At a March 9 news conference, Health and Human Services Secretary Tommy Thompson announced HHS will sponsor a national advertising campaign to encourage Americans to eat less and exercise more.
“The increase in Americans’ waistlines is shrinking our lifelines,” Thompson warned. “We’ve just gotten too darn fat, ladies and gentlemen, and we are going to do something about it.”
The only physician in the U.S. Senate, Majority Leader Bill Frist (R-Tennessee), lauded the HHS move in a March 10 statement to the media. “I’m pleased that the CDC has addressed this growing concern, and that Secretary Thompson has taken action with a new education campaign and research agenda.”
Making an IMPACT
“However, we must do more,” continued Frist, who said he is especially alarmed by studies showing minorities are particularly susceptible to obesity.
The U.S. Centers for Disease Control and Prevention (CDC) last fall released a study showing Americans born today have a 1 in 3 chance of developing obesity-related diabetes. Among Hispanics and blacks, the risk is 1 in 2.
“The House should follow the Senate’s lead,” said Frist, “and act to pass the Improved Nutrition and Physical Activity Act (IMPACT), introduced by Representatives Mary Bono (R-California) and Kay Granger (R-Texas). The health of our nation is at stake if we don’t act now.”
Frist introduced the IMPACT Act in the Senate last year with colleagues Jeff Bingaman (D-New Mexico) and Christopher Dodd (D-Connecticut). Among other things, the act calls for training grants to teach health profession students how to treat and prevent obesity; community grants to promote physical activity and obesity prevention; obesity education programs for young people to help them develop healthy habits early; studies of the causes of obesity; and authority to use mass media to carry out a campaign to promote physical activity in young people.
The legislation has passed the Senate by unanimous consent and is pending in the House Energy and Commerce Committee. An earlier version of the bill died in that committee last year.
Frist also has introduced the “Closing the Health Care Gap Act,” which would create within the Department of Health and Human Services an Office of Minority Health. The office would work with federal agencies and the Surgeon General to study health disparities, develop strategies to address them, and increase awareness of the problem among health care providers, health plans, and the public.
The Gap Act also provides for health care access and awareness grants; tax credits and other means to reduce the number of persons without health insurance; increased federal support for historically black colleges and universities; and demonstration projects to test model curricula for minority cultural awareness and sensitivity among health professionals.
Politics and Yet Another Program?
The legislation is being viewed with a jaundiced eye by some health policy experts.
Grace-Marie Turner, president of the Galen Institute, told Health Care News she worries about the Gap Act “institutionalizing” racial thinking in medicine.
“This legislation is making it a political issue rather than a medical issue,” Turner said. “As far as obesity, I think the government has a positive role to play in public education. If they can do some research and education, that’s fine. But once you set up new programs, they have a life of their own.”
Dr. Sally Satel, resident scholar at the American Enterprise Institute, said she believes the Gap Act is unnecessary.
“What’s good about it could be done through HHS,” Satel told Health Care News. “The good things are health literacy, demonstration projects, data collection. But the CDC could collect that data.
“Some other aspects of it, I think, miss the point,” Satel continued. “I don’t think diversity of the health workforce is an especially important element in reducing the health care gap. And if anyone could clearly define ‘cultural competence,’ I’d be grateful.”
Satel said there is no need to create federal programs to help medical personnel adjust to cultural differences.
“Whenever I’ve spoken to people who work near Indian reservations or with immigrants, they’re aware of the need to learn the local anthropology and are aware of cultural differences. You adapt organically to your patient population,” Satel said.
Cato Institute policy analyst Radley Balko agreed. “My first reaction is that it’s not the government’s responsibility,” Balko said. “As far as the racial disparities, I would suggest these are more class issues than race issues.”
Balko has other objections to Frist’s legislation.
“There is a more fundamental problem, which is throwing government grants at these problems and not letting them sort themselves out,” he said. “My problem [with Congress’s reaction to the obesity epidemic] is that they are abandoning federalism. The way they should be attacking this is by giving people ownership over their own health care.
“When you have responsibility for your own health care, you take better care of yourself. They’re inching our system more and more toward socialism. They passed this ‘cheeseburger bill’ [to block lawsuits that accuse fast-food restaurants of causing obesity]. Well, if I’m paying for my neighbor’s heart attack, I’m likely to support those lawsuits. My neighbor’s excess weight becomes my business.”
Your neighbor’s health as your business was a repeated theme at the annual meeting of the American Public Health Association held in San Francisco last November. More than 13,000 members attended, and, according to an account by Kelly Jane Torrance published December 23, 2003 at Reasononline.com: “Speaker after speaker scorned the notion that individual Americans are responsible for their own choices.”
She cited Margo Wootan of the Center for Science in the Public Interest as saying, “We have got to move beyond personal responsibility,” and Skip Spitzer of the Pesticide Action Network, who said “the idea of ‘personal responsibility'” is merely “a cultural construct.”
Yale psychologist Kelly Brownell, originator of the “Twinkie tax” idea, said activists should focus on obesity in children because “then you get away from these arguments about personal responsibility.”
Torrance also cited Public Health Institute lawyer Edward Bolen, who “called for tobacco-style restrictions on food, including price controls; minimum age requirements to buy certain foods” and even bans on producing certain foods.
Diabetes Key Concern
The CDC study, reported in the October 2003 issue of the Journal of the American Medical Association, concluded 400,000 deaths in the U.S. in 2000 were attributable to obesity and lack of exercise. Ten years earlier, obesity accounted for about 300,000 deaths. By comparison, tobacco use (mainly smoking) accounted for about 435,000 deaths in 2000, according to the study.
A chief obesity-related ailment is diabetes. American females born in 2000 have a 38.5 percent risk of developing diabetes, cutting life expectancy by 14.3 years if the disease is diagnosed by age 40, according to the study. Males born in 2000 have a 32.8 percent risk of developing diabetes, shortening life expectancy by 11.6 years if diagnosed by age 40.
Among minorities, the risks are disproportionately high. The CDC report says female Hispanics have a 52.5 percent risk of diabetes from birth; male Hispanics a 51.9 percent risk. The risk is 49 percent for black women and 41.4 percent for black males.
White females have a 31.2 percent risk and white men a 26.7 percent risk.
Dr. K.M. Venkat Narayan, a diabetes epidemiologist at the CDC, conducted the study using data from the annual National Health Interview Survey of about 360,000 people from 1984-2000, from the U.S. Census Bureau, and from a previous study of diabetes as a cause of death.
“I think the fact that the diabetes epidemic has been raging has been well known to us for several years. But looking at the risk in these terms was very shocking to us,” Narayan told reporters when releasing the study.
Researchers believe about 17 million Americans have diabetes today, including undiagnosed cases. That is triple the number from the 1960s. If CDC predictions are accurate, some 45 to 50 million U.S. residents could have obesity-related diabetes by 2050. Diabetes can lead to heart disease, kidney failure, blindness, and poor circulation, resulting in limb amputations.
A recent study by the American Cancer Society found obesity spread across all regions and demographic groups in the United States during the 1990s. Overweight men whose weight is 130 percent or more above average are 2.5 times more likely to die of prostate cancer during a 20-year followup compared to men of average weight, according to the study. Overweight women have higher rates of cancer of the uterus and ovaries.
A study by Duke University’s Clinical Research Institute in Durham, North Carolina tracked more than 9,400 heart patients for 12 years and found that overweight and obese patients (defined as 30 percent or 35 to 50 pounds above ideal weight) got heart disease earlier in life than normal-weight patients and died at younger ages.
The study found normal-weight patients were first diagnosed with heart disease at an average age of 66. Initial diagnosis for overweight patients was age 62, and for obese patients 57. Normal-weight patients on average lived to age 78; obese patients lived to 74. Obese patients also had three to four more years of illness than normal-weight patients.
Though there recently has been a flood of information citing skyrocketing rates of obesity, the problem has been under study for many years. The 1996 Surgeon General’s Report on Physical Activity and Health showed nearly two-thirds of adults fail to get the recommended 30 minutes a day of moderate physical activity most days of the week. Most researchers advise regular exercise as an integral part of weight control.
Steve Stanek is an Illinois-based freelance writer and regular contributor to Health Care News. His email address is [email protected].