EDITORIAL - Fat America: Our biggest health issue is written on the scale

 An epidemic is sweeping across America, an affliction so pervasive that seven in 10 adults already are in its grip. It is hitting a growing number of our children, too, and there's no vaccine to cure it.

The real tragedy is that this illness is largely self-inflicted, a killer we bring into our homes every day. As a nation, we eat too much that is bad for us, we don't get enough exercise and we can't afford it any longer.

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Just look at the statistics. In 1990, not one state in the nation had an obesity rate that exceeded 15 percent. Now, not one state has a rate under 15 percent. In 32 states, at least a quarter of the people are obese -- for example, 35 pounds overweight for someone who is 5 feet, 9 inches.

America is too fat and, as a result, our health care has become so expensive that we can't afford to provide it for everyone. Congress and the president can debate all they want about how to reform the system, but if the country doesn't get its weight under control, reform will be unaffordable.

A study released last month put the price tag on obesity at $147 billion a year. That means the condition is now responsible for 9.1 percent of our national health-care bill. Medical costs for an obese person are $1,429 a year higher than they are for someone of healthy weight.

On a national level, these escalating costs are derailing efforts to remake the U.S. health-care system. The nonpartisan Congressional Budget Office has estimated that supplying near-universal coverage for 97 percent of residents, excluding illegal immigrants, would cost just over $1 trillion in a 10-year period. The nation could afford it if it wasn't spending $147 billion a year to treat the effects of obesity.

That's shocking -- and the real-world tradeoffs are stark. Should a sick infant with no health insurance suffer because of the high cost of obesity? Should a family's uninsured bread winner be among the millions who miss out on health-care reform because obesity makes it unaffordable?

We need a radical transformation, and the change will look oddly familiar to Americans over the age of 50. We need to start cooking for ourselves and eating more meals at home. We need to walk more, as our parents and grandparents did.

Even so-called healthier choices at a fast-food restaurant are not good for us. One look at a McDonald's menu should make that clear. McDonald's Premium Southwest Salad without chicken is just 140 calories, but toss in the crispy chicken and creamy southwest dressing and you're looking at a 530-calorie lunch. You might as well have the Quarter Pounder with cheese, at 510 calories, or a Big Mac, with 540. And too many of us do, consuming huge portions laden with fat, salt and calories.

A New York Times Magazine article last week quoted a 2003 study by Harvard University that put the blame for obesity on the increasing amount of food we eat that's prepared outside the home. The economists looked at other countries and found that the more time a nation devotes to cooking at home, the lower its obesity rate. The article also referenced a 1992 study in The Journal of the American Dietetic Association that said even poor women who cooked were more likely to eat healthy meals than affluent women who didn't.

Then there's exercise -- or America's lack of it. Kids don't play outside the way they used to, adults don't walk to work or to stores. We do too much sitting around in front of TV, video games and computers. We lack the discipline to turn it off, put it away and get out and on our feet.

Last Tuesday we first took note of the study released by the Centers for Disease Control on the cost of obesity. But such studies are for naught if Americans don't take Draconian measures to change their ways. No one questions that moderation is the way to go with alcohol. No one questions that discipline is needed to resist tobacco. So it is with food, where responsible consumption -- in meal choice and portion size -- must become the rule of the day.

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One week before last year's Ohio primary, Post-Gazette Publisher and Editor-in-Chief John Robinson Block presented Democratic candidate Barack Obama with an inscribed copy of "Healthy Heart," a guide to healthier eating, cooking and lifestyle. In the book's foreword, Steven E. Nissen, M.D., chairman of the Department of Cardiovascular Medicine at Cleveland Clinic, wrote:

"If every American followed the dietary and lifestyle guidelines in the book, some marvelous things would happen. Heart disease would be reduced dramatically. Diabetes would diminish to manageable proportions. People would live longer and need less medical care. Whole wings of our hospitals would have to be shut down. I, and most of my colleagues, could be thrown out onto the streets, unemployed. It would be the happiest day of my life."

We should try to grant Dr. Nissen his wish, but the Obama administration has yet to take the findings of this and similar prescriptions to heart. There is no national campaign to fight obesity.

Americans need nothing short of an Apollo program to recover their waistlines. Strong leadership from Washington is necessary, but the good news is it can also be launched with a few steps down the sidewalk and eat-in dinners made right in our own kitchens. Our very health and health care are at stake.