The high cost of fat: $21 billion

How much does that Big Mac really cost? Or that big-screen TV you've had your eyes on? About $21.7 billion a year in California, according to researchers who have calculated the costs of the state's big obesity problem.

The study, thought to be one of the first efforts to quantify the effect of physical inactivity and weight gain in the state, determined that it is largely employers who have been shouldering those expenses, in the form of rising medical care costs, workers' compensation rates and lost productivity. The report, prepared for the California Department of Health Services, was released Tuesday.

"This is money out of California's economy," said report author David Chenoweth, who estimates that about 8 percent of the state's health care dollars are now being spent on ailments stemming from obesity and inactivity.

The report, which estimated the direct and indirect costs of our growing girth in year 2000 dollars, projected that the expenses would rise to more than $28 billion this year if Californians don't start to lose weight.

But those numbers, Chenoweth cautioned, are "pretty conservative," and probably underestimate the true costs of obesity.

The price of obesity

Public health proponents hope that by placing a dollar sign on the problems associated with obesity and inactivity, government, school and community leaders will be more likely to adopt aggressive anti-obesity measures.

The statistics are especially sobering, they said, when you consider what else that money could be spent on.

"You could buy something like 14,000 parks. Or workers could have an apple a day for 35 years that the employer would pay for," calculates Susan Foerster, chief of cancer prevention and nutrition for the Department of Health Services.

Three weeks or more per year of lost productivity can be attributed to inactivity, obesity and overweight, the report estimates.

But if just one or two Californians out of every 20 who are overweight or inactive were to become leaner and more physically fit, "significant savings could be realized," the report found. A 5 percent increase in the percent of physically active and thinner adults, for example, could save the state about $1.3 billion a year.

To come to those conclusions, Chenoweth's team analyzed 3.7 million medical claims filed in California in 1999. Recognizing that diseases are caused by other factors and not just a couch-potato lifestyle, they estimated what percent of conditions were due to physical inactivity, obesity or overweight using an epidemiological model. About 12 percent of heart attacks, they reasoned, were due to inactivity, and about 16 percent resulted from obesity and overweight.

Similar costs

Surprisingly, California's cost isn't out of line with what other states are spending as a result of obesity-related ailments, Chenoweth said.

Long considered a state of sprouts-eating yoga lovers, California had one of the lowest adult obesity rates little more than a decade ago. But that rate doubled between 1991 and 2001, a much faster increase than in most other regions. In 1999, 53 percent of the state's residents were overweight or obese, the report says.

"The state of California," said Chenoweth, "has gone from the cream of the crop to the middle of the pack."

Reversing the trend will take a combination of efforts, public health officials believe, involving schools, local governments, community leaders, food manufacturers and individuals themselves. But because Americans spend so many of our waking hours at work, employers are in a unique position to make some beneficial changes that could help their workers' waistlines -- and their own bottom line.

They point to a handful of Silicon Valley companies like Google that have made it easier for workers to be healthy. The Internet search engine firm encourages its workers to participate in roller hockey games, bike rides and walks in the wildlife preserve next door. Workers are also given free passes to enjoy rock climbing or gymnastics at a Mountain View gym, and are provided with free healthy lunches every day.

Kaiser Permanente, practicing what it preaches, paints its stairwells in bright funky colors so that employees and patients are more likely to use them. The medical giant also offers discounts to Weight Watchers for its employees and hosts farmers markets at several of its hospitals, to make fresh fruits and vegetables more readily available to workers and community members.

"I think employers need to look at their own workers and their own work sites and ask what kind of changes they can make to make the healthier choices easier," said Dr. David Sobel, director of patient education and health promotion for Kaiser Permanente Northern California.

"Although individuals are paying a huge cost for overweight and obesity," he said, "employers are facing enormous challenges from productivity, from illness and disability."

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