Mississippi's still fattest but Alabama closing in

Mississippi's still king of cellulite, but an ominous tide is rolling toward the Medicare doctors in neighboring Alabama: obese baby boomers.

It's time for the nation's annual obesity rankings and, outside of fairly lean Colorado, there's little good news. In 31 states, more than one in four adults are obese, says a new report from the Trust for America's Health and the Robert Wood Johnson Foundation.

And obesity rates among adults rose in 23 states over the past year, and no state experienced a significant decline.

"The obesity epidemic clearly goes beyond being an individual problem," said Jeff Levi, executive director of the Trust, a nonprofit public health group.

It's a national crisis that "calls for a national strategy to combat obesity," added Robert Wood Johnson vice president Dr. James Marks. "The crest of the wave of obesity is still to crash."

While the nation has long been bracing for a surge in Medicare as the boomers start turning 65, the new report makes clear that fat, not just age, will fuel much of those bills. In every state, the rate of obesity is higher among 55- to 64-year-olds - the oldest boomers - than among today's 65-and-beyond.

The report provides one of the first in-depth looks at obese boomers, and its implications are sobering. This first wave of aging boomers will mean a jump of obese Medicare patients that ranges from 5.2 percent in New York to a high of 16.3 percent in Alabama, the report concluded. In Alabama, nearly 39 percent of the oldest boomers are obese.

Health economists once made the harsh financial calculation that the obese would save money by dying sooner. But more recent research instead suggests that better treatments are keeping them alive nearly as long - but they're much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese, Levi said.

"There isn't a magic bullet. We don't have a pill for it," said Levi. "It's not going to be solved in the doctor's office but in the community, where we change norms."

His group is pushing for health reform legislation to include community-level programs that help people make healthier choices - like building sidewalks so people can walk their neighborhoods instead of drive, and providing healthier school lunches to help fight the childhood obesity that turns into adult obesity. The pending House and Senate bills address obesity in different ways; one provision would particularly target baby boomers.

Many states have begun programs to try to tackle obesity, and there are hints of improvements, Marks said.

"We're still getting fatter, but maybe a little more slowly than before," he said: Last year's report found obesity rates rising in 37 states compared with 23 this time around.

He's encouraged that 19 states have implemented nutritional standards for school meals that are stricter than the federal government's; in 2004, just four states did. Some are requiring nutritional information for restaurant food, he added.

States "recognize the solutions will lie outside traditional medical care," Marks said.

The Centers for Disease Control and Prevention has long said that nearly a third of Americans are obese. The Trust report uses somewhat more conservative CDC surveys for a closer state-by-state look. Among the findings:

-Mississippi had the highest rate of adult obesity, 32.5 percent, for the fifth year in a row.

-Three additional states now have adult obesity rates above 30 percent, including Alabama, 31.2 percent; West Virginia, 31.1 percent; and Tennessee, 30.2 percent.

-In 1991, no state had more than a 20 percent obesity rate. Today, the only state that doesn't is Colorado, at 18.9 percent.

-The South is the fattest region. The Northeast and West are slightly slimmer than the rest of the country.

-Mississippi also had the highest rate of overweight and obese children, at 44.4 percent in total. It's followed by Arkansas, 37.5 percent; and Georgia, 37.3 percent.

-Following Alabama, Michigan ranks No. 2 with fat boomers; 36 percent of its 55- to 64-year-olds are obese. Colorado has the lowest rate, 21.8 percent.

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On the Net:

Trust for America's Health: http://healthyamericans.org/

Robert Wood Johnson Foundation: http://www.rwjf.org/