Renewing Efforts to Control Obesity

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During 2009, the Journal for Nurse Practitioners has tried to have some features in each issue that address the U.S. obesity epidemic. Controlling obesity is now prominently on the health care agenda, and obesity is something nurse practitioners (NPs) cannot ignore.

Newly published statistics in the July/August 2009 issue of Health Affairs indicate that obesity may have cost the United States $147 billion in 2008, up from the estimated $78.5 billion in costs in 1998.1 The study showed that an individual with a body mass index > 30 kg/m2 spends $1429 more per year on health care than the roughly $3400 per year spent by a normal-weight individual with a body mass index between 18.5 and 25 kg/m2 with similar characteristics. The analysis was based on cost estimates of obesity across Medicare, Medicaid, and private insurers and looked at separate costs for inpatient and non-inpatient care and prescription drugs. The estimates were that about $40 billion of increased medical spending through 2006 was a result of the increased prevalence of obesity, including $7 billion in Medicare prescription drug costs.2 Prescription medication use accounted for the majority of the cost differential.

The Centers for Disease Control and Prevention (CDC) has developed a set of community strategies to address obesity. “Obesity, and with it diabetes, are the only major health problems that are getting worse in this country,” said Thomas Frieden, MD, CDC director. “This is the first time the CDC has provided a comprehensive approach to obesity prevention and control.”1 The July 24, 2009, Morbidity and Mortality Weekly Report (MMWR)3 listed the 24 community strategies for reducing obesity. Each strategy describes the best evidence available to support the recommendation and identifies a corresponding measurement to assess its implementation. The strategies are very specific and focus on promoting the availability and affordability of healthy foods and beverages, supporting healthy food and beverage choices, encouraging breastfeeding, pushing young people to exercise, and creating safe environments for physical activity.2 Some of the strategies are simple, such as decreasing the availability of foods served with high fats and carbohydrates, decreasing portion size, and decreasing the availability of sugared drinks in public venues. Other strategies are broader, such as advocating for a tax on all sugar-sweetened soft drinks.

If NPs wish to make a difference in obesity levels, first of all, NPs need to accept that they are role models when it comes to weight. NPs need to take a hard look at themselves and lose weight by changing their own diet and activity patterns whenever needed. Our credibility to counsel patients is enhanced when it is clear we practice what we teach. As NPs, we should not delay in helping our communities and our patients make changes that will affect their weight. We cannot afford to maintain the status quo.