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Reshaping the obesity debate

Lawmakers weigh the right prescription for obesity

By Leigh E. Rich

Akin to the never-ending nature vs. nurture debate, buzz from the Capitol these days is pitting government involvement vs. personal responsibility.

At the Colorado YMCA’s advocacy day on March 21, Colorado lawmakers and members of the Christian nonprofit group discussed a growing problem in America: obesity.

As to what to do about the increasing trend in Americans’ increasing waistlines, some disagree.

Lt. Gov. Jane Norton, who offered the opening remarks of a nearly daylong event that began in the Old Supreme Court Chambers, spoke to the “proper role of government” in the lives of individuals.

“Government can play a role in the lives of people,” she told the group of about 50. But, she added, “it can never be a substitute for personal responsibility.”

After a brief overview of the ins and outs of being Colorado’s second-in-command and touching on topics such as health insurance reform, the collegiate alcohol task force and bipartisan politics, Norton resorted to her oft-used metaphor comparing America’s current health care system with paid business travel.

She garnered a few laughs as she facetiously described how—if, instead of a per diem allowance, one merely had to front a co-pay during a business trip—she would “go first class” all the way, staying at the Ritz-Carlton and driving about town in a Hum V.

Instead, Norton said, America needs more “consumer-directed” health care, because currently we have “no sensitivity” in terms of what care actually costs.

“We’re going to have to start asking our doctor what it costs,” she said.

The lieutenant governor did not talk specifically about obesity, the leading topic of the YMCA event, but merely added that “we believe strongly, our administration, in consumer-driven health care.”

Senate Minority Leader Mark Hillman, R-Burlington, might agree. In an unrelated editorial penned earlier this week (see page 6), Hillman placed Senate Bill 197 at the top of his list of “lousy laws” put forth thus far in the 65th General Assembly.

Raising his now-familiar claim that the Legislature is creating a “nanny state” under Democratic leadership, the “School Vending Machine Requirements” bill by Sen. Deanna Hanna, D-Lakewood, would require “each school district board of education to adopt a policy providing that, by the 2007-08 school year, at least 50% of all items offered in vending machines located in public schools of the school district meet acceptable nutritional standards.”

The bill, which has been laid over in the Senate, is an attempt to place more nutritious choices within the reach of Colorado’s public school students.

Such structural changes that might encourage healthier choices and healthier communities resonated with what presenters at the YMCA’s advocacy day offered from the Capitol’s second-floor chambers.

Following Norton, House Majority Leader Alice Madden, D-Boulder, praised the YMCA for being a cornerstone in many communities and then spoke about her House Bill 1066 that would create a pilot project for Medicaid clients who are morbidly obese.

“We really are a ‘Y’ family,” Madden said, explaining how she was a YMCA soccer coach even during campaign season. “I refused to give that up.”

In addition to praising Colorado as a “citizen legislature”—limiting legislators to five bills per session and, as mandated by GAVEL, requiring a public hearing for every bill—the House Democrat touted the school vending machine bill and her obesity project as steps toward a healthier Centennial state.

Currently, Colorado is the slimmest of all of the 50 states, though that’s not saying much. According to the Centers for Disease Control and Prevention (CDC), 47 percent of adult Coloradans are overweight or obese, compared to a national average of 65 percent. “Overweight” is defined as having a body mass index (BMI) between 25 and 29.9, while “obese” means having a BMI of 30 or greater.

But, the CDC notes on its Web site, the “obesity rate among Colorado adults increased by 141% from 1990 to 2002.”

As for children and adolescents, approximately 16 percent of America’s youth are overweight (medical professionals and researchers do not use the term “obese” with regards to this group).

While the HB 1066 pilot project would only allow adults to participate in the two-year behavioral modification program, Madden acknowledged the medical and economic costs associated with obesity at any age and said she is “really excited” about the bill. In its current form as a pilot program, HB 1066 would be “of no cost to the state, because we don’t have any money,” she explained. Instead, Madden is arranging for pharmaceutical companies to donate funding as well as related prescription medication.

Originally, the bill would have classified obesity as a disease under Medicaid. If successful, the pilot project could demonstrate both financial and health-related incentives for doing so.

Overweight and obese individuals are at increased risk for a number of illnesses, including hypertension, Type II diabetes, coronary heart disease, congestive heart failure, several types of cancer, stroke, sleep disorders and osteoarthritis, just to name a few. Economically, overweight and obesity have direct and indirect costs that, according to the CDC, accounted for 9.1 percent of total U.S. medical expenditures in 1998. Two studies have estimated annual national costs to be between $51.5 billion and $78.5 billion in 1998 dollars.

Colorado’s estimated adult obesity-related expenditures total about $874 million, according to a 2004 study by Finkelstein, Fiebelkorn and Wang.

Madden applauded the YMCA for being an organization that’s “really working on” America’s problem with obesity.

“We have a serious epidemic in front of our country—obesity and inactivity,” said YMCA guest speaker Tyler Norris, president of Community Initiatives and chair of the Robert Wood Johnson Foundation’s “Active Living by Design.”

Norris gave a slide presentation outlining trends in obesity and physical inactivity in the United States, noting that one in three high school students do not engage in vigorous physical activity and less than 30 percent attend daily physical education.

Also, Norris emphasized, children spend more time watching television in the course of a year than attending school.

With an “over-glamorization” of sports that discourages less athletic individuals from participating and a disappearance of “walkable communities,” Norris cited NIH estimates that “we could cut life expectancy by five years with this generation” of Americans—an unprecedented decline in the health-related measure of longevity.

“We’re going to have to own this issue,” he told the YMCA group while discussing the “seven patterns of a healthy community” and how to design a community centered on activity. His suggestions described a community that cultivates leadership, connects people and resources, practices ongoing dialogue and shapes its future.

An “active community,” moreover, includes mixed land use with parks and walking and biking trails; proximity to convenient services; perceived traffic safety and aesthetics; and policy support.

When it comes to the topic of health care at the policy level, Norris emphasized, “most of the conversation is about the financing and delivering of services.” While those are “vitally important,” he warned that “what creates health is rarely in that conversation. … What is it that creates outcomes at the end of the day?”

Norris offered examples, including the “walking school bus”—where parents take turns walking the neighborhood’s children to school—and how a Chicago community reduced its teen pregnancy rate to nearly nonexistent.

“There’s an inside job and an outside job,” he added, explaining that individuals and communities also benefit from partnerships with hospitals, schools, other organized groups and civic components.

“We need to make sure we’re building communities into healthy ones, places that encourage non-sedentary (living).”

Shana Pattterson, a dietitian with the Colorado Department of Public Health and Environment (CDPHE), agreed, describing the various efforts in the state that are coordinated by the CDPHE’s Colorado Physical Activity and Nutrition Program (COPAN). The COPAN coalition promotes nutrition and physical activity interventions that target Coloradans essentially from the cradle to the grave.

“There should not be a single Coloradan that’s untouched,” she said.

Patterson did speak to the individual level as well. Reminiscing of her days in college when she decided to become an aerobics instructor, Patterson admitted, “I was terrible. I just wasn’t coordinated at all. … It was more like I was the entertainment.”

And that was OK, she said, because she knows her shortcomings made exercise more accessible to others.

“Oh, she’ll make you feel better about your level of ability,” she imagines what her students must have told others.

Combined with programs like TV Turnoff Week, National Employee Fitness Month, Walk to School Colorado, 5 a Day and the U.S. Department of Education’s Physical Education Program, Patterson said, “It’s really at this level that we begin to affect change.” 

Rich, L. E. (2005, April 8). Reshaping the obesity debate: Lawmakers weigh the right prescription for obesity. The Colorado Statesman, pp. 7, 10.

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