If I was Surgeon General…

I would follow the lead of our country’s first Mom.

This is serious folks.

We, as an American society, need to solve the obesity crisis.  Not just for our physical health, but for our country’s financial stability.

Reducing the spiraling costs of health care is wanted by all.  So far, prevention of the diseases which contribute most to our health care costs, (heart disease, cancer and orthopedic issues, to name just a few) has been given only lip service, by our future supplier of health care–the American government.

It turns out that the mechanisms to reduce our most costly ailments are the same as those that mitigate obesity. It is like simple math. (If a=b, and b=c, than a=c.)  If lifestyle choices reduce obesity, and less obesity means less consumption of health care for heart disease and cancer, than better lifestyle choices means less health care consumption.  Bunches less.  It is for this reason, that I believe the most productive way to reduce health care expenditures is to reduce obesity.

Right now, the government and third-party payers are using other means to wrestle the rising costs of health care.  Dr Berwick and his like-minded academics from cocoons like Cambridge plan to reduce costs by rationing care.  Presently, we have the increasingly used covert rationing techniques, like using “doctors in cubicles” who, without seeing the patient, deny tests and procedures.   But soon, there will be no way to avoid overt rationing.   Others think that reducing doctors’ compensation will reduce costs. It will, but the price of this strategy will be reducing access to care for the majority. WItness the VA healthcare system. 

My vision is that we can conquer the obesity epidemic.  Doing so will improve our country’s health, productivity and likely lead us out of the health care morass.

Here are a few components of my plan…

First, some important assumptions:

• High calorie food and drink are not going away.  Fast-food restaurants with drive-thrus are here to stay.  Coke, Pepsi and the infinite concoctions of sweetened fluids are staying as well. Very easy access to high-calorie inexpensive food is a certainty in the future. 
• Automation in the work place will continue to make it more difficult to burn calories at work.  The professor and the judge are right about this. 
• We will continue our evolution into a car-dominated society.  Outside of the unusual places where vegetarians and granola-munching dominate, like Boulder and Bend, it will become increasingly harder to navigate by foot or bike.
• Society is unlikely to tax junk food like we do for cigarettes.  Although, the benefits of financially discouraging junk food consumption seems obvious, implementing such a tax is implausible and politically untenable.  For example, which foods get labeled junk and which do not, would prove to be a circus.  Baked chips versus regular chips, dark chocolate versus milk chocolate are just two of many vexing examples.  Further, the influence of our snack-food companies, like Coke, Pepsi and Frito-Lay would surely unleash their political fury against such a “regressive” tax, as they would call it.
• Public education campaigns can work.   The benefits of eliminating smoking in public places has taken hold even in the heart of a tobacco growing community, Glasgow, KY.  I believe with enough effort, reducing fat-creating behaviors is achievable.   

These assumptions provide the background in which we will have to work out solutions.  A multi-prong attack on fatness will be needed.  (Please, feel free to add another prong.)

Prong 1:  Hit em early.

Generational change will be needed.  As such, changing fat-creating behaviors needs to start early.  Pediatric leaders will need to make obesity education and treatment as high a priority as vaccinations.  Excessive calorie intake needs to be targeted at a young age, like measles mumps and other infectious diseases. Surely, obesity is worse than pink eye.  For example, kids naturally stop eating when they are full–this behavior needs to be carried forward, aggressively.

Prong 2:  Educational reform.

Educational leaders need to passionately move forward in teaching children about the new world of available calories and challenges to finding places and time for exercise.  No longer should lip-service be paid to gym and nutrition classes.  Physical education should morph into exercise time.  Invoking the excuse that there is not enough time in a school day for exercise needs to be banished.  Oodles of data show that exercise actually enhances learning.  Junk food should be removed from schools.  There is plenty of room for fame and fortune for those who can make inroads here.  Maybe even a Nobel prize.

Prong 3:   In treating obesity, adult doctors are guilty of passivity.

Simply saying to a patient, “try and lose weight,” is woefully inadequate.  Adult doctors need to be much more aggressive in their approach to fatness.  A high BMI is a high BMI. It is hard data that should be frankly discussed, like blood pressure, blood sugar and testosterone levels.  And, I am not just talking about Kentucky-level obesity, even “bike-jersey” fatness needs to be discussed.  Are you fat?  Put a bike jersey on and look in the mirror.  The answer will be obvious.

Lowering the threshold of discussing fatness is critically important, as catching any disease in its early stages makes therapy easier.  Obesity is no exception.

Prong 4:  A massive public-service campaign needs to emerge.

So far, we have the pediatricians, educators and adult doctors on board.  Now we need the government.  Give the rationing a break for a moment, and let’s work on preventing the diseases which really impact our medical system. With the fury of the “got Milk” campaign, healthcare leaders need to convince Americans (especially in places like Manchester, KY) that drinking sugary drinks, eating fat-laden snack foods and not finding a place and time each day to exercise is dangerous. “You don’t exercise?…Holy cow, that’s bad,” should be our country’s new mind-set.

Here would be one slogan,  “Exercise every day you eat!” 

Prong 5:  Reward objective evidence of wellness and fitness.

Although it would be controversial, it seems self-evident that thinness and fitness should be rewarded.  Twenty years ago, I remember that the sponsor of the Indy half-marathon–an insurance company–offered a discount for those that ran a certain time.  Drastic times call for drastic measures, and so it seems that those with normal BMI’s should pay less.  Sorry if this sounds prejudicial or caustic, but incentives are an important motivator, and none better than money.

Prong 6:  Not finding a place or time for regular exercise needs to be unacceptable.

The message is that we no longer live in a world where kids walk to school and people burn calories at work.  It is a new world, where food is available everywhere. We are not devolving our cities backwards for pedestrian or bike traffic. Therefore, like brushing our teeth and hair are societal norms, so should finding time and a place to exercise.

Implementing such a radical new paradigm will require children.  Children can mold adult behaviors.  They brought us old folks Facebook and texting, so surely they can bring us the new social norm of daily life with exercise.  Our new America will need to look at those that run, ride or walk as the mainstream rather than the fringe.

Business leaders can also help with this new norm.  Forward thinking companies should encourage such a new paradigm.  Many already do.  Our new paradigm of exercise and eating right is good for business as well.

Such a message will take time and persistence, but it is possible.  Isn’t it? 

JMM