Obesity In A Rural Setting

The plethora of recent studies pointing to the high cost of carrying excess body fat prompted this question: Could Americans start saving money if thousands of much-too-hefty nurses, doctors, and other health providers across the country led a national initiative to lose weight themselves?

Might they not only pare down their own healthcare bill, but could they become models for their families and their patients as well, and perhaps provoke a sea change in attitude to reflect the very significant dangers associated with being overweight and obese?

What if by their activities, it became as socially unacceptable to be severely overweight as it now is to be a cigarette smoker? What if people stopped saying that they can't do anything about their weight, or, that it's nobody's business but their own?

Obesity is a bigger problem in rural areas, some studies say, than it is in urban ones, so such an initiative might be especially important for small towns.

A study last week underscores what's at stake.

Writing in the journal Health Affairs, Eric Finkelstein of RTI International and his co-authors analyzed national survey data and discovered that obese people incur more medical costs, $1,429 (42%) a year more, than people of "normal weight," in 2006 dollars.

Extrapolating to 2008, their report said, the costs of obesity could have risen to $147 billion, or one in every $10 spent on healthcare. Roughly half that bill is paid by Medicare and Medicaid—in other words, the taxpayers.

"What this says, basically, is that for those lifestyle decisions (resulting in obesity), the taxpayers and normal weight people end up paying their cost of care," Finkelstein told me in a phone interview.

Much of the cost is for treating diseases that are the consequences of adult onset diabetes, which is largely preventable, he says.

"Ultimately, it's a decision by employers and policymakers to decide if it's acceptable to finance those costs," Finkelstein says. "And if they decide it's not, they can create incentives or strategies so people who engage in healthier behaviors can get rewarded for doing so."

For obese Medicare patients, non-inpatient medical services and pharmaceuticals were major drivers of spending. "Our results suggest that spending within these categories for each obese beneficiary was more than $600 per year higher than for a normal weight beneficiary," the authors wrote.

For obese privately insured payers, medical cost increases ranged from $284 for prescription drugs to $443 for inpatient services. "In percentage terms, these increases represent 82% and 90% increases in costs, respectively, compared with people of normal weight."

According to a recent report from the Centers for Disease Control and Prevention, 26% of the population is now fully obese with two thirds of America either obese or overweight.

It occurred to me that the message has special relevance for rural areas.

After all, rural communities experience much higher rates of obesity than urban areas, and the health care workforce in rural areas is probably similarly affected.

It's known that many rural providers, hospitals, and clinics, take care of large numbers of the uninsured, and many of them are obese or overweight as well. It's also known that many rural facilities struggle to stay solvent and maintain a respectable level of care for their communities. These lifestyle choices are adding to the hospitals' challenges.

"Rural residents tend to eat diets higher in fat and calories, exercise less and watch more television, all of which can contribute to unhealthy weight gain," according to the Obesity and Weight Control section of the Rural Assistance Center.

So what if whole communities, led by their doctors, nurses, and other health professionals, just got together and said they'd give it a try? That's a suggestion of Nick Yphantides, MD, now consulting medical director for the San Diego County Health and Human Services Agency, who lost 270 pounds himself after realizing his ineffectiveness in trying to counsel his patients to lose weight.

It seems like there's a potential win, win, win situation here.

Maybe they could lead exercise activities several days a week that their patients could join. Or perhaps they could amass support groups. How about "Biggest Loser" competitions in their hometowns?

Given the ultimate increase in the cost of care that often is absorbed by the healthcare system, maybe there could be financial incentives for health workers to meet and maintain their goal?

A recent New England Journal of Medicine paper discussed a successful experiment in Philadelphia to get long-time smokers to quit. In a clinical trial, 878 employees who smoked cigarettes were randomized to either receive information about smoking cessation or to receive that information plus financial incentives if they succeeded in quitting for six months. The project was financed by the Centers for Disease Control and Prevention and the Pennsylvania Department of Health with cooperation from a large multinational company's employees.

Those in the second group received $100 for completing a smoking cessation program, $250 for cessation of smoking as confirmed by a biochemical test, and another $400 if they were still clear of tobacco, as confirmed by that test, six months later.

The results? Those who received the full $750 were three times more likely to have stopped smoking than those who only received information about quitting.

Could something like that be translated to a weight loss campaign? Say, $500 to get one's weight to an optimal level by the end of a year? What about $1,000?

Heck, it'd still be cheaper than making taxpayers spend that extra $1,429.