainly will be swamped by the nation's rising weight.

Obesity lurks behind the top chronic illnesses — heart disease, diabetes, stroke and colon, breast and prostate cancers, among many others — whose treatments routinely cost hundreds of thousands of dollars. In two decades the obesity rate in Texas has more than doubled — 29 percent of Texans in 2007 were obese.

Every third child born in 2000 is likely to wind up diabetic. Obesity strikes hardest at the poor and minorities; black women are nearly 40 percent more likely to contract heart disease than white women. Two out of three adults are overweight in Texas and nationwide.

Obesity is causing “death and illness on a massive scale,” according to a new study by University of Virgina and Urban Institute researchers. And it is all but impossible to treat.

“Rising obesity rates are increasing health care expenditures per person in a way that is going to be very difficult to finance,” said Jay Bhattacharya, a doctor and health economist at Stanford University's Center for Primary Care and Outcomes Research. “Unless there is some vast improvement in the efficiency of the health care system — and I mean vast — we're going to be spending a lot more just because a lot more people will have diabetes” and other obesity related diseases.

Prevention is the only cure. If obesity-prevention efforts are not implemented, Texas will have more than 15 million obese adults by 2040, according to projections by Texas State Demographer Karl Eschbach.

Yet while health care legislation in Congress would raise spending on prevention of chronic disease, it does little to tackle the underlying obesity epidemic directly. In fact, most of the bills are silent on what many health professionals contend would be one of the most effective weapons: a tax on soda.

Junk food taxes are part of a growing consensus among public health experts to adapt the successful fight against tobacco to the more complex obesity epidemic. Food, unlike tobacco, is necessary to life, and cheap food has all but eliminated hunger among the poor. Yet there are parallels with smoking.

Texas getting help

The Texas Legislature has not seriously considered politically controversial junk food taxes. Instead, the state and health groups are focusing on education and community strategies to fight excess weight from birth. The Texas Department of State Health Services will receive $4.7 million over the next two years to support obesity-prevention programs, including a “Texas! Bringing Healthy Back” initiative that was launched last year.

Since 2000, Texas has been one of 25 states also receiving funds from the federal Centers for Disease Control and Prevention to fight obesity. Lindsay Rodgers, a health department prevention specialist, said the CDC has urged sending money to communities for vegetable gardens, sidewalks and work site wellness programs and to hospitals to make them baby-friendly so more mothers will breast feed, one way to reduce obesity risk in children.

Statistics indicate that African-Americans and Latinos have higher obesity rates than Anglo Texans. But experts say that obesity prevention programs have not successfully targeted minority residents.

Texas Sen. Leticia Van de Putte of San Antonio said education programs that have tried to teach kids about eating nutritious foods have “backfired” because they made the food their families cooked for them seem bad.

“We love Mexican food in this state,” Van de Putte said, adding that there are ways to prepare it to be healthier.

More can be done, she said, like tax incentives for workplace wellness programs.

“The government can't be a nanny to someone, but if we continue to ignore (obesity), we all pay the price. … It's not a moral imperative, it's a financial imperative.”

A mixed performance

Mitchell Gibbs, a Texas Health Institute spokesman, said the Legislature's record on obesity issues is mixed.

In the past session, lawmakers agreed to encourage healthy food in schools and funding for physical education programs.

But bills allowing the use of food stamps at farmers' markets, banning unhealthy trans fats in restaurants, and requiring menu labels at chain restaurants failed.

What's more, the Legislature made high school health class optional and reduced physical education requirements from 1½ semesters to one.

In Washington, Republicans on the House Energy and Commerce Committee mocked proposed jungle gyms and bike trails in health reform legislation, yet studies show such efforts help.

“It doesn't sound crazy if you start looking at the causes of the problem,” said Kelly Brownell, an obesity researcher at Yale University's Rudd Center for Food Policy and Obesity. “In poor neighborhoods there is low access to healthy foods, high access to calorie-dense, nutrient-poor foods, and when healthy foods are available, they're more expensive.”

Fast food on every corner

The same holds for physical activity, where crime, poor facilities and parents working multiple jobs limit opportunities for safe play and exercise. The obesity problem took hold over one generation, a short period in the history of public health.

“Every successful public health movement, whether it was sanitation or air pollution or drunk driving or tobacco, has shown that people can only be healthy if there are policies in place that support them in making healthy choices,” said Harold Goldstein, executive director of the California Center for Public Health Advocacy.

“We put fast food on every corner, we put junk food in schools, we got rid of PE, we put candy and soda at the checkout stand of every retail outlet you can think of,” he said. “The results are in. It worked.”

carolyn.lochhead@chron.com

amy.d'onofrio@chron.com