Colorado is joining about a dozen other states that are not requiring health insurance companies to revive canceled health plans.
No one mentioned cancellation notices. And no one expressed concerns about costs. Instead, at a sparsely attended public meeting about health insurance issues Tuesday evening, potential customers wanted to know if they could skip filling out Colorado’s complex Medicaid application.
Health exchange board members on Monday pressed for immediate improvements to Colorado’s mandatory Medicaid application, but state officials, who contend that Colorado is a “shining example” among the states, refused to promise that a full slate of short-term fixes will be completed before Dec. 15.
Colorado has no quick fix for a seemingly endless Medicaid application that health exchange board members believe is driving away customers and decreasing the number of people buying health insurance through Colorado’s new multi-million dollar health exchange.
In Choosing Wisely, physicians across the spectrum of medical specialties nationwide have created lists of procedures, tests and drug treatments that deserve second thoughts before doctors order them or patients accept them.
Colorado No. 2 in Increased Rate of Childhood Obesity
A report by Health Policy Solutions
By Diane Carman
Colorado once again laid claim to being the fittest of the 50 states in 2010 with an obesity rate of 19.1 percent – well below the national figure of 34 percent. When the statistics were released last summer, the chorus of self-congratulations could be heard from the Cherry Creek trail to the top of Mount Bierstadt.
Behind those numbers lurks the specter of a far different future for the state, however. Childhood obesity here appears to be out of control.
Lisa Piscopo, vice president of research for the Colorado Children’s Campaign, crunched the latest numbers from the National Survey of Children’s Health and found that childhood obesity in Colorado increased 23 percent between 2003 and 2007 – the second-fastest rate of increase in the nation behind Nevada.
“We went from fourth or fifth least obese (among children) to 23rd in two or three years,” said James O. Hill, executive director of the Anschutz Health and Wellness Center and a professor of pediatrics at the University of Colorado School of Medicine. “This presents a call to action.”
The threat posed by runaway increases in childhood obesity is daunting.
“One of the things we hear over and over is that we’re raising the first generation of kids who are going to die before their parents,” said Hill. “I don’t believe that.”
Instead, he said, “What’s going to happen is that they’re going to live 30, 40 or 50 years with debilitating chronic diseases. What happens to adults, we’re beginning to see starting in children. We have 13-year-olds with (Type 2) diabetes, 20-year-olds with cardiovascular disease. Now we’ve got very good drugs and procedures to keep people alive, but they’re going to live the majority of their lives with debilitating chronic diseases, and for many people that’s a lot scarier than dying early.”
For policymakers determined to cut health care costs, that prospect is scary, too. The estimated cost of obesity-related health care in 2009 was $147 billion. If the rate of obesity continues to increase unchecked, those costs will be harder to contain.
• Schools test anti-obesity programs
• Treatment options few for overweight kids
It’s one reason why local and national foundations have focused so much of their attention – and their resources – on addressing the challenges of childhood obesity.
In one of the most ambitious nationwide initiatives, the Robert Wood Johnson Foundation announced in 2007 that it would commit $500 million – or more – toward reversing the rate of childhood obesity in the United States by 2015.
Laura Leviton, senior advisor for evaluation at RWJF, said that the emphasis is on prevention.
“For kids who are already overweight, adolescents would have to do something on the order of reducing their intake by 1,000 calories a day or getting that much more exercise. That’s a serious issue,” she said. “But think about how little might be required to prevent kids from becoming obese.”
Leviton said researchers estimate that American children and adolescents on average consume 110 to 165 calories more than they need for growth and activity every day. “That’s the equivalent of a can of soda.”
Over a year, that relatively slight bit of daily overeating amounts to more than 15 extra pounds. In five years, a pattern of lifelong obesity often has been set.
So reducing intake by 165 calories or increasing activity by 30 to 60 minutes a day across the population seems like a reasonably achievable goal.
“What could you do?,” she said. “Maybe bring recess back to schools that don’t have it or require that kids not be excused from physical education classes. There are curricula out there for really active physical education classes that are not punitive.”
That’s not to say it will be easy. Nothing about reversing the obesity epidemic is easy.
“To do that is going to be very tough,” said Hill.
“All these things play a role. Where we err is in thinking that addressing any one of those things is going to solve the problem. If we start tomorrow and have no high-fructose corn syrup in anything, it wouldn’t solve the problem.
“The challenge we face,” he said, “is there are so many things that contribute to childhood obesity, we have to stop thinking about fixing one or two things and look at the whole problem.”
Research on the problem is voluminous and breathtakingly frank. Among the findings:
- Children who spend several hours on computers or watching TV are more likely to be obese;
- Certain ethnic and racial groups, including African-Americans and Hispanics, have higher rates of childhood obesity;
- Breastfeeding reduces the risk of obesity later;
- Families with higher education levels have higher rates of physical activity and lower obesity rates;
- Obese persons seldomeat the recommended servings of fruits and vegetables;
- Low-income communities tend to foster obesity because they have fewer recreation centers, fewer grocery stores and more fast-food restaurants, and because healthier fresh fruits and vegetables are more expensive than processed foods.
Beyond all those influences, Hill said one overriding fact remains: “More and more people are choosing to be obese rather than doing what it takes to not be obese. It comes down to motivation.”
It’s one more reason that advocates are focusing on children; there’s still time to influence how that choice is made. “We talk about ‘little things for little people,’” said Leviton.
The little things include changing taste preferences by serving more baked foods instead of fried foods in school cafeterias; removing sweetened beverages from school vending machines – or removing vending machines altogether; restoring recess; supporting active before- and after-school programs; and offering cooking classes, nutrition programs or other changes in the curriculum that support healthy lifestyles.
Beyond schools, Leviton said, a sea change is needed in communities nationwide.
A 2009 report by the Centers for Disease Control recommended 24 wide-ranging public-policy strategies for communities to help address the nation’s obesity epidemic. They range from improving the availability of healthier food choices in public venues and limiting advertisements of less healthy foods in public buildings to encouraging physical education in schools, improving access to recreation facilities and enhancing urban services to encourage walking, cycling and outdoor play.
The Campaign to End Obesity also has called for changes in federal policy to identify obesity as a disease, which would enable patients to negotiate for health coverage for treatment and prevention programs.
In Colorado, lawmkers are pursuing a handful of anti-obesity initiatives.
Last year, the food exemption from sales taxes was eliminated for candy and soda despite relentless lobbying from the soft-drink and grocery industries. Pepsico alone spent a reported $8.6 million in the last quarter of 2009 and the first quarter of 2010 lobbying against soft-drink taxes and other anti-obesity initiatives nationwide.
This session, House Bill 1069 has been introduced calling for public schools to provide at least 150 minutes of activity per week for elementary school children.
Across the country, public policy strategies mimicking the successful anti-tobacco campaigns have begun to take root in the anti-obesity movement, calling for nutritional labeling in restaurants, targeting taxes on certain foods and mobilizing public education campaigns.
While Hill doesn’t object to the various legislative attempts to address the problem, he cautions that one or two targeted strategies can’t begin to produce the results the state needs.
“One of the problems in this field is it’s like the rest of politics in the U.S. We debate at the extremes,” he said. “We have people who believe that the government should regulate all this, and tax bad food, and mandate this and that. And on the other hand, people say it’s personal responsibility.
“There’s some truth on both sides. I don’t think we’re going to solve this problem with the government telling you what to eat. Alternatively, if we leave it to the individual, it’s going to continue like it is.”
Hill believes we have to “figure out how to create a better environment so people make better choices.”
Colorado, he said, is poised to take the lead in this field. “We’re one of the top places in the country with more than 100 researchers doing obesity research, everything from cell biology and clinical studies to community studies.
“I’m very positive Colorado will be the first state ever to show a reduction in obesity rates.”
In an attempt to innovate in this arena, Hill said the Health and Wellness Center, Children’s Hospital and two school districts – Cherry Creek and Aurora — are working on a long-range project to design a model school district for the nation using a wide variety of strategies and measuring outcomes to determine what approaches offer the greatest chance for success.
“It’s a very exciting project,” he said. “We look at the science and look at what we can implement. We’re taking a very long-term approach.”
One of the keys, he said, is looking at the entire population at the schools – teachers, administrators and students. “We’re implementing some exciting workplace wellness programs.
“But it’s hard,” he said. “It’s going to be a long, long road if we’re going to turn this obesity epidemic around.”
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