Stateline Story

Obesity Weighing Down State Health Care Budgets

  • April 08, 2004
  • By Genelle Hoban

(This is the first of a two-part series on state actions on obesity.)

After being diagnosed with diabetes last spring, Arkansas Gov. Mike Huckabee (R) started exercising, eating healthier and lost more than 90 pounds. Now Huckabee is leading the way to trim pounds from his state employees and hopefully health care costs from the Arkansas budget.

This spring, Arkansas plans to roll out an initiative to give cash incentives to state employees who make healthy changes, such as losing weight and quitting smoking. Details have not yet been released.

The governor said he hopes Arkansas' unique get-healthy program will become a model and catch on with other statesmuch like welfare reformto address the nationwide obesity crisis.

"The issue of health has to become a lifestyle," Huckabee said in a telephone interview. Eating habits already have started changing in his Little Rock, Ark., office. Instead of pastries, co-workers now bring in fruit and vegetable trays. His office held a contest: whoever walked the most steps in a month using a pedometer was rewarded with the best parking spot for two weeks.

More and more states are waking up to the perils of obesity because of the skyrocketing effects on their health care expenses, which already eat up a third of state budgets. Obesity now costs states almost as much in medical expenditures as tobacco-related diseases, according to an Issue Brief by the National Governors Association Center for Best Practices.

California, for example, is expected to incur $7.7 billion -- more than any state in the country -- in obesity-related health care costs in 2003, with taxpayer-funded Medicaid and Medicare programs paying $3.4 billion of those costs, according to a state-by-state estimate in the January issue of Obesity Research.

With state budgets stretched thin, lawmakers are having a hard time paying for the escalating costs from high blood pressure, heart disease, diabetes and other ailments caused by obesity. More than 20 percent of adults are now obese and are quickly weighing down state health care budgets, which pay for medical coverage for state employees and pick up a big share of Medicaid costs for the poor and disabled.

States are trying to trim obesity rates and costs in three ways: changing eating habits of students to address childhood obesity, taxing soft drinks and motivating citizens to exercise more.

Texas is now the strictest state in keeping junk foods away from students during the school day. Starting Aug. 1, Texas will ban candy, pizza parties, sodas, popsicles and deep-fat frying in elementary schools that receive federal lunch subsidies. Junk food will be kept away from older students until after lunch, including restricting access to vending machines.

The Texas Department of Agriculture adopted the new guidelines in March to address what it called a "crisis" and "alarming rates" of diet-related disease in school-age children. More than 35 percent of Texas schoolchildren are overweight or obese.

Beverly Boyd, spokesperson for the department, said Texas goes further than any other state and the federal government in limiting the grams of fat and sugar that students can consume in a school day, downsizing portions of chips, cookies and other treats and restricting vending machines.

California in 2001 was the first to take steps to rid elementary schools of candy and soda vending machines, but the law still is not strictly enforced in all schools.

More than 28 states currently are considering legislation to attack obesity in children by banning sugary foods and soft drinks from vending machines in elementary schools, increasing physical activity or educating children on nutrition.

The Kentucky House passed abill in January that would replace junk food in school vending machines with healthier alternatives such as pretzels, crackers, nuts, milk, juice and water. The measure now goes to the Senate.

"What is going to turn lawmakers' heads is when they see a dollar sign for obesity costs for the state. Once they see this, they will start implementing programs into elementary schools," said Charlotte Postlewaite, a lead education policy analyst for The Council of State Governments.

Arkansas is one state that is using its tax authority to staunch unhealthy consumption, much like imposing taxes on cigarettes to curb smoking. It collects two cents per soft drink can and raises more than $40 million a year to help finance its state portion of Medicaid expenses. More and more states are considering such taxes to finance obesity and nutrition programs, the NGA study said.

Besides Huckabee in Arkansas, governors in Colorado and South Carolina also are leading their citizenry to battle the bulge through more physical activity.

In 2002, Republican Gov. Bill Owens and the Colorado Legislature launched "Colorado on the Move," a statewide initiative that concentrates on two main goals: walking an extra 2,000 steps a day and eating 100 fewer calories a day. With more than 200,000 members, it has participants in schools, workplaces and communities.

"The state legislators were one of the first groups of people to take part in this program," said Mary Barry, a faculty member at the University of Colorado Health Sciences Center.

Colorado's idea spread to the 50 states in 2003. Now, "America on the Move" plans to reach one million people by year's end and five million people within the next three years.

South Carolina Gov. Mark Sanford (R) is fighting obesity in his state by starting the "Family Fitness Challenge" with a cross-state bike ride that he and his family will do in May. He is challenging South Carolinians to come out and bike, run or walk with him for any part of the 160-mile bike ride over three days. His purpose is to encourage residents to make more healthy selections in their daily lives.

Florida Gov. Jeb Bush (R) created a task force in October 2003 to make recommendations on how to lower obesity rates. More than half of Florida's adults are overweight or obese, and without proper measures placed in schools, government officials fear that number will rise.

State legislatures also are being asked to grapple with obesity through the issue of whether consumers should be able to sue fast-food restaurants for making them fat. In June 2003, Louisiana became the first state to ban court actions blaming the food industry for causing adults and children to be overweight. Utah passed similar legislation this month, and at least 17 states have pending legislation that would block lawsuits, such as the one filed and thrown out in New York in 2003 against McDonald's.

Bills in Arizona, California, Colorado, Florida, Georgia, Idaho, Illinois, Kentucky, Mississippi, Missouri, Nebraska, New Hampshire, Ohio, Pennsylvania, South Dakota, Tennessee and Washington are designed to keep consumers whose eating habits make them fat from fattening their wallets by suing fast-food places.