Abstract
The paper discusses the background, processing, and potential consequences of a Congress bill presented as H.R.1953: Treat and Reduce Obesity Act of 2017. The issue of the bill is to amend title XVIII of the Social Security Act. The essence of the amendment is the coordination of programs aimed at the prevention and treatment of obesity, and for other related issues. Sociocultural, ethical, economic, political, and legislative environments that influenced the creation of the bill are analyzed. The progression of the bill identifying its sponsors, stakeholders, and determining the timelines is reviewed.
Attention is paid to the possible outcomes of the bill acceptance. The consequences can be both long- and short-term, and also influence the stakeholders positively or negatively. Moreover, the paper provides a comparison of obesity policies implemented in the United Kingdom with the policy suggested in the bill. The efficiency of the policies is estimated and their common or different features are outlined. Finally, it contains possible measures that can improve the outcomes of the suggested policy. These measures include interventions that can be included in the policy suggested in the act to increase its chance to be enacted.
Introduction
A generally accepted human right for life comprises the issue of health which is one of the crucial components of people’s life. Thus, the state authorities are supposed to guarantee the protection of health and access to healthcare facilities to the citizens. Consequently, legislation in the field of health care is one of the primary governmental concerns. Bills and laws dedicated to burning health issues are frequent in Congress.
For example, one of the recent bills related to the nation’s health problems is H.R.1953: Treat and Reduce Obesity Act of 2017 (2017). Its legislative issue is to “amend title XVIII of the Social Security Act to provide for the coordination of programs to prevent and treat obesity, and for other purposes” (US Congress House Committee on Energy and Commerce and Committee on Ways and Means, 2017, p. 1).
The bill can introduce changes to the activity of advanced practice nurses. In case the bill passes, it will determine the behavioral therapy for obesity which is likely to improve the situation with obesity in the United States. This paper is going to study the environment of the bill, its progression in the Congress, possible consequences of its adoption, and review other policies aimed at the reduction of obesity.
The environment of the Treat and Reduce Obesity Act of 2017
Sociocultural Environment
Obesity was once identified as a burden of American society and some high-income countries. However, it became a global problem which is characteristic not only to then the Western world. Thus, the data of the National survey prove that the obesity epidemic started in the USA more than 40 years ago. Since then, the obesity prevalence in the United States has increased more than twice from 1980 to 2010 and worldwide from 1980 to 2008 (Malik, Willett, & Hu, 2013). Although there was no significant increase in the obesity rates in the United State recently, they are dangerously high.
According to the data of the U.S. Department of Health and Human Services, the prevalence of obesity among the adult American population during 2011-2014 was 36.5% (Ogden, Carrol, Fryar, & Flegal, 2015). There are racial disparities in the prevalence of obesity as well. Thus, the highest rates of obesity were indicated in non-Hispanic blacks (48.1% in men and 56.9% in women), 34.5% of non-Hispanic white men and 35.5% of women were obese, while non-Hispanic Asian adults showed only 11.7% and 11.9% for men and women correspondently (Ogden, 2015, p. 2).
The situation among the youth is better but still serious. Thus, 17% of American young people aged 2-19 were obese in 2011-2014 (Ogden, 2017). Adolescents showed the highest rates with 20.5% compared to 8.9% of obesity among preschool children (Ogden, 2017). Also, life expectancy for men and women with obesity at age of 65 is 1.6 and 1.4 years less correspondently (US Congress House Committee on Energy and Commerce and Committee on Ways and Means, 2017). Pelletier et al. (2017) speak of the importance of evidence-based policies on school nutrition and physical education. These policies demand state-level collaboration and consideration of social and economic indicators. On the whole, the sociocultural aspect of the obesity problem demands some regulations on the governmental level.
Economic Environment
Economic issues are not frequently mentioned in the disputes on obesity. Nevertheless, the problem has economic roots. Thus, many countries experienced economic structural changes in the last decades of the twentieth century. These changes included “implementation of more market-oriented or liberal agricultural trade policies” (Malik, Willett, & Hu, 2013, p. 15). These policies influenced the schemes of the food supply and appeared to be meaningful for the obesity epidemic.
They caused nutritional transition and altered the choice and availability of foods. Moreover, the liberalization of trade can influence the variety and availability of products by selling more varied food (Malik, Willett, & Hu, 2013). Also, economic reforms eliminated the barriers to foreign investment in food production and distribution which includes the spread of international food enterprises and fast-food networks.
Another economic concern in the problem of obesity is the fact that it increases the incidence of chronic diseases such as type 2 diabetes, heart disease, high blood pressure, etc. (US Congress House Committee on Energy and Commerce and Committee on Ways and Means, 2017). Thus, beneficiaries of insurance plans are treated to form more comorbid diseases that demand more expenses. Thus, the findings of the Congress stated in the Treat and Reduce Obesity Act of 2017 claim that “the direct and indirect cost of obesity is more than $450 billion annually” and “a Medicare beneficiary with obesity costs $1,964 more than a normal-weight beneficiary” (US Congress House Committee on Energy and Commerce and Committee on Ways and Means, 2017, p. 2).
Also, patients with serious diseases that develop as a result of obesity, cannot work and thus do not pay taxes which negatively influences the economy taking into consideration the global character of obesity. Consequently, the economic environment related to the problem of obesity, demands legal actions to resolve the issue, and reduce its impact on the increase of the obesity rates.
Ethical Environment
Obesity developed from a personal health issue into one of the primary public health concerns worldwide (Azevedo & Vartanian, 2015). One of the reasons for this fact is the low efficiency of the individual-level interventions for the reduction of obesity rates. Consequently, the focus shifted from the individual to the public health approaches. When it comes to public health interventions, ethical implications should be considered together with their efficiency.
It is necessary to protect human rights and improve the well-being of society. The researchers suggest that “interventions that target the physical environment/access (making it easier for people to engage in healthy behaviors), that target the entire population (rather than just individuals with obesity), and that focus on health behaviors (rather than on weight) have the least potential for ethical concerns” (Azevedo & Vartanian, 2015, p. 324). Thus, then research findings can be used during the planning of health interventions aimed at the reduction of obesity rates to evaluate their ethical concerns.
Political and Legislative Environments
The political situation is one of the determining factors for the bills and laws which are introduced to Congress. Treat and Reduce Obesity Act of 2017 is proof of increased attention to health and social issues in American society and, as a result, American politics. Legislation, in its turn, is one of the approaches that are used to promote some public strategies. In the case of the obesity issue, legislation as a public health strategy is applied to “modify the environment in ways that facilitate and impede behavior” (Donaldson et al., 2015, p. 121).
Legislation of the previous years addressed the problems of adult obesity including access to healthy food and alterations in the infrastructure. On the whole, the role of legislation was advocative. Legislative activity is different in different periods. For example, for the period from 2010 to 2013, there were 487 bills related to adult obesity prevention introduced (Donaldson et al., 2015). Only 81 of them which makes 16.6%, were enacted in 36 jurisdictions. The distribution of bills’ enactment was also uneven.
Thus, there were 71 bills introduced in New York and no bills were introduced in such states as Montana or Wyoming. It is difficult to evaluate the influence of the introduced bills on the problem of obesity because of their small amount. Anyway, it is preferable to assess the quality and efficiency of acts rather than their quantity. Moreover, it is important to include the distribution of the bill throughout the country as a factor of its enactment.
Progression of the Bill
Sponsors
Every bill introduced in the Congress has a sponsor or some sponsors who support the document. The major sponsor of the Treat and Reduce Obesity Act of 2017 is Erik Paulsen. He is a representative of Minnesota’s 3rd congressional district. Mr. Paulsen is a Republican. On the whole, there are 107 sponsors, 66 of them are Democrats and 41 are Republicans.
Stakeholders
The stakeholders of the bill are the House Energy and Commerce and the House Ways and Means, the Subcommittee on Health. Other interested parties are organizations involved in health promotion and preventive care, mental health, nutrition and diet issues, and problems of physical fitness and lifestyle. All those stakeholders are involved in the problem of obesity treatment and reduction and thus are interested in the introduction of the Treat and Reduce Obesity Act of 2017.
Timelines
Every bill follows a certain timeline. It must be passed by both the House and Senate. The House and Senate must review identical forms of the bill. After that, the bill can be signed by the President and become law.
The possible optimistic timeline for this bill is as follows. After it was introduced on April 5, 2017, it is going to pass some readings. Bills and resolutions are always connected to some committees which debate the bill before it can be sent on to the whole chamber. It can be ordered reported, pass the House, the Senate, and be signed by the President by the end of March 2018.
In the case of a pessimistic scenario, the bill can repeat the timeline of its predecessor, H.R. 2404: Treat and Reduce Obesity Act of 2015. This bill was introduced on May 18, 2015, in a previous 114th session of Congress, but was not enacted and died.
Actual and Potential Consequences of the Bill
The bill is likely to influence both healthcare providers and consumers. There are short and long-term consequences expected. Since the bill has not passed House and Senate, it is not functioning and thus does not have any actual consequences. However, its potential consequences can be both positive and negative. For providers, possible short-term positive consequences can include the increased number of consumers.
Customers can become interested in new opportunities to deal with obesity and thus visit healthcare providers more often. A probable short-term negative consequence of the bill for providers can be the necessity to reform their structure due to the need to pay more attention to behavioral therapy for obesity. Long-term consequences for providers can include a decrease in expenses on the treatment of comorbid diseases such as diabetes, heart disease, high blood pressure, etc. These diseases are frequent among overweight people and obesity treatment is expected to prevent their development.
For consumers, confusion in the new opportunities for treating obesity can become a negative short-term consequence of the bill. Common strategies for managing the problem of obesity include physical activity and diet while the amendments suggested in the bill are concentrated on behavioral therapies. A positive short-term consequence for consumers can be the increased attention to the issue of obesity and thus more people will have a chance to change their lives. A general long-term consequence for consumers of health care services will be the improvement of the health of the population due to the decrease in obesity rates. However, these consequences are potential. The actual ones will be assessed after the enactment of this Act and its implementation in the conditions of community healthcare providers.
Comparison of Obesity Policies
The bill addresses the policy of reducing and treating obesity among the adult population. There are various interventions applied to this policy in different countries. Thus, Moreira et al. (2015) compare various policy scenarios aimed at the reduction of ultra-processed foods consumption in the United Kingdom. The authors focus on the problem of increased exposure to the consumption of ultra-processed food products.
This type of food which is extensively advertised is not expensive and easy to use. However, it contains many sugars and salt which negatively influences the health of consumers stimulating the development of dangerous diseases and conditions including obesity. Thus, the decrease in ultra-processed foods consumption is going to have a positive impact on the rates of obesity and cardiovascular disease (Moreira et al., 2015).
Consequently, food policies can be efficient for the resolution of the obesity problem. This intervention is concentrated on the creation of a healthier food environment which can not only reduce the number of existing obesity cases but also contribute to its prevention. At the same time, the policy outlined in the Treat and Reduce Obesity Act of 2017 has a focus on intensive behavioral therapy that will be executed through the healthcare facilities (US Congress House Committee on Energy and Commerce and Committee on Ways and Means, 2017). The difference is that the policy introduced in the bill deals more with treatment and reduction than the prevention of obesity.
Another policy that is applied both in the UK and the US is nudging. Petrescu, Hollands, Couturier, Ng, and Marteau (2016) analyze public acceptability of this policy on the example of reducing sugar-sweetened beverages consumption. The policy of nudging presupposes “modifying environments to change people’s behavior, often without their conscious awareness” (Petrescu et al., 2016, para. 1). This intervention can contribute to the improvement of public health in general and the reduction of obesity in particular.
The policy is accepted by the public and is implemented on the governmental level. For example, both in the United States and the United Kingdom there are government interventions that reduced the use of sugar-sweetened drinks. For example, these interventions comprise the introduction of smaller portions of those drinks or the alteration of the drinks containers’ shape (Petrescu et al., 2016). This policy is similar to the one presented in the bill under analysis because they both deals with the reduction of obesity through changing people’s behavior. However, the difference is that nudging policy can influence people without their awareness while behavioral therapy in the bill is provided in conditions of healthcare facilities after people visit their healthcare provider.
One more policy to reduce obesity that has international application is the taxation of sugar-sweetened beverages (Jou, & Techakehakij, 2012). Taxation of sugar-sweetened beverages, on soft drinks, in particular, is supposed to be a tool for decreasing obesity rates worldwide. It has been proved that the consumption of those drinks favors gaining weight and, consequently, less consumption will cause weight loss (Jou, & Techakehakij, 2012).
The research by Gortmaker et al. (2016) claims that the sugar-sweetened beverage excise tax is one of the most efficient and cost-saving interventions to reduce childhood obesity. Its estimated efficiency is preventing 576,000 cases of obesity among children (Gortmaker et al., 2016, p. 1935). This policy includes methods different from those presupposed in the bill. Nevertheless, they follow one goal of reducing obesity among the population. However, obesity reduction policies are not limited to healthy eating. They also comprise health education, promotion of active lifestyles, and other strategies.
Refining the Measures to Improve Policy Outcomes
The bill under consideration is likely to bring positive changes to healthcare policies aimed at the reduction of obesity. However, it does not include some aspects which can improve it. First of all, it is aimed at the issue of obesity among the adult population. Although adult obesity is a burning problem, it is evident that frequently overweight children grow to become obese adults. Thus, there is a necessity to manage the question of childhood obesity to prevent the development of the problem in adulthood.
There are diverse interventions that can be effective. However, many of them are expensive and thus not wide-spread. Gortmaker et al. (2016) analyze three interventions aimed at childhood obesity reduction which are not only efficient but also cost-saving. These interventions include “the sugar-sweetened beverage excise tax, eliminating the tax subsidy for advertising unhealthy food to children, and setting nutrition standards for food and beverages sold in schools outside of school meals” (Gortmaker et al., 2016, p. 1936).
Any actions will be more productive with governmental support. Consequently, more attention from Congress to the problem of childhood obesity can increase the chances of the bill to be enacted and improve the outcomes of the obesity reduction policy.
Another issue that can be included in the bill to cover different aspects of obesity is the creation of healthy food environments. Swisburn et al. (2015) speak of the interventions that can develop an accountability framework to create healthy food environments. This process can be assisted by governmental regulations of food regulations. Their goal is to support the nutrition objectives of the population. Hawkes et al. (2015) also support the implementation of food policies that “have an essential role in curbing the global obesity epidemic” (p. 2411). Thus, the Treat and Reduce Obesity Act of 2017 policy can result in better outcomes with more attention to healthy food environments. The environment is often decisive for lifestyles and the food choices of the people. Consequently, healthy environments will contribute to the selection of healthier lifestyles.
Conclusions
The problem of obesity is an international burden. It is not a concern of developed and rich countries at present. Thus, it demands the development of legislation to manage the issue of obesity on the government level. Obesity legislation considers socio-cultural, ethical, economic, and political environments. The introduction of the Treat and Reduce Obesity Act of 2017 is proof of a necessity of interventions in the issue of obesity.
However, the fact that the bill did not progress since it was introduced in May 2017, speaks of a lack of interest of the Congress in social and health problems. Moreover, a similar act presented in 2015, was not enacted. The issue of obesity is not new and is managed differently in different countries. Thus, the United Kingdom applies some efficient interventions such as taxation, reduction of the consumed products, health education, etc. The Treat and Reduce Obesity Act of 2017 has the potential for the improvements in functioning of healthcare providers and making them more useful for consumers. However, it needs some changes because it is focused on obesity among adults and does not include solutions for obesity among children and adolescents which is also a problem.
References
Azevedo, S.M., & Vartanian, L.R. (2015). Ethical issues for public health approaches to obesity. Current Obesity Reports, 4(3), 324-329. Web.
Donaldson, E.A., Cohen, J.E., Villanti, A.C., Kanarek, N.F., Barry, C.L., & Rutkow, L. (2015). Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010–2013. Preventive Medicine, 74, 117-122. Web.
Gortmaker, S.L., Wang, Y.C., Long, M.W., Giles, C.M., Ward, Z.J., Barret, J.L. … Cradock, A.L. (2015). Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Affairs, 34(11), 1932-1939. Web.
Hawkes, C., Smith, T.G., Jewell, J., Wardle, J., Hammond, R.A., Friel, S. … Kain, J. (2015). Smart food policies for obesity prevention. The Lancet, 385(9986), 2410-2421. Web.
Jou, J., & Techakehakij, W. (2012). International application of sugar-sweetened beverage (SSB) taxation in obesity reduction: Factors that may influence policy effectiveness in country-specific contexts. Health Policy, 107, 83-90. Web.
Malik, V.S., Willett, W.C., & Hu, F.B. (2013). Global obesity: Trends, risk factors and policy implications. Nature Reviews. Endocrinology, 9, 13-27. Web.
Moreira, P.V.L., Baraldi, L.G., Moubarac, J.-C., Monteiro, C.A., Newton, A., Capewell, S., & O’Flaherty, M. (2015). Comparing different policy scenarios to reduce the consumption of ultra-processed foods in UK: Impact on cardiovascular disease mortality using a modelling approach. PLOS ONE 10(2): e0118353. Web.
Ogden, C.L., Carrol, M.D., Fryar, C.D., & Flegal, K.M. (2015). Prevalence of obesity among adults and youth: United States, 2011-2014. Web.
Pelletier, J., Laska, M., MacLehose, R., Nelson, T., & Nanney, M. (2017). Evidence-based policies on school nutrition and physical education: Associations with state-level collaboration, obesity, and socio-economic indicators. Preventive Medicine, 99, 87-93. Web.
Petrescu, D.C., Hollands, G.J., Couturier, D.-L., Ng, Y.-L., & Marteau, T.M. (2016). Public acceptability in the UK and USA of nudging to reduce obesity: The example of reducing sugar-sweetened beverages consumption. PLoS ONE, 11(6), e0155995. Web.
United States Congress House Committee on Energy and Commerce and Committee on Ways and Means. (2017). H.R.1953: Treat and Reduce Obesity Act of 2017: Hearing before the Committee on Energy and Commerce and Committee of Ways and Means, House of Representatives, One Hundred Fifteenth Congress, first session, 2017. Washington, DC.