OAC Testimony to the Florida Committee on Health Policy

Chairperson Dawson and members of the Committee on Health Policy, my name is Joseph Nadglowski, Jr. and I am President and CEO of the Obesity Action Coalition.

The Obesity Action Coalition or OAC is a nonprofit organization dedicated to educating and advocating on behalf of those affected by all forms of obesity. Based in Tampa, Florida, the OAC was formed nearly three years ago with the sole focus of representing those impacted by obesity after a legislator from Colorado pointed out during a nationwide meeting on obesity that although he was frequently asked to address the obesity epidemic, he never heard from those directly affected – the individuals with obesity. The OAC was created to fill this gap.

As a patient-based organization, the OAC is managed by a volunteer Board of Directors, a majority of whom have successfully treated their obesity and also including medical experts in obesity. For disclosure purposes, the OAC, a 501c3 public charity, receives funding from a wide variety of sources in the general public as well as the obesity community including individuals, physicians, allied health professionals, hospitals and industry and I am a full-time employee of the OAC which provided for my travel expenses today.

The OAC operates with a few key principals. First, that obesity is a complex, chronic disease. Second, that as a disease, obesity needs to be prevented and treated. Third, that obesity should be both be prevented and treated under the guidance of health care professionals and finally that access to such treatment, what we call obesity management services, should be made widely available through health insurance.

Today, nearly 23 percent of the adult residents of Florida have obesity and approximately 5 percent have severe obesity or 100 pounds over ideal body weight. More than 14.4 percent of children in Florida have obesity. This is a dramatic explosion considering that in just 1989, fewer than 10 percent of the citizens of Florida were affected by obesity. In less than 15 years, the number of citizens with obesity of Florida doubled. I have a few slides from the CDC showing this dramatic growth in Florida and in other states. Many of you may have seen these before, but I think it is an important reminder of the growth of the obesity epidemic.

These slides are courtesy of the CDC who makes them publicly available on their Web site. They consist of data from the Behavioral Risk Factor Surveillance Survey. One point to remember before we view the slides, is that it is very likely that the percentages shown on these slides are significantly underestimated as they rely on self-reported weights and heights. Let’s be frank about self-reported weights, most of us aren’t honest as we actually have studies showing that men have the tendency to say they are taller, therefore lowering their body mass index (BMI) and women have the tendency to say they are lighter, again lowering their BMI.

Slide 1:

Going all the way back to 1985, we can see that Florida was one of the few states collecting data and our obesity rates were below 10 percent.

Slide 2:

This slide from 1989 shows more states collecting data but Florida remains below 10 percent.

Slide 3:

In 1990, Florida joins many states with obesity rates between 10 and 14 percent.

Slide 4:

In 1992, the first of the states showing obesity rates of 15 – 19 percent begin showing.

Slide 5:

Florida joins those with 15 – 19 percent rates in 1995.

Slide 6:

In 1999, we begin to see widespread obesity rates above 20 percent

Slide 7:

and Florida joins the ranks in 2004. Also note the widespread prevalence of states with greater than 25 percent rates.

Slide 8:

Here’s the latest data displaying a couple of states showing higher than 30 percent obesity rates and Florida still in the 20 – 24 percent range. But please keep in mind, again, that these estimates are low and one national study that does not look at state of residence but does look at medical records to determine weight and height suggests the obesity rate nationally is 34 percent.

So I have mentioned the rates of obesity but haven’t explained how an individual is determined to have obesity. As I am sure most of you know, obesity is determined in adults by calculating a person’s BMI. A BMI between 18.5 and 25 is considered normal. 25 and 30 is considered overweight and 30 and above is considered to have obesity. In children, BMI’s are not always used. In fact, the CDC recommends the Weight-for-age percentile charts for children age 2-20. Children above the 85 percentile, but below the 95 percent are considered at risk for overweight and those at the 95 percentile or above are considered overweight. The use of the term obesity to describe a child is controversial because of the social stigma associated although some experts urge utilizing the term obesity to emphasize the importance of addressing the issue.

These rising rates raise concern because of their implications for the health of the
citizens of Florida. Having excess weight or obesity, increases the risk of many diseases and health conditions, including the following:

Hypertension
high total cholesterol or high levels of triglycerides
Type 2 diabetes
Coronary heart disease
Stroke
Gallbladder disease
Osteoarthritis
Sleep apnea and respiratory problems
Some cancers (endometrial, breast, and colon)

Others testifying today will outline the impact of these on the health of those affected.

In addition to the personal and emotional costs of obesity, real dollars are expended as well in treating obesity and it related diseases. These numbers are astounding estimated in 2003 to be approximately 4 billion dollars annually in the state of Florida with more than half of these costs, about 2.1 billion born by the State and Federal government. These are solely the medical costs and don’t include other employer related costs such as absenteeism, workers compensation and disability related payments.

So how do we solve the problem? In order to tackle the epidemic, the OAC strongly believes we need to change our approach. The battle on obesity must be fought on two, and in my opinion, equally important fronts. We must prevent those who are normal weight or just overweight from developing obesity and second, we must intervene or treat those who are currently have obesity. These are two vastly different battles and it is my strong belief that our efforts to date have been less than successful because of the tendency to lump the two together. Prevention and Intervention are vastly different and must be treated so.

We must treat obesity as we do any other disease. Every major medical organization and the government recognizes obesity as a disease but too often, the public and payors see it as a personal failing and a personal responsibility. Most people continue to lack the ability to walk into their doctor’s office and ask their doctor if their weight is affecting their health and if it is, seek help to address their weight. Furthermore, it is our job to educate the public about obesity. A large majority of the U.S. population does not realize where they fall on a BMI chart; therefore, many individuals misconceive obesity for overweight and do not realize the health risks.

Health Insurance, especially in Florida, almost always excludes such coverage. The insurance will pay to address their hypertension, diabetes and other obesity related conditions but won’t help them address the cause of those conditions – their obesity. Insurance rates continue to grow annually because of the costs of chronic obesity related illnesses, but the insurers themselves, with their focus on short-term profits, are partially to blame as they fail to provide programs and coverage to lower the weights of their members.

As part of this, efforts expanding prevention must continue. The state of Florida in recent years has done an admirable job in this arena with increasing physical activity in schools, encouraging physical activity in communities among other programs. But as I mentioned above, we are failing when it comes to Intervention for those already affected. We need to find ways to encourage insurers and employers to add vastly improved access to obesity treatments including medical nutrition therapy (also called dietary counseling), physician supervised weight loss and for appropriately selected candidates, bariatric surgery. Without such an effort, the costs of obesity in dollars, lives and quality of life will continue to grow annually.

Finding a way to make such coverage available is important to Floridians. In fact, the most common call received in the OAC offices in Tampa is someone who is ready to take those first steps and seek help in addressing their obesity, but is being told by their doctor or their insurance company that obesity treatment is not a covered benefit. Addressing ones obesity is hard enough without these types of roadblocks and too often, such individuals fall victim to the many unproven products and services that target this group. Even more troubling is that fully-insured health plans in Florida don’t even offer obesity treatment coverage at any cost. It is not even an option if an individual or an employer wants such coverage to pay for it.

Health insurer and employer supported coverage for medical services and treatment of obesity and morbid obesity makes sense. As an organization, the OAC urges this committee to develop mechanisms to ensure access to the treatments of obesity. It will require a short-term investment to offer such services but should ultimately lower health and other related employer costs in the long-run as we reduce the prevalence of obesity-related illnesses.

In conclusion, I would like to remind the committee that both Prevention and Intervention are the keys in the battle against obesity. And it is an important battle, for if we are unsuccessful in addressing the obesity epidemic, the current generation of children in Florida and across the United States will be the first to have lower life expectances than their parents. Their lives will be shorter because we have failed to take action and respond to this growing epidemic.

Chairperson Dawson and members of the Committee on Health Policy, on behalf of the Obesity Action Coalition, I would like to thank you for allowing my testimony today and for your work on ensuring that obesity is both prevented and treat.