F as in Fat: How Obesity Threatens America’s Future 2012 is the 9th edition of the annual report by RWJF and Trust for America’s Health.

Washington, D.C.—The number of obese adults, along with related disease rates and health care costs, are on course to increase dramatically in every state in the country over the next 20 years, according to F as in Fat: How Obesity Threatens America's Future 2012, a report released today by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

For the first time, the annual report includes an analysis that forecasts 2030 adult obesity rates in each state and the likely resulting rise in obesity-related disease rates and health care costs. By contrast, the analysis also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index of their residents by just 5 percent by 2030.

“This study shows us two futures for America’s health,” said Risa Lavizzo-Mourey, MD, RWJF president and CEO. “At every level of government, we must pursue policies that preserve health, prevent disease and reduce health care costs. Nothing less is acceptable.”

The analysis, which was commissioned by TFAH and RWJF and conducted by the National Heart Forum, is based on a peer-reviewed model published last year in The Lancet. Findings include:

Projected Increases in Adult Obesity Rates

If obesity rates continue on their current trajectories, by 2030, 13 states could have adult obesity rates above 60 percent, 39 states could have rates above 50 percent, and all 50 states could have rates above 44 percent.

By 2030, Mississippi could have the highest obesity rate at 66.7 percent, and Colorado could have the lowest rate for any state at 44.8 percent. According to the latest data from the U.S. Centers for Disease Control and Prevention (CDC), obesity rates in 2011 ranged from a high of 34.9 percent in Mississippi to a low of 20.7 percent in Colorado.

Projected Increases in Disease Rates

If states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension and arthritis could increase 10 times between 2010 and 2020—and double again by 2030.

Obesity could contribute to more than 6 million cases of type 2 diabetes, 5 million cases of coronary heart disease and stroke, and more than 400,000 cases of cancer in the next two decades.

Currently, more than 25 million Americans have type 2 diabetes, 27 million have chronic heart disease, 68 million have hypertension and 50 million have arthritis.  In addition, 795,000 Americans suffer a stroke each year, and approximately one in three deaths from cancer per year (approximately 190,650) are related to obesity, poor nutrition or physical inactivity.

Projected Increase in Costs for Health Care and Lost Productivity

By 2030, medical costs associated with treating preventable obesity-related diseases are estimated to increase by $48 billion to $66 billion per year in the United States, and the loss in economic productivity could be between $390 billion and $580 billion annually by 2030. Although the medical cost of adult obesity in the United States is difficult to calculate, current estimates range from $147 billion to nearly $210 billion per year.

Over the next 20 years, nine states also could see their obesity-related health care costs climb by more than 20 percent, with New Jersey on course to see the biggest increase at 34.5 percent. Sixteen states and Washington, D.C., could see increases between 15 percent and 20 percent.

How Reducing Adult Obesity Could Lower Disease Rates and Health Care Costs

The analysis also explored a scenario based on states successfully lowering adult obesity rates. It found that, if states could reduce the average body mass index (BMI) of residents by just 5 percent by 2030, every state could help thousands or millions of people avoid obesity-related diseases, while saving billions of dollars in health care costs. For a six-foot-tall person weighing 200 pounds, a 5 percent reduction in BMI would be the equivalent of losing roughly 10 pounds.

If BMIs were lowered, the number of Americans who could be spared from developing major obesity-related diseases could range from:

• Type 2 diabetes: 14,389 in Alaska to 796,430 in California;
• Coronary heart disease and stroke: 11,889 in Alaska to 656,970 in California;
• Hypertension: 10,826 in Alaska to 698,431 in California;
• Arthritis: 6,858 in Wyoming to 387,850 in California; and
• Obesity-related cancer: 809 in Alaska to 52,769 in California.

And nearly every state could save between 6.5 percent and 7.9 percent in health care costs. This could equate to savings ranging from $81.7 billion in California to $1.1 billion in Wyoming. Florida, the only state that would save less than 6.5 percent in health care costs, could save 2.1 percent or $34 billion.

“We know a lot more about how to prevent obesity than we did 10 years ago,” said Jeff Levi, PhD, executive director of TFAH.  “This report outlines how policies like increasing physical activity time in schools and making fresh fruits and vegetables more affordable can help make healthier choices easier. Small changes can add up to a big difference. Policy changes can help make healthier choices easier for Americans in their daily lives.”

Report Recommendations

On the basis of the data collected and a comprehensive analysis, TFAH and RWJF recommend making investments in obesity prevention in a way that matches the severity of the health and financial toll the epidemic takes on the nation.  The report includes a series of policy recommendations, including:

• Fully implement the Healthy, Hunger-Free Kids Act, by implementing the new school meal standards and updating nutrition standards for snack foods and beverages in schools;
• Protect the Prevention and Public Health Fund;
• Increase investments in effective, evidence-based obesity-prevention programs;
  Fully implement the National Prevention Strategy and Action Plan;
• Make physical education and physical activity a priority in the reauthorization of the Elementary and Secondary Education Act;
• Finalize the Interagency Working Group on Food Marketed to Children Guidelines;
• Fully support healthy nutrition in federal food programs; and
• Encourage full use of preventive health care services and provide support beyond the doctor’s office.

The full report with state rankings in all categories is available on TFAH's website at www.healthyamericans.org and RWJF's website at www.rwjf.org. TFAH and RWJF collaborated on the report, which was supported by a grant from RWJF.

STATE-BY-STATE ADULT OBESITY RATE PROJECTIONS FOR 2030

Researchers calculated projections using a model published in The Lancet in 2011 and data from the Behavioral Risk Factor Surveillance System, which is an annual phone survey conducted by the CDC and state health departments. The data were adjusted for self-reporting bias. Adults are considered obese if their BMI is 30 or higher. The District of Columbia (D.C.) is included in the rankings because the CDC provides funds to D.C. to conduct a survey in an equivalent way to the states. The full methodology is available in the F as in Fat report.

1. Mississippi (66.7%); 2. Oklahoma (66.4%); 3. Delaware (64.7%); 4. Tennessee (63.4%); 5. South Carolina (62.9%); 6. Alabama (62.6%); 7. Tie Kansas (62.1%); and Louisiana (62.1%); 9. Missouri (61.9%); 10. Arkansas (60.6%); 11. South Dakota (60.4%); 12. West Virginia (60.2%); 13. Kentucky (60.1%); 14. Ohio (59.8%); 15. Michigan (59.4%); 16. (tie) Arizona (58.8%); and Maryland (58.8%); 18. Florida (58.6%); 19. North Carolina (58.0%): 20. New Hampshire (57.7%); 21. Texas (57.2%); 22. North Dakota (57.1%); 23. Nebraska (56.9%); 24. Pennsylvania (56.7%); 25. Wyoming (56.6%); 26. Wisconsin (56.3%); 27. Indiana (56.0%); 28. Washington (55.5%); 29. Maine (55.2%): 30. Minnesota (54.7%); 31. Iowa (54.4%); 32. New Mexico (54.2%); 33. Rhode Island (53.8%); 34. Illinois (53.7%); 35. (tie) Georgia (53.6%); and Montana (53.6%); 37. Idaho (53.0%); 38. Hawaii (51.8%); 39. New York (50.9%); 40. Virginia (49.7%); 41. Nevada (49.6%); 42. Oregon (48.8%); 43. Massachusetts (48.7%); 44. New Jersey (48.6%); 45. Vermont (47.7%); 46. California (46.6%); 47. Connecticut (46.5%); 48. Utah (46.4%); 49. Alaska (45.6%); 50. Colorado (44.8%); 51. District of Columbia (32.6%).

Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity.

STATE-BY-STATE POTENTIAL HEALTH CARE COST SAVINGS BY 2030 IF STATES REDUCE AVERAGE BODY MASS INDEX BY 5 PERCENT

1. California ($81,702,000,000); 2. Texas ($54,194,000,000); 3. New York ($40,017,000,000); 4. Florida ($34,436,000,000); 5. Illinois ($28,185,000,000); 6. Ohio ($26,328,000,000); 7. Pennsylvania ($24,498,000,000); 8. Michigan ($24,187,000,000); 9. Georgia ($22,743,000,000); 10. North Carolina ($21,101,000,000); 11. Virginia ($18,114,000,000); 12. Washington ($14,729,000,000); 13. Massachusetts ($14,055,000,000); 14. Maryland ($13,836,000,000); 15. Tennessee ($13,827,000,000); 16. Arizona ($13,642,000,000); 17. Indiana ($13,400,000,000); 18. Missouri ($13,368,000,000); 19. Wisconsin ($11,962,000,000); 20. Minnesota ($11,630,000,000); 21. Colorado ($10,794,000,000); 22. Louisiana ($9,839,000,000); 23. Alabama ($9,481,000,000); 24. Kentucky ($9,437,000,000); 25. South Carolina ($9,309,000,000); 26. Oregon ($7,938,000,000); 27. Oklahoma ($7,444,000,000); 28. Connecticut ($7,370,000,000); 29. Mississippi ($6,120,000,000); 30. Arkansas ($6,054,000,000); 31. Kansas ($5,979,000,000); 32. Nevada ($5,921,000,000); 33. Utah ($5,843,000,000); 34. Iowa ($5,702,000,000); 35. New Mexico ($4,095,000,000); 36. Nebraska ($3,686,000,000); 37. West Virginia ($3,638,000,000); 38. Idaho ($3,280,000,000); 39. New Hampshire ($3,257,000,000); 40. Maine ($2,870,000,000); 41. Hawaii ($2,704,000,000); 42. Rhode Island ($2,478,000,000); 43. Montana ($1,939,000,000); 44. Delaware ($1,912,000,000); 45. South Dakota ($1,553,000,000); 46. Alaska ($1,530,000,000); 47. New Jersey ($1,391,000,000); 48. Vermont ($1,376,000,000); 49. North Dakota ($1,177,000,000); 50. Wyoming ($1,088,000,000); 51. District of Columbia ($1,026,000,000).

2011 STATE-BY-STATE ADULT OBESITY RATES

According to recently released CDC data, part of the 2011 Behavioral Risk Factor Surveillance Survey, adult obesity rates by state from highest to lowest were:

1. Mississippi (34.9%); 2. Louisiana (33.4%); 3. West Virginia (32.4%); 4. Alabama (32.0%); 5. Michigan (31.3%); 6. Oklahoma (31.1%); 7. Arkansas (30.9%); 8. (tie) Indiana (30.8%); and South Carolina (30.8%); 10. (tie) Kentucky (30.4%); and Texas (30.4%); 12. Missouri (30.3%); 13. (tie) Kansas (29.6%); and Ohio (29.6%); 15. (tie) Tennessee (29.2%); and Virginia (29.2%); 17. North Carolina (29.1%); 18. Iowa (29.0%); 19. Delaware (28.8%); 20. Pennsylvania (28.6%); 21. Nebraska (28.4%); 22. Maryland (28.3%); 23. South Dakota (28.1%); 24. Georgia (28.0%); 25. (tie) Maine (27.8%); and North Dakota (27.8%); 27. Wisconsin (27.7%); 28. Alaska (27.4%): 29. Illinois (27.1%); 30. Idaho (27.0%); 31. Oregon (26.7%); 32. Florida (26.6%); 33. Washington (26.5%); 34. New Mexico (26.3%); 35. New Hampshire (26.2%); 36. Minnesota (25.7%); 37. (tie) Rhode Island (25.4%); and Vermont (25.4%); 39. Wyoming (25.0%); 40. Arizona (24.7%); 41. Montana (24.6%); 42. (tie) Connecticut (24.5%); Nevada (24.5%); and New York (24.5%); 45. Utah (24.4%); 46. California (23.8%); 47. (tie) District of Columbia (23.7%); and New Jersey (23.7%); 49. Massachusetts (22.7%); 50. Hawaii (21.8%); 51. Colorado (20.7%).

Note: 1 = Highest rate of adult obesity, 51 = lowest rate of adult obesity.