The rise of the obesity epidemic occurred during the same time period as the rise of managed care, personal training and the introduction of fat free foods. How did we fail to stop this epidemic and all its potential health dysfunctions? I wrote about this problem in “Should your physician provide exercise or nutritional advice”. Until recently, medical schools didn’t offer courses in exercise or nutrition. Patients visiting a doctor’s office would have received poor if any advice. The food industry were attempting to meet the needs of the markets without the availability of longitudinal scientific food research. Personal trainers had good intentions but many lacked the full scope of the issues related to obesity. We all failed to slow the growth of this epidemic and its health dysfunctions into the future.
People Don’t Die from Obesity
I’ve often said the problem with obesity is that nobody dies from obesity. People die from risk factors of being overweight, cardiovascular diseases, strokes, cancers and diabetes. Contrast that to the rush to find a cure for HIV, the virus which causes AIDS. If people died of obesity, the issue would have been handled differently. During the height of the epidemic we lived in an environment where being overweight was seen as a personal weakness. Only recently, are we beginning to come to grips with obesity being a disease.
If we viewed obesity as a disease, we might have researched its epidemiology. We might have discovered that adoption of modern technological innovations in the home, workplace and schools had reduce the demand of physical activity. People used to do relatively intense labor everyday. Cooking food from scratch, walking most places and doing things by hand rather than using a machine. Even after machines like dishwashers, vacuum cleaners and word processors came into use, walking somewhere was still common, in 1960, only about 13% of Americas were obese, according to the University of Iowa.
Then came car dependent community designs making it harder for school children to walk to school and much harder for adults to shop or carry out simply errands by foot or bicycles. Making matters worse schools began to cut in school physical education.
Food production changed, portion sizes increased substantially such that a burger in 1957 went from 1 ounce to 6 ounces in 1997. People were consuming an additional 200 calories per day by 1996 compared to the 1970’s. That equates to 20 pounds of weight gained per year. High calorie, fast and inexpensive foods became widespread. While we were spending more time sitting in front of electronic devices all day, reducing the number of calories spent.
The prevalence of obesity changed relatively little during the 1960’s and 1970’s, but it increased sharply over the ensuing decades—from 13.4% in 1980 to 34.3% in 2008 among adults and from 5% to 17% among children during the same period. The prevalence of extreme obesity also increased during 1976–1980 and 2007–2008, and approximately 6% of U.S. adults now have a BMI of 40 or higher.
Managed Care Program
The enactment of the Health Maintenance Organization Act of 1973 provided a major impetus to the expansion of managed health care. The legislation was proposed by the Nixon Administration in an attempt to restrain the growth of health care costs and also to preempt efforts by congressional Democrats to enact a universal health care plan. Passage of this legislation marked the turning point in U.S. health care because it introduced the concept of for-profit health care corporations to an industry long dominated by a not-for-profit business model.
“Managed health care programs were enacted to ensure the flow of patients and revenues for the clinics”.
During the late 1980’s and early 1990’s, managed care plans were credited with curtailing the runaway growth in health care costs. This was achieved by eliminating unnecessary hospitalizations and forcing providers to offer their services at a discount, in exchange for a steady stream of customers. By 1993 51% of Americans owned managed health care insurance through their employers.
Since its inception managed care program were implemented to “slow the growth rate of health care cost”. This was done in three ways; shifting medical services from inpatient hospital stays to outpatient doctor visits, by forcing doctors to discount their rates and later by shifting insurance premiums from employers to employees. There is no mention of improving health outcomes for patients.
Medical Insurance and Health Outcomes
Several large studies reveal that there is little evidence that insurance (medical coverage) improves health outcomes. The first was a study by Research and Development (RAND), from 1971 to 1982. The only health outcome improvement came from the sickest participants (6%), but in the majority of participants having medical coverage (insurance) showed no health improvements.
The second study by Oregon Health (2008), showed zero mortality difference between those who had insurance and those who did not. The only difference was those who had insurance self-reported feeling healthier.
The Department of Veterans Affairs (VA) found that more access to care, produced worse health outcomes than quality primary care. More access to care is described as; the number of doctors involved in providing care, the number of minor test performed and the amount of time patients spend under care. Diagnostic test when overused can be counterproductive because they create false positive results than otherwise found. They went on to state that “hospitals are dangerous places especially if you do not need to be there.
We failed to stop the rise in obesity rates because we were not focused on the effects of obesity. The fitness industry was focused on new techniques in exercise science and delivering these techniques to their customers. The medical industry was focused on rising medical cost and increasing customer base. The food industry was focused on providing more inexpensive and easy to deliver food.
The consumers of food, fitness and medicine failed themselves. Too many American’s were eating like its 1999, every meal. Consumers were too comfortable allowing someone else tell them what was best, without being actively engaged in what was happening to their bodies.
There were success, weight loss surgery is better than diet and exercise if you’re more than 100 pounds overweight. Carbs are not evil, especially in moderation. As mentioned earlier we don’t put in a full day’s work (manually), most people jobs are primarily sitting in front of screen. That’s not the type of work which requires a massive amount of carbs. Vegan or carnivore is likely a personal decision, the science points more to a mixture of the two. Exercising is still a fringe activity for too many Americans. Devices like step counters have drawn more people’s awareness and provided a measureable they can track.
The future of care must involve more collaboration between the major partners delivering care. As long as the factions that provide care continue to work in silos, customer care will suffer. Entrepreneurs developing wearable devices and technologies should not rush to create for the industry complexes. These technologies should be created for the end users. Industry innovations are a must, but innovations which serve to interface with the consumer need to be developed for the consumer. To do this the other way will lead to stagnated innovations and decades of lost creativity. Developing innovative technologies for end users will push entrepreneurs to create faster and more exacting technologies. This will allow the consumers to push industry towards innovating, competitively towards a better product or service which meets the consumer’s needs.