In the U.S., the growing prevalence of multi-morbidity is contributing to increased mortality and healthcare cost growth in America. Underlying this clinical and economic phenomenon is obesity, which primary care doctors are challenged to deal with as a chronic condition along with typically co-occurring comorbidities of hypertension, diabetes, and hyperlipidemia.

The line chart come from a new study into Multimorbidity Trends in United States Adults, 1988-2014, published in the July-August 2018 issue of the Journal of the American Board of Family Medicine.

The authors, affiliated with the West Virginia University Department of Family Medicine, call out that obesity (the pink-red line) experienced the largest increased trend of any condition included in this study’s timeframe.

“Obesity is associated with a large number of pathologic processes and risks, including metabolic syndrome, vascular disease, cancer, oxidative stress, inflammation, as well as many others.”

The authors recommend that public health leaders and policy makers address the obesity trend when designing “policies and interventions to improve the public’s health.”

Unless this trajectory reverses, multimorbidity trends will continue to drive up healthcare costs in the U.S.

Health Populi’s Hot Points:  I note that the authors of this study are based at the West Virginia University Department of Family Medicine. I’ve frequently looked at West Virginia here in Health Populi and elsewhere as a state that bears a heavy public health burden based on a range of risk factors: smoking, health care service access and insurance coverage (with 29% of the state’s citizens covered by Medicaid, the highest share of a U.S. state’s population enrolled in the plan), and, yes, obesity.

The 2017 Gallup-Sharecare Well-Being Index found West Virginia ranked last of the 50 states in terms of citizen health. The Index is based on five measures: physical, financial, social, purpose, and community. West Virginia’s overall score was heavily weighted against the physical and financial compared with other states.

Decades of research have shown that nutrition, economic stability, and a clean and safe physical environment make individual and public health. In the United States, however, there’s been under-investment in these social determinants that closely tie to health. Why has this been the case? Because they are public goods, and the U.S. hasn’t looked through that macro-lens on health policy for some time, discussed in Social Determinants As Public Goods: A New Approach To Financing Key Investments in Healthy Communities, published in the August 2018 issue of Health Affairs.

The American obesity challenge calls for a multi-pronged, multi-sectoral approach to nutrition, physical activity, transportation and town planning, and of course, healthcare service access. A JAMA article, Potential Policy Approaches to Address Diet-Related Diseases, speaks to a broad range of food-specific strategies including taxing sugar, regulating sodium in processed foods, labeling, educating and promoting healthy eating styles, and increasing subsidies to low-income people for the purchase of healthy foods.

This last tactic, of nudging consumers through behavioral economics, to change eating styles, is no easy feat. Food is baked, literally, into our home cultures: it’s emotional, historical, traditional, ritual, deeply personal. Couple that life-flow with a person’s external environment which may be challenged by both food deserts and food swamps — the former, lack of local healthy food options, and the latter, a preponderance of poor, unhealthy food choices.

These complexities call for America to work across policy silos and industry sectors to address the health-economic challenge of obesity. It’s about way more than food access, coupons, and well-intended nutrition education programs. We need all hands on deck: in the kitchen, grocery stores and retailers, schools, doctors’ offices, and government agencies.