Financial costs of the U.S. obesity epidemic reach new heights

Sharon Begley, Reuters  Apr 30, 2012

NEW YORK – U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960.

The nation’s rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows.

Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops.

The startling economic costs of obesity, often borne by the non-obese, could become the epidemic’s second-hand smoke. Only when scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air did policymakers get serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also spurred action. Now, as economists put a price tag on sky-high body mass indexes (BMIs), policymakers as well as the private sector are mobilizing to find solutions to the obesity epidemic.

“As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, ‘what policy knob can I turn to stop this hemorrhage?’” said Michael O’Grady of the National Opinion Research Center, co-author of a new report for the Campaign to End Obesity, which brings together representatives from business, academia and the public health community to work with policymakers on the issue.

The U.S. health care reform law of 2010 allows employers to charge obese workers 30% to 50% more for health insurance if they decline to participate in a qualified wellness program. The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.

Such measures do not sit well with all obese Americans. Advocacy groups formed to “end size discrimination” argue that it is possible to be healthy “at every size,” taking issue with the findings that obesity necessarily comes with added medical costs.

The reason for denominating the costs of obesity in dollars is not to stigmatize plus-size Americans even further. Rather, the goal is to allow public health officials as well as employers to break out their calculators and see whether programs to prevent or reverse obesity are worth it.

LOST PRODUCTIVITY

The percentage of Americans who are obese (with a BMI of 30 or higher) has tripled since 1960, to 34%, while the incidence of extreme or “morbid” obesity (BMI above 40) has risen sixfold, to 6%. The percentage of overweight Americans (BMI of 25 to 29.9) has held steady: It was 34% in 2008 and 32% in 1961. What seems to have happened is that for every healthy-weight person who “graduated” into overweight, an overweight person graduated into obesity.

Because obesity raises the risk of a host of medical conditions, from heart disease to chronic pain, the obese are absent from work more often than people of healthy weight. The most obese men take 5.9 more sick days a year; the most obese women, 9.4 days more. Obesity-related absenteeism costs employers as much as US$6.4-billion a year, health economists led by Eric Finkelstein of Duke University calculated.

Total annual cost of presenteeism due to obesity:

US$30-billion

Even when poor health doesn’t keep obese workers home, it can cut into productivity, as they grapple with pain or shortness of breath or other obstacles to working all-out. Such obesity-related “presenteeism,” said Finkelstein, is also expensive. The very obese lose one month of productive work per year, costing employers an average of US$3,792 per very obese male worker and US$3,037 per female. Total annual cost of presenteeism due to obesity: US$30-billion.

Decreased productivity can reduce wages, as employers penalize less productive workers. Obesity hits workers’ pocketbooks indirectly, too: Numerous studies have shown that the obese are less likely to be hired and promoted than their svelte peers are. Women in particular bear the brunt of that, earning about 11% less than women of healthy weight, health economist John Cawley of Cornell University found. At the average weekly U.S. wage of $669 in 2010, that’s a $76 weekly obesity tax.

MORE DOCTORS, MORE PILLS

The medical costs of obesity have long been the focus of health economists. A just-published analysis finds that it raises those costs more than thought.

Obese men rack up an additional US$1,152 a year in medical spending, especially for hospitalizations and prescription drugs, Cawley and Chad Meyerhoefer of Lehigh University reported in January in the Journal of Health Economics. Obese women account for an extra US$3,613 a year. Using data from 9,852 men (average BMI: 28) and 13,837 women (average BMI: 27) ages 20 to 64, among whom 28% were obese, the researchers found even higher costs among the uninsured: annual medical spending for an obese person was US$3,271 compared with US$512-for the non-obese.

Nationally, that comes to US$190-billion a year in additional medical spending as a result of obesity, calculated Cawley, or 20.6% of U.S. health care expenditures.

That is double recent estimates, reflecting more precise methodology. The new analysis corrected for people’s tendency to low-ball their weight, for instance, and compared obesity with non-obesity (healthy weight and overweight) rather than just to healthy weight. Because the merely overweight do not incur many additional medical costs, grouping the overweight with the obese underestimates the costs of obesity.

A hospital room in Birmingham, AL that has oversized chairs and strengthened mobile medical beds to accommodate the increasing size of overweight Americans.

     Marvin Gentry/Reuters

An oversized chair and an oversized hospital bed are pictured in the children's and women's maternity ward at the University of Alabama Hospital in Birmingham, Alabama.

Contrary to the media’s idealization of slimness, medical spending for men is about the same for BMIs of 26 to 35. For women, the uptick starts at a BMI of 25. In men more than women, high BMIs can reflect extra muscle as well as fat, so it is possible to be healthy even with an overweight BMI. “A man with a BMI of 28 might be very fit,” said Cawley. “Where healthcare costs really take off is in the morbidly obese.”

Those extra medical costs are partly born by the non-obese, in the form of higher taxes to support Medicaid and higher health insurance premiums. Obese women raise such “third party” expenditures US$3,220 a year each; obese men, US$967 a year, Cawley and Meyerhoefer found.

One recent surprise is the discovery that the costs of obesity exceed those of smoking. In a paper published in March, scientists at the Mayo Clinic toted up the exact medical costs of 30,529 Mayo employees, adult dependents, and retirees over several years.

“Smoking added about 20% a year to medical costs,” said Mayo’s James Naessens. “Obesity was similar, but morbid obesity increased those costs by 50% a year. There really is an economic justification for employers to offer programs to help the very obese lose weight.”

LIVING LARGE, BUT NOT DYING YOUNG

For years researchers suspected that the higher medical costs of obesity might be offset by the possibility that the obese would die young, and thus never rack up spending for nursing homes, Alzheimer’s care, and other pricey items.

“Growing obesity rates increase fuel consumption.”

That’s what happens to smokers. While they do incur higher medical costs than nonsmokers in any given year, their lifetime drain on public and private dollars is less because they die sooner. “Smokers die early enough that they save Social Security, private pensions, and Medicare” trillions of dollars, said Duke’s Finkelstein. “But mortality isn’t that much higher among the obese.”

Beta blockers for heart disease, diabetes drugs, and other treatments are keeping the obese alive longer, with the result that they incur astronomically high medical expenses in old age just like their slimmer peers.

Some costs of obesity reflect basic physics. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.

“Growing obesity rates increase fuel consumption,” said engineer Sheldon Jacobson of the University of Illinois. How much? An additional 938 million gallons of gasoline each year due to overweight and obesity in the United States, or 0.8%, he calculated. That’s US$4-billion extra.

Not all the changes spurred by the prevalence of obesity come with a price tag. Train cars New Jersey Transit ordered from Bombardier have seats 2.2 inches wider than current cars, at 19.75 inches, said spokesman John Durso, giving everyone a more comfortable commute. (There will also be more seats per car because the new ones are double-deckers.)

The built environment generally is changing to accommodate larger Americans. New York’s commuter trains are considering new cars with seats able to hold 400 pounds. Blue Bird is widening the front doors on its school buses so wider kids can fit. And at both the new Yankee Stadium and Citi Field, home of the New York Mets, seats are wider than their predecessors by 1 to 2 inches.

The new performance testing proposed by transit officials for buses, assuming an average passenger weight of 175 instead of 150 pounds, arise from concerns that heavier passengers might pose a safety threat. If too much weight is behind the rear axle, a bus can lose steering. And every additional pound increases a moving vehicle’s momentum, requiring more force to stop and thereby putting greater demands on brakes. Manufacturers have told the FTA the proposal will require them to upgrade several components.

Hospitals, too, are adapting to larger patients. The University of Alabama at Birmingham’s hospital, the nation’s fourth largest, has widened doors, replaced wall-mounted toilets with floor models able to hold 250 pounds or more, and bought plus-size wheelchairs (twice the price of regulars) as well as mini-cranes to hoist obese patients out of bed.

The additional spending due to obesity doesn’t fall into a black hole, of course. It contributes to overall economic activity and thus to gross domestic product. But not all spending is created equal.

“Yes, a heart attack will generate economic activity, since the surgeon and hospital get paid, but not in a good way,” said Murray Ross, vice president of Kaiser Permanente’s Institute for Health Policy. “If we avoided that heart attack we could have put the money to better use, such as in education or investments in clean energy.”

The books on obesity remain open. The latest entry: An obese man is 64% less likely to be arrested for a crime than a healthy man. Researchers have yet to run the numbers on what that might save.

© Thomson Reuters 2012

Enzymes in Saliva Help Offset Effects of Diabetes

Enzyme found to help regulate blood glucose

5 April 2012 -- Blood glucose levels following starch ingestion are influenced by genetically determined differences in salivary amylase, an enzyme that breaks down dietary starches, according to a new study in the Journal of Nutrition (April 4, 2012) by scientists from the Monell Center.

In the study, amylase activity was measured in saliva samples obtained from 48 healthy adults. Based on extremes of salivary amylase activity, two groups of seven were formed: high amylase (HA) and low amylase (LA).

Each subject drank a simplified corn starch solution and blood samples were obtained over a two-hour period afterwards. The samples were analyzed to determine blood glucose levels and insulin concentrations.

After ingesting the starch, individuals in the HA group had lower blood glucose levels relative to those in the LA group. This appears to be related to an early release of insulin by the HA individuals.

"Not all people are the same in their ability to handle starch," said senior author Paul Breslin, PhD, a sensory geneticist at Monell, in a press release. "People with higher levels of salivary amylase are able to maintain more stable blood glucose levels when consuming starch. This might ultimately lessen their risk for insulin resistance and non-insulin-dependent diabetes."

The findings are the first to demonstrate a significant metabolic role for salivary amylase in starch digestion, suggesting that this oral enzyme may contribute significantly to overall metabolic status.

Additional studies will confirm the current findings using more complex starchy foods, such as bread and pasta, the researchers noted.

Heart Disease - Are We to Blame?

World Renown Heart Surgeon Speaks Out On What Really Causes Heart Disease

PreventDisease.com

March 1, 2012

We physicians with all our training, knowledge and authority often acquire a rather large ego that tends to make it difficult to admit we are wrong. So, here it is. I freely admit to being wrong.. As a heart surgeon with 25 years experience, having performed over 5,000 open-heart surgeries,today is my day to right the wrong with medical and scientific fact.

I trained for many years with other prominent physicians labelled “opinion makers.” Bombarded with scientific literature, continually attending education seminars, we opinion makers insisted heart disease resulted from the simple fact of elevated blood cholesterol.

The only accepted therapy was prescribing medications to lower cholesterol and a diet that severely restricted fat intake. The latter of course we insisted would lower cholesterol and heart disease. Deviations from these recommendations were considered heresy and could quite possibly result in malpractice.

It Is Not Working!

These recommendations are no longer scientifically or morally defensible. The discovery a few years ago that inflammation in the artery wall is the real cause of heart disease is slowly leading to a paradigm shift in how heart disease and other chronic ailments will be treated.

The long-established dietary recommendations have created epidemics of obesity and diabetes, the consequences of which dwarf any historical plague in terms of mortality, human suffering and dire economic consequences.

Despite the fact that 25% of the population takes expensive statin medications and despite the fact we have reduced the fat content of our diets, more Americans will die this year of heart disease than ever before.

Statistics from the American Heart Association show that 75 million Americans currently suffer from heart disease, 20 million have diabetes and 57 million have pre-diabetes. These disorders are affecting younger and younger people in greater numbers every year.

Simply stated, without inflammation being present in the body, there is no way that cholesterol would accumulate in the wall of the blood vessel and cause heart disease and strokes. Without inflammation, cholesterol would move freely throughout the body as nature intended. It is inflammation that causes cholesterol to become trapped.

Inflammation is not complicated -- it is quite simply your body's natural defence to a foreign invader such as a bacteria, toxin or virus. The cycle of inflammation is perfect in how it protects your body from these bacterial and viral invaders. However, if we chronically expose the body to injury by toxins or foods the human body was never designed to process,a condition occurs called chronic inflammation. Chronic inflammation is just as harmful as acute inflammation is beneficial.

What thoughtful person would willfully expose himself repeatedly to foods or other substances that are known to cause injury to the body? Well,smokers perhaps, but at least they made that choice willfully.

The rest of us have simply followed the recommended mainstream dietthat is low in fat and high in polyunsaturated fats and carbohydrates, not knowing we were causing repeated injury to our blood vessels. This repeated injury creates chronic inflammation leading to heart disease, stroke, diabetes and obesity.

Let me repeat that: The injury and inflammation in our blood vessels is caused by the low fat diet recommended for years by mainstream medicine.

What are the biggest culprits of chronic inflammation? Quite simply, they are the overload of simple, highly processed carbohydrates (sugar, flour and all the products made from them) and the excess consumption of omega-6 vegetable oils like soybean, corn and sunflower that are found in many processed foods.

Take a moment to visualize rubbing a stiff brush repeatedly over soft skin until it becomes quite red and nearly bleeding. you kept this up several times a day, every day for five years. If you could tolerate this painful brushing, you would have a bleeding, swollen infected area that became worse with each repeated injury. This is a good way to visualize the inflammatory process that could be going on in your body right now.

Regardless of where the inflammatory process occurs, externally or internally, it is the same. I have peered inside thousands upon thousands of arteries. A diseased artery looks as if someone took a brush and scrubbed repeatedly against its wall. Several times a day, every day, the foods we eat create small injuries compounding into more injuries, causing the body to respond continuously and appropriately with inflammation.

While we savor the tantalizing taste of a sweet roll, our bodies respond alarmingly as if a foreign invader arrived declaring war. Foods loaded with sugars and simple carbohydrates, or processed withomega-6 oils for long shelf life have been the mainstay of the American diet for six decades. These foods have been slowly poisoning everyone.

How does eating a simple sweet roll create a cascade of inflammation to make you sick?

Imagine spilling syrup on your keyboard and you have a visual of what occurs inside the cell. When we consume simple carbohydrates such as sugar, blood sugar rises rapidly. In response, your pancreas secretes insulin whose primary purpose is to drive sugar into each cell where it is stored for energy. If the cell is full and does not need glucose, it is rejected to avoid extra sugar gumming up the works.

When your full cells reject the extra glucose, blood sugar rises producing more insulin and the glucose converts to stored fat.

What does all this have to do with inflammation? Blood sugar is controlled in a very narrow range. Extra sugar molecules attach to a variety of proteins that in turn injure the blood vessel wall. This repeated injury to the blood vessel wall sets off inflammation. When you spike your blood sugar level several times a day, every day, it is exactly like taking sandpaper to the inside of your delicate blood vessels.

While you may not be able to see it, rest assured it is there. I saw it in over 5,000 surgical patients spanning 25 years who all shared one common denominator -- inflammation in their arteries.

Let’s get back to the sweet roll. That innocent looking goody not only contains sugars, it is baked in one of many omega-6 oils such as soybean. Chips and fries are soaked in soybean oil; processed foods are manufactured with omega-6 oils for longer shelf life. While omega-6’s are essential -they are part of every cell membrane controlling what goes in and out of the cell -- they must be in the correct balance with omega-3’s.

If the balance shifts by consuming excessive omega-6, the cell membrane produces chemicals called cytokines that directly cause inflammation.

Today’s mainstream American diet has produced an extreme imbalance of these two fats. The ratio of imbalance ranges from 15:1 to as high as 30:1 in favor of omega-6. That’s a tremendous amount of cytokines causing inflammation. In today’s food environment, a 3:1 ratio would be optimal and healthy.

To make matters worse, the excess weight you are carrying from eating these foods creates overloaded fat cells that pour out large quantities of pro-inflammatory chemicals that add to the injury caused by having high blood sugar. The process that began with a sweet roll turns into a vicious cycle over time that creates heart disease, high blood pressure, diabetes and finally, Alzheimer’s disease, as the inflammatory process continues unabated.

There is no escaping the fact that the more we consume prepared and processed foods, the more we trip the inflammation switch little by little each day. The human body cannot process, nor was it designed to consume, foods packed with sugars and soaked in omega-6 oils.

There is but one answer to quieting inflammation, and that is returning to foods closer to their natural state. To build muscle, eat more protein. Choose carbohydrates that are very complex such as colorful fruits and vegetables. Cut down on or eliminate inflammation- causing omega-6 fats like corn and soybean oil and the processed foods that are made from them.

One tablespoon of corn oil contains 7,280 mg of omega-6; soybean contains 6,940 mg. Instead, use olive oil or butter from grass-fed beef.

Animal fats contain less than 20% omega-6 and are much less likely to cause inflammation than the supposedly healthy oils labelled polyunsaturated. Forget the “science” that has been drummed into your head for decades. The science that saturated fat alone causes heart disease is non-existent. The science that saturated fat raises blood cholesterol is also very weak. Since we now know that cholesterol is not the cause of heart disease, the concern about saturated fat is even more absurd today.

The cholesterol theory led to the no-fat, low-fat recommendations that in turn created the very foods now causing an epidemic of inflammation. Mainstream medicine made a terrible mistake when it advised people to avoid saturated fat in favor of foods high in omega-6 fats. We now have an epidemic of arterial inflammation leading to heart disease and other silent killers.

What you can do is choose whole foods your grandmother served and not those your mom turned to as grocery store aisles filled with manufactured foods. By eliminating inflammatory foods and adding essential nutrients from fresh unprocessed food, you will reverse years of damage in your arteries and throughout your body from consuming the typical American diet.

Dr. Dwight Lundell is the past Chief of Staff and Chief of Surgery at Banner Heart Hospital , Mesa , AZ. His private practice, Cardiac Care Center was in Mesa, AZ. Recently Dr. Lundell left surgery to focus on the nutritional treatment of heart disease. He is the founder of Healthy Humans Foundation that promotes human health with a focus on helping large corporations promote wellness. He is also the author of The Cure for Heart Disease and The Great Cholesterol Lie.

The Curse of Processed Foods: White Sugar = White Death

The massive problem with processed foods is that almost all of them contain refined white sugar. This can be in several forms such as sugar, sucrose, corn syrup etc but the bottom line is that all are highly detrimental to your health and achieving the body you deserve. This section is quite detailed but it's important that you know the TRUTH about how white sugar just totally destroys your ability to get lean and muscular and with this knowledge 'eating clean' becomes a powerfully sane choice. 

The following information comes from 'Sugar Blues' by William Duffy. 

Why is sugar toxic to the body? 

In 1957 Dr William Coda Martin tried to answer the question: When is a food a food and when is it a poison? His working definition of "poison" was: "Medically: Any substance applied to the body, ingested or developed within the body, which causes or may cause disease. Dr Martin classified refined sugar as a POISON because it has been depleted of its life forces, vitamins and minerals.


"Sugar consumption forms 'toxic metabolites' such as pyruvic acid and abnormal sugars containing five carbon atoms. Pyruvic acid accumulates in the brain and nervous system and the abnormal sugars in the red blood cells. These toxic metabolites interfere with the respiration of the cells. They cannot get sufficient oxygen to survive and function normally. In time, some of the cells die. This interferes with the function of a part of the body and is the beginning of degenerative disease."


Refined sugar is lethal when ingested by humans because it provides only that which nutritionists describe as "empty" calories. In addition, sugar is worse than nothing because it drains and leaches the body of precious vitamins and minerals through the demand its digestion, detoxification and elimination make upon one's entire system. 

Sugar taken every day produces a continuously over acid condition, and more and more minerals are required from deep in the body in the attempt to rectify the imbalance. Finally, in order to protect the blood, so much calcium is taken from the bones and teeth that decay and general weakening begin.


Excess sugar eventually affects every organ in the body. Initially, it is stored in the liver but the liver's capacity is limited, a daily intake of refined sugar soon makes the liver expand like a balloon. When the liver is filled to its maximum capacity, the excess glycogen is returned to the blood in the form of fatty acids. These are taken to every part of the body and stored in the most inactive areas: the belly, the buttocks, the breasts (man boobs anyone?) and thighs.


When these small & comparatively harmless places are completely filled, fatty acids are then distributed among active organs, such as the heart and kidneys. These begin to slow down; finally their tissues degenerate and turn to fat. The whole body is affected and abnormal blood pressure is created. The parasympathetic nervous system is affected; and organs governed by it, such as the small brain, become inactive or paralyzed. The circulatory and lymphatic systems are invaded, and the quality of the red corpuscles starts to change. An overabundance of white cells occurs, and the creation of tissue becomes slower. Our body's tolerance and immunizing power becomes increasingly limited, so we cannot respond properly to extreme attacks, whether they be cold, heat, mosquitoes or microbes.


Excessive sugar has a strong mal-effect on the functioning of the brain. The key to orderly brain function is glutamic acid, a vital compound found in many vegetables. The B vitamins play a major role in dividing glutamic acid into antagonistic-complementary compounds, which produce a "proceed" or "control" response in the brain. B vitamins are also manufactured by symbiotic bacteria that live in our intestines. When refined sugar is taken daily, these bacteria wither and die, and our stock of B vitamins gets very low. Too much sugar makes one sleepy; our ability to calculate and remember is lost.


Thus it should be clear that in order to get your body as lean and muscular as possible, you have to stop kneecapping yourself and your progress every time you have something to eat.