Mardi Gras has once again hit Mobile and I am taking some time to enjoy the festivities although today it is raining more rain than beads. I did spend some time while running today discussing the relative merits of staying fit, staying skinny, and the effect on health (as opposed to the negative effect on the medico-industrial complex’s bottom line). I have a couple of evidence based observations that I would like to share before I go to collect moon-pies for future consumption thrown to me by perfect strangers.

1) If you want to live a longer and healthier life, it is better to be skinny than fat. From the New England Journal of Medicine:

…overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.

2) If you are overweight, it is better to be in shape than not in shape. From the journal Obesity:

Low Cardiorespiratory Fitness (CRF) in women was an important predictor of all-cause mortality. Body Mass Index, as a predictor of all-cause mortality risk in women, may be misleading unless CRF is also considered.

This remains true even if you look within groups. So, fit people who are very overweight outlive those very overweight people who are unfit, and so on.

3) The real problem for America, in addition to folks dying prematurely,  is that those who are not in shape will consume a lot more health care dollars in their old age. Those dollars are all federal tax dollars. From AHRQ:

Currently, almost one-third of total U.S. health care expenditures is for older adults (over age 65). Health care expenditures for people aged 65 years or older are four times that for 40-year-olds. By 2030, health care spending will increase by 25 percent, simply because the population will be older, before inflation or new technologies are taken into account. Estimates from a study by Harvard researchers calculated that the direct medical costs attributable to inactivity and obesity accounted for nearly 10 percent of all health care expenditures in the United States (Colditz, 1999). Being inactive results in loss of muscle strength and balance and increases the risk of falls. Every year, fall-related injuries among older people cost the nation more than $20.2 billion. By 2020, the total annual cost of these injuries is expected to reach $32.4 billion.

So whose problem is it? As many like to point out, folks need to take “individual responsibility.” Here are some things we all should do from the AHRQ website:

  • Make activity a daily part of your life. Find activities that you enjoy that can become a regular part of your routine, and find others to join you. Partners can make it more fun, can provide encouragement, and help overcome problems of transportation or safety.
  • Consult your clinician about what level of activity is safe and appropriate for you. Discuss any medical issues that might be interfering with more regular activity and review any symptoms and problems that might affect what activities are safe for you.
  • Set specific activity goals. Start slowly and build up to increasing levels of activity. Try to be active for 30 minutes a day on a regular basis.

However, as I like to point out, we need to change how we spend “health care dollars” as well. If, as I pointed out previously, we were to redirect funds into wellness instead of illness, here are some things that have been proven to work that we could do (again from AHRQ):

  • Conduct community-wide campaigns that combine highly visible messages to the public, community events, support groups for active persons, and creation of walking trails.
  • Establish community-based programs, such as those that take place at community centers and senior centers, that can provide individually tailored programs for seniors to become more active. Such groups help members set individual goals; teach participants how to incorporate physical activity into daily routines; provide encouragement, reinforcement, and problem solving; and help sustain progress.
  • Establish community programs that help build social support (at work or in the community) for physical activity.
  • Improve access to places that people can be active, such as walking or bike trails, classes at gyms or senior centers, athletic fields, etc. A review of 12 studies that created or enhanced access to places for physical activity found, on average, a 25 percent increase in the number of persons exercising at least 3 days per week (Kahn, Ramsey, Brownson et al., 2002).