What this fat, out of shape country needs is a Diet and Exercise Czarina. I hereby volunteer.
First, let’s get two philosophical things straight. Eating too much and exercising too little is obviously a matter of individual responsibility. Nobody’s force-feeding us, or tying us down so we can’t exercise.
But the fact that 64% of Americans are now either overweight or obese, the fact that physical inactivity combined with bad diet is overtaking tobacco as our leading killer, and the fact one in every four adults does little or no exercise all suggest that other things are at play, too. We live in what some call a “toxic” environment – surrounded by junk food and stressed by too much work and too little time to work out.
In other words, the forces beyond our immediate control – government, employers, the food industry, health insurers, schools, city planners – could do a lot more to supplement our individual efforts to get trim and fit.
For instance, Congress could pass and the president could sign something like the bill recently sponsored by Sen. Tom Harkin (D-IA) that would force chain restaurants – and vending machines – to display the calories, sodium, fat and transfat content of menu items. (Instead, the House recently passed the so-called “cheeseburger bill,” which bans lawsuits that blame the food industry for making us fat.)
Restaurants could offer lower-calorie kids’ meals. A recent study by the Washington-based Center for Science in the Public Interest showed that some kids’ meals have enough fat and calories to choke an adult. The group tested food from chain restaurants and found that a “Boomerang Cheese Burger with Fries” at the Outback Steakhouse contained 840 calories, more than half of what a sedentary kid aged four to eight needs a day.
Schools could add a BMI, or body mass index, score to kids’ report cards. Arkansas schools already do this, says exercise physiologist William J. Evans, chief of the nutrition, metabolism and exercise lab at the University of Arkansas for Medical Sciences. (The BMI is a ratio of height to weight. To calculate it, take your weight in pounds and multiply by 703; then divide this number by height in inches squared. Ideally, BMI should be about 23, maybe slightly older for older folks.)
Schools could also bring back physical education. Only 8 percent of elementary schools, 6.4 percent of middle schools and 5.8 percent of high schools provide daily physical education, according to the federal Centers for Disease Control. Another no-brainer: Schools could restrict the sale of sugary drinks, as the American Academy of Pediatrics recommends.
Employers could do a lot more, too. Helen Darling is the president of the Washington, D.C.-based National Business Group on Health, which represents 207 of the country’s largest employers. Big employers are just “starting to wake up” to the impact that America’s obesity and flabbiness have on the bottom line, she said.
For years, “the view among enlightened employers was that things that have to do with one’s person – what you eat, whether you exercise or not – was none of their business. It would be considered invasive. But as of just about a year and a half ago, our organization looked at what drives health care costs and disability costs and productivity,” she said. Members were “stunned.”
Medical claims for an obese employee are typically twice as high as those of a non-obese employee, her group found. Indeed , obesity costs American business an extra $13 billion a year in health, disability and life insurance, as well as in paid sick leave. (Overall, obesity costs the country $117 billion a year.)
Even more startling, the biggest increases in both medical and disability claims are in younger employees. A recent study by the Rand Corporation, a nonprofit California think tank, found a 40 to 50 percent increase in recent years in the number of people aged 30 to 49 who are too disabled to care for themselves or do routine tasks. “The only factor researchers could identify that would explain such a large jump in disability is obesity,” the Rand researchers said in a prepared statement.
So what can businesses do? Plenty, said Darling. “The number one way to have any kind of fitness as part of the [corporate] culture is if the CEO and the CFO and the senior VPs are fitness buffs.” Behavior change is tough, but “the workplace is the facilitator,” she said. After all, workplace smoking bans helped many Americans quit. To encourage fitness and weight loss, employers can make stairwells well-lit and cheerful, they can provide healthy food choices in the cafeteria and offer to pay for health risk appraisals from an employee’s own doctor, and give employees who follow their doctors’ plans $100 or extra benefits.
Company gyms can help, but not if “people are looked down on” for taking time from work to exercise, noted James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver. A better approach may be “walking meetings.” One CEO in Colorado, he said, goes for a walk every day at 3 and employees are free to join him.
City planners and civic groups could help by making streets more pedestrian-friendly. Nationally, a group called Walkable Communities, Inc. helps civic groups do just that. In Boston, a group called WalkBoston worked with city planners to make sure that some of the green space freed up by the Big Dig construction project becomes walkable, says Liz Levin, the group’s president. [Note: I have just been put on the WalkBoston board.]
Health insurers, too, are beginning to create incentives to boost the survival of the fittest. HealthCare Dimensions in Tempe, Arizona, sells a program called “Silver Sneakers” to 21 health insurers in 14 states, including Fallon Community Health Plan in Massachusetts. Companies like Fallon buy the program for their customers on Medicare, and the Silver Sneakers folks contract with private health clubs and not-for-profit fitness centers like YMCAs to offer classes – free – to enrolled seniors.
Mohit Ghose, a spokesman for America’s Health Insurance Plans (AHIP), a Washington-based industry group for the insurers who cover more than 200 million Americans, says many health plans already offer some kind of exercise benefit. About 18 percent offer exercise counseling or cardiovascular fitness programs as a basic benefit. Roughly 76 percent will help customers get access to a gym at a discount, but “people need to ask the question by calling the 800 numbers of their plans,” he said.
Starting in January, PacifiCare, a consumer health organization in Cypress, CA, has been offering a “health credits” program that offers prizes – like exercise bikes or treadmills – to members who earn credits by participating in health promotion programs, such as exercise or smoking cessation.
None of this is rocket science. But as Czarina, I have hope, and not just because I’m an idealist. As the big players figure out how badly obesity and sloth affect the bottom line, things will have to change.