Betting on Michelle

On Tuesday, Michelle Obama took on the traditional First Lady supporting role and announced that while her hubby is focusing on the heady and heated arguments surrounding health-care reform (not to mention a few other minor details like wars in Iraq and Afghanistan, an economic meltdown, and a deficit-to-shame-all-deficits), she’ll be starting a new initiative to address childhood obesity. It’s a traditional relegation of roles for presidents and their first ladies — one of the few truly bipartisan achievements of administrations from the Roosevelts, Nixons, Reagans, to the Clintons: He deals public sphere of hard-line politics and policies, while she focuses on the personal. I’m not saying that they all did equally well in their roles — just that the gender division seems to play out across political party lines.

But in the world of health and health-care reform, my bet is on Michelle.

Why? Health-care reform is desperately needed in the United States. We need to rein in health-care spending and ensure that everyone has access to affordable health-care. You’ve heard it before, and I’ll say it again: We Americans spend more money on health care, and we have poorer health, than any other developed nation. And kudos to Barak Obama for taking it on. Whether the current initiative succeeds or not, the issue has finally become the national discussion that it needs to be. But no matter how effectively or efficiently we rein in health-care costs, and no matter how equitably we disperse health-care resources, we’re fighting a losing battle unless we address obesity.

Health problems associated with obesity are going to overwhelm our health-care systems, our families, our communities, and our economic stability unless we do something about it, and do it now. Obesity costs us far more than we know, not only because of its immediate effects but its effects on chronic diseases. People who are overweight or obese are much more likely to experience heart and blood vessel disease including sudden cardiac death and stroke, hypertension, high blood cholesterol, diabetes, cancer, asthma and other breathing problems, difficulty sleeping, orthopedic injuries, depression, and more. In 2003, we spent $75 billion of our health-care dollars on obesity, about half of which came from public sources. By 2018, we can expect to spend $343 billion on health-care costs related to obesity. That’s $1425 per person, compared to $316 per person in 2008. And we’re not even talking about lost productivity or other indirect costs associated with obesity, nor the costs to the health-care workforce in back injuries and more as they try to move those obese patients around.

We Americans are fat — and getting fatter. Two-thirds of adults in the United States are overweight or obese. Even more troubling, the proportion of those who are obese appears to be on the rise. The prevalence of obesity in the United States increased from 19.4 percent in 1997 to 27.6 percent in 2009; the rate was highest among people ages 40 to 59 (31.8 percent). For a striking visual look at obesity trends, take a look at the Centers for Disease Control and Prevention (CDC) graphic representation of their data at And just in case you Brits are chuckling, take a look at the Foresight Report’s predictions: by 2050, 60 percent of adult men, 50 percent of adult women, and 25 percent of children in the U.K. could be obese.

Right now, the bulk of our spending on obesity-related illnesses is among older adults. You know anyone who hit their 40s, 50’s, or 60’s who suddenly put on a few pounds? The negative effects of obesity on those people’s general health didn’t start until their middles began to spread in middle age. But a whole new generation of kids is coming up the pipeline — and they’re fat already. The prevalence of obesity among children as young as two years of age increased dramatically between 1980 and 2004. By 2004, nearly one out of ten children between aged two to five were obese. By the time they reach adolescence, one-third (33.3 percent) of U.S. kids are overweight or obese. The chance that those children will make it to adulthood without serious health problems are slim indeed. A recent CDC study ( suggests that they might not even have to wait that long. When researchers analyzed results from the National Health and Nutrition Examination Survey (NHANES) for 1999–2006, they found 20 percent — that’s one out of five — adolescents in the United States already had abnormal blood lipids (translate: high total cholesterol levels and/or high levels of “bad” cholesterol and triglycerides). In other words, they already have heart and blood vessel disease.

So will Michelle Obama’s “Let’s Move” initiative really address the problem? I’ve only taken a quick look, but it’s heading in the right direction by recognizing that overweight and obesity are caused as much by community factors — such as the distance to grocery stores versus fast food outlets — as by individual choices. Even more fundamentally, the initiative seems to recognize that individual choices are themselves the result of community factors. That’s a topic for another post.

It’s also a reminder that often it is in the personal sphere that we are most effective at creating real change. I’m reminded of those famous remarks delivered by First Lady Obama’s predecessor, Eleanor Roosevelt, at the United Nations in March 1 953: “Where after all do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person: The neighborhood he lives in; the school or college he attends; the factory, farm or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.”

Add health as one of those fundamental human rights to be found in our neighborhoods, schools, and workplaces, and you’ll understand why my bet is on Michelle.

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