Wei LinWR13300-04Kurt Milberger15 April 2013Final Draft

Fighting Obesity with Community-Based Initiatives

Obesity is one of the most serious health issues and will continue to rise if we do not

correct the problem. It is a concern especially with children, who risk carrying obesity into their

adult lives where it becomes a catalyst for more serious health issues, ranging from back pains to

cancer. By 2005, obesity cost more than tobacco-use in health care expenditures. According to

Campaign to End Obesity’s researchers, Michael J. O’Grady, and James C. Capretta, the United

States health care system spends about $146.6 billion on obesity-related illnesses (O’Grady and

Capretta 12). The economy of a community is important since obesity and poverty are linked

through the poverty-obesity paradox. The city of McAllen, Texas, the fattest city in America,

feels the full repercussions of both a failed economy and fragile health conditions. McAllen, with

its high prevalence of obesity and massive health care expenditures, may represent America’s

future. To be able to combat obesity in McAllen can set an example for the rest of the American

population struggling with obesity. In order to ensure the financial security and longevity of

McAllen’s future generations, we need to promote new community-based initiatives, such as

improving community safety, eliminating food deserts, and improving health curriculum in

school, to reduce the prevalence of obesity-related illnesses and improve the financial crisis in

McAllen.

There are a variety of approaches that can be used to define the financial impact of

obesity. For this paper, the financial impact of obesity will be defined by the decrease in

productivity from work and the cost of treatment for obesity-related diseases. The figure we are

calculating is not representative of the amount spent solely by the national health care, but,

Lin 2

instead, a more holistic way of calculating the total impact in many aspects that arise due to

obesity. By calculating the holistic financial impact of obesity-related issues, we will have a

better understanding of the adverse effects obesity has on our nation, particularly McAllen. The

poverty-obesity paradox pertains to the fact that the most obese are also the most impoverished.

It’s a never-ending loop and by studying the financial impact of obesity, we can recognize how

to break that loop.

The decrease in productivity observed by employees who were obese or over-weight is

very apparent. In a study done by Jordana K. Schmier, Mechelle L. Jones, and Michael T.

Halpern, they found that the “obese [were] significantly more likely to have moderate and high

absenteeism (absent [up to] 6 [days for obese women] and 7 days [for obese men] in past 6

months) than the non-obese,” which is about 8 per year (Schmier, Jones, and Halpern 6).

Absenteeism does not also cost employees their salaries, but it also costs employers up to $12.7

billion per year; including health insurance, life and disability insurance, and paid sick leave for

employees between 25 and 64 years of age (Schmier, Jones, and Halpern 8). Another decrease in

productivity due to obesity is workplace injuries, such as lower back injuries and accidents. The

loss of productivity is only part of the enormous financial costs incurred because of obesity.

So much of the financial impact is rooted in the direct and apparent costs of dealing with

the medical expenses of obesity. In a study led by Dr. Christina C. Wee, the “adjusted

expenditure was $2127 for a typical normal-weight (BMI of 20 to 25) [Caucasian] woman aged

35 to 44 years and $3506 for women with BMIs of 40 or higher,” showing a substantial increase

in medical costs in women with higher BMIs. In the article “Obesity Now Costs Americans

More In HealthCare Spending Than Smoking,” Rick Ungar states that we spend about 190

billion dollars a year due to obesity-related health issues, which has surpassed the cost of the

Lin 3

adverse effects of smoking (Ungar). Direct costs of health services provided include surgery,

laboratory and radiological tests, and drug therapy. These costs produce a strain on the health

care system, but there are costs that are not medical related and still threaten the financial

stability of individuals who are suffering from obesity.

In 2012, McAllen, Texas was named the fattest city in America. The prevalence of

obesity is 38 percent, which is way above the national average of 26.1 percent. Poverty has also

stricken this city with 34.8 percent of the people living below the poverty line. Due to the

increasingly high number of obesity-related health issues, such as cardiovascular diseases

(CVD), surgeries are performed very frequently and the average individual’s Medicare

expenditures is about fifteen thousand dollars, which is about twice than the national average

(Gawande, “The Cost Conundrum”). McAllen is a poverty and obesity-stricken area, and it

represents the future that much of the American population will suffer if nothing is done about

the issue of obesity. However, if you can overcome the most extreme case of obesity, then you

should also be able to implement the same things across the country where it’s not as

exasperated. So by extension, a solution to McAllen’s health troubles may be the solution to

most of America’s obesity concern.

The prevention of obesity is the key to lowering the prevalence of obesity. The onset of

obesity in adults is largely affected by habits developed during their childhood. About 17 percent

of children are considered obese, that means, their BMI’s are among the top 95 in their age and

gender group. Obese children usually continue to practice bad habits and will result in adverse

health effects as they grow up. In fact, obese children are twice as likely to die before the age of

55 than their non-obese counterparts due to possible health complications. Obesity is a

preventable condition, yet about 112,000 people die each year due to obesity-related causes,

Lin 4

making it the second leading cause of preventable deaths in the United States. To clarify,

smoking is still the leading cause of preventable death, but obesity has cost more in health care

spending. To combat rising obesity rates in McAllen, we need to promote new community-based

initiatives. I suggest community-based initiatives because they influence a larger population, and

while individual results may not be as great or noticeable, the population as a whole may notice a

more gradual progress. Many factors that lead to increase occurrences of obesity are rooted in the

community and the characteristics of the individual’s neighborhood. These factors include

neighborhood safety, accessibility to healthy food sources, and school nutrition. The initiatives I

am proposing should combat these problems and a gradual improvement in health should be

noticeable after a couple of years. Combatting obesity at a young age is the best way to escape

the downward spiral to an unhealthy and life-threatening lifestyle. We need to focus these

initiatives to assist the children first.

Children get most of their physical activity from playing outside, but parents may be

concerned about the neighborhood safety and be more reluctant to let kids out. A report written

by Laure DeMattia and Shannon Lee Denney states that parents are concerned about

neighborhood safety more frequently on behalf of girls than for boys and are reported more

frequently by Hispanic parents than by non-Hispanic white and black parents (DeMattia and

Denney 88). Children living in the least safe neighborhood conditions are reported to have spent

more time watching television than other children (DeMattia and Denney 88). A study done for

Ohio State University states that poverty, not race, is tied to higher crime rates (Grabmeier).

With 34.8 percent of the population of McAllen falling below the poverty line, the neighborhood

may seem less safe and further worry parents. Reducing these uncertainties and reassuring

parents of their neighborhood’s safety may allow children more time to play outside. We can

Lin 5

reduce these hesitations by introducing neighborhood patrols or encouraging parents to

accompany their children when they want to head out. Neighborhood safety also dictates the

mode of transportation to school for many kids. Top reasons for the decrease in active transport,

bicycling or walking, to school are concerns about distance and safety. Government officials of

McAllen should consider programs that will reduce the hesitations of these worried parents.

Safe Routes to School (SR2S) is a national program started in 2005 that is attempting to

make progress in addressing those concerns. SR2S funds communities and encourages the

development of programs and projects related to bicycle and pedestrian safety in an attempt to

encourage more students to walk to school. These projects include building more schools to in

different areas to make it more accessible to more families and easier for parents to walk their

kids to school. This initiative has been taken by the city of Milwaukee and should be

implemented in McAllen. DeMattia and Denney believe that “this small increase in physical

activity has the potential to [decrease and curb] weight gain we have seen in our community,”

and it may just be a very effective method of combatting childhood weight gain. McAllen should

try its best to bring SR2S to its communities (DeMattia and Denney, 89). Officials should

consider providing tax incentives for schools that choose to endorse SR2S and its programs. This

is one potential method of fighting obesity, but another option would be to improve the

availability of healthy and cheap foods.

The lack of accessible sources of healthy food is also a leading cause of childhood

obesity. In a study done by Morland, Diez Roux, and Wing, they made the correlation that

survey respondents in communities with access to a supermarket observed a lower incidence of

obesity, whereas areas with access to convenience stores observed just the opposite (Morland,

Diez Roux, and Wing). These areas with an abundance of fast food restaurants and poor access

Lin 6

to healthy food choices are coined “food deserts.” Governor Ed Rendell of Pennsylvania

launched a program to form public-private partnerships attempts to improve the access to more

healthy food in food deserts. To rid areas of food deserts, the program encourages business

development in low-income areas by offering over $2 billion in incentives to encourage

businesses to start supermarkets, corner markets, or healthy food shop in these food deserts

(Flournoy, "Healthy Foods, Strong Communities").

New York City is laden with food deserts, especially in the borough of Bronx, Northern

Manhattan, and Brooklyn, with an estimate of 750,000 residents living in food deserts (“Fresh

Food for Urban Deserts”). Supermarkets all over the city are shutting down due to the increasing

rents and shrinking profits. The increase of food deserts in New York City has had the most

serious impact on low-income communities. To combat this issue, the city started the Green

Carts program and the Greenmarket program which brings affordable fresh fruits and vegetables

to underserved areas while providing jobs for vendors and farmers. Hundreds of Green Carts are

already on the streets in food deserts, and that number is rapidly increasing as prospective

vendors obtain training, licenses, and permits from the city. Greenmarket in Union Square

provides local farmers from upstate New York a way to increase profits by selling directly to

consumers while providing cheaper and healthier alternatives to New Yorkers who would

otherwise be unable to find such cheaper alternatives to fast food. These are all great and viable

solutions for parents who are struggling to find affordable and healthy foods to provide their

kids. The communities of McAllen should start urging government official to support these

programs by providing tax incentives to farmers and local produce vendors. They are

economically sound for both producers and consumers and provide a better source of nutrition

for both parents and children. By introducing healthy eating habits to their children, parents are

Lin 7

setting up an example that the children will follow as they mature. Not only do these initiatives

boast healthier lifestyles, but also these initiatives will allow McAllen to secure its future

economy by benefitting both the farmers and families that engage in this business. As a result,

the residents can afford healthier lifestyles and prevent obesity. We can also target the problem

of obesity through another channel, the school system.

Since most children are required to attend school, schools are ideal environments for

providing community-wide health interventions while seamlessly incorporating it into regular

school activities such as physical education requirements, cafeteria nutrition, and health classes.

Experiments have been done by initiating classes that aimed to reduce the amount of time spent

watching television, using videotapes, and playing video games and then comparing the average

BMI to a school that did not implement such classes. Results showed that the school that

implemented these classes had lowered their average BMI by .45, which is an overall significant

success (DeMattia and Denney, 93). The Head Start Program is an example of a successful

educational initiative.

The Head Start Program is a pre-school program operated by United States Department

of Health and Human Services. It works to not only educate children of low-income households,

but it also teaches them to eat healthy. Based on farm-to-school food programs that were being

piloted around the country, it brought not only healthier foods into the Head Start food service

program, but it would also educate children about fresh fruits and vegetables by engaging the

children in activities centered around a featured food. One study examined the impact of

increasing exposure on children's acceptance of given foods. It was found that, while 2 to 3 year

olds were more reluctance to taste new or unfamiliar foods than 5 to 6 year olds, preference

increased with at least 8 to 10 exposure across both age groups (Swadener 294). These Head

Lin 8

Start programs are confirmation of the success that curriculum-based initiatives and changes can

make a difference in a child’s life.

McAllen is in dire need of a solution. This Texan city is the prime example of a failed

health system and economy. With community-geared initiatives aimed at decreasing the

prevalence of obesity in children, we could have a profound influence on them and prepare them

with healthier habits for the future. This can potentially reduce the financial strain that it places

on these future adults and the future livelihood of McAllen. The people of McAllen need to start

asking public officials to provide tax incentives to encourage the implementation of programs

such as SR2S and Greenmarkets. The schools, too, need to recognize what is at stake and alter

their curriculum to combat obesity and set their students of a healthier path. Any one or mix of

these solutions will provide a long-term decrease in obesity and poverty rates. These plans have

been tested in other communities and they have reaped the benefits. It is time for McAllen to do

the same and escape this situation it is in. Obesity is preventable and by taking and implementing

precautionary measures with the younger generations, a brighter future lies ahead of McAllen.

Lin 9

Works Cited

DeMattia, Laure, and Shannon Lee Denney. "Childhood Obesity Prevention: Successful Community-

Based Efforts." Annals of the American Academy of Political and Social Science 615 (2008): 83-

99. JSTOR. Web. 22 Mar. 2013.

Flournoy, Rebecca. "Healthy Foods, Strong Communities." Shelterforce 147 (2006): n. pag. National

Housing Institute. Web. 15 Apr. 2013.

"Fresh Food for Urban Deserts." Editorial. The New York Times. N.p., 20 Mar. 2009. Web.

Gawande, Atul. "THE COST CONUNDRUM." New Yorker 85.16 (2009): 36-44. Academic Search

Premier. Web. 15 Apr. 2013.

Grabmeier, Jeff. "POVERTY, NOT RACE, TIED TO HIGH CRIME RATES IN URBAN

COMMUNITIES." Research and Innovation Communications. The Ohio State University, n.d.

Web. 01 May 2013.

Morland, Kimberly, Ana V. Diez Roux, and Steve Wing. "Supermarkets, Other Food Stores, and

Obesity: The Atherosclerosis Risk in Communities Study." American Journal of Preventative

Medicine 30.4 (2006): 333-39. ScienceDirect. Web. 15 Apr. 2013.

O'Grady, Michael J., and James C. Capretta. "Assessing the Economics of Obesity and Obesity

Interventions." Campaign to End Obesity (2012): 12. Web.

Schmier, Jordana K., Mechelle L. Jones, and Michael T. Halpern. "Cost of Obesity in the Workplace."

Scandinavian Journal of Work, Environment, & Health 32 (2006): 5-11. JSTOR. Web. 15 Apr.

2013.

Swadener, Susan S. "Nutrition Education for Preschool Children." Journal of Nutrition Education 27.6

(1995): 291-97. USDA. Web. 1 May 2013.