Health inequalities in pandemic reveal need for greater obesity prevention

The pandemic has boldly highlighted long-standing disparities in racial and economic health. Americans of color have died from COVID-19 at two to three times the rate of the rest of the population. Obesity is one of the main underlying causes.

“The fact that obesity has proven to be such a significant risk factor for serious illness and death from COVID-19 has the potential to draw more public attention to the need to start doing something. about it, “said Chief Medical Officer Dr Marcus Plescia. for the Association of State and Territory Health Workers, in an interview with Stateline.

The effects of obesity make up a significant portion of the country’s health spending, but funding for obesity prevention and control has been insufficient for decades, Plescia said.

At an annual cost of $ 147 billion to the health care system, obesity affects 42% of adults and 19% of children in the United States, putting them at higher risk for chronic diseases such as diabetes , heart disease and some cancers, according to the federal government. Centers for Disaster Control and Prevention.

The coronavirus pandemic has increased the health risks of obesity. The CDC estimates that obese people who contract COVID-19 are three times more likely to be hospitalized compared to the rest of the population.

Of the first 900,000 hospitalizations for COVID-19 in 2020, 30.2% were attributed to obesity, according to the agency.

Despite increased concerns about the health dangers of obesity, Congress is only providing the CDC with 31 cents per U.S. resident for grants to support state-level obesity prevention programs.

This level of funding is woefully inadequate for a disease that accounts for 21% of the nation’s health spending, according to a new report from the Trust for America’s Health, a public health research and advocacy organization based in Washington, DC.

Between 1999 and 2018, the number of obese adults rose from 30.5% to 42.4%, according to the CDC. During the pandemic, rates jumped again for a variety of reasons: job losses, school closings, increased food insecurity, reduced physical activity, stress and other factors that combined to put extra pounds on millions. Americans.

According to recent CDC data, the number of states with self-reported adult obesity rates of 35% or more has risen to 16, almost double the number in 2018.

Among black and Hispanic residents, the number of states was much higher: 35 states and the District of Columbia had an obesity prevalence of 35% or more among black residents, and 22 states had this prevalence among Hispanic residents. .

This compares to just seven states with an obesity rate of 35% or more among white residents.

Poverty, food insecurity, lack of physical activity and poor access to health care are risk factors.

One of the reasons federal, state and local politicians haven’t made adequate investments in obesity prevention and management is that there is no easy cure-all. Reducing poverty and redesigning neighborhoods to improve access to healthy food and exercise, for example, are daunting propositions.

“Obesity is a complex disease with many contributing factors and no simple solutions,” said Dr. J. Nadine Gracia, President and CEO of Trust for America’s Health. “To address this, we need to increase and maintain investment in innovative programs that show promise in the prevention and management of obesity.

“It is important to address the full spectrum of solutions, from preventing childhood obesity to screening, support services and treatment for adults,” she said in an interview with Stateline .

The CDC uses a person’s body mass index, or BMI, to determine obesity. This number is calculated by dividing a person’s weight in kilograms by the square of their height in meters. A BMI of 30 or more is in the range for obesity. For example, a person who is 1.75 meters (5 feet 9 inches) tall and weighs 203 pounds (92.07 kilograms) or more would be considered obese.

In 2000, no state had an adult obesity rate greater than 25%. Today, 16 states – Alabama, Arkansas, Delaware, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, Texas and West Virginia – have equal obesity rates or greater than 35%.

The CDC provides funds to states to implement a variety of policies that have been shown to be effective in reducing obesity rates. The National Physical Activity and Nutrition Program, the agency’s grant program, aims to reduce health disparities among people at high risk of unhealthy diets and inadequate physical activity.

But with a budget of $ 108.9 million for fiscal 2020, the CDC’s Division of Nutrition, Physical Activity, and Obesity was only able to distribute grants to 16 states this year: Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Kentucky, Minnesota, Missouri, New York, North Carolina, Ohio, Pennsylvania, Texas, Utah and Washington.

Every state should have a CDC obesity prevention program, Plescia said. To varying degrees, state and local governments fund their own prevention programs. But without CDC grants, he said, most states don’t have any type of program dedicated to tackling obesity.

A portion of the CDC’s anti-obesity grants goes to universities that grant land to work with communities in counties where 40 percent of residents are obese.

Called the High Obesity Program, the money supports, among other projects, the development of hiking trails in Kentucky; farmers’ markets, farm-to-school programs and improved nutritional standards for Oklahoma food banks; and improving transportation to grocery stores and exercise opportunities in underserved parishes in Louisiana.

The US Department of Agriculture also offers nutrition programs that states can exploit to prevent obesity. In 2019, the USDA National School Meal Program served more than 4.8 billion healthy meals to children in low-income families nationwide.

But during the pandemic, school closures caused millions of children to miss what was often their healthiest meal of the day. Many schools offered packed lunches to parents who could pick them up.

In April, USDA announced that it would continue to provide free meals to all students until the end of the 2021-2022 school year – an extension of the program started at the start of the pandemic to feed students. who learned from a distance.

In addition, President Joe Biden included $ 17 billion in a $ 1.7 trillion aid bill for American families that would expand school meals in very poor neighborhoods over 10 years.

California is ahead of the game. In July, Democratic Governor Gavin Newsom signed a bill allocating $ 54 million in state money to supplement USDA funding for an expanded school meals program available this year for all 6.2 million students in state schools.

The program makes breakfasts available to all children, regardless of family income, with the aim of removing the stigma of accepting free lunches and feeding more children with nutritious meals. Next year, California will make the program permanent, at an annual cost of $ 650 million.

Some states are also working with the USDA’s Supplemental Nutritional Assistance (SNAP) program, formerly known as food stamps, which serves 38 million people.

In addition to providing cash for groceries, SNAP partners with states to help residents lead healthy, active lives. Massachusetts offers healthy cooking classes, for example, and Nevada helps seniors participate in online exercise classes.

Several cities – including Boulder, Colorado; Washington DC; Philadelphia Cream; Seattle and four California cities have levied taxes on sugary sodas that contribute to obesity. Some cities use soda tax revenue to support local nutrition and exercise programs.

This year, lawmakers in several states tried unsuccessfully to pass similar taxes on soda. A few states, including California, have banned any new local soda tax.

Christine Vestal, Stateline.org

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