Large Problem

Georgia faces economic pressure from chronic illness

Obese woman - shopperBig people are big business in the United States, where about one in three adults and one in six children and adolescents are considered obese.

It’s known that obesity takes a toll on physical health, often leading to chronic conditions like diabetes, hypertension and joint problems. What many don’t recognize is the financial burden associated with obesity — costs that go far beyond the obese individual.

In Georgia, the cost of obesity is expanding like the waistbands of adults and children statewide; nearly one in three of the state’s adults is obese, and childhood obesity rates are second only to Mississippi.

The health care costs linked to excess weight in Georgia’s adults are currently estimated at around $2.5 billion per year, according to a 2009 report from United Health Foundation, the American Public Health Association and the Partnership for Prevention. But if current trends continue, the report projects these costs could reach $10.8 billion by 2018.

At the current rate, by 2018 as many as 41 percent of Georgia adults could be obese and spending over $1,000 each for obesity-related health care annually, according to the report.

“An obese adult spends about 40 percent more on health care than a normal weight adult does in a given year,” said Kenneth Thorpe, lead researcher for the report and a professor of health policy and management at Emory University. “It adds expenditures, results in lower workplace productivity and a higher prevalence of chronic health conditions.”

While obese individuals pay more for their own health care, they aren’t the only ones who pay the price for their extra weight — businesses and taxpayers shoulder the burden as well. In Georgia, Medicare and Medicaid are estimated to pay 28 percent of the state’s obesity-attributable expenditures, according to a recent study published in the journal Obesity.

And the costs continue to add up, for everything from the price of heavy-duty chairs in offices to the extra gasoline needed for cars carrying heavier people.

Growing waists and shrinking wallets

Rising rates of obesity nationwide and in Georgia are due to far more than individual behavior. Our surroundings play a huge role in what we eat and how much we exercise.

Georgians consistently rank among the lowest in health promoting behaviors like physical activity, with less than half of Georgia adults and only one in four kids getting the recommended amount of physical activity – two and a half hours of moderate activity per week – in 2009.

Only 17 percent of Georgia’s youth consume the recommended five servings of fruits and vegetables per day, according to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System.

Unhealthy foods, like those found in vending machines or at fast food restaurants, are often cheaper and easier to find than nutritious meals. Food deserts — residential areas lacking healthy, affordable food options and supermarkets — abound. The Georgia map is dotted with several USDA-designated food deserts, mostly in poverty-stricken inner-city Atlanta and rural areas in the southern half of the state, where obesity rates tend to be higher.

In addition, urban sprawl encourages people to drive instead of walk to work, school or stores, a Georgia Department of Public Health spokesperson said in an email. Every additional hour spent in a car translates to a six percent greater chance of being obese, according to a transportation study conducted by researchers at the Georgia Institute of Technology.

Who pays the price?

The most obvious and direct costs of obesity are the diagnosis and treatment of the numerous chronic conditions that go along with excess weight.

“Managing chronic illness is an extremely expensive thing to do,” said Phaedra Corso, the department head for Health Policy and Management at the University of Georgia’s College of Public Health. “And we don’t have good systems of care to deal with chronic diseases.”

Someone who is overweight or obese could be seeing several doctors — one to manage diabetes, one to manage cardiovascular disease, one for joint issues — and taking numerous prescription drugs at a time.

Add in lost wages due to disability or illness, and a lower quality of life, and obesity becomes more than just the cost of changing a diet and buying a gym membership. According to a George Washington University study, obese women employed full-time earn six percent less than their healthier counterparts. With more treatment for obesity-related illness comes larger bills and higher insurance premiums and higher costs for publicly funded programs like Medicaid and Medicare.

And it’s not just individuals who pay: employees with additional pounds raise health care costs for everyone including the businesses covering them. According to a 2010 Duke University study, obesity costs U.S. employers $73.1 billion annually in medical costs and lost productivity.

“There is an impact on the economic viability of the state, and on our ability to attract industry,” said Lizann Roberts, a health management consultant and executive board member for Healthy Savannah. “Ultimately this affects an employer’s bottom line.”

Prevention at Work

Some Georgia businesses have started to see the value in addressing the problem directly.

“One way to start is to work with the business community,” said Thorpe. “It’s just getting the programs into place and then providing incentives for workers to engage in them.”

Worksite prevention programs or employer referrals to wellness initiatives can result in healthier individuals, improved worker productivity, and a better bottom line.

“It’s about removing barriers to care,” said Gary Rost, executive director for the Savannah Business Group, a business coalition that buys health care services for local self-funded employers. “We encourage employers to pay for preventive care; paying for the small things first helps to avoid larger costs later.”

Members of the Savannah Business Group (SBG) have subsidized gym memberships, performed health risk assessments and changed the options available in cafeterias — all to improve the health of their workers and prevent the build-up of costs later.

Chatham Steel Corporation, a Savannah-based company and member of SBG, has incorporated a culture of wellness into its business with on-site changes like using an employee committee to select what goes into vending machines.

Another member, the City of Savannah, has implemented a diabetes management program that includes weight loss as a goal. As a result, says Rost, the City has noticed less absenteeism and fewer visits to the ER among its employees.

A Healthier Future Workforce

Addressing obesity before it happens is considered the best route by public health experts, but it’s often hard for government, businesses and taxpayers to think long-term when treatment after-the-fact can seem faster and more tangible.

“Prevention is key for costs,” said UGA’s Corso. “But a lot of people don’t buy into the idea of prevention because we’re married to the cost effectiveness of treatment, where the time frame is shorter.”

But Georgia has recently launched prevention campaigns that focus on the future; young people are the primary targets of anti-obesity efforts at the state and community levels.

“We’re seeing so many diseases in kids that were traditionally only found in adults,” said Tim Whitehead, the vice president of Marketing and Communications for Children’s Healthcare of Atlanta, which is currently running a hard-hitting and controversial advertising campaign spotlighting Georgia’s childhood obesity problem.

Diabetes, joint problems and heart disease are now showing up in obese children. And they won’t grow out of these problems as kids with extra weight are 80 percent more likely to be overweight adults than children of normal weight, according to the Centers for Disease Control and Prevention.

“We want people to make the connection between childhood obesity and health problems later in life,” said Whitehead.

Childhood obesity can have real consequences for Georgia. Annual health care costs for an obese child being treated for obesity are estimated at $2,500 to $4,200 more than the annual health care costs for a normal weight child, according to the Robert Wood Johnson Foundation.

Georgia children’s increasing weight will fuel future economic challenges for the state. “We talk around it now,” said Roberts, “but the children that are growing up now are our future employees.”

The Georgia Department of Public Health has mounted a public fight against obesity with a new focus on improving policy and built environments. Georgians can now expect to see wellness programs popping up in schools, workplaces, childcare facilities and communities.

This year, school children will undergo a required fitness evaluation in physical education classes as part of SHAPE — the Student Health and Physical Education Act recently enacted by the state legislature. Results of the evaluation will be sent to parents.

The state is laying more sidewalks through the Safe Routes to School Program in collaboration with the DOT and with funding from the Federal Highway Administration. Georgia Organics, a non-profit, is launching farm-to-school programs with the aid of state agencies and community groups through the 2009 American Recovery and Reinvestment Act’s Communities Putting Prevention to Work grant.

“We don’t want to penalize people for being obese, but provide them with the right avenues,” said Corso.

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Laura Smith

Laura Smith

Laura Smith graduated in 2010 from UGA with degrees in journalism and sociology. In addition to earning her master's in health and medical journalism, Laura is also pursuing a certificate in global health from the College of Public Health. She has a soft spot for infectious disease, which led her to East Africa in July 2011 to report on schistosomiasis control efforts. She hopes to use her degree to write truthful, effective health messages to the public on vaccination, infectious disease and the dynamics of our health system.