While the White House and Congress grapple with the costs of a new healthcare system, the American people must recognize that these costs cannot be contained without a significant change in the American lifestyle, which adds billions of dollars yearly to the cost of healthcare.

Tobacco use results in the single most expensive burden to the healthcare system, costing $324 billion* according to the U.S. Treasury Department; when the cost of increased mortality is included, the figure rises to nearly $500 billion

Obesity costs the American health system more than $147 billion annually according to the CDC, and the proportion of all medical costs related to obesity increased by 50% between 1998 and 2006. Because obesity is a risk for many chronic diseases – such as diabetes, cardiovascular disease and some cancers – healthcare costs for obese individuals is 42% higher than for those of normal weight. Major contributors to obesity rates:

Sugars – Those added in manufacturing and by consumers should be limited to 100 calories (6 tsp) daily for women and 150 calories (9 tsp) for men. Current consumption averages 355 calories (more than 22 tsp). Major culprits:

• Soft Drinks – one 12-oz can contains about 8 tsp of sugar. It should be noted that both sugar-added and artificially-sweetened colas also contribute to such medical problems as osteoporosis, kidney stones, reduced kidney function and – in the case of caffeinated colas – hypertension (not so with coffee).
• Fruit Juices and Fruit Drinks – on average, fruit drinks contain 8 tsp per serving; sports drinks contain 8 tsp, and ice slush contains 12 tsp.
• Sweetened Cereals – provide almost half the daily allowance of sugar. An interesting Yale study showed that when children were free to make breakfast choices, those choosing low-sugar cereal ate half as much cereal, added only a small amount of sugar, and tended to put fruit on top when compared to those choosing high-sugar types. The two types of choices rated equally high in taste and satisfaction.
• Candy, Cake, Pies and Muffins – it goes without saying that these are high in sugar calories and low in nutrition.

Fats – contribute not only to obesity but also have a direct link to heart disease and strokes – which cost the U.S. $475 billion yearly. Although all fats have the same number of calories (100-120 calories per Tb) and should be limited, they differ in other health consequences, demanding that food labels be scrutinized carefully:

• Transfats and Hydrogenated Fats are dangerous to the heart and should avoided entirely.
• Saturated Fats are also heart-unhealthy and should be limited to 10% of calories. These fats are found in such animal products as full-fat dairy products and fatty meats and also in coconut and palm oils.
• Unsaturated fats help to lower cholesterol if they replace saturated fats. With the exception of coconut and palm oils, liquid vegetable oils are unsaturated.

Exercise – Fewer than 20% of Americans exercise daily. According to guidelines from the National Association for Sports and Physical Education (NASPE), children between 5 and 12 need at least one hour of moderately vigorous exercise a day. Only 20 to 40 percent of American children get that much. Not only are they spending more time in front of the TV and video games, but schools have markedly reduced time devoted to physical education and recess. Lack of exercise is a strong factor in rising obesity rates as well as in adult coronary disease, osteoporosis and Type II diabetes.

Hypertension costs our health system more than $73 billion annually according to the American Heart Association. In addition to hereditary factors, obesity, and caffeinated soft drinks, salt intake is a significant contributor. The Institute of Medicine recommends limiting sodium to between 1500 and 2400mg daily.

• 11% of sodium in the average American diet comes directly from the salt shaker – try halving the amount you use for cooking and at the table.
• 12% comes naturally in vegetables, meat, poultry and dairy products
• The remaining 77% comes from processed foods, suggesting that you’re obliged to read labels carefully. You’re likely to be astonished at the salt in processed meats, fish and cheese, canned soups and vegetables, frozen dinners, snack foods such as chips and salted nuts, and fast food.

Alcohol excesses cost the U.S. nearly $50 billion yearly, not including the indirect costs of reduced work productivity, industrial injuries and industrial and driving fatalities – which would likely double that figure.

Reducing the costs of these hidden healthcare culprits is a matter of:

Individual responsibility – by quitting smoking, reducing alcohol consumption, and cooking more meals at home ‘from scratch’, using fresh fruits and vegetables, more grains, and less sugar, salt and meats.

Community responsibility. The CDC has published guidelines based on its Common Community Measures for Obesity Prevention Project. It includes challenges to communities to

• Improve access to foods fresh from local farms
• Provide incentives to food retailers to offer healthier food and beverage choices in underserved areas
• Restrict the advertising and availability of less healthy food and beverages in public service venues
• Institute smaller portions in public service venues
• Provide support for breastfeeding
• Require physical education in schools
• Increase opportunities for extracurricular physical activity
• Provide safe neighborhood playgrounds
• Support infrastructure to allow safe bicycling and walking

Dr. Margaret Lewin is the Medical Director of Cinergy Health www.cinergyhealth.com

*All figures are in 2007 dollars.