How do we trim health care costs? Weighing in on the national debate, a new study in the journal Health Affairs urges: Fight fat by fighting fat.
An obese person spends $1,400 more in medical expense per year than normal-weight people, and obesity-related diseases cost this nation anywhere from $86 billion to $147 billion per year. "Real (health care) savings are more likely to be achieved through reforms that reduce the prevalence of obesity and related risk factors," the study's scholars conclude.
Addressing "poor diet and inactivity," they say, will require "policy and environmental changes that extend far beyond what can be achieved through changes in health care financing and delivery."
Federally funded fat-fighters! Congressional greengrocers in the inner city! Taxpayer-subsidized gym clubs and personal trainers! Surgeon general warnings on Twinkies! The mind boggles.
The statistics they have marshaled are impressive. The debate they have stirred so far is less so.
The problem from a public health perspective is that there is very little evidence that any of these weight-loss strategies (taxing fat, funding nutrition programs and/or exhorting fat people) work.
The most successful scientifically validated weight-loss programs find that a year or two later, almost all the patients are fatter -- just not as fat as the patients not in the program.
Scour the evidence. More people each year kick heroin addictions than keep 50 pounds of fat off their bodies for five years. I'm not saying we chubby folk are not personally responsible. I happen to believe that gluttony is a sin. I'm just saying, "Don't spend my tax dollars on strategies that aren't going to work." We shouldn't have to pay both for the cost of obesity and the cost of failed obesity-fighting programs.
But here's the good news. We do have a silver bullet when it comes to fighting fat. It's called Lap-Band surgery -- a brilliant scientific advance that amounts to putting a big rubber band around the stomach, which is tightened with saline. Genius!
Patients lose about half their excess weight, on average, and (unlike more drastic gastric bypass surgery) have almost no serious risk of complications. Bariatric surgery -- which includes the Lap-Band procedure -- also cures three-quarters of patients with type 2 diabetes.
A study of the cost savings from laparoscopic bariatric surgery for managed care was recently published in the American Journal of Managed Care. The cost of such surgery ($17,000) for morbidly obese patients was recouped by the insurance carriers in just two years.
Yet insurance companies are cutting this benefit, no doubt because it tends to attract the morbidly obese -- expensive folk to insure.
Solutions? Please, not government health care. In Canada, according to a description of a clinical trial being sponsored by the University of Alberta, "waiting lists are several years long. Provincial governments, unable to keep pace with surgical demand, are sending patients to the U.S. for surgery."
Mandating insurance coverage is one possibility but not the one I prefer.
Let's take advantage of the fact that people are willing to spend a lot of their own money for this health care. Because, let's face it: It's not particularly fun to be fat in this world. We can both increase the public health and decrease the public costs -- and draw more personal money from young people into health care -- by taking advantage of the fact that becoming thinner is not only healthier, it is sexier. Young folks are not that interested in the former but they are really interested in the latter.
Why don't we create fat-fighting health savings accounts for Lap-Band surgery? We could let anyone donate to them on a tax-deductible basis (i.e., let Grandma help). We could add a subsidy for poor and working-class people, and also make low-cost government-guaranteed loans available to moderate-income patients to help cover the cost of the surgery. If you can finance a car, you can afford Lap-Band surgery.
Watch a market blossom: better health, lower public costs, more satisfied clients in control of their lives.
Now watch: Would something that simple and sensible ever happen on Capitol Hill?