The 570-Calorie Renegotiation

ABC News recently reported that the average American eats 570 more calories per day than in 1977 according to a study from the University of North Carolina at Chapel Hill. No wonder the CDC says that more than one-quarter of the nation’s population is obese.

What struck us about these findings was how absent they have been from the larger debate about what to do about health care in the United States. There is a lot of conversation about controlling reimbursement rates, cost capping, and the like — but little about behavior changes that could lower the need for health care services.

A significant portion of health care costs are tied to the treatment of chronic conditions: asthma, heart disease, high blood pressure, diabetes, and yes, obesity to name just a few of the major conditions. Excess body weight can lead to negative outcomes — and greater use of health care services — with each of these. Dialing back the calorie intake of the average person would make them healthier and result in lower health care costs.

The challenge is one of “them” vs. “us.” So much of what we see as wrong with the health care system can be pinned on “them”: greedy insurance companies, lawyers, and pharmaceutical companies…doctors practicing defensive medicine. Yet part of the problem is clearly “us” and the decisions we make every day about eating, exercise, and other behaviors. Only when each of us embraces the idea that we are part of the problem and can be part of the solution can we get serious about this critical component of the challenge.

Part of this is tied to reimbursement — y0ur doctor has no billing code to use when a patient “maintains healthy weight” yet he has many for treating the results of excess weight. Part of this is tied to the cost structure of insurance — there is no incentive or penalty  based on one’s body mass index. Part of this is tied to government — such as policies that help make high calorie snacks less expensive than fresh vegetables. Part of this is human nature — people tend to favor short-term pleasure even if it results in long-term pain.

Yet one of the challenges for those renegotiating the health care system is creating the conditions under which health-beneficial decisions are most likely to be made. All stakeholders must be considered and all aspects of the system must be examined — even those traditionally seen as outside of health care such as agricultural policy. We use a process we call “The Walk in the Woods” to lead stakeholders through such a process. It moves people from their self-interests to a place of enlightened interests where fresh possibilities emerge and new agreements can be reached. Its structured steps ensure that everyone is heard, their viewpoints valued, their input sought — and uses all of this to allow people to craft possibilities that they would not otherwise have imagined.

Ignoring the role that individuals play in escalating health care costs through their personal choices serves no one. One thing on which President Obama and his critics should be able to agree is that asking American’s eat like it is 1977 all over again would benefit us all. Unfortunately, it is too rare to ask people to take responsibility — even make a healthy sacrifice — and too common to point fingers. It is a negotiation that we have to have with ourselves.

As Barry Popkin, the study’s author put it, “”We kind of just have to grow up. We weigh too much and our health is on the line.”


  1. Mark Bittman wrote an interesting piece in the Sunday New York Times on July 24 addressing the diet issue:

    Bittman, however, calls for a tax on “bad food” in order to lower the cost of “good food” and raise money to address public health issues. This is interesting in that if one can factor public health costs concretely (and credibly) into the cost of food, market mechanisms would have a better chance of working. After all, the more transparent a market is about costs and benefits, the more smoothly it should function.

    Such a tax has little if any chance of passing on a national level. However, look for interesting experiments at the city and state level. The food lobby will fight it like crazy. The anti-tax people will fight it like crazy. Those opposed to a “nanny state” will fight it like crazy. Advocates for public health, the environment, and lowering health care costs will likely embrace such an idea.

    Another renegotiation…

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