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America's Costliest Disease

Tevi Troy

The United States is rushing toward a health and economic catastrophe, with significant repercussions on our global competitiveness and national security. The emerging obesity epidemic has no real parallel with any other health crisis in our history. In the past, we have met the challenges of epidemics and other serious diseases and emerged with new knowledge, new technologies and superior tools to better our nation’s health. We need to take the same approach with obesity, coming up with tested and reasonable programs that both address the problem and help inspire new life-saving and wealth-creating technologies.

Toward that end, a report from the Campaign to End Obesity examining the economics of obesity makes a very strong case that obesity prevention and intervention efforts can provide cost-effective improvements in health and generate long-term budget savings for our country.

I wrote the forward to this new study, Assessing the Economics of Obesity and Obesity Intervention, by Michael O’Grady and James Capretta, because I fear that the consequences of the crisis are already upon us and are likely to worsen in the future.

Clearly we need to act. Recently researchers from Cornell University found that obesity’s health costs are much higher than previously thought. They reported that obesity costs the nation $190.2 billion a year, or 20.6 percent of total U.S. health spending, doubling previous estimates.

The Department of Defense considers obesity not only a national problem, but a national security issue. About a quarter of entry-level candidates are too overweight to actually either enter the military or sustain themselves through the first enlistment. An independent study reports that the Department of Defense spends more than $1.1 billion annually for medical care associated with excess weight and obesity.

Too often the policy debate circles around unproven and controversial proposals. We must move beyond divisive ideas such as imposing a soda tax, or taking obese kids away from their parents. These are ideological and unworkable and just sharpen the political divide. And with a fragile economy and the focus on federal deficit reductions, any new programs will have to show meaningful health benefits and demonstrate real cost savings in order to continue receiving funding.

In the new study, O’Grady and Capretta recommend applying strict criteria when evaluating the health benefits of obesity prevention and intervention programs, the kind of scrutiny that comes from peer-reviewed studies published in reputable scientific and health professional journals.

O’Grady and Capretta also provide the valuable service of demonstrating how the Congressional Budget Office’s 10-year budget scoring window fails to account for the real potential benefits of addressing the obesity challenge in an effective way. They recommend improving this 10-year scoring window, saying that the current process fails to account for the real, long-term savings of effective interventions aimed at reducing obesity’s toll on the nation’s health and pocketbook. Successful programs create savings by reducing spending on the treatment of chronic diseases.

It makes sense, then, to assess the savings over a longer 25-year time frame. The idea of a longer timeline is not new or even unconventional. CBO has for some time employed 35-year baseline projections and uses them extensively in the budget process. During the George W. Bush administration, the OMB presented 45-year projections in the FY2010 budget submission. This is similar to the way actuaries calculate the financial impact of different events.

Budget estimates that account for the savings of sound, stringently reviewed obesity prevention and intervention programs ought to provide more options for policymakers. Our perilous fiscal state, combined with our hyper-partisan and divisive political situation, creates severe limitations on the options available for addressing obesity. The approaches O’Grady and Capretta suggest could go a long way to help bridge the partisan divide and stimulate new thinking on this pressing problem.

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