The High Price of a Sedentary America and the Challenge of Getting Society Moving

THE LURE OF THE COUCH IS COSTING US AND KILLING US!

Health

Unless trends change quickly, the current generation will be the first to lead shorter and sicker lives than their parents (Olshansky et al. 2005). Many of them won't live to see their grandchildren!

Hollywood images aside, being sedentary is the norm in America. According to the National Health and Nutrition Survey, 95 percent of Americans do not get enough physical activity (Troiano et al. 2008), but even that figure is an underestimate of Americans' love affair with their couches. We get an average of 10 minutes of moderate to vigorous physical activity every day, at best, and spend most of our waking time—more than nine hours per day—sitting, reclining, or lying down (Owen, Bauman, and Brown 2009).

That's the national average. Physical activity levels are even lower in less affluent or ethnic minority populations. In Los Angeles County, one of the most culturally diverse locales in the nation, more than 40 percent of residents report less than 10 minutes of continuous physical activity per week (Yancey, Wold, et al. 2004).

Physical inactivity drives up the risks for many chronic diseases (Physical Activity Guidelines Advisory Committee 2008; Breslow and Breslow 1993; Mokdad et al. 2004). It's on a par with smoking and high blood lipid levels as an independent risk factor for heart disease and stroke, and it also increases the risk of diabetes, osteoporosis and hip fractures, breast and colon cancer, Alzheimer's disease, depression, and other chronic conditions (Physical Activity Guidelines Advisory Comm. 2008).

Physical inactivity also contributes to the energy imbalance producing obesity. Obesity is pandemic in modern society, with two in three US adults now classified as overweight or obese (Ogden et al. 2006). Obesity and sedentariness are a lethal combination driving illness, disability, and death. Obesity not only exacerbates inactivity-related health conditions but also adds a litany of indirectly related problems: cancers of the uterus, ovary, prostate, esophagus, stomach, lung, pancreas, rectum, and liver; gall bladder disease; knee osteoarthritis and gout; low back pain; increased risk from anesthesia; reproductive hormone abnormalities, impaired fertility, and fetal defects; and sleep apnea (US Department of Health and Human Services 2001). The epidemics of obesity and sedentariness are projected to take a tremendous toll on American health, productivity, and economic growth, exacerbated by the browning and graying of the population. Sedentariness and obesity are clearly eroding the strides we've made in fighting heart disease and diabetes (Olshansky et al. 2005).

I spoke of the browning of society: lower-income communities and communities of color continue to be plagued by higher levels of obesity and illness, disability, and death due to chronic diseases (Flegal et al. 2002; Truong and Sturm 2005). For example, among middle-aged Americans, 60 percent of white women were overweight or obese in 2001–2, compared with 80 percent of black and Mexican American women (Flegal et al. 2002).

Childhood obesity is a growing problem (Ogden et al. 2006; Freedman et al. 2006). About 16 percent of school-age children and adolescents are obese (Ogden et al. 2006). That's a threefold increase in young kids, and a fourfold increase for teenagers, from past decades. In communities of color, childhood obesity is much more common (Freedman et al. 2006). Rates of overweight and obesity top 50 percent in many urban school districts (Slusser et al. 2005). A similar escalation in excess weight has even occurred in infants and toddlers (Wang and Lobstein 2006).

Wealth

The dangerous combination of expanding waistlines and pervasive sedentary behavior may spell disaster for the health, economic, and social security of the United States. Beyond the high toll on individuals and families from loss of earnings, job and income security, and retirement flexibility, the costs are mounting for employers. Physically inactive or obese workers have higher rates of absenteeism, attrition, health care costs, injury, short- and long-term leaves, and workers' comp claims (Anderson et al. 2005; Chenoweth 2005). Moreover, from the standpoint of the company's bottom line, productivity and morale are down and "presenteeism" (occupying your chair but doing little or no work) is up among these employees.

At a time when youth are increasingly at risk for diabetes and heart disease, health care demand and costs for young workers are expected to rise considerably over the next few decades. This will coincide with the time of peak demand from aging baby boomers, overwhelming our medical care system, and the nation's increasing ethnic diversity—over half ethnic minority by 2060 (Yancey, Bastani, and Glenn 2007). However, the intangible costs of obesity are also highly significant: fewer years of productivity and a diminished quality of life, like not living to see your grandchildren grow up. Medicare data suggest that obese seventy-year-olds will spend 40 percent more time disabled than normal-weight people of that age (Lakdawalla, Bhattacharya, and Goldman 2004). Personal losses due to the obesity crisis are not as easy to quantify but do have a tremendous impact on society. These costs will only escalate as obesity continues to affect younger and younger populations.

Sedentariness and obesity affect not only our national productivity but also US corporations' global competitiveness in a tightening economy. Physical inactivity has become so commonplace that the costs imposed on society by people with sedentary lifestyles (for example, for the treatment of diabetes and other chronic diseases in the uninsured) rival those imposed by smokers and heavy drinkers (Keeler et al. 1989; Sturm 2002). In fact, the majority of the population fails to achieve the amount of regular activity necessary to maintain a desirable weight—no matter how little they eat! US expenditures related to overweight, obesity, and low levels of physical activity have been estimated at 27 percent of the total costs of health care in 2005. More than 10 percent were attributed to physical inactivity alone (Anderson et al. 2005).

Obesity is estimated to have cost the United States $117 billion in 2000 and $147 billion in 2008 (Finkelstein et al. 2009). In California alone, the total direct and indirect costs of physical inactivity, obesity, and overweight were more than $21 billion in 2005 (Chenoweth 2005). That's $638 per...