Build It Bigger? Maybe Not: Addressing Obesity in the US today

This week I came upon an article in the Wall Street Journal describing the challenges of producing a new “plus size MRI scanner“. Companies that manufacture imaging equipment such as MRI and CT scanners have been challenged in recent years to produce technology that will adequately image larger patients. There are several physical limitations beyond the actual size of the scanner in obtaining good images from obese patients including the fact that tissue absorbs x rays and limits the penetration needed to adequately image critical structures. According to Siemen’s chief executive, Americans account for the majority of the extra large imaging market due to increased average patient size. The CDC estimates that nearly 35% of all Americans are considered obese–as compared to 20% only 15 years ago. More than ⅓ of adults and almost 17% of children are considered obese. Some agencies estimate that obesity and obesity related illnesses costs the US healthcare system nearly 150 billion dollars annually. Even with efforts to contain costs, US hospitals will spend 40% more on imaging equipment that will accommodate larger patients. As I have mentioned in previous blogs, the US spends a disproportionate amount of money on healthcare as compared to other industrialized nations. Costs are skyrocketing out of control. It seems to me that the American way of “build it bigger” may not be the most effective strategy when it comes to managing larger patients. Instead we should approach the real issue–prevention and treatment of obesity.

The CDC defines obesity as a body mass index (BMI) of 30 or greater. The BMI is calculated by taking the weight in kg and dividing by the height in meters squared. A report released this week jointly by the Robert Wood Johnson Foundation and The Trust for America’s Health estimates that nearly 45% of Americans will be classified as obese by the year 2030 unless major public health changes are made. The report goes on to say that the numbers of cases of type II diabetes, coronary artery disease, stroke, and arthritis will grow by 10% between 2010 and 2020 and double again by 2030. These frightening statistics should provide ample evidence for addressing the obesity epidemic in the US today. By reducing obesity rates by 5%, we can save billions of dollars in healthcare costs and prevent numerous chronic diseases–in fact, we can reduce costs by nearly 7.5%.

How Can We Prevent Obesity?

In order to effect change in obesity rates in the US, we must individually take responsibility for our waistlines and our overall health. We must work to support out patients, our families and our colleagues. I have listed what I believe to be four key components to preventing obesity:
1. Set an example for today’s youth:

As parents and adults, we must demonstrate a culture of physical activity to today’s children. It is important to emphasize daily physical activity and smarter, healthier eating choices. Children mimic the behavior of their parents. Obesity prevention starts at home.

2. Move:

Physical activity and exercise is essential to the treatment and prevention of obesity. The CDC recommends 150 minutes of brisk exercise per week. This boils down to walking roughly 20 minutes each day. In addition, strength and resistance training such as lifting weights will provide increased bone strength and “jump start” metabolism. Increased metabolic rates result in increased calorie consumption and weight loss

3. Remember that Calories OUT must be more that Calories IN:

It is simple math. The more calories you consume, the more you must burn in order to maintain or lose weight. Calorie counting is essential to making good nutritional choices. Choose foods carefully and avoid high fat, calorie dense foods. For example, a “fast food” lunch at a popular US chain can contain as many as 1500-1700 calories. For many of us, 2000 calories may be our ideal DAILY target for intake!

4. Set Goals/Get Support:

Obesity prevention and treatment requires support and sometimes even psychological counseling. By investing time and money in counseling and support the job of managing obesity can be made easier. Goal setting is an important part of obesity management and prevention. Goals must be reasonable but challenging. Goals are necessary so that we can hold ourselves and others accountable.

The Upshot:
As a nation, we have a choice to make. There are two clearly divergent paths for US health going forward. If we continue to gain weight, remain sedentary and “build it bigger”, we can expect obesity levels to approach 50% and obesity related disease to triple by 2030. If we begin to focus on treatment and prevention (even reducing obesity rates as little as 5%) we can save billions of dollars and millions of lives. This choice begins on the individual level–we must each take responsibility for our own health and set a positive example for the generations that are to follow.

Dr. Campbell enjoying a coffee after a morning run on the beach