The overall health of the United States improved throughout the 20th Century (U.S. Department of Health and Human Services, 2001). The ten greatest public health achievements in the United States from 1900 to 1999 included improvements in the areas of vaccinations; motor vehicle safety; safer workplaces; control of infectious diseases; reduced deaths from coronary heart disease and stroke; safer and healthier foods; healthier mothers and babies; family planning; fluoridation of drinking water; and recognition of tobacco as a health hazard (Centers for Disease Control and Prevention, 2001a). The nation faces other health challenges in the 21st Century, including the noninfectious diseases of overweight and obesity. These diseases have reached epidemic proportions (U.S. Department of Health and Human Services, 2001). The prevalence of obesity increased from 12.0% in 1991 to 17.9% in 1998 (Mokdad, et al., 1999), and continued to increase to 19.8% in 2000 (Mokdad, et al., 2001), reaching 20.9% in 2001 (Mokdad, Stroup, & Giles, 2003).
Overweight and obesity are associated with increased health risks for certain chronic diseases, including coronary heart disease, type 2 (non-insulin dependent) diabetes, various cancers (e.g., endometrial, breast, and colon cancers), among other diseases and disorders (Mokdad, et al., 2003; Must, et al., 1999; Thompson, Edelsberg, Colditz, Bird, & Oster, 1999). The top five chronic disease killers, which include heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes, accounted for 68% of all deaths in the United States in 1999 (U.S. Department of Health and Human Services, 2002). Obesity has been estimated to lead to the death of 300,000 adults in the United States each year (Allison, Fontaine, Manson, Stevens, & VanItallie, 1999).
In addition, overweight and obesity impose substantial costs on the United States' health care system (Roux & Donaldson, 2004; U.S. Department of Health and Human Services, 2001). Direct health care costs of overweight and obesity include preventive, diagnostic, and treatment services (such as physician visits and hospital care). Indirect health care costs of overweight and obesity include lost wages due to an inability to function properly, and the value of future earnings due to premature death. Wolf and Colditz (1998) estimated the total costs of obesity to be $99 billion in 1995. Wolf (2001) estimated the total cost of obesity to be $117 billion in 2000, including $61 billion in direct costs and $56 billion in indirect costs. The costs of obesity are primarily due to its contribution to incidences of coronary heart disease, type 2 diabetes, and hypertension (Wolf, 1998).
Pronk, Goodman, O'Connor, and Martinson (1999) estimated a 1.9% increase in medical charges for every one-unit increase in body mass index (BMI). Thompson et al. (1999) estimated lifetime medical care costs are at least $10,000 higher for moderately obese (BMI of 32.5 kg/[m.sup.2]) as compared to non-obese (BMI of 22.5 kg/[m.sup.2]) 45-54 year old men in 1996. Severely obese (BMI 37.5 kg/[m.sup.2]) men in the same age group could expect $17,000 higher lifetime medical care costs as compared to non-obese men in 1996. Nearly half of their estimated lifetime medical care costs, regardless of degree of obesity, were due to coronary heart disease. They also reported similar results across other age groups and for women (Thompson et al., 1999). The relative magnitudes of excess lifetime medical care costs associated with increasing degrees of obesity were similar to estimates for smoking (Thompson et al., 1999).
Chronic diseases, including overweight and obesity, are not only the most prevalent and costly of all health problems, but they are also among the most preventable (U.S. Department of Health and Human Services, 2002). Many chronic diseases are a function of people's daily choices. The lack of physical activity and poor dietary habits are second only to tobacco use as leading causes of preventable death in the United States (McGinnis & Foege, 1993; U. …