Government Must Join Obesity Fight, Advocates Argue


By Marguerite Higgins
Published July 13, 2004

Government intervention, not just a better diet and daily exercise, is needed to combat obesity, public-health advocates and government officials said yesterday.

With about 400,000 annual deaths attributed to obesity, speakers at the World Obesity Congress and Expo in Washington said a combined effort from the food, pharmaceutical and health care industries in conjunction with the federal government is needed to shed society's extra pounds.

"If we don't do something, we'll have a horrendous problem on our hands," said U.S. Food and Drug Administration Commissioner Lester Crawford.

Sixty-four percent of the U.S. population is overweight or obese, according to the Centers for Disease Control and Prevention. Individuals with body mass indexes of 25 to 29 are considered overweight, while those with 30 or higher are considered obese. A healthy body mass index is 19 to 25.

Public-health advocates at the conference, backed by representatives in the pharmaceutical industry, said the government should classify obesity as a chronic disease.

Health and Human Services Secretary Tommy G. Thompson is expected to announce later this week whether Medicare, the federal health-insurance program, will start classifying obesity as a disease. That change would open up some coverage for obesity treatments such as bariatric surgery.

Mr. Crawford said the FDA is educating consumers on maintaining a healthy weight by promoting a "Calories Count" campaign and encouraging chain restaurants to put nutritional information on menus. The agency also plans to revamp food labels on packaged foods.

Mr. Crawford said the government might apply more pressure to chain restaurants on menu labeling if there is not a general availability of nutritional information at locations.

"Here's the dilemma. Obesity is a side effect of our success," said health economist Eric Finkelstein, pointing to better technology as a main factor for the public's low exercise levels and increased caloric intake.

The Internet, computer games and television have become more attractive pastimes than physical activity, Mr. Finkelstein said, adding that one in four persons does not exercise at all.

Public and private health initiatives will need to be multifaceted to make a dent in obesity, which costs individual taxpayers about $180 per year in medical expenses, said Mr. Finkelstein, with RTI International, a Research Triangle Park, N.C., nonprofit research institute.

Even a 30-minute daily walk on the treadmill, followed by eight hours on the computer, falls short of the recommended 10,000 steps a day, Mr. Finkelstein said.

Morgan Downey, executive director for the American Obesity Association, said too much emphasis is made on people who are overweight compared with those who are morbidly obese, generally 100 pounds overweight.
Morbid obesity, with body a mass index of 40 or higher, has posted the sharpest increase in the United States, but has few affordable treatments, Mr. Downey said.

He noted that other afflictions linked with personal responsibility such as alcoholism are considered diseases.
But not all participants at the conference agreed with promoting obesity as a disease.

Gerard Musante, a psychologist and founder of the Structure House, a Durham, N.C., weight-loss facility, said obesity can be treated with overall behavior modification instead of extensive surgeries or drugs.

"The worst thing to do is to blame some outside cause that allows people to say it's not their problem and they are helpless victims," he said.

Health care consultant Dwight "Pete" Fullerton said health-insurance companies probably would cover some prescription drugs, but the variety would be limited and would be included as part of an overall weight-loss program that would include changes in diet and exercise.

Current anti-obesity drugs on the market such as Orlistat and Sibutramine have insufficient long-term success required for physicians to regularly prescribe them to patients, said Carole Gleeson, an analyst with Decision Resources Inc., a Waltham, Mass., research firm for the drug industry.

The significant side effects associated with those drugs also keep private insurance carriers from picking up the tab, Mr. Fullerton said.

"There will have to be new and effective drugs, clinical data on sustained weight loss, low incidence of adverse side effects and more clinical trials" to change the skepticism in the health-insurance industry, he said.