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The Canada eZine - Health Care Costs

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Lowering Health Care Costs

Obesity in Canada is costing the Canadian health care system billions of dollars per year. The health system is buckling under the cost pressures.

According to Statistics Canada 65% of men (7.7 million) in Canada are overweight or obese and 53.4% of women (6.5 million) in Canada are overweight or obese. Approx. 23.1% of Canadian men and women are obese (5.5 million).

According to Health Canada the health care costs of overweight people is 13.8% higher than people of normal weight and 37.3% higher for obese people. Per-capita health care costs in Canada went up 67% between 1993 and 2005 and continues to rise, and obesity and the babyboomer population is the main culprits. The same is true in the United States, where health care costs have doubled and obesity rates are even higher than Canada's.

So here is our challenge to Canadians: Lose weight together.

Join or create your own jogging group.

Join or create your own weightlifting group.

Join or create your own exercise group.

Join or create your own sports team.

Why? Because if we all lose weight the health care costs will go down and our health care costs/taxes will go down. So when you sit down at your computer and open up your TurboTax program, not only will you fell better physically, but financially as well. What does that mean for you? A healthier (and presumably happier) life with more money in your wallet.

Obesity Stats in Canada

The percentage of Canadians who are overweight or obese has risen dramatically in recent years, mirroring a worldwide phenomenon. The health consequences of excess weight are well known. It is a risk factor for type 2 diabetes, cardiovascular disease, high blood pressure, osteoarthritis, some cancers and gallbladder disease.5, 6, 7 As well, psychosocial problems, functional limitations and disabilities are associated with excess weight.

For more than a decade, information about the weight of Canadians has been based on self-reports, that is, survey respondents reported their own height and weight rather than being measured and weighed. However, such data are known to underestimate the prevalence of overweight and obesity. The 2004 Canadian Community Health Survey: Nutrition (CCHS), which directly measured respondents’ height and weight, makes it possible to draw a more accurate picture.

Majority overweight or obese

According to the 2004 CCHS, 23.1% of Canadians aged 18 or older, an estimated 5.5 million adults, had a body mass index (BMI) of 30 or more, indicating that they were obese. This is significantly higher than estimates derived from self-reported data collected in 2003, which yield an obesity rate of 15.2% (see Methodology makes a difference). Another 8.6 million, or 36.1%, were overweight.

Among people who are obese, BMIs vary greatly. As a result, obesity is divided into three categories, with successive values representing escalating health risks. People in Class I (BMI 30.0 to 34.9) have a high risk of developing health problems. For those in Class II (BMI 35.0 to 39.9), the risk is very high, and in Class III (BMI 40 or more), extremely high. In 2004, 15.2% of Canadian adults had a BMI in Class I; 5.1% were in Class II, and 2.7%, in Class III.

Sharp increase

In 1978/79, the Canada Health Survey collected measured height and weight data for a nationally representative sample of adults. That year, the age-adjusted obesity rate was 13.8%, far below the 2004 rate of 23.1%. The increase was evident in each of the three obesity categories, especially Class II and Class III. The proportion of adults in Class II went from 2.3% to 5.1%; in Class III, from 0.9% to 2.7%.

The obesity rate of every age group except 65 to 74 rose during this period. The most striking increases were among people younger than 35 and 75 or older. For instance, the percentage of 25- to 34-year-olds who were obese more than doubled, rising from 8.5% in 1978/79 to 20.5% in 2004. The extent of the increase among people aged 75 or older was about the same: from 10.6% to 23.6%.

The average BMI of adults rose from 25.1 in 1978/79 to 27.0 in 2004, and the BMI distribution of the adult population shifted toward the heavy end of the continuum.

In 2004, men and women were equally likely to be obese: 22.9% and 23.2%, respectively. However, when the three obesity categories are examined separately, a difference between the sexes emerges. A higher percentage of women than men were in Class III.

For both sexes, obesity rates were lowest at ages 18 to 24 (10.7% of men and 12.1% of women), and peaked around 30% among 45- to 64-year-olds. The percentage of seniors who were obese was lower at about 25%.

Provincial differences

With a few notable exceptions, obesity rates did not vary greatly by province. In 2004, men’s rate was significantly above the national level (22.9%) in Newfoundland and Labrador (33.3%) and Manitoba (30.4%). Women’s rate surpassed the national figure (23.2%) in Newfoundland and Labrador (34.5%), Nova Scotia (30.3%) and Saskatchewan (32.9%).

Canada-United States

While Canada’s obesity rates have, for the most part, been based on self-reported data, the United States has derived rates from actual measurements of height and weight since the early 1960s. With the directly measured data from the 2004 CCHS, it is possible to compare the prevalence of obesity in the two countries.

Age-standardized results show that 29.7% of Americans aged 18 or older were obese in 1999-2002, significantly above the 2004 figure for Canada (23.1%). Most of this difference was attributable to the situation among women. Whereas 23.2% of Canadian women were obese, the figure for American women was 32.6%. As well, each obesity category (Class I, II and III) accounted for a higher percentage of American than Canadian women. The difference in obesity rates between American and Canadian women prevailed in all age groups except 45 to 54 and 75 or older.

The obesity rate of Canadian men was 22.9%, significantly below the age-adjusted American rate of 26.7%. However, this was mainly a reflection of Class III obesity: American men were much more likely to have a BMI of 40 or more. The percentages of Canadian and American men whose BMI put them in Class I or II were statistically similar. American men aged 18 to 24, 35 to 44 and 65 to 74 were more likely than their Canadian counterparts to be obese.

Related to lifestyle

As might be expected, the likelihood of being obese was related to diet and exercise. Men and women who ate fruit and vegetables less than three times a day were more likely to be obese than were those who consumed such foods five or more times a day. Although other factors may be driving this relationship, the association persisted when age and socio-economic status were taken into account. Another study has also shown obesity to be independently associated with infrequent consumption of fruit and vegetables. However, because the CCHS data are cross-sectional, the direction of this relationship cannot be determined.

Physical activity, too, was related to the prevalence of obesity. People whose leisure-time was sedentary were more likely than those who were physically active to be obese. For example, 27.0% of sedentary men were obese, compared with 19.6% of active men. Among women, obesity rates were high not only for those who were sedentary, but also for those who were moderately active. These relationships remained statistically significant when adjustments were made to account for age and socio-economic status.

Socio-economic differences

Obesity rates varied by marital status for women, but not for men. About a quarter of married men and women aged 25 or older were obese. The rate was significantly higher among women who were widowed (30.0%). By contrast, the percentages of married, separated/divorced, widowed and never-married men who were obese were not significantly different.

The association between education and obesity was not straightforward. Men aged 25 to 64 with no more than secondary graduation had significantly high obesity rates, compared with men who were postsecondary graduates. Among women, those with less than secondary graduation were more likely than postsecondary graduates to be obese. As well, the obesity rate of women who had some, but had not completed, postsecondary education was high.

Men in lower-middle income households were less likely to be obese than were those in the highest income households. For women, those in middle and upper-middle income households had significantly elevated obesity rates, compared with women in the highest income households. When age was taken into account, the results for men persisted, but for women, only those in middle-income households had a significantly high obesity rate.

Chronic conditions

Being overweight or obese is a risk factor for a number of chronic conditions. Analysis of CCHS data reveals associations between excess weight and high blood pressure, diabetes, and heart disease.

In 2004, less than 10% of men and women whose BMI was in the normal range reported having high blood pressure. The figure rose to just over 15% among those who were overweight, and to more than 20% among those who were obese. Even when age, marital status, education, household income, smoking status and leisure-time physical activity were taken into account, excess weight was strongly associated with reporting high blood pressure.

A high BMI is a risk factor for type 2 diabetes.15 Just 2.1% of men whose BMI was in the normal range reported having diabetes; the figure was 3.7% among overweight men, and almost tripled (to at least 11%) among those who were obese. The pattern was similar for women. And even when the effects of the other factors were taken into consideration, men and women who were obese had significantly high odds of reporting diabetes.

The prevalence of heart disease increased with BMI among men. While 2.8% of men with a normal BMI reported having heart disease, the figure was 6.0% among men who were overweight and almost 8% among those who were obese. Even when age, marital status, education, household income, smoking, and leisure-time physical activity were taken into account, the association between BMI and heart disease among men remained.

For women, the prevalence of heart disease did not differ significantly by BMI, except for those in obese Class I who were slightly more likely to have it than were women whose BMI was in the normal range. But when the other demographic, socio-economic and lifestyle factors were considered, this relationship disappeared.

Concluding remarks

Although it has generally been known that obesity rates have risen dramatically in Canada over the past quarter century, the extent of the increase was uncertain, because estimates relied on self-reported data. Results from the 2004 Canadian Community Health Survey: Nutrition (CCHS), based on directly measured height and weight, indicate that 23% of adults were obese. This was up from 14% in 1978/79, but still below the obesity rate in the United States (30%). However, in 2004, another 36% of Canadians were overweight. Consequently, a majority of Canadians—almost 60%—were in a weight range that increased their risk of developing health problems. In fact, according to results of the CCHS, as BMI increases, so does the likelihood of having high blood pressure, diabetes and heart disease. And for many people, further weight gain is probable. Longitudinal research has shown that those who are overweight are far more likely to continue to gain weight than to lose it.

No more coddling the obese

By Shelley Fralic

Much like reformed smokers who can't abide the taste or smell of nicotine and who annoyingly never let you forget they have defeated their demon, reformed fat people are just as sanctimonious about their new-found virtue.

They especially have no patience for the current trend in which over-eating is regarded as a disease, or the non-stop testimonials about the wonders of gastric bypass or the courtship of societal sympathy for the obese in television shows like The 1,000 Pound Man, Big Medicine and The Biggest Loser.

I know this because I am one.

A big loser, an unsympathetic former fatty who took the cottage cheese butt and double chins by the horns six years ago, after KFC-ing my sad-sack, self-pitying self into a dangerous supersize 230 pounds on a five-foot-eight frame.

I did something about it: stopped eating junk, counted smart calories, moved a little more than usual (OK, really, not much) and in less than a year went from a size 20 to a size 12, where I've stayed.

It wasn't easy, because the girl likes her food, but it was necessary, and it was certainly doable.

Not that I'm anything special on this front: millions of people are looking in the mirror and seeing their life pass before their eyes, surprised to find they've entered the territory where too much weight not only looks awful, but is a portal to early death, or at the very least exposure to a list of grave health issues as long as a chubby arm. (See accompanying story, left.)

So they do something about it.

Which is why this insidious trend to coddle the overweight, who gained that poundage by choice, is so galling.

The latest irritant is the study published last week by Yale University's Rudd Center for Food Policy and Obesity, which maintains that health-care professionals are biased against the obese, deliberately ignoring the needs of the 59 per cent of adults considered overweight, and the 23 per cent who are obese. (Those figures courtesy of the most recent Canadian Community Health Survey.)

Millions of our children, too, lacking parental tutelage in healthy eating choices and exposed to the cheap fast food nation, are also shockingly overweight, prompting health-care officials across North America to sound the alarm.

And, yet, this study takes the medical profession to task for not being respectful of obese people, for not having armless chairs in waiting rooms or "weight-sensitive" reading material or floor-bolted oversized examination tables and plus-size gowns, for having scales that don't go over 300 pounds and for not weighing them in privacy.

"If we coddle the obese, aren't we just endorsing them to gain more weight?" - Suzanne MacNevin.

All of these things, the study says, contribute to isolation and can lead to depression, anxiety and low self-esteem for the obese.

Well, boo hoo.

It's one thing if a doctor is purposely overlooking obese women when it comes to screening for breast and cervical cancer, as the study suggests. That's unconscionable.

But it's another thing entirely for obese people to expect their own weigh-in room.

Or, for that matter, a free second seat on an airplane, which became a national regulation last month when the Canadian Transportation Agency ruled that airlines must accommodate the disabled, a decision that translates into providing an extra free seat on domestic flights for the obese or those in need of a companion caregiver, thereby equating obesity with multiple sclerosis.

But why -- if the vast brainpower and resources of medical expertise have determined, through actuarial charts and body mass index magic, that we need to eat right and exercise in order to live long, healthy lives -- are we asked to empathize with those who don't care enough about themselves to heed that advice?

This is not about people with mental or glandular afflictions whereby excess weight is an unwitting byproduct, people who truly need help, but about those who choose Lay's over lettuce.

In the TLC show Inside Brookhaven Obesity Clinic, the doctor who runs the New York facility for the clinically obese spends much of his time counselling 600-plus-pound patients not to cheat.

After being told they're this close to death if they don't stop eating, they secretly order pizza late at night, trusting that gastricbypass, or liposuction, will save them.

How, exactly, does coddling fat people help them?

And are we really expected to categorize obesity as a disability, like breast cancer or autism?

If one is choice, and one is fate, why should we treat them equally, which is what fat people seem to be asking us to do?

Instead of looking inward and changing the changeable -- addictions to food, liquor and drugs are said to be the only "diseases" that one can cure just by waking up one morning and deciding to stop -- they choose instead to look outward, to society, for solutions.

Maybe we should treat overeaters the way we do smokers.

There was a time when millions of cigarette smokers were bamboozled by tobacco firms, lobbyists and tax-collecting governments into the misguided belief that inhaling tar and chemicals through a sexy little paper tube wasn't really bad for us.

But the truth won out, and millions of smokers quit, even though it was hard, choosing life over death by tobacco.

No one feels sorry for smokers these days, because they know the consequences of their addiction and because they have the power to heal themselves.

Be fat if you want. But own it. And don't expect special treatment.

As I said. There's nothing worse than a reformed fatty.

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