Addressing Michigan’s Obesity Problem
Report 387, August 2014

Appendix A was updated on August 20 to correct a spreadsheet error. Access the revised Appendix A.

Summary

With one of the highest rates of obesity in the country, Michigan has a weight problem. Currently, one in every three Michigan adults and one in eight children are obese. Obesity is associated with major health risks such as diabetes, coronary heart disease, hypertension, stroke, asthma, and other serious chronic diseases.
In addition to increased health risks, obesity results in significant economic costs. Obese individuals are more likely to have a number of serious medical conditions and thus incur higher medical costs. These costs increase significantly among those classified as severely obese. The high rate of obesity among those insured through Medicaid, a state and federally funded health insurance program for low-income individuals and families, means that more tax dollars are being funneled toward this problem, leaving less for other important policy matters such as education and local governments.
Lesser known costs of obesity are a reduction in the productivity of the workforce through absenteeism, short-term and long-term disability, and reduced productivity while present at work. These factors increase business costs and diminish the competitiveness and economic viability of Michigan businesses.
Additionally, obesity has environmental and human capital costs. More gasoline is consumed by transporting obese persons, raising fuel expenditures and increasing emissions of greenhouse gases. Obese children and adolescents tend to perform lower than average in school and on average will eventually complete fewer years of school than their healthy weight peers. As obesity rates climb, it is becoming more difficult to find physically capable workers who can serve in the military, work in public safety positions and other jobs requiring manual labor. These factors diminish Michigan’s human capital through reduced capacity of the workforce.
Obesity Rates in Michigan. While on average, 31.1 percent of Michigan adults are obese, the rates by county vary widely. Saginaw County has the highest adult obesity rate at 39.7 percent of its adult population, while Washtenaw has the lowest rate at 23.3 percent of its adult population. This CRC report explores reasons why these rates may vary across the state and why Michigan’s obesity rate is so much higher than that in most other states.
Risk Factors for Obesity. A plethora of factors can and do contribute to obesity. Obesity results when individuals intake a higher amount of energy (food) than they expend (physical activity). Researchers generally posit that no one factor drives increased caloric intake or decreased physical activity that results in obesity. In fact, various factors and institutions within a population may explain the complexity of these influences on obesity. These factors include societal norms and values; sectors of influence such as government, health care, education, and businesses; the behavioral setting of communities, worksites, health care, and schools; and the demographic, psychosocial, and genetic factors of an individual, their home, and their family.
More specifically, risk factors for obesity may include:

• Limited access to nutritious foods and easy access to low nutrition foods;
• Low rates of activity among children and adolescents during school and outside of school;
• Lack of opportunity for and access to physical activity among adults during the workday and in their communities;
• High prices for healthy foods;
• Confusion about nutrition facts and general lack of knowledge of healthy nutrition and lifestyle principles;
• Insufficient coverage of obesity treatment by health insurers;
• Distribution of the costs of obesity among everyone, not just obese persons; and
• Insufficient public health expenditures.

Each of these factors are complex and often interact with one another. Most of these risk factors are real and present issues driving obesity rates in Michigan.
The Role of Government in Obesity Policy. While obesity is very much an individual and personal matter, the widespread costs of obesity demonstrate that the rise in obesity rates impact everyone. Whether or not, and if so, how, the government should intervene to remedy this problem is widely debated. On one hand, many market failures leading to obesity may warrant government intervention: asymmetric information in food nutrition, the limited ability of children to assess the consequences of food and activity choices, and the distribution of the financial costs of obesity to all taxpayers through support of Medicaid. Government also has a long history of intervening in similar matters: requiring bike helmets, restricting smoking in public places, and placing taxes on tobacco and alcohol products, to name a few.
On the other hand, government intervention in the choices of what food people consume, the amounts they consume, and how they spend their leisure activities limits personal choices. Businesses’ ability to capitalize on market demand may also be stunted through restrictions on the calorie content in foods, food portion sizes, and the ability to market to certain groups. However, there are proven effective policies that may garner support from stakeholders on both sides of the issue.
School, State, and Local Level Policy Solutions. Based on these factors, and how relevant they are to Michigan’s obesity crisis, CRC has identified roughly a dozen potential policy solutions. These solutions are categorized by those best implemented at the school-level, at the state-level, and at the local or community level. These solutions include school-level policies that:

• Ensure availability to healthy food options and minimize access to unhealthy foods;
• Expand opportunities and requirements for physical activity before, during, and after school hours; and
• Include health education in the curriculum for all grades.

State-level policies include those that:

• Increase public health spending;
• Set and enforce nutrition and physical education standards for all grades;
• Institute a tax on unhealthy foods to decrease consumption and subsidize healthy foods to make them more affordable;
• Adopt and enforce nutrition and physical activity requirements for child care providers; and
• Encourage greater cost-sharing, penalties, and incentives for employer health insurance plans that encourage healthy lifestyles and access to health improving services.

Local-level polices include those that:

• Use zoning and financial incentives to influence food access such as increased availability of healthy foods and decreased access to fast foods;
• Incorporate consideration of active and healthy lifestyles in local government planning processes;
• Improve safe physical activity options for children and adults; and
• Expand community programs that target obesity prevention and reduction.

Because there is no one cause for the growth of obesity in the state, there is not a simple solution. School, state, and local leaders have already learned this through the variety of programs and policies they have implemented. A multitude of factors contribute to the growing instance of obesity and a variety of solutions must be executed. School, state, and local government policies have a unique role in that they have the potential to do a great deal of good, but in the end, they cannot force residents or students to eat less or exercise more. Their role is one that shapes the environment in which we live, work, and learn so as to create opportunities, incentivize actions, and educate about both.