politicalization of obesity

Politicalization of Obesity -- Policy Analysis

One of the most prevalent health issues presently in the United States is that of childhood obesity. The goal of this work in writing is to analyze a specific health care policy issue, which specifically is that of obesity. This work will further propose nursing strategies to address the problem. This work will use two bills currently in Congress. Two pieces of legislation have been introduced to address the problem of childhood obesity are those of H.R. 3144 and H.R. 3092. This work in writing conducts a policy analysis of these two bills presently before the U.S. Congress.

Politicalization of Obesity -- Policy Analysis

One of the most prevalent health issues presently in the United States is that of childhood obesity. The goal of this work in writing is to analyze a specific health care policy issue, which specifically is that of obesity. This work will further propose nursing strategies to address the problem. This work will use two bills currently in Congress.

II. Introduction

In a 2009 report published by The Hill that there are two House Bills, specifically 3092 and 3144 that have as their objective to cut obesity rates and other related illnesses. The reporter, Democratic Representative of Pennsylvania, Kathy Dahlkemper reports that the obesity crisis in this country "is real." (2009) Two pieces of legislation were introduced to address the problem of obesity, which are identified as:

(1) H.R. 3092 - The Obesity Treatment and Wellness Act of 2009. This bill is reported to address "…the CDC estimate that approximately half the costs associated with obesity are paid through Medicare or Medicaid." (Dahlkemper, 2009) Medicaid reportedly will pay for diseases resulting from obesity but will however not pay for nutrition, which can serve to treat the disease. This is stated to be a "glaring and costly oversight" that will be addressed by the Obesity Treatment and Wellness Act of 2009 that will "promote healthy living and wellness by requiring Medicaid to cover nutritional therapy." (Dahlkemper, 2009)

(2) H.R. 3144 -- The Health Communities Act of 2009 is reported to set up "…a five-year, public-private community grant program to combat obesity. Based on the successful program in my district called Healthy Armstrong, the bill would direct the secretary of Health and Human Services to award grants to communities who can form a diverse coalition of stakeholders, including parents, hospitals, school districts, health insurance companies, pediatricians and local employers." (Dahlkemper, 2009) The emphasis of the program is on "…physical exercise, nutritional counseling and obesity prevention education. Each year, the program would have to meet certain benchmarks with regard to reducing obesity in order to continue to receive funding." (Dahlkemper, 2009) This will not only improve the individual's health and well-being but as well would serve to improve the "overall environment to encourage sustainable and health living." (Dahlkemper, 2009)

III. Background

Dahlkemper (2009) states that a report published by the New England Journal of Medicine states that the "current generation of children in American may have shorter life expectancies than their parents for the first time in two centuries. In fact, the rapid rise in childhood obesity could shorten life spans by as much as five years if left unchecked." (2009) If reform is to be achieved then Dahlkemper states that "Congress must begin to face reality. Any meaningful attempts to create long-term sustainable healthcare must begin with taking control of skyrocketing costs." (2009) The Centers for Disease Control and Prevention (CDCZZ) reports that between the years 1976 and 1980 "approximately 5% of youths aged 2 through 19 were identified as obese. Compare that to a recent study by the National Center of Education Statistics that stunningly concluded that nearly one in five American 4-year-olds are obese." (Dahlkemper, 2009) The New England Journal of Medicine is additionally stated to report that children "…who are obese after age 5 have a 50% greater chance of being obese adults. And overweight adolescents have a have 70% change of being overweight or obese adults." (Dahlkemper, 2009) Reported, as consequences of obesity, are such health problems as "heart disease, Type 2 diabetes, high blood pressure and some forms of cancer." (Dahlkemper, 2009) Obesity is reported to account for approximately 9.1% of all medical spending and reported as well is the fact that a patient with obesity "has $4,871 in medical bills a year compared with $3,442 for a patient at a healthy weight." (Hellmich, 2009) Furthermore, obesity is stated to be the primary reason for health care cost increases. A reported 34% of adults, which is in excess of 72 million individuals in the United States, were found to be obese in 2006, which is up 23% from 1994 figures. The average American is reported by the Centers for Disease Control to be 23 pounds overweight -- a collective 4.5 billion pounds overweight. (Hellmich, 2009, paraphrased)

Findings reported from a study conducted by obesity experts which analyzed the medical expenditure data including other direct medical costs including prescription medications, doctor visits and outpatient and inpatient services states findings that include the following: (1) Taxpayers paid fifty percent of the 147 billion in 2008 through Medicare and Medicaid; and (2) Obese patients on Medicare spent approximately $600 each year more in prescription medications than patients at a healthy weight. (Hellmich, 2009)

The work of the Center for American Progress entitled "Confronting America's Childhood Obesity Epidemic: How the Health Care Reform Law Will Help Prevent and Reduce Obesity" published in May, 2010 reports that children is some communities "account for almost half of new cases of type 2 diabetes" and as well that "hospitalization of obese children and adolescents aged 2 to 20 nearly doubled between 1999 and 2005 for obesity related conditions such as asthma, diabetes, gallbladder disease, pneumonia, skin infections, pregnancy complications, depression, and other mental disorders." (Whelan, Russell, and Sekhar, 2010) Since 1980 childhood obesity, rates "...have more than tripled…and current data show that almost one-third of children over 2 years of age are already overweight or obese." (Whelan, Russell, and Sekhar, 2010) It is reported that the estimated costs for hospitalizations for obesity-related conditions "increased from $126 million in 2001 to almost $238 million in 2005." (Whelan, Russell, and Sekhar, 2010)

The cost to Medicaid for these hospitalizations more than doubled from $53.6 million in 2001 to about $118 million in 2005. (Whelan, Russell, and Sekhar, 2010) Obese children also contribute to these health care costs. Studies have found that obese children stay nearly a full day (0.85 day) longer in the hospital which resulted in $1,634 per patient in increased hospital charges." (Whelan, Russell, and Sekhar, 2010) Children from racial and ethnic minority families and children from low-income households are reported to be "…disproportionately overweight and obese." (Whelan, Russell, and Sekhar, 2010) Statistics show the following facts:

(1) Among families living below the federal poverty level 44.8% of children are overweight or obese, while 22.8% of children living in families with incomes above 400% of poverty are overweight or obese;

(2) Recent data show that Hispanic and black high school children have obesity rates of 16.6% and 18.3%, respectively, which is significantly higher than their white counterparts (10.8%).12 The same disparities exist for younger children; and (3) Children of racial and ethnic minorities are more likely to live in low-income communities, which too often have limited access to healthy food options, fewer parks, and generally are less safe. (Whelan, Russell, and Sekhar, 2010)

It is reported that a study of Cornell University shows that that the "…inflation-adjusted price of fruits and vegetables rose 17% between 1997 and 2003, while the price of a McDonald's quarter-pounder and Cola-Cola fell by 5.44% and 34.89%, respectively." (Whelan, Russell, and Sekhar, 2010) It is reported as well that studies have established that a strong relationship exists between "the costs of fat foods and the body mass index of children and adolescents, especially in families of low-to middle-socioeconomic status." (Whelan, Russell, and Sekhar, 2010)

The reasons that children and adolescents are overweight and obese is clear in that the problem has been identified as an imbalance in the calories that they consume and the expended calories during activity and exercise. Factors that contribute to children becoming overweight or obese include such as a trending toward physical activity decreases and the expanding of sedentary forms of play, including video games and activities, as well as the change in transportation modes. Other factors that contribute to obesity in children are societal in nature and include biological and behavioral factors within the cultural, social and environmental framework. Therefore, it is necessary that obesity be addressed from both a sociological and psychological standpoint. Some of the provisions in the bills addressing childhood obesity are inclusive of such as improved nutritional labeling in fast food restaurants and community transformation grants. Others include such as prevention and public health programs and primary care and coordination efforts with an emphasis on prevention as well as community-based care targeting communities disproportionately affected by obesity and material and child health care promoting such as early-child nutrition and breastfeeding.

IV. H.R. 3144

H.R. 3144 -- Health Communities Act of 2009 serves to amend the Public Health Service Act and directs the Secretary of Health and Human Services to "make five-year grants to community partnerships for programs to combat obesity." (CRS Summary, The Library of Congress, 2009) Requirements of the community obesity prevention program are that the following components of fighting obesity are addressed: (1) physical exercise and physical activity; (2) nutritional counseling and nutritional environment activities; (3) community education about the importance of nutrition and physical fitness; and (4) evidence-based curriculum with the National Institutes of Health Ways to Enhance Children's Activity and Nutrition program and curriculum as a guide. (CRS Summary, The Library of Congress, 2009)

The program is required to: (1) makes use of evidence-based practices, strategies, programs, and policies in designing program guidelines; (2) develop a communications plan that involves the entire community; (3) have both in-school and workplace wellness programs; and (4) identify a Wellness Coordinator. Requires the executive council and the steering committee to: (1) perform an assessment of the obesity problem in each respective community; and (2) work with the Wellness Coordinator to lay out achievable short- and long-term goals for reducing childhood obesity. (CRS Summary, The Library of Congress, 2009) The Secretary is directed to give preference to the selection of recipients of grants for communities with high obesity and related chronic disease levels. (CRS Summary, The Library of Congress, 2009, paraphrased)

V.H.R. 3092

H.R. 3092 serves to amend title XIX (Medicaid) of the Social Security Act and to require that Medicaid cover medical nutrition therapy for treating and preventing the progression of a chronic condition of disease that the individual either has or is at risk of developing due to be overweight or obese. (CRS Summary, The Library of Congress, 2009, paraphrased)

VI. Stakeholders

The stakeholders at issue in this policy analysis clearly include individuals, families, communities and the American society at -- large as obesity is prevalent across all racial, ethnic and socioeconomic boundaries.

VII. Policy Statement

The fight against obesity is one that can and must be addressed by Congress towards the goal of providing intervention and prevention measures to the individual and their community in the nature of intervention and prevention in combating childhood obesity.

VIII. Policy Goals/Objectives

The goals and objectives of policy concerning combating obesity in children are the provision of intervention and prevention measures geared ultimately toward bringing about a reduction in childhood obesity in the United States.

IX. Policy Options and Alternatives

Policy alternatives and options have been examined in this study and include a necessity to make fast food and other foods known to contribute to obesity less affordable and accessible to individuals who are likely to develop obesity due to having consumed these foods. As well, physical activity programs should be more at focus than H.R. 3144 and H.R. 3092 require.

X. Evaluation of Options

H.R. 3092 and H.R. 3144 will only be effective in addressing obesity issues if other bills are also passed including S. 1500 -- A bill to prohibit schools from serving trans fats and S. 3144 which is a bill to amend the Richard B. Russell National School Lunch Act to improve the health and well-being of school children. Other acts that should be passed into legislation that are intricately and inherently linked to the success of H.R. 3144 and H.R. 3092 are the 'Health Children Through School Nutrition Education Act. H.R. 4958 and the Health Food Choices for Kids Act, H.R. 2322.