Nation's Obesity Problem Puts Strain On Health Care Costs

A new study published by the Journal of Health Affairs reports the obesity-related health spending has doubled in the last decade. Some economists worry that health care reform could become more costly if Americans don't start shedding those extra pounds. Dr. David Kessler, former head of the Food and Drug Administration, and author of the book "The End of Overeating: Taking Control of the Insatiable American Appetiten" explains the seriousness of America's obesity problem, and who should foot the bill.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

Coming up, another story about how America is changing and how those changes are playing out in different ways. We'll hear about why Sudanese immigrants in Portland, Maine believe that the police are not doing enough to solve a wave of crimes against members of the community. And we'll hear what the new top cop in town is doing to mend the divide. That's a little later.

But first, another angle on the health care debate. President Obama took to the road yesterday in another effort to persuade Americans they need to embrace a health care overhaul. But now a new study examining the country's obesity crisis says no amount of reform will be enough to make medicine affordable if Americans don't also reform their eating habits. That study, published Monday by the journal "Health Affairs" says obesity-related health care spending has doubled in the last decade.

Medical spending averages $1400 a year more for an obese person than for someone of normal weight, and the spending gap will only get worse if the country does not get its weight problem under control. We wanted to talk more about that so we called on Dr. David Kessler. He's the former head of the Food and Drug Administration. He formerly served as dean of the medical schools at Yale and the University of California at San Francisco, and he is also the author of the book "The End of Overeating: Taking Control of the Insatiable American Appetite." Dr. Kessler, thank you so much for talking to us.

Dr. DAVID KESSLER (Author, "The End of Overeating: Taking Control of the Insatiable American Appetite"): Thank you for having me, Michel.

MARTIN: Now, I want to mention you were not involved with this study, but you've been thinking a lot about obesity for the research for your book and also because over the years you've also, to be honest, struggled a little bit with your weight. So, I just wanted to ask, how did we get here? Why are so many Americans overweight?

Dr. KESSLER: I have struggled with weight over my lifetime. I have suits in every size. Back seven, eight years ago, I was sitting asking a very basic question, if you want to stay alive what are the things you can do? Three quarters of us are going to die from either cancer, cardiovascular disease, or stroke. How did we get here? We've taken fat, sugar and salt, we've put it on every corner. We've made it available 24/7. We made it socially acceptable to eat any time. We made food into entertainment. Go into any mall, any food court, it's like a food carnival.

MARTIN: The Obamas have made healthy eating part of their cultural message, if you will. For example, Ms. Obama made a lot of headlines by starting a kitchen garden at the White House and inviting school kids in to kind of help plant the garden and try to re-introduce them to the joys of fresh food and so forth. But do you think the whole issue of obesity is playing enough of a role in the health care reform debate which is also going on now in Washington?

Dr. KESSLER: It's a profound issue. It's as complicated as anything we've ever tackled. Understand the behavior of not only us, but of our kids, is becoming conditioned and driven. We're being set up with neural circuitry that will stay with us for a lifetime. And the consequences are more profound than we've understood. Are we doing enough? We're barely scratching the surface.

MARTIN: One of the points that you make in your book is not only that our sort of modern food processing techniques are constantly introducing unneeded salt, sugar and fat, but they also make it easier to eat quickly. Why does that matter?

Dr. KESSLER: Our food is so processed it's as if it's predigested. Twenty years ago, the average bite, about 20-30 chews. Today it's half that. When the food doesn't linger, it goes down in a woosh, we stimulate ourselves and it's gone, what do we do? We reach for the next piece of food.

MARTIN: How would you then integrate everything that you have learned in the course of investigating this whole question of obesity? How would you integrate that into the debate that we are now having in Washington about health care reform?

Dr. KESSLER: You're asking me the policy question, but in essence they're the same. How did we succeed with tobacco? The success that we had - 20, 30, 40 years ago we had a reinforcing product, nicotine, but it was viewed as cool, sexy, something we wanted to do. What was the real change over the last 30, 40 years? We changed how we viewed the stimulus. Instead of viewing tobacco as something we want, now we view it for what it is, a deadly, disgusting, addictive product.

We had what psychologists call a critical perceptual shift. If you want something and it's reinforced then you're going to approach it. If you view it as your enemy, you're going to avoid it. That's what happened with tobacco. But tobacco, in some ways, was easy because you can live without tobacco. Food we need, but we need to campaign against big food, and I'm not talking corporate big, I'm talking literally big. We need to campaign against food being loaded with fat, sugar and salt. We need to change the way we view food. That's the only way we can cool down the stimulus, in essence, cool down our brains.

MARTIN: As you mentioned, it took 30 or 40 years to change attitudes about tobacco. I mean, we all remember those famous ads featuring our former President Ronald Reagan, before he was president, of course, when he was an actor, promoting cigarettes in a way that of course he would never have done decades later. Do you think it will take 30 years to change our attitudes about food?

Dr. KESSLER: This is as hard a public health challenge as we've ever tackled. We saw the numbers on the economics of what obesity is costing us today, but understand with type-2 diabetes emerging earlier and earlier in life, we got to get our hands around this. We have to change how we as a nation view food. This is as big a challenge as we've ever faced.

MARTIN: Dr. David Kessler is the former head of the Food and Drug Administration. He's author of a book, "The End of Overeating: Taking Control of the Insatiable American Appetite." He was kind enough to join us from KQED in San Francisco. Dr. Kessler, thank you so much for speaking with us.

Dr. KESSLER: Thank you.

MARTIN: The Center for Disease Control and Prevention announced last week that more than a third of African-Americans are obese. Hispanics are not far behind. Yesterday, Health and Human Services Secretary Kathleen Sebelius announced that the government will give state and local governments more money to fight obesity. So we wanted to ask you, what do you think would work? What incentive do you think you need to take off some pounds if you need to?

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