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Will Obesity Reverse Rise in U.S. Life Expectancy?

May 8, 2012 at 12:00 AM EDT
Public health experts have long warned of a growing obesity epidemic in America. This week, the Institute of Medicine and others launched a major campaign in hopes of curbing the problem. Ray Suarez and Dr. Francis Collins of the National Institutes of Health discuss the personal and public consequences of obesity.
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GWEN IFILL: Public health experts have long warned of a growing obesity epidemic in America.

This week, government officials and others have launched a major campaign, warning those long-feared consequences are at hand. In a 474-page report, the Institute of Medicine called for systemic policy changes, from overhauling farm policies and the way food is marketed, to building more walkable neighborhoods, to ensuring children get at least 60 minutes of physical activity a day.

Our Health Unit has an in-depth look tonight, beginning with a Ray Suarez report on the rising toll.

RAY SUAREZ: Americans are fat and continue to get fatter. Today, two out of three adults in this country are overweight or obese.

ROSS HAMMOND, Brookings Institution: In 1960, the average height for a man was 5’8”, and the average weight was 165 pounds. Today, the average height for a man has gone up one inch to 5’9”,and the average weight has gone up 25 pounds to 190 pounds.

RAY SUAREZ: One of the most striking things about this change is that most people are aware of it, understand what causes it, yet nothing seems to stop it.

MRC GREENWOOD, president, University of Hawaii System: In spite of the fact that people get lots of information, it hasn’t changed their behavior in the ways that we have been trying to change it. So I guess it tells you that more information doesn’t necessarily mean better behavior.

RAY SUAREZ: New research from universities, think tanks and the federal government has tried to put a dollar cost on tens of millions of pounds of excess weight, in getting heavier and heavier passengers from place to place on public transportation and burning millions of excess gallons of gasoline in private cars, and jet fuel in the air, in lost productivity and increased absenteeism at work, and the tremendous impact obesity has on medical costs year after year.

The annual price tag for all of it? One estimate puts it at $190 billion a year.

TEVI TROY, Hudson Institute: The numbers are just enormous. And given our long-term budget situation, I think it’s important to address this issue as soon as possible.

Tevi Troy is a health care economist and former deputy secretary of health and human services.

TEVI TROY: Well, let’s look at a 12-year-old kid who is around today. And between ages 10 and — 12 and 22, so over a 10-year window, he is not going to change that much in terms of the cost he has on society. But if you look at a 25-year window, the costs that might be imposed could be potentially huge in terms of earlier hospitalizations, less productivity at work, less ability to pursue and achieve his dreams.

RAY SUAREZ: Take a look at this animation from the Centers for Disease Control. It tracks the increasing incidence of obesity in America state by state from 1985 on, ending at today, with a large swathe of the country centered on the Southeast and Midwest in red, meaning more than 30 percent of adults are obese.

Ross Hammond has been studying the economic impact of obesity for the Brookings Institution.

ROSS HAMMOND, Brookings Institution: Part of the difficulty with something like obesity is that it’s the accumulation of action over a long period of time that leads to obesity. If you eat a cheeseburger today, you won’t necessarily have a heart attack today. But over many, many, many days of eating unhealthily and gaining a lot of weight, you might. And because of that time angle, it becomes harder to think about in your daily routine what the long-term consequences are. That’s harder for people.

RAY SUAREZ: Just how hard is apparent to Dr. Frederick Finelli, who, in 33 years practicing medicine, has seen a change in his hospital’s patients. He’s now the medical director of the operating rooms at MedStar Washington Hospital Center.

DR. FREDERICK FINELLI, MedStar Washington Hospital Center: Oh, my God, it’s been pretty dramatic.

RAY SUAREZ: How so?

DR. FREDERICK FINELLI: It used to be, years ago, we wouldn’t have patients over 300, 400 pounds very often. Now we’re seeing them daily. And it’s become an operational problem at times.

RAY SUAREZ: Dr. Finelli’s specialty is bariatric surgery, limiting the size of the stomachs of severely overweight people. The scales in his office are specially built to handle patients hundreds of pounds overweight, as are the exam tables, even the surgical instruments, now supersized to reach through larger bellies in order to operate.

One particular cost driver of excess weight is diabetes. According to the CDC, someone with diabetes costs an average $6,600 more per year to care for than someone without diabetes, and, collectively, diabetes costs about $150 billion a year.

DR. FREDERICK FINELLI: When someone gets diabetes, it increases their risk for all kinds of other problems, heart disease, kidney disease, eye disease, also makes them more prone to infection, more prone to arthritis.

So, as we get — patients become obese and then get diabetes, it’s really important to try to get the weight off them, because you can completely reverse that — the disease processes by getting the weight off the patients. And it’s. . .

RAY SUAREZ: Just through weight loss, you can become an ex-diabetic?

DR. FREDERICK FINELLI: Yes. For type two diabetes, just by weight loss, you can become an ex-diabetic.

RAY SUAREZ: But millions of us continue to gain weight, forcing hospitals to invest in new equipment, like the ambulance driven by Richard Biondi specially designed to handle patients up to 1,200 pounds.

RICHARD BIONDI, MedStar Transportation EMT: The size of the vehicle is tremendous. It’s the size of a rescue squad for many fire departments. Everything else here is custom. Have this entire 10-foot-long ramp system. There’s a winch system in the front. Stretcher is specially designed to accommodate patients that size. And then just the overall size inside the ambulance accommodates them as well.

RAY SUAREZ: The winch alone usually, used in trucks, is $8,000. The stretcher designed to hold patients over 1,000 pounds is $9,000. The ambulance alone costs $180,000.

Biondi says the super-obese are often confined to bed by their weight and wait until the last minute to call for help. Helping such a patient from an apartment can take three full ambulance crews. When he looks at the downstream costs of obesity to Medicare and Medicaid, Tevi Troy says the added costs could break the bank.

TEVI TROY: Absolutely, it’s a large and looming issue and it’s something that really threatens to cause huge problems for our budget situation. Our budget situation, however, is already quite perilous and quite difficult. Medicare is facing over a $35 billion annual budget deficit. That’s more than the total budget deficit of Greece.

RAY SUAREZ: The terrible costs, physically and financially, of America’s growing obesity problem hasn’t been enough to get us to stop gaining weight.

Doctors say one thing that’s holding us back might be the notion — mistaken — that we have to lose all the weight we have gained since we were teenagers. But if you just lose 7 percent to 10 percent of your body weight, start small, the tendency toward hypertension, heart disease and diabetes drops precipitously.

How do you get people to change their habits? That’s the. . .

MRC GREENWOOD: Well, you know, the thing that’s so interesting about it is that I had these when I was a kid.

RAY SUAREZ: MRC Greenwood is the vice chair of a huge and comprehensive report on the measures under way to fight back, accelerating progress in obesity prevention, solving the weight of the nation from the Institute of Medicine, incremental steps, like using dinner plates with measuring markers to control portion size, a modest daily exercise program, bringing P.E. back to the school day. They work.

MRC GREENWOOD: It can’t just be that, you know, researchers or scientists say, this would be a good thing to do. Your mayors have to believe it. The families whose children are in school have to believe it. Teachers have to believe it.

It has to be — it has to be more widespread than an individual doctor telling a particular family how to handle an obese child or telling you or me that we should take off 20 or 30 pounds.

RAY SUAREZ: The report is part of a series of initiatives to educate the public launched by the Institute of Medicine, the National Institutes of Health, and the Centers for Disease Control. And HBO will air a four-part documentary next week. It features dozens of top experts exploring the causes and solutions for obesity in the U.S.

WOMAN: I don’t want to be fat for the rest of my life. I have got diabetes.

MAN: Sleep apnea.

WOMAN: High blood pressure.

MAN: I get dizzy when I get up.

WOMAN: Everything’s hurting now.

RAY SUAREZ: New numbers out this week from Duke University predict that one in nine Americans will be more than 100 pounds overweight by 2030. Unless individuals and institutions begin pushing back on current trends, the cost of what we devour will eventually devour us.

We get more on the personal health consequences of obesity and the call for changing the larger environment that contributes to the epidemic, one problem, an ever-growing BMI, or body mass index.

We turn Dr. Francis Collins, director of the National Institutes of Health. The NIH is one of the leading partners in this week’s efforts.

And, Dr. Collins, a lot of our conversation in this area goes to the super-obese. A lot of the statistics that are most troubling come from those people who have gained a huge amount of weight. But aren’t there real health dangers that come from gaining a small amount of weight over a long amount of time?

DR. FRANCIS COLLINS, Director, National Institutes of Health: Well, there are significant health consequences even for those who are not in what you would call the severely obese category.

That would be somebody with a BMI over 40. But if your BMI is even over 25 — and that’s easy to do if you’re just eating maybe an extra couple hundred calories a day over what you would need to maintain a normal weight — that can actually put stress on a number of systems.

Importantly, it really stresses your system as far as how to handle sugar. And that results in over the course of time difficulties in producing enough insulin to keep your sugar in the normal range. And lots of people who are not really obese in a major way already have pre-diabetes.

That is, if you test their glucose tolerance, it’s already abnormal — 79 million people in the U.S. have pre-diabetes. Most of them don’t know it. Most of them have a chance of going on to full-blown diabetes in five years that’s as high as 40 percent or 50 percent. And that doesn’t require you to be massively obese.

Other things happen also as you begin to gain weight. Obviously, it puts a stress on your joints. Interestingly, it also increases your risk of cancer, which many people have not really recognized until recently. We don’t understand all the mechanisms for that, but it’s a very serious concern.

RAY SUAREZ: One interesting finding that’s emerged in all this new research is that kids are eating hundreds of calories per day more than they did a generation ago. Are we seeing diseases that we used to see in older people in ever-younger children?

DR. FRANCIS COLLINS: I think our greatest concern when you look at this public health crisis that is surrounding us is what’s happening with kids.

Fully a third of kids are now overweight or obese. And about 17 percent of them are obese. And we know from studies that NIH has done over many years, including this Bogalusa Heart Study in Louisiana, that an obese child has a 77 percent chance of becoming an obese adult. And that means these kids are already on a pathway towards a lot of trouble.

And there are kids now getting what we used to call adult-onset diabetes, so called type two diabetes, at the age as young as 10, 11 or 12. We never would have seen that in past years. And those kids, it turns out, are very hard to treat, as was recently shown in a study that was just published a week or so ago.

And they, if not successfully treated, may find themselves in real trouble with heart disease, with diabetes, with kidney failure as young as age 30. We are therefore facing for the first time the chance that the current generation may have a shorter lifespan than their parents or their grandparents because of this obesity epidemic.

RAY SUAREZ: But, for years, we’ve been telling people that this is the case, that they have to change the way they’re living. And just telling them so hasn’t been enough, apparently.

The IOM report has a much broader set of suggestions for how to reengineer the way Americans eat, the way they live, the way they get through the day. Talk us through some of that.

DR. FRANCIS COLLINS: Well, clearly, the sort of moralistic finger-shaking at people is not the way to get the results that we hope our nation can achieve.

And we have spent too much time doing that, sort of considering that somehow if people just took initiative to watch their diet and exercise, everything would be fine. It’s going to have to be much more than that. And the Institute of Medicine report outlines that. It’s going to take, sure, the efforts of individuals. We all are going to have to take some additional responsibility for our part, but that’s not sufficient.

It is going to take families working together. It is going to take your own social network. It’s interesting. Your friends can make you fat. It’s pretty clear that the way in which individuals interact with each other influences things like body weight.

I guess your friends can also make you thin. Think about that. And I think a very important role will be for local governance, for mayors and other community leaders to work on providing the kind of environment that makes it easier for individuals to find ways to exercise safely. Schools are a critical part of this.

And the IOM recommends that physical education should now be 60 minutes a day for children, which it has not been for a long time in many schools. And then, on top of that, industry has a role to play. We’re barraged by advertisements for foods that are high in calories and otherwise may be low in nutritive value, and we need to systematically think about how we are surrounded by those kinds of options.

We need a place where the healthy choice is actually the easy choice, where the healthy choice is not a matter of self-deprivation; it’s actually the desirable choice. And right now, the way things look, that’s not how it is.

RAY SUAREZ: Dr. Collins, thanks for joining us.

DR. FRANCIS COLLINS: Nice to be with you, Ray.

RAY SUAREZ: Online, watch my interview with John Hoffman, producer of a new HBO documentary, “The Weight of the Nation,” and find some stunning statistics about overweight Americans on our infographic called “Obesity by the Numbers.” And check out our interactive map of obesity rates across the United States.