Pandemic Health Inequities Expose Need for Greater Obesity Prevention

The pandemic has thrust longstanding racial and economic health disparities into bold relief. Americans of color have died from COVID-19 at two to three times the rate of the rest of the population. A primary underlying cause is obesity.

“The fact that obesity has proven to be such a significant risk factor for severe COVID-19 illness and death has the potential to focus more public attention on the need to start doing something about it,” said Dr. Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officers, in an interview with Stateline.

The effects of obesity account for a large share of the nation’s health care spending, but funding for obesity prevention and control has been inadequate for decades, Plescia said.

At an annual cost to the health care system of $147 billion, obesity affects 42% of adults and 19% of children in the U.S., putting them at higher risk for chronic diseases such as diabetes, heart disease and some cancers, according to the federal Centers for Disease Control and Prevention.

The coronavirus pandemic has multiplied obesity’s health risks. The CDC estimates that people with obesity who contract COVID-19 are three times more likely to be hospitalized compared with the rest of the population.

Of the first 900,000 hospitalizations for COVID-19 in 2020, 30.2% were attributed to obesity, the agency found.

Despite heightened concerns over obesity’s health dangers, Congress only provides the CDC with 31 cents per U.S. resident for grants to support state-based obesity-prevention programs.

That level of funding is woefully inadequate for a condition that accounts for 21% of the nation’s health care spending, according to a new report from the Trust for America’s Health, a Washington, D.C.-based public health policy research and advocacy organization.

Between 1999 and 2018, the number of adults with obesity rose from 30.5% to 42.4%, according to the CDC. During the pandemic, the rates have jumped again for a variety of reasons: job losses, school closings, increased food insecurity, reduced physical activity, stress and other factors that combined to put extra pounds on millions of Americans.

According to recent CDC data, the number of states with a self-reported adult obesity rate at or above 35% rose to 16, nearly double the number in 2018.

Among Black and Hispanic residents, the number of states was much higher: 35 states and the District of Columbia had a 35% or higher obesity prevalence among Black residents, and 22 states had that prevalence among Hispanic residents.

That compares with only seven states with a 35% or higher obesity rate among White residents.

Poverty, food insecurity, lack of physical activity and poor access to health care are risk factors.

Insufficient Investment

One reason federal, state and local politicians have failed to make adequate investments in obesity prevention and management is that no easy panacea exists. Curtailing poverty and redesigning neighborhoods to increase access to healthy food and exercise, for example, are daunting propositions.

“Obesity is a complex disease with many contributing factors and no simple solutions,” said Dr. J. Nadine Gracia, president and CEO of Trust for America’s Health. “To address it, we need to increase and sustain investment in innovative programs that show promise in preventing and managing obesity.

“It’s important to address the full spectrum of solutions from obesity prevention in children to screening, support services and treatment for adults,” she said in an interview with Stateline.

The CDC uses a person’s body mass index, or BMI, to determine obesity. That number is calculated by dividing a person’s weight in kilograms by the square of that person’s height in meters. A BMI that is 30 or higher falls in the obesity range. For example, a person who is 5 feet 9 inches tall (1.75 meters) and weighs 203 pounds (92.07 kilograms) or more would be considered obese.

In 2000, no state had an adult obesity rate above 25%. Now, 16 states—Alabama, Arkansas, Delaware, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Ohio, Oklahoma, South Carolina, Tennessee, Texas and West Virginia—have an obesity rate at or above 35%.

The CDC provides funding for states to implement a variety of policies that have been shown to be effective at reducing obesity rates. The State Physical Activity and Nutrition Program, the agency’s grant program, aims to reduce health disparities among people who are at high risk of poor nutrition and inadequate physical activity.

But with a fiscal year 2020 budget of .9 million, the CDC’s Division of Nutrition, Physical Activity, and Obesity was able to distribute grants to only 16 states this year: Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Kentucky, Minnesota, Missouri, New York, North Carolina, Ohio, Pennsylvania, Texas, Utah and Washington.

Every state should have a CDC obesity prevention program, Plescia said. To varying degrees, state and local governments fund their own prevention programs. But without CDC grants, he said, most states lack any type of dedicated anti-obesity program.

Innovative Programs

A portion of the CDC’s anti-obesity grants goes to land-grant universities to work with communities in counties where 40% of residents are obese.

Called the High Obesity Program, the money supports, among other projects, walking trail development in Kentucky; farmers markets, farm-to-school programs and improved nutritional standards for food banks in Oklahoma; and improved transportation to grocery stores and exercise opportunities in underserved parishes in Louisiana.

The U.S. Department of Agriculture also provides nutrition programs that states can tap to prevent obesity. In 2019, the USDA’s National School Lunch Program served more than 4.8 billion healthy lunches to children from families with low incomes nationwide.

But during the pandemic, school closures caused millions of kids to miss what was often their healthiest meal of the day. Many schools offered bagged lunches for parents who were able to pick them up.

In April, the USDA announced it would continue offering free meals for all students through the end of the 2021-2022 school year—an extension of the program started at the beginning of the pandemic to feed students who were learning remotely.

In addition, President Joe Biden included billion in a proposed .7 trillion aid bill for American families that would expand school meals in high-poverty districts over 10 years.

California is a step ahead. In July, Democratic Gov. Gavin Newsom signed a bill appropriating million in state money to supplement USDA funding for an expanded school lunch program available this year for all of the state’s 6.2 million public school students.

The program makes lunches available to all kids regardless of family income in an effort to eliminate the stigma of accepting free lunches and feed more children nutritious meals. Next year, California will make the program permanent, at an annual cost of million.

Some states are also working with the USDA’s Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, which serves 38 million people.

In addition to providing money for groceries, SNAP partners with states to help residents lead healthy, active lives. Massachusetts offers healthy food cooking lessons, for example, and Nevada helps older adults get involved in online exercise classes.

Several cities—including Boulder, Colorado; Washington, D.C.; Philadelphia; Seattle and four California cities—have levied taxes on sugary sodas that contribute to obesity. Some of the cities are using the soda tax revenue to support local nutrition and exercise programs.

This year, lawmakers in several states have tried but failed to pass similar soda taxes. A few states, including California, have banned any further local soda taxes.

Read Stateline coverage of the inequities exacerbated by the COVID-19 pandemic.