A Heavy Price Maine faces health, social costs of growing obesity epidemic

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Editor’s Note: Some 64 percent of Americans are obese or overweight. Poor diet and physical inactivity soon may overtake tobacco as the leading cause of death in the United States. In New England, Maine has the highest percentage of obesity among the adult population, and the problem is escalating among children as young as kindergartners. Today and in coming months, the Bangor Daily News will explore this complex issue in a series of occasional stories.

In just two generations, Maine public health officials have gone from worrying about a population that was poorly fed to one that is overfed.

A 1944 state study of nutrition among Maine schoolchildren found that more than a third of them were undernourished, and just 1 percent were overweight.

Today, three of every five Maine residents are considered obese or overweight. Since 1990, obesity rates among adults and children have nearly doubled.

In Maine, “36 percent of kindergartners weigh too much; that’s startling,” said Dr. Dora Anne Mills, director of the Maine Bureau of Health.

An overweight child is more likely to end up an overweight adult.

The affliction of obesity is not confined to Maine. Roughly 64 percent of American adults are overweight or obese.

In the Pine Tree State, “the problem cuts across all socioeconomic classes and income levels,” Dr. Erik Steele of Bangor, co-chairman of the

Governor’s Council on Fitness, Health and Wellness, said in a recent interview. “The issue of obesity in Maine is every bit as important as economic development. It’s hard to attract businesses to a state with high health care costs and an unhealthy population.”

In 2002, 21 percent of Maine adults were considered obese, the highest rate in New England. Nationally, 24 percent of adults were obese.

While it doesn’t constitute a disease, obesity creates the conditions for a host of degenerative diseases to flourish, such as hypertension, diabetes, heart disease, atherosclerosis (hardening of the arteries) and others.

Maybe the most worrisome is an explosion in the number of children who have what used to be called adult onset diabetes but which had to be renamed type 2 diabetes.

The rapidly rising rates of obesity and diabetes among the young “could lead to our current adolescents and young adults being the first generation in U.S. history to not live longer than their parents,” Dr. Mills said.

Health officials estimate that in Maine the number of people with diabetes soared from 33,000 in 1994 to 73,000 in 2002.

“Poor diet and physical inactivity may soon overtake tobacco as the leading cause of death” in the United States, according to an article in the March 10 edition of the Journal of the American Medical Association. “Overweight would account for the major impact of poor diet and physical inactivity on mortality.”

Obesity makes society pay a higher price in health care than it should. Being obese is not just a personal problem, according to Mark Anderson, a senior instructor in resource economics and policy at the University of Maine. There is a “spillover effect” onto other people because the obese incur greater medical expenses, which drives insurance premiums and taxes higher.

Obese adults have annual medical expenses that are 36 percent higher than normal weight adults, according to an article by a trio of researchers at the Centers for Disease Control and Prevention in the May 2003 edition of the journal Health Affairs.

A recent national study estimated that obesity-related ailments consume 5.6 percent, or $357 million, of total health care spending in Maine each year. The cost of obesity problems eats up 11 percent of annual, taxpayer-funded Medicaid spending in the state.

Nationally, as much as $75 billion a year is spent on medical expenses stemming from obesity, 5.7 percent of total spending on health care in the United States, according to researchers from RTI International and the CDC.

“Obesity accounts for a considerable, and preventable, portion of the nation’s medical bill,” the report said.

But what “scared the hell out of us was when we began to see obesity in the adolescent and childhood population,” Steele said. “We used to see diabetes in people in their 40s, 50s and 60s. Now we see it in people in their teens, 20s and 30s.”

Diabetes appears in the obese because excessive fat causes the body to develop progressive resistance to its own insulin, leading the body to use less sugar to drive activity, Steele said, and “Insulin is what gets the sugar out of your blood and into use in the tissue so that it’s burned off.”

The “real kicker,” Steele said, is that when type 2 diabetes appears in the young, it has more time to wreak its havoc on the body.

“We cannot afford obesity as a disease in adolescents,” Steele said. “It’s gutting this state’s economy.”

The basic cause of being overweight is simple: eating more than necessary.

As Dr. C.M. Young wrote in 1972: “No one violates the basic laws of thermodynamics … if energy intake in food and drink is greater than energy output, body fat will be stored.”

Energy intake is measured in calories, and American caloric intake skyrocketed in the late 1980s.

From 1910 to 1985, the amount of calories an American consumed hovered between 3,100 and 3,500 per day, according to the Economic Research Service of the U.S. Department of Agriculture.

In 1982, however, American caloric consumption began to rise steeply, reaching 3,900 calories per person per day in 2000.

This “big jump in average calorie intake … without a corresponding increase in the level of physical activity … is the prime factor behind America’s soaring rates of obesity and type 2 diabetes,” according to the agency.

Today, “kids are sitting more than they ever did,” said Katherine O. Musgrave, professor emerita of food and nutrition at UMaine.

Sitting in front of the TV or computer often means simultaneously drinking soda or munching on snacks.

When people eat, Musgrave said, they “just graze all day rather than eating set meals.” With “grazing,” the body’s appetite control panel doesn’t register that we’ve eaten, so we remain hungry.

Ironically, the obesity upsurge has coincided with an unprecedented abundance of fresh food in grocery stores, even in winter.

“The body is still geared to feast and famine cycles,” said Richard Cook, an associate professor of nutrition at UMaine. “But [we] never have famine anymore.”

Also, food has become less costly year by year. According to the Economic Research Service of the U.S. Department of Agriculture, the share of disposable personal income Americans have had to spend on food has fallen steadily from 23.4 percent in 1947 to 10.1 percent in 2002.

The problem is that too often people – especially the poor – turn to cheap, processed foods for meals, Mills said.

These processed foods go straight into the body as sugar, said Dr. Joseph Benoit, an obstetrician, gynecologist, and bariatric physician in Bangor.

The constant availability of appealing, high calorie food – such as soda, french fries and fast food – is a root cause of today’s obesity.

“Everywhere you go there’s food in front of you,” Cook said. “Even gas stations are food centers today.”

Monstrously large portions don’t help.

“I can’t get my mouth around some sandwiches today,” Musgrave said.

It does not help that “towns are planned around cars, not walking and biking,” Mills said. “Workplaces are planned around cubicles, computers and sitting. We have built obesity into our society.”

There is a need to “reintegrate” physical activity, such as walking and biking, into home, community, school and work sites, Mills said.

Not everyone in Maine is taking the problem sitting down.

State Rep. Sean Faircloth, D-Bangor, made a fistful of legislative proposals last year to reverse the burgeoning of Maine’s girth.

“A multiplicity of [government] policies melded together into the perfect storm to promote obesity,” Faircloth said. For example, government has subsidized the oil industry and, by extension, automobile usage.

None of his proposals passed, but the Maine Department of Education is looking at banning soda and candy from vending machines in schools, and a commission was formed to study public health issues, obesity in particular.

In the Calais area, SAD 106 students and administrators convinced the district’s three school boards to rid vending machines of soda and candy and to fill them with juices, water and snacks such as granola bars and trail mix.

The key was overcoming opposition if the changes meant a reduction in vending-machine revenues, which are used to fund a variety of student activities.

Heather Henry, the district’s school health coordinator, went to the Calais High School student council and showed it what kind of healthy snacks could go into the machines. Then she pointed out that, filled with those foods, the machines could stay on all day, unlike machines filled with soda and candy.

After the changes, “It’s hard to keep the machines stocked,” Henry said. “I was so happy the kids took action. It’s created awareness about healthy eating.”

Henry’s efforts were done in conjunction with Healthy Maine Partnerships, a program established, in part, to combat teen smoking with funds from the national tobacco settlement. Now the tactics used to cut teen smoking are being turned toward obesity prevention.

Awareness is crucial to battling obesity, according to Mills, especially having people know how much they weigh.

This is where measures such as the Body Mass Index – a ratio of height to weight – come into play. BMI, however, is not a perfect method for assessing whether someone is obese. Tom Cruise, Sylvester Stallone, Arnold Schwarzenegger and Mel Gibson are all considered obese by BMI.

But it is accurate enough that “people should know their BMI just as they do their blood pressure and cholesterol level,” Mills said.

Benoit wishes insurance companies would pay for obesity treatment. Insurers reimburse for diabetes treatment, he said, “but if we can fix obesity, we can fix a ton of stuff, including diabetes.”