We lost a friend a few weeks ago. Reg Alcock was a Governing contributor with longstanding ties to the Harvard Policy Group. A former cabinet minister in the Canadian federal government, Alcock thought deeply about how things worked. He helped improve -- even transform -- government systems. But he was tough on his own system: At one point in his career, he weighed in at 430 pounds. After repeated health scares, he lost a third of his weight and recently told colleagues that he was feeling great. He died unexpectedly at age 63.
Alcock will be on my mind as we travel to Atlanta this month to convene Governing’s inaugural Summit on Healthy Living, which is a euphemism for reducing obesity. Our host city is also the home of the Centers for Disease Control and Prevention (CDC), which has tracked obesity in the U.S. for more than a quarter century. The CDC’s longitudinal view is not encouraging. In 1996, there was not a single state with an obesity rate that was more than 20 percent of the adult population. Today, there is not a single state with an obesity rate of less than 20 percent. Three dozen states are at 25 percent or higher -- a dozen of which are at 30 percent or higher.
Obesity is not the worst diagnosis to hear -- news of other diseases can be truly devastating -- but it can be enough to get your attention. And that goes double for morbid obesity, a term that simultaneously sounds coldly clinical and value-laden.
In the name of full disclosure, that was my diagnosis. Through more fits and starts than I care to admit, I have managed to lose enough weight to drop the “morbid” designation. But being merely “obese” is not a status that provides much comfort.
While the problem -- and the magnitude of the problem -- is obvious for all to see, weight is still an intensely private matter. That is at least part of what makes public discussions so awkward at best and cringe-worthy at worst.
The weight debate around New Jersey Gov. Chris Christie’s brief flirtation with presidential politics this fall went beyond concerns about the governor’s health or the societal costs of treating obesity. Noted national columnists advanced a too-fat-to-be-president narrative, implying that obesity reflects a moral failing and that the obese lack the character to lead.
Such overdrawn conclusions have been the bane of the fat acceptance movement, which has fought weight discrimination for more than four decades. But its messages have become muddled over the years, with critics charging that acceptance has been confused with promoting unhealthy lifestyles.
This challenge, along with stereotypes, has been a boon for the weight-loss industry, with sales estimated at $3.3 billion for 2011, but it also has made public policy decisions all the more difficult. A George Washington University study in 2010 found that only eight states ensure coverage of comprehensive obesity treatments for adults through Medicaid or private insurance. Most states allow obesity to be used in adjusting rates or, in some cases, denying coverage by private insurers.
That may leave an individual’s decision about eating less and exercising more as the best hedge against heavily processed and marketed foods on one hand, and a complex array of treatable (even preventable) medical problems on the other. To aid prevention and mitigate costs, policymakers face growing pressure to use taxation and regulation to reduce the cost of foods that are better for us while increasing the cost of the rest. The policy discussion also extends to the indirect effects of aligning public transportation, safety and education to encourage healthy living.
It is a broken and disjointed system, but it’s a system just the same. We must continue the hard work of fixing the component parts, and changing our personal behaviors, with the overall system in mind.