A Question of Scale

The bad news: Massachusetts is facing an obesity crisis. The good news? There’s a way to fix it.

CHANCES ARE YOU, TOO, are overweight. Despite Massachusetts’ status as one of the healthier states in the country, the Department of Public Health study found that 59 percent of adults here weigh too much, compared with 40 percent two decades ago. One-fifth of the population is technically obese (meaning a BMI higher than 30). “The increase has been dramatic, and it’s been steady over the last 20 years,” Auerbach says. As a result, the state has seen dramatic growth in diabetes cases, while heart disease, strokes, gall bladder disease, and musculoskeletal disorders also loom large.

These statistics speak to a financial problem as much as a health one. According to the research group RTI International, nearly 10 percent of all healthcare costs can be attributed to obesity. That adds up to $147 billion per year nationally, with each obese person costing, on average, $1,400 more than their fit friends. In Massachusetts, where businesses and governments are already grappling with the nation’s highest family-coverage health premiums, we can ill afford our extra pounds.

Auerbach says that when state officials were formulating Patrick’s plan, they looked for programs that had worked elsewhere. “We didn’t want to simply come up with a list of things that we thought made sense without any evidence that they would be effective,” he says. The BMI letters to parents, for instance, are modeled after ones in a similar program in Arkansas.

Overall, Auerbach says, the goal is to provide a steady flow of information that will change the way people think. The state wants to stigmatize unhealthy habits the same way smoking has been branded as taboo. “That’s what we’re trying to do with eating habits and exercise: begin to change what people think of as socially acceptable behavior by doing a bunch of different activities that will hopefully have a cumulative impact,” he says.

BUT THERE’S A FLAW in that thinking. For one, eating healthy is a much more complicated problem than giving up cigarettes. Just imagine trying to quit smoking while still requiring at least three cigs a day. Recent reports also indicate that posting nutrition information at restaurants isn’t nearly as useful as it might seem. A study in the journal Health Affairs found that it had no effect on how people in poor neighborhoods ordered their food, while the New York City health department has admitted that ordering habits citywide have changed only modestly, if at all.

That’s not a surprise to Kevin Volpp, a professor at the University of Pennsylvania School of Medicine who studies weight loss. “When it comes to self-harmful behaviors, like behaviors leading to obesity, the problem is not having too little information; it’s more a problem with self-control and behavior,” he says.

In 2008 Volpp completed a study to determine what would work. A group of 57 people — all of whom were seeking to slim down — was divided into three sets. One group wagered a small amount daily and earned matching funds if its members lost weight; another was eligible to participate in a daily lottery of $10 to $100 if members met their weight-loss goals; the third received no incentives. After 16 weeks, those given no incentives had lost an average of 3.9 pounds. Those in the lottery group had lost an average of 13.1 pounds. And those in the daily-wager group had lost an average of 14 pounds.

  • Ashley

    I like the idea of incentivizing behavior (in general, not just this context) and I wonder in this context if it could be applied more proactively. For example health plans offer $150 reimbursements

  • Ashley

    for members who attend the gym. What about adding something like that for people who maintain a healthy weight?