Obesity, Sedentary Habits Could Cost U.S. $3.4 Trillion by Decade's End

Half of all American adults are destined to develop diabetes or pre-diabetes by 2020 if they don't slim down, according to a dire new prediction that pegs the cost of their care at $3.35 billion by decade's end.

Under the scenario, if current trends continue, the ranks of American adults with excessive blood sugar levels would swell from 93.8 million this year (about 28 million diabetics and 66 million more with pre-diabetes) to 135 million in 2020.

Sixty percent of the annual $500 billion burden of the obesity-driven diabetes epidemic would be borne by the U.S. government, according to "The United States of Diabetes," a provocative working paper produced by the Center for Health Reform & Modernization, part of the healthcare giant UnitedHealth Group Inc. UnitedHealth issued the report on the heels of an Oct. 22 forecast from the Centers for Disease Control and Prevention that as many as 1 in 3 adults could be diabetic by 2050. That's an enormous jump from current diabetes prevalence, which is 1 in 10 among adults.

The nation's "diabesity" epidemic, part of a paired global rise in obesity and Type 2 diabetes, has enormous ramifications for Americans' health and well-being, as well as their pocketbooks. Type 2 diabetes, the form of the disease associated with excess body weight, is a powerful driver of heart disease, stroke, blindness, kidney failure and amputation, all of which are expensive conditions.

"Our new research shows there is a diabetes time bomb ticking in America, but fortunately there are practical steps that can be taken now to defuse it," Simon Stevens, executive vice president of UnitedHealth Group and chairman of its Center for Health Reform & Modernization, said in a prepared statement. "Making a major impact on the pre-diabetes and diabetes epidemic will require health plans to engage consumers in new ways, while working to scale nationally some of the most promising preventive care models."

UnitedHealth, the nation's largest health insurer based upon sales, already has engaged with the CDC and the National Council of YMCAs in developing a National Diabetes Prevention Program authorized under health care reforms President Obama signed into law. The goal is to create community-based programs that encourage men and women to drop five to seven percent of their body weight and exercise at least a half-hour five days each week, activities which have been found to profoundly reduce diabetes risk.

Dr. Anne Peters, director of clinical diabetes programs at the University of Southern California, said she welcomed UnitedHealth's report, and a profit-making company's efforts to encourage meaningful, lasting lifestyle changes. The report's projections "seem consistent with the fact that by 2050, 30 percent of the population will have diabetes, and if you're Latino, African-American, any minority, it will be up to 50 percent," she said.

Peters said she is particularly bothered by what's ahead for America's children. Among Caucasian youngsters born in 2000, 30 percent "will have diabetes in their lifetime; if you're of color, half of those kids will have diabetes in their lifetime... You

Obesity, Sedentary Habits Could Cost U.S. $3.4 Trillion by Decade's End.

see it everywhere if you know what to look for," said Peters, who practices in low-income, mostly Latino East Los Angeles, as well as in upscale Beverly Hills. The key indicator of risk for diabetes is body fat around the waistline.

In the report, UnitedHealth Group, headquartered in Minnetonka, Minn., recommends interventions based upon evidence that intensive lifestyle changes can prevent or delay the onset of diabetes. The landmark Diabetes Prevention Program, chaired by Dr. David M. Nathan, director of the diabetes center at Massachusetts General Hospital in Boston, demonstrated that overweight and obese people with pre-diabetes could reduce by 58 percent their risk of becoming diabetic with diet and exercise. But despite those results, which appeared in 2002 in the New England Journal of Medicine, most people have proven themselves unwilling or unable to keep up the long-term with steps necessary to achieve these improvements.

Look AHEAD Trial Reinforces Intensive Intervention with Social Support

Peters, an investigator in the federally funded Look AHEAD trial, a long-term study of weight loss and exercise on Cardiovascular risks among overweight and obese diabetics, said it reinforces an intensive Diabetes Prevention Program-like model with social support. "We have parties and classes and individual sessions and group sessions; we have a lot of ways that we engage patients in their health."

The problem is that "people do lose weight, and will regain it once the intervention stops. Basically, everybody with diabetes needs a lifelong lifestyle coach. You need somebody to call you and bug you. You need a support group and a walking group."

And, mindful of Thanksgiving, she said, "You need not to be able to ignore it because it's the holidays."

The solution comes down to constant community outreach, Peters said. "If 50 percent either have diabetes or pre-diabetes, then the whole community needs to support this. There needs to be the mayor's office leading a walking collective; there needs to be a healthy dinner once a week at Town Hall.

She suggested that health care companies may be able to lead the way with incentives for good behavior, rather than penalties for bad habits.

Peters, who prides herself on being a lifelong exerciser, said even she can be motivated by the right incentives. Staffers at her East L.A. clinic decided that everyone should engage in two corporate walking challenges. "Every week we have to give our miles to our team captain. All of a sudden, I became a fanatic. It really drove me to exercise more when I might not have. The accountability totally motivated me." But even she noted that her enthusiasm dropped off once the competition ended.

The solution, she said, comes down to determining "how do we motivate each person?" And, more difficult, how the country finds the money to pay for that.

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