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When the U.S. Surgeon General addressed the epidemic of obesity in U.S.: The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity and Steps to a Healthier U.S.: Putting Prevention First, he noted: “We wait for people to get sick, and then we spend top dollar to make them healthy again. As I see it, we can no longer tolerate treating people who make poor choices.” [92] The Surgeon General’s “Call to Action,” noted that overweight and obesity have reached nationwide epidemic proportions and both the prevention and treatment of overweight and obesity and their associated health problems were important public health goals. [93]
The “Steps to a Healthier U.S.” program proposed a $125 million budget, an increase of $110 million from the previous year, including $100 million in new investments to pursue a prevention initiative to reduce the burden of diabetes, obesity, and asthma-related complications. This program, which made awards to states and communities to implement effective public health strategies, [94] was not funded.
In 2013, U.S. First Lady Michelle Obama launched Let’s Move! Active Schools, a collaborative program to increase physical activity in school environments. Obama planned to engage 50,000 schools in the program and received $70 million in support from partnering organizations such as GENYOUth Foundation, Kaiser Permanente, General Mills Foundation, including a $50 million investment from Nike, Inc.
Obama designed the program to address the sedentary state of the United States’ students, only 1 in 3 children were active on a daily basis. Only nine states required recess in elementary schools and 4% of primary schools, 8% of middle schools, and 2% of high schools offered daily P.E. classes. [95] Let’s Move! Active Schools provided simple steps to assist schools in creating active environments so students could get a minimum of 60 minutes of physical daily.
The yearly adult, male and female, per participant medical spending attributable to overweight and obesity, respectively, by insurance status was: Medicare—$533 and $1,486; Medicaid—$271 and $864; Commercial (private)—$143 and $423; and Out-of-pocket—$53 and $125. [96]
Medicare and Medicaid The two payers most affected by obesity were Medicare (for the elderly) and Medicaid (for the poor).
Although the U.S. government established several public policy initiatives to decrease the prevalence of obesity, the Centers for Medicare and Medicaid (CMS) for long did not classify obesity as a disease. But, when Medicare recognized obesity as an illness, this change in policy allowed millions of Americans to make insurance claims for obesity-related treatments. Also, the Internal Revenue Service revenue enabled taxpayers to deduct the uncompensated amounts paid for participation in a weight loss program in the treatment of a disease (includes obesity) diagnosed by a physician. [97]
[c] For additional description of the Six Forces, see Regina E. Herzlinger, “Innovating in Health Care—Framework,” HBS No. 306-042 (Boston: Harvard Business School Publishing, 2005).
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