In The News

Ounces & Pounds, Dollars & Sense – The compelling case for obesity control

November 16, 2009

David L. Katz, MD, MPH, FACPM, FACP
Director, Prevention Research Center
Yale University School of Medicine

Chair, Partnership to Fight Chronic Disease
Connecticut Chapter

If an ounce of prevention is worth a pound of cure, what is failure to prevent the gain of innumerable pounds worth?  Quite possibly the difference between national solvency and financial ruin.  That is the rather dire message that emanates from a novel projection of the future costs of obesity by health economist Ken Thorpe of Emory University.

What’s around the next bend isn’t pretty.  By 2018 over 100 million Americans will be obese, and we will be spending $344 billion annually on obesity, a quadrupling of current levels that are already breaking the bank.  Per capita spending will rise from $361 to over $1400 a year.  That’s every year, per every person.

The report goes on to project costs specific to each state, demonstrating, inevitably, that the burden will be greatest for the states that can afford it least.  But the overall message that matters most is: we’re all in the same boat, and it’s sinking fast.

And, frankly, the human cost of this calamity makes the dollar cost seem almost a bargain.  What was, not long ago, “adult onset” diabetes is now called “type 2,” because it now occurs in children and adults alike.  When 7 and 8-year-olds, due to obesity, succumb to “adult onset” diabetes, they will certainly be vulnerable to heart disease by age 17 or 18.  I know a 17-year-old boy who has had a triple coronary bypass.  What keeps me up at night is the prospect of angina becoming a routine adolescent rite of passage alongside acne.

Why is this happening?  For the most fundamental of reasons.  Throughout most of human history, calories were scarce and hard to get, and physical activity was unavoidable.  We have devised a modern world in which physical activity is scarce and hard to get, and calories are unavoidable.

The health care we are currently embroiled in reforming is not the solution.   After all, the paths to weight control and vitality do not run through CCUs, ICUs, clinics, and ERs.  True vitality, in fact, is pretty good at avoiding just such places.

We have known for decades that along with tobacco use, dietary and physical activity patterns overwhelmingly account for our societal burden of premature death and chronic disease.  A 2009 study conducted among over 20,000 adults in Germany suggests that these same behaviors account for fully 80% of the risk for acquiring any major chronic disease.

Data gathered by the CDC and the World Health Organization show clearly that were we to apply what we know about lifestyle, we could reduce heart disease rates by 80%; diabetes by 90%; and cancer by between 30% and 60%.  Much of this benefit would result directly from weight control, as obesity is on the causal pathway to every major chronic disease of modern life.

In other words, feet and forks will address the origins of epidemic obesity and chronic disease far more effectively and far more affordably than drugs and scalpels.  Feet and forks are the truest tools of health reform, and the master levers of medical destiny.

What stands in our way is not lack of knowledge, but a lack of both collective will and universally accessible ways to convert the knowledge we have into the power of action.

Fixing epidemic obesity and the metabolic mayhem that follows in its wake is simple; it just won’t be easy!  We simply need to undo the causes of epidemic obesity we created in the first place.  We have made high-calorie, highly processed food the most available, familiar, and economical choice.  We need to reverse that.  Wholesome food should abound, and nutrition per dollar should be our measure of food value, rather than calories per dollar.  After all, maximizing calories per dollar merely lowers the cost of getting fat, and sick.

We have made labor-saving technology the norm in every situation once served by muscle power.  We need to reverse that, and make movement part of every ordinary day.

The reforms we need most must play out in schools and supermarkets, shopping malls and suburban neighborhoods, worksites and restaurants, legislatures and living rooms.  We must move from our narrow vision of “health care” to societal reform that is truly about the cultivation of health.

Fundamentally, we need a dedicated, sustained and urgent application of nothing less, but nothing more, than our collective good sense.  It can’t come too soon, because lives are at stake.  And so, we now know, is a truly vast sum of dollars.


Dr. David L. Katz;