Do candidates care about our health or just how much it costs?

Over two-thirds of U.S. adults and one-third of U.S. children are overweight or obese. The direct healthcare costs are over $200 billion annually. Our weight is our biggest health burden and it should be at the forefront of health policy discussions. Yet there is little evidence that any of the presidential candidates consider it a serious issue. Neither Democratic candidates Hillary Clinton and Bernie Sanders, nor Republican candidates Ohio Gov. John Kasich and Sen. Marco Rubio (Fla.), have commented on this issue in mainstream media. Republican candidate Ben Carson, a retired neurosurgeon, described obese people as “addicted to eating.” Sen. Ted Cruz (R-Texas) has said that if he’s elected, school meals will improve because “French fries are coming back to the cafeteria.” In response to direct inquiries about the obesity crisis, Republican front-runner Donald Trump said, “I would build a nationwide network of weight-loss clinics and I would force Rosie O’Donnell to pay for it.” If taken seriously, better health is not a losing proposition. Recent studies suggest that we have currently available means to slenderize and economize. Simply put, weight and healthcare cost reductions can go hand in hand.

{mosads}Obesity treatment results are poor (the likelihood of sustained non-surgical long-term weight loss remains at about 15 percent to 20 percent) and the disease has long-term morbidities even if “cured” (high blood-pressure and sleep apnea persist in over 50 percent of people who have lost over 50 percent of their excess body weight via bariatric surgery). And treatment isn’t cheap. Annual costs for commercially available weight-loss plans range from about $350 to $400 for Weight Watchers to over $2,500 (Jenny Craig) or about $150 to $250 per pound of weight lost. Adult weight-loss retreats range from about $2,000 to $7,000 per week or thousands of dollars per pound of weight lost. How many Americans can even afford to lose weight? The costs of obesity treatment and the low likelihood of success without surgery suggest that obesity prevention should be a major topic of political discussion. In fact, appropriate, cost-effective recommendations and legislation are already there. Our next president should stop them from languishing in committee.

Sugar-sweetened beverage taxes, such as those proposed in the Sugar-Sweetened Beverages Tax Act (the SWEET Act) introduced by Rep. Rosa DeLauro (D-Conn.), would prevent almost 600,000 cases of childhood obesity by 2025. The costs of weight loss in children are typically defined as dollars per unit of body mass index (BMI), a rough index of body fatness calculated as weight in kilograms divided by height squared in meters. Passage of the SWEET Act would cost only $2.50 per unit of BMI reduction (more than a pound) with a projected savings return on healthcare costs of $30.78 per dollar spent. For an annual investment of $50 million, America would save over $1.5 billion.

The federal government gives tax subsidies for advertising of foods that are bad for our children. Programs like the Stop Subsidizing Childhood Obesity Act, introduced by then-Sen. Tom Harkin (D-Iowa) and Sen. Richard Blumenthal (D-Conn.) in 2014, would have ended those subsidies and rerouted the money to provide fresh fruits and vegetables to low-income schools. Those changes were projected to prevent over 129,000 cases of childhood obesity by 2025. The price is about $800,000 per year with a cost of 66 cents per unit of BMI and a savings of $32.50 in healthcare costs per dollar spent ($260 million). Sixty six cents for a lifetime of reduced risk of diabetes, high blood-pressure, fatty liver disease, fat bias and countless other problems!

Schools are an ideal venue in which to promote good health habits by example. The U.S. Department of Agriculture has issued nutrition standards for all food sold in schools. If these were actually implemented, they would reach about 45 million individuals and prevent about 350,000 cases of childhood obesity over the next decade. This cost is about $22 million per year or $6 per unit of BMI lost with a savings return of $4.50 per dollar spent ($99 million). Larger interventions, such as implementing the better standards for school meals, are less cost-effective at about $50 per unit of BMI with only a 42 cent return on each dollar invested, but further reaching and are projected to prevent over 1.8 million cases of childhood obesity over the next decade.

These are just examples of cost-effective ways to address the fattening of America that have been ignored. Legislators and political candidates may avoid this common health issue because of pressure from lobbyists representing the sugar-sweetened beverage industry, food advertisers and vendors of what is really just junk food in our schools, or because obesity has taken on such a negative stigma that it is just not discussed. Even worse, they may refuse to use common sense to address these issues because the actual benefits may not be evident before the next election cycle.

This is an election year. Democratic and Republican candidates have spent a good bit of their airtime either supporting or denigrating the Affordable Care Act and other health policies of the Obama administration. They have all posited different means to reduce healthcare expenditures, which is obviously important, but are failing to discuss reasonable ways to reduce the disease burden provoking those expenditures. First lady Michelle Obama had it right when she focused her efforts on childhood obesity in the “Let’s Move” program and we need to ask the candidates in this election what they intend to do to ensure that these efforts are continued and expanded. Better health promotes less healthcare spending. We want both of these for our children. So candidates, let’s discuss America’s health along with its wealth.

Rosenbaum is a professor of pediatrics and medicine at Columbia University Medical Center and a practicing pediatrician in New York City. He has been conducting research regarding the treatment and prevention of obesity in adults and children for over 25 years.