DEFINING OBESITY

Often just defining a problem helps lead to a solution. Such is the case with the announcement last week from the Department of Health and Human Services that it will now consider obesity an illness. Although the change for now only affects federal Medicare reimbursements (although private insurers tend to follow the government’s lead), it is an important first step in a shift in thinking about what is fast becoming the nation’s top health problem.

While health care providers have long been concerned about obesity, without it being classified as an illness in its own right it has been hard to track patients and treatments. The new classification means that a patient’s body mass index, the measure of obesity, can be recorded on medical charts just as blood pressure, and often, cholesterol levels are measured and recorded. Further, it will enable health care providers to intervene before obesity has led to heart disease, diabetes or other illnesses.

Just within the population affected by the language change, obesity rates are climbing rapidly. Between 1991 and 1998, the rate of obesity among people 60 to 69 years old increased 45 percent, according to the American Obesity Association. Eighteen percent of the Medicare population is obese.

The numbers are worse for younger age groups. Nationally, 24 percent of adults were obese in 2002. Twenty-one percent of Maine adults were considered obese, the highest rate in New England. More than a third of Maine’s kindergarten students are considered overweight.

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. 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-related illnesses cost $357 million a year in Maine.

A recent article in the Journal of the American Medical Association warned that poor diet and physical inactivity may soon overtake tobacco as the leading cause of death in the United States.

The change by the Department of Health and Human Services means that more can be done to treat obesity and related problems, both physical and mental. The small language change becomes even more important if more emphasis is put on treating obesity and related health problems before they become severe. Promoting diet changes and more physical activity to prevent obesity, for example, is preferable to paying for bariatric surgery after it has occurred.

This small change could pay big dividends.