Can Michigan win the battle against obesity?
Ray Medina Jr. (center) hangs out with his wife, Stefanie, and children Kameron, 8; Julian, 2; and Adrianna, 9; at their home in Ovid in the days before his bariatric surgery, which was Wednesday. Medina weighed more than 400 pounds when he started his weight loss journey. / ROD SANFORD/Lansing State Journal
The numbers are staggering.
They get quoted all the time, dire estimates about how much it costs Michigan to be the 10th fattest state in the nation.
They show up in expert testimony before the Legislature. They appear in press releases by advocacy groups trying to influence state law. Gov. Rick Snyder himself reportedly relied on one estimate — $9 billion — as the basis for listing obesity reduction as a priority in his administration.
But is it really $9 billion? Or is it more like $42 billion, as one study suggests? Or maybe only $52 million, cited by yet another?
The wide-ranging disparities raise more questions than they answer about what Michigan’s rising obesity epidemic means for the businesses, taxpayers and individuals of the Great Lakes state.
Where do the estimates come from? What do they include? And, most importantly, who ultimately pays the bill?
“The costs of obesity are enormous,” said Dr. Lee Kaplan, chairman of the national Campaign to End Obesity, a consortium of roughly 50 businesses, nonprofits, government agencies and other groups. “You have medical costs, you have disease, you have death and quality of life, military preparedness, and of course, lastly, you have lost productivity in the economy. What part of modern society have we not touched on as being adversely affected by obesity? None. So who pays the bill? We all do.”
Here’s a breakdown of Michigan’s obesity invoice.
Line item: Medicine
If every single Michigander carrying a little extra around the middle managed to slim down just that much — maybe not even that much, maybe just 15 pounds — then people like Jean Chabut might sleep a little better at night.
Because according to Chabut — deputy director of public health administration for the Michigan Department of Community Health — just 15 to 20 pounds may be all it takes to stave off disaster come 2018.
That’s the year when Michigan’s health care costs for treating the medical problems of overweight and obese citizens are projected to reach $12.5 billion annually, according to a study by Emory University researchers.
Call it a diabetic apocalypse. Experts like Chabut fear that without proper intervention today, we’ll reach a point when the skyrocketing costs of obesity-related chronic conditions like heart disease and diabetes become so financially overwhelming that they threaten whatever post-recession economic progress we manage to make in the interim.
“It’s a huge burden, and on that, everyone agrees,” said Chabut from her office overlooking the state Capitol. “That is simply not sustainable.”
Michigan is certainly not alone. The nation’s total health care spending for obesity is projected to reach $344 billion by 2018, according to the same Emory study.
Nationally, medical spending for overweight and obese patients doubled between 1987 and 2007, according to the Congressional Budget Office, and it’s estimated that 83 cents of every health care dollar spent in America is for someone at an unhealthy weight.
Some public health experts say the financial effects of obesity have already eclipsed smoking.
In fact, health experts compare the decades-long campaign to reduce America’s tobacco dependence with what’s needed today to reduce obesity.
“Starting in the 1960s, when the first published research (showed) that tobacco was bad for your health, we had a multi-pronged strategy over decades that were eventually effective in reducing the rate of smoking in the U.S.,” said Marianne Udow-Phillips, head of the Center for Healthcare Research and Transformation. “With obesity, we are still at the early stages of figuring out what to do. And if we could reduce it some — since this is a preventable condition — we could free money for many other things. One study found that in 2003, Michigan spent $3 billion, roughly the same for smoking, just on obesity.”
And just like with the smoking problem, the biggest piece of that spending is for covering chronic conditions.
Line item: Complications
Doris Sims was not the kind of person someone would look at and think, whoa, there’s diabetes waiting to happen.
She wasn’t obese. Just a little over the healthy ideal.
But just that little bit of extra weight — fueled by a high-stress job in the Legislature and too many exhausted trips to the drive-through — was just enough to threaten her health.
A few years ago, Sims was diagnosed as pre-diabetic. Then in 2007, she ended up in the hospital with full-blown diabetes.
Immediately, the single-mother from Lansing found herself on several medications, injecting herself twice a day with two different kinds of insulin.
She had insurance. Luckily. Because her out-of-pocket expenses alone top $1,100 a year.
Each insulin prescription was $40 a pop. Her oral medications, another $50. There were test strips for measuring her blood sugar and routine check-ups with her doctor.
Diabetes, she learned, wasn’t just a health problem. It was also expensive.
“I don’t know how a person does this without insurance,” said Sims, 56, who now works for the Greater Lansing Convention & Visitors Bureau. “In the last three years, this has cost well over $40,000. I couldn’t do it without insurance.”
The insurance industry has long blamed the rise in chronic conditions — things like heart disease, arthritis, asthma and, most dramatically, diabetes — as the reason why private insurance premiums have gone up 119 percent since 1999, according to a report by the nonprofit The Commonwealth Fund.
There is certainly debate over that — and that alone is a massive understatement — but nearly all public health experts agree on one thing: Chronic conditions are the most expensive to treat, and their rise can be traced to the nation’s expanding waistlines.
Obesity is now considered the root cause of at least a dozen chronic conditions and a contributing factor in at least 50 others.
“We all share the cost,” said Kaplan of the Campaign to End Obesity. “Insurance is just that — insurance. Those of us who are healthy share the cost with those of us who are sick.”
But experts say we’re not just paying through our insurance premiums. We’re also paying as taxpayers.
Line item: Caring for the poor
Way back in the early 1990s, the nurses and doctors at the Ingham County Health Department’s health centers — a network of clinics serving the needy and uninsured — realized they needed to find ways to better treat and help the rising numbers of obese patients in their waiting rooms, said Marcus Cheatham, spokesman.
They joined a collaborative aimed at studying why low-income people were at greater risk of obesity.
They applied for grant funds and pilot programs.
And then watched as their patients got bigger and sicker.
“We did not succeed,” Cheatham said. “The problem is much more complicated and difficult than we previously understood.”
Treating the rising obesity rates among low-income patients presents a financial challenge above and beyond that of the general population.
There’s a not-so-simple reason: The less money you make, the more likely you are to be overweight.
More than 30 percent of people who earn between $15,000 and $25,000 are considered obese, compared to only 24 percent of those earning more than $50,000.
Which leaves taxpayers footing the bill for a larger percentage of obesity-related expenses through Medicaid — the publicly funded health plan for low-income and disabled citizens.
Nearly 12 percent of Medicaid spending can be traced to obesity-related conditions, according to research by the Research Triangle Institute.
It’s estimated that Medicare and Medicaid spend about $1,600 more per obese person than they do on a normal-weight person.
At $522 million a year — so far — Michigan has the fifth highest percentage of Medicaid expenses going to treat obesity-related chronic conditions in the United States, according to the RTI study.
Medicaid is funded through a combination of state and federal funds. Enrollments in the program have skyrocketed in the past several years because of the economy, as more and more people have lost jobs and their health insurance.
Enrollments will increase again starting in 2014 because of federal health care reform legislation passed in 2010. The new laws allow more people to become qualified for Medicaid.
“That’s the scary thought,” said Cheatham of Ingham County. “If all these people get on Medicaid and are entitled to buy as much health care through the program as they can consume, and all the while they’re getting sicker and sicker as time goes by, it’s not going to reduce the cost of health care for America. Not unless we can get up stream and deal with policies that are affecting our lifestyles. Something will have to give somewhere.”
Line item: Lost productivity
Something had to give.
The executives and number crunchers and human resources folks at Accident Fund Holdings, Inc. in Lansing knew that as long as a decade ago.
In 2005, the company gave its employees a health-risk survey.
The result? Not surprisingly, 60 percent of the staff was overweight. The company decided to look at that as an opportunity.
“We want our people to be happier and healthier,” said Jenny Quinn, health promotion specialist for Accident Fund. “The more productive and happier people are, they’re going to benefit the state and the company and everyone.”
Accident Fund launched an employee wellness program called eBalance and began offering fitness classes and educational classes. They added a 4,000-square-foot fitness center to its new location in the renovated Board of Water and Light building overlooking the Grand River.
And, perhaps most effectively, they partnered with a company called IncentaHEALTH.
The Denver-based company offers an automated weight-management system for employees that includes daily email coaching, financial incentives for positive health gains and an on-site kiosk where employees can weigh-in and log their lifestyle changes.
The nearly 1,000-person Accident Fund staff is now 8,000 pounds lighter.
The company didn’t have specific figures for how much they have saved in health care costs, but they estimate a two-to-one return on investment.
“It’s hard to put price tag on employee morale,” Quinn said.
There is, however, a price tag on productivity.
Some experts say the indirect costs of obesity are just as, if not more, expensive than the direct medical expenditures.
“For every dollar an employer spends on medical care for chronic illness, they lose about $4 in productivity,” said Kenneth Thorpe of Emory University.
According to one estimate, employers lose $74 billion a year in weakened productivity because of an overweight, sluggish workforce, according to Kaplan, chairman of the national Campaign to End Obesity.
Lost productive means lost jobs he said. Because $74 billion could pay
for 1.8 million new workers at $42,000 salaries.
Total bill: Public health
The ultimate cost, said Kaplan, is life.
“Second to cigarette smoking, obesity is the number one cause of death in the United States,” he said. “We’re talking about dead people. If we can’t get excited about these (other things), maybe we can get concerned about the percentage of these people who are going to die.”
Nationally, obesity has already shown to be reducing the life expectancy of Americans in some parts of the country.
A recent study found that life span in one county in Mississippi — the fattest state in the nation — has dropped by two full years.
Obesity is partly to blame, according to researchers.
“We’ve only watched the problem get substantially worse,” Kaplan said. “We are in an era of an epidemic. And we are losing the war dramatically.”
But there is hope.
Ask Doris Sims.
Thanks to health changes in her life, she’s off one of her insulin prescriptions and almost off the second. She’s lost weight, eats better and gets more exercise.
“I feel great,” she said. “It can be done.”