The simple explanation is that we eat too much junk food and spend too much time in front of screens — be they television, phone or computer — to burn off all those empty calories. The real problem is a landscape littered with inexpensive fast-food meals; saturation advertising for fatty, sugary products; inner cities that lack supermarkets; and unhealthy, high-stress workplaces, reports Natasha Singer in an August 2010 New York Times article.

One handy prescription for healthier lives is behavior modification. If people only ate more fresh produce. (Thank you, Michael Pollan.) If only children exercised more. (Ditto, Michelle Obama.) Unfortunately, behavior changes won’t work on their own without seismic societal shifts, health experts say, because eating too much and exercising too little are merely symptoms of a much larger malady.

In other words: it’s the environment.

Indeed, despite individual efforts by some states to tax soda pop, promote farm stands, require healthier school lunches or mandate calorie information in chain restaurants, obesity rates in the United States are growing. America’s expanding waistlines have nearly doubled medical spending on obesity-related conditions which could reach $147 billion a year.  Most people know they should eat less junk food and exercise more.  Cost of healthy food and easy access to fast food combined with little time or incentive to exercise creates an unhealthy environment.

As Congress debated President Barack Obama’s major push to overhaul US healthcare, researchers warned that the prevalence of obesity — which now affects over 25% of Americans, up from 18.3% in 1998 — and associated medical problems, are behind ballooning overall medical spending.  Obesity currently accounts for 9.1% of all medical spending, up from 6.5% in 1998.  According to RTI International, one of the world’s leading research institutes for human health, medical costs from obesity are almost entirely from treating the diseases caused by obesity, than for treating obesity itself.  Excess weight, they noted, is the best predictor of developing diabetes, which costs $191 billion each year.  The connection between rising rates of obesity and rising medical spending is undeniable.

So what can help Americans get healthier? Equalizing food pricing, for one.

Fast-food restaurants can charge lower prices for value meals of hamburgers and French fries than for salad because the government subsidizes the corn and soybeans used for animal feed and vegetable oil, says Barry Popkin, a professor of nutrition at the Gillings School of Public Health at the University of North Carolina at Chapel Hill. “We have made it more expensive to eat healthy in a very big way,” says Dr. Popkin, who has a doctorate in agricultural economics and is the author of a book called “The World Is Fat: The Fads, Trends, Policies and Products That Are Fattening the Human Race.” Cutting agricultural subsidies would allow better prices for fruits, vegetables, and low fat items.

Corporations are looking at ways to have healthier employees.  It’s less expensive for businesses to keep healthy workers healthy than to cover the medical costs of obesity and related problems like diabetes. For employees at IBM and their families, for example, the annual medical claim for an obese adult or child costs about double that of a non-obese adult or child, says Martin J. Sepulveda, IBM’s vice president for integrated health services.  IBM has been promoting wellness for employees since the 1980s.

All efforts are promising, but the environment of obesity is so entrenched in today’s world that policy makers, companies, communities, families and individuals will need to work at efforts to replace it.

American efforts can seem piecemeal compared with those in Britain, where the government has undertaken a national attack, requiring changes in schools, health services and the food industry.  By 2011, cooking classes will be mandatory for all 11- to 14-year-old students in the nation. The hope is to teach a generation of children who grew up on prepared foods how to cook healthy meals, and perhaps to make eating at home the default option.

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