Posted by: Richie Bernardo

Americans are the fattest people in the world. By one measure, more than 70 percent of the U.S. population aged 15 and older is overweight or obese. But such a finding should come as no surprise, considering the proliferation of fast-food establishments and increasingly cheaper grocery items that have negatively altered our diets. Unfortunately, the extra pounds have inflated the costs of obesity-related medical treatment to nearly $316 billion a year and annual productivity losses due to work absenteeism to more than $8.6 billion.

But certain places are more responsible than others for tipping the scale in favor of bad health. To identify them, WalletHub’s analysts compared 100 of the most populated U.S. metro areas across 17 key indicators of weight-related problems. Our data set ranges from share of physically inactive adults to projected obesity rates by 2030 to healthy-food access. Read on for our findings, expert advice on tackling America’s growing obesity problem and a full description of our methodology.

1. Main Findings
2. Ask the Experts
3. Methodology

Main Findings

 

  Embed on your website<iframe src="//d2e70e9yced57e.cloudfront.net/wallethub/embed/10532/geochart-obesity4.html" width="556" height="347" frameBorder="0" scrolling="no"></iframe> <div style="width:556px;font-size:12px;color:#888;">Source: <a href="http://ift.tt/2o3JHTe;  

 

Overall Rank	Metro Area	Total Score	‘Fat Prevalence’ Rank	‘Weight-Related Health Problems’ Rank	‘Healthy Environment’ Rank
98	Boise, ID	50.93	91	75	93
99	Reno, NV	49.42	87	95	90
100	Honolulu, HI	46.16	97	100	85

Ask the Experts < >

• Carolyn Dunn Professor and Head of the Department of Youth, Family, and Community Sciences at North Carolina State University - Cooperative Extension
• Wendy E. Parmet Director of the Program on Health Policy and Law and Associate Dean for Interdisciplinary Education and Research Support at Northeastern University
• David E. Frisvold Assistant Professor of Economics in the Henry B. Tippie College of Business at University of Iowa
• Joanna S. Short Associate Professor in the Department of Economics at Augustana College
• Thomas G. Sherman Associate Professor on the Medical Educator Track in the Department of Pharmacology & Physiology at the Georgetown University Medical Center
• Miriam E. Nelson Director of the Sustainability Institute at University of New Hampshire
• Emily Yates-Doerr Assistant Professor of Anthropology at University of Amsterdam and Research Associate in Anthropology at New York University
• Bruce Lee Associate Professor of International Health and Director of the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health
• Lisa Harnack Professor and Director of the Nutrition Coordinating Center in the Division of Epidemiology and Community Health at the University of Minnesota, School of Public Health
• Elizabeth W. Cotter Professorial Lecturer and Director of Undergraduate Health Promotion in the Department of Health Studies at American University
• Flavia Herzog Liebel Registered Dietitian and CEO at Therapeutic Nutrition, LLC
• Tammy Chang Assistant Professor of Family Medicine in the Medical School and Practicing Physician in the Ypsilanti Health Center at the University of Michigan
• Susan E. Swithers Professor and Director of Undergraduate Studies in the Department of Psychological Sciences at Purdue University, College of Health and Human Sciences
• Dawn Earnesty Ph.D. Student in the Department of Food Science and Human Nutrition at Michigan State University, and Educator at Michigan State University Extension
• Dean Sienko Associate Dean for Prevention and Public Health at the Michigan State University College of Human Medicine
• Ruth E. Grossmann Assistant Professor in the College of Nursing and Research Scientist in the Obesity Education and Research Initiative at University of Iowa

Carolyn Dunn Professor and Head of the Department of Youth, Family, and Community Sciences at North Carolina State University - Cooperative Extension What are some tips for eating healthy without breaking the bank? Healthy and low cost is very possible: think dried beans, canned beans, canned or frozen vegetables, in-season fresh fruits and vegetables. For about $2 you can get a pound of dried beans. Soak overnight and cook in a slow cooker with your favorite spices for 8 hours. Avoid the dollar menu. It may seem like a money saving idea but if you get 3-4 items, you have just spent more than you could on a healthy meal prepared at home from fresh ingredients. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Cutting out quality carbohydrates and healthy fats. Carbs and fats have gotten a bad rap. Refined carbohydrates are a great thing to cut out of your diet for better health. However, whole grains, especially the grain itself like quinoa or oatmeal, provide a sense of fullness thanks to fiber. Fat free is no good either. A low fat diet may leave you hungry and unsatisfied. Instead of going low fat or fat free - switch to healthy fats. An ounce of nuts is high in fat but it is good fat and makes the perfect snack. Portion control is important to keep calories in check. What is the impact of obesity on the economy and worker productivity? Obesity and related chronic illnesses costs billions each year in health care and lost productivity. Should employers play a role in helping workers maintain a healthy weight? How? Worksites have a large role to play in worker health, especially maintaining a healthy weight. Workers often spend more waking hours at their worksite than they do their own home. Making the worksite healthy with opportunities to choose healthy foods and be active helps with worker productivity, health, and morale. Healthy foods in vending, in the break room, and in the cafeteria; policies about what to bring for shared meals; policies about when and where workers can be active; discounts on health insurance for positive health behaviors; are all steps in the right direction. What policies should government pursue to combat obesity and rein in the cost of healthcare? Examine the way agriculture is funded. Could we subsidize healthy foods as we have corn and soy? Could the government provide more funding for school lunch to allow for healthier meals to be served? Wendy E. Parmet Director of the Program on Health Policy and Law and Associate Dean for Interdisciplinary Education and Research Support at Northeastern University Should employers and the government play a role in helping people maintain a healthy weight? How? I do think both employers and government can and should play constructive roles in enabling people to live healthy lifestyles, for example, by ensuring access to nutritious food, providing time and safe spaces for children to engage in physical activity, and limiting children’s exposure to junk food and sodas. At the same time, it is important that neither government nor businesses rely on shame or punitive policies. We need to understand that the increasing prevalence of overweight and obesity in the last few decades is not the result of individuals’ lack of will, but of a changing food and physical activity environment. Hence, policy efforts should focus on altering the landscape, not on scapegoating individuals. David E. Frisvold Assistant Professor of Economics in the Henry B. Tippie College of Business at University of Iowa What is the impact of obesity on the economy and worker productivity? The excess medical costs of obesity are substantial. There is still a lot of information that is not well understood, such as how the length of time that an individual is obese and how fluctuations in weight over time are related to lifetime medical costs. However, the best evidence suggests that the medical costs due to obesity are thousands of dollars per obese adult per year. Additionally, obesity is linked to higher worker absenteeism, but this relationship may not reflect a causal effect of obesity. Should employers play a role in helping workers maintain a healthy weight? How? Many employers provide financial incentives to workers to exercise or to reduce weight, but the results of these incentives are mixed. What policies should government pursue to combat obesity and rein in the cost of healthcare? In general, public programs and policies that broadly influence the environment while encouraging healthy eating and physical activity are more effective than narrowly targeted policies that influence a small aspect of daily life. Further, policies targeting children can prevent or delay obesity and are more effective than policies targeting adults. As such, a wide range of policies would be needed as no single policy is likely to significantly combat obesity and rein in the cost of healthcare. Joanna S. Short Associate Professor in the Department of Economics at Augustana College What are some tips for eating healthy without breaking the bank? Cooking at home is generally cheaper than eating out. It is also healthier if you can resist the unhealthy foods at the grocery store (eat before that trip to the store!) and surround yourself with healthy alternatives at home. You can also save by shopping around for produce and buying organic only when it's warranted -- some foods are rarely grown using pesticides or have a thick rind or skin that protects the edible part. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Everyone wants quick results, so many try extreme diet or exercise programs. These are ineffective because they cannot be maintained over the long term. Instead, we should implement more gradual changes that can be maintained. Keeping a food and exercise log has been shown to work -- you can quickly see where your calories are coming from, how many you have burned, and decide for yourself where you can most easily cut calories or increase activity to stay within a calorie budget. Food diary apps like Lose It! make this very easy to track. What is the impact of obesity on the economy and worker productivity? Obesity contributes to health costs, which we all pay in the form of higher health insurance premiums and taxes. It has also been shown to be associated with higher absenteeism from work, and lower productivity while at work. These effects are largest for the most obese. Should employers play a role in helping workers maintain a healthy weight? How? Employers have a vested interest in the health of their employees. Some offer wellness programs that provide carrots like cooking classes, health screenings, or subsidized gym memberships. Some penalize those who don't participate with higher health insurance premiums. To the extent these programs are effective, it's a win-win. However, employers must be careful to avoid being too intrusive or demanding of employees. What policies should government pursue to combat obesity and rein in the cost of healthcare? Local governments can invest in making cities more walkable through careful growth planning. On a larger scale, subsidies for healthy food should be considered. Thomas G. Sherman Associate Professor on the Medical Educator Track in the Department of Pharmacology & Physiology at the Georgetown University Medical Center What are some tips for eating healthy without breaking the bank? Learn how to cook. The two most important ways to eat healthy are to limit added sugars and to avoid processed foods, and both of these are achieved by cooking your own food. Plus, your new found cooking skills will decrease the frequency of eating at restaurants, a tremendous financial saving. Nearly 80% of the salt we consume comes from processed and restaurant foods; thus, cooking is almost magical in its ability to decrease costs and increase our health and decrease our risks of cardiovascular disease, hypertension, and excessive weight gain. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? The three biggest mistakes are (1) depending on exercise as a means of losing weight, (2) focusing on specific food groups, such as carbohydrates or fat, as the cause of their weight gain, and (3) setting a weight-loss goal that is unrealistic. (1) Although exercise is one of the single most important things one can do for their health, it is not a strategy for weight loss. Exercise improves cardiovascular health, strengthens bones, helps maintain mental acuity, and any number of additional benefits, but it also increases appetite. (2) There is no magic in diets that limit carbohydrates, or fat or protein; these diets result in short-term weight loss by limiting consumption. A focus on eating whole foods, such as fruits and vegetables, whole grains, lean meats and fish, and vegetable oils is more important. Many diets, including many fad diets, including the Mediterranean diet, the Atkins diet, a vegetarian or vegan diet, or even the Paleo diet, are much more similar to each other than they are to the typical American diet, because all of these diets eschew added sugars and processed foods. (3) There is very little evidence that dieting leads to meaningful long-term weight loss. Almost by definition, a diet frequently sets both a goal and a calendar date for completion. This sets the dieter up for failure. Either they reach their goal and then return to their previous habits, or they fail to reach their goal and are frustrated. Rather than set a goal, therefore, I counsel the advantage of adopting a system within which the person can live. Create a system of eating that yields a healthier you, rather than explicitly a thinner you. For example, adopt the Mediterranean dietary system; increase the consumption of fruits and vegetables, seafood, lean meats, olive oil with the aim of becoming healthier. As you begin to feel better and better, your activity levels will rise, and with time, perhaps you will shed part or all of your excess weight. Either way, however, you are healthier. Should employers play a role in helping workers maintain a healthy weight? How? Although greater gains can be made through federal strategies, as detailed in the next answer, employers can play a role. (1) Avoid having vending machines that encourage the consumption of sodas, sweets, chips and junk. Provide resources or space for a daycare for employee children and private locations for breastfeeding mothers. Permit unorthodox behaviors such as standing desks, walking meetings, or opportunities for telecommuting for parents with children. Recognize that a happy employee, a valued employee, is a more productive employee. What policies should government pursue to combat obesity and rein in the cost of healthcare? We need to establish an evidence-based National Food Policy, and to substantially revise the Farm Bill. It makes no sense to federally subsidize the production of sugar, animal feed grains and meat, and other commodity crops. Such subsidies lead to artificially low prices for processed foods, fast foods, and sugar-sweetened beverages that make it difficult for people, especially the poor, to resist purchasing them. The consumption of inexpensive foods leads to increased risks for very expensive chronic medical conditions, such as diabetes, obesity, hypertension, and cancer. So we are paying higher taxes to subsidize the production of foods that further increase our taxes for greater healthcare costs. It makes no sense. We need to tax foods that ultimately cost taxpayers, and to subsidize foods that result in decreases in healthcare and environmental costs. There is no reason why a poor family is forced to purchase fast foods because it is cheaper for them to feed their family that way. Miriam E. Nelson Director of the Sustainability Institute at University of New Hampshire What are some tips for eating healthy without breaking the bank? Don’t eat out so much. You eat better when you eat home cooked food. It is also much less expensive. So you gain two things – better health and more dollars in your wallet. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? They think that by exercising more the pounds will just melt away. They don’t. Exercise is critical but it isn’t the most important part of weight loss/maintenance. You also need to eat well. What is the impact of obesity on the economy and worker productivity? Obesity contributes to low productivity and absenteeism. In addition, higher healthcare expenditures. Should employers play a role in helping workers maintain a healthy weight? How? Yes. They should create work environments that support health; healthy affordable food in the cafeteria, incentives to be physically active, active commenting incentives and building a culture of health from the CEO on down. What policies should government pursue to combat obesity and rein in the cost of healthcare? Adopt some best practices that support and incentivize the population to be more active and to eat more healthfully. Including a tax on sugar sweetened beverages, better public transportation and built environment that supports activity, and preventive care that supports professionals that can counsel people to assist with health, not just sickness. Emily Yates-Doerr Assistant Professor of Anthropology at University of Amsterdam and Research Associate in Anthropology at New York University What are some tips for eating healthy without breaking the bank? It really depends on workday schedules and the budgets people are living within. In Guatemala, where I have carried out a lot of my research, many of the traditional foods are soups and stews that can be shared among many. This is cost-effective, but doesn’t work well when food must be prepared to be eaten individually, as is the case when people are working long office and factory hours and eating on the go. Brazil’s recent dietary guidelines call for people to eat in company whenever possible. Not only eating in company, but sharing food, can have health and economic advantages. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Weight often has more to do with social and economic factors — access to clean food and water for example — than an individual's decisions or mistakes. Many of the nutritionists that I have worked with are adamant that the worst thing one can do for his or her weight is to try to control it. What is the impact of obesity on the economy and worker productivity? I’d like to turn this on its head to ask: what is the impact of the economy and worker productivity on obesity? It’s no coincidence that reported obesity rates have risen along with changes in workday schedules and demands. Metabolism is linked to circadian rhythms. We can’t have a labor force required to work night-shifts to keep businesses in constant operation and expect that this won’t have consequences on bodies. Hannah Landecker at UCLA has made the point that metabolism is a labor issue as well as a health issue. Should employers play a role in helping workers maintain a healthy weight? How? Providing workers with decent working conditions, which includes fair minimum wages and time-off so that people can enjoy leisurely meals, would be a great place to start. There is a lot of research that shows that finding pleasure in food is important for health. It’s hard to do what is necessary to eat well — let alone find pleasure in eating — if people have poor working conditions. What policies should government pursue to combat obesity and rein in the cost of healthcare? I’d love to see more government-backed funding for obesity research, including research on the successes and failures of existing policies. Currently, much of the existing research on food and health is funded by the food industry. Marion Nestle is doing a great job drawing attention to conflict of interest here. In the Netherlands, where I work, the government has the idea that obesity is a social problem and requires social science solutions. I think this is a great attitude! Bruce Lee Associate Professor of International Health and Director of the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health What are some tips for eating healthy without breaking the bank?

• Drinking lots of water will keep you full and reduce the number of calories, sugar, and salt that you would get from other types of beverages.
• The key is to purchase and eat food that are not heavily processed or have additives. The closer the food is to its original form, the better.
• Buying fruits and vegetables at local markets; frozen fruits and vegetables, as long as they don’t have added salt, sugar, or artificial ingredients.
• Forming cooking groups that can buy healthy food together in bulk, to get discounts.

What are the biggest mistakes people make when trying to achieve and maintain a healthy weight?

• Using crash diets or intensive exercise programs. Losing weight is about changing and maintaining new habits. If you cannot sustain a change, the weight will just come back.
• Skipping meals or fasting. The body will adjust to what it perceives as starvation by slowing metabolism. The body is very adaptable.
• Using highly processed weight loss supplements or foods.
• Not eating a balanced diet. Beware of any diet that says all-something.
• Listening to advice that is not grounded in science.
• Believing that weight management is just an individual problem. Weight management is a systems problem. The people around you, your social connections, your work, your food and physical activity environments, your financial situation, surrounding economics, etc., all affect you. To make a real change you have to look at everything around you and determine how they can be adjusted to make the change.

What policies should government pursue to combat obesity and rein in the cost of healthcare?

• Policies to encourage and reward the provision of healthier food (versus highly processed food) and reduce the cost of healthier food.
• Urban planning to promote walking, exercise, and public transportation. e.g., parks, recreation areas, bike lanes.
• Shifting reimbursement policies and structures to favor preventive care.

Lisa Harnack Professor and Director of the Nutrition Coordinating Center in the Division of Epidemiology and Community Health at the University of Minnesota, School of Public Health What are some tips for eating healthy without breaking the bank? Eating healthy can actually be a money saver since many of the food swaps people need to make to eat healthier are less costly. A few examples: Choose water instead of sugar sweetened beverages like soft drinks. Buy a water filter if you don’t like the taste of your home tap water or consider adding a splash of lemon juice concentrate to your glass of water. Ask for a cup for water at fast food restaurants. Most charge nothing for the glass and have water available from the beverage fountain. Eat at home or pack your lunch instead of eating out. It can be exceedingly difficult to keep calories in check when eating out, and it costs a bundle too. So, it pays in multiple ways to stock your home with healthy foods for meals at home and work. When eating at fast food restaurants, avoid the bundled meal deals. They often aren’t the deal they appear to be - usually too many calories, and you’ll spend less if you order items individually and go with water (free option) instead of a fountain soda. Choose fruits and vegetables for snacks instead of chips, cookies, candy, etc. No doubt raspberries cost a bundle, especially when purchased off season. But, the most popular fruits and vegetables (apples, bananas, etc.) are less per ounce than most junky snack foods. Don’t overlook canned and frozen fruits and vegetables when buying produce. Most are as nutrient-packed as their fresh counterparts. Just choose products that aren’t packed in sugar or sauces. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? People tend to fall prey to diets and weight loss products that don’t work in the long-run. As a reminder, if it sounds to be good to be true it probably is. Also, if the diet sounds like something that would be hard to follow for life because it is super restrictive (e.g., raw foods only) or requires eating a lot of a certain foods it is apt to be a diet that fails in the long-run. Choose a diet plan that you see yourself following for life. Another mistake is thinking there is one perfect diet for a healthy weight. We now know there are many ways people can eat to achieve and maintain a healthy weight. For some, a lower-fat diet rich in fruits, vegetables, and whole grains is a diet they enjoy and find helpful in keeping calorie intake in check. For others a protein rich diet with lean meats, low-fat dairy, and limited in grains (especially refined grains and sugary foods) is a workable diet. What is the impact of obesity on the economy and worker productivity? Medical costs related to obesity are estimated to be as much as $210 billion annually, accounting for 20% of health care spending in the U.S. Employers are estimated to pay $6.4 billion annually for employee absenteeism and $30 billion per year due to reduced productivity that is due to obesity. Should employers play a role in helping workers maintain a healthy weight? How? Worksites across America are implementing policies and programs to promote good nutrition and physical activity for obesity prevention. Examples of policies include offering more healthy and fewer unhealthy foods in worksite cafeterias, vending machines, and catered events. Programs include subsidized gym memberships, walking clubs, and onsite weight loss programs. Some employers are taking a serious look at how they structure their worksite, such as providing standing work desks and accessible stairwells to build physical activity into the daily work routine. Employers are realizing that it makes sense to create a work culture that supports health. What policies should government pursue to combat obesity and rein in the cost of healthcare? Federal, state, and city governments are experimenting with various policies to promote healthy population weight. Research is underway to evaluate some of these policies, and in the coming years we should know more about which are effective. Elizabeth W. Cotter Professorial Lecturer and Director of Undergraduate Health Promotion in the Department of Health Studies at American University What are some tips for eating healthy without breaking the bank? There are many strategies one can use to eat healthy on a budget. For example, buy fresh produce when it is currently in season and less expensive (e.g., asparagus in the spring, spinach and squash in the fall). When produce is not in season, check out canned and frozen options, which are typically less expensive. Just be sure to choose items that are low in sodium. Another tip is to plan your meals ahead of time, and think how you might use one item throughout the week in different meals, such as using leftovers in soups, stir-fries, school lunches, etc. Incorporating more meatless meals is another great way to stretch your budget, such as by basing meals around whole grains, rice, or beans, which are typically less expensive than meat. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? In my opinion, one mistake people make is thinking there is one single "diet" that works for everyone. It's important to tailor strategies to your unique lifestyle and preferences. For example, instead of completely changing the way you eat in a way that's unfamiliar, think about how you might adapt favorite recipes so that they can be healthier. Similarly, consider exercise options that are enjoyable to you and fit your lifestyle. Another common mistake is restricting oneself. If you deprive yourself completely of things you enjoy, you become much more likely to binge on those foods later. Enjoying these foods in moderation is a much more sustainable approach. Another mistake includes eating processed, "diet" foods. These foods are often higher in sugar and other artificial ingredients, and are less nutritious. Instead, try to incorporate as many fresh, whole foods as possible into your diet. What is the impact of obesity on the economy and worker productivity? Studies do suggest that obesity impacts the economy and worker productivity. Obesity is associated with higher rates of absenteeism, as well as reduced productivity while at work. Obesity is also associated with higher risk for a number of medical conditions (e.g., hypertension, diabetes, cardiovascular disease), which raises medical spending. Should employers play a role in helping workers maintain a healthy weight? How? Yes, I think whenever feasible, employers should implement programs and policies that can help their employees maintain a healthy weight. Employee wellness programs can significantly reduce health care costs for employers, and also lead to improvements in retention, morale, and productivity. Existing research highlights certain characteristics of programs that are more likely to be successful, such as: Creating a "health-conscious" work environment that facilitates healthy weight management, such as ensuring that cafeteria and vending machine options are healthy, appealing, and affordable; or ensuring that stairwells are appealing and clearly marked. Making programs accessible, such as holding lunchtime exercise or stress management classes, or having an exercise facility onsite. Ensuring programming is "fun" and utilizes positive incentives, such as employee wellness challenges where groups of employees compete against each other (e.g., a pedometer challenge, a weight loss challenge) for certain incentives. Flavia Herzog Liebel Registered Dietitian and CEO at Therapeutic Nutrition, LLC What are some tips for eating healthy without breaking the bank? Unfortunately, it can be challenging to eat healthfully on a budget. This is especially true of eating nutrient dense fruits and vegetables. One cost saving tip is to buy frozen or canned vegetables. Having frozen vegetables in the freezer whenever you need them is preferable to having fresh vegetables go bad and get thrown out because you didn't have the time (or the interest) to cook them. Vegetables picked, and frozen immediately, have the nutrients sealed in and therefore can be more nutritious than fresh vegetables that may lose nutrients through exposure to light and heat when transported. Canned vegetables can be an inexpensive option as well. However, you may want to rinse them before heating because they often come with an extra dose of sodium. The same cost savings apply to buying frozen or canned fruits. Frozen fruits are an excellent choice for smoothies. In addition, canned fruits have a longer shelf life and therefore less waste. Look for fruits packed in their own juices for a calorie savings. We all know that eating at home can be healthier and is less expensive but the challenge is figuring out "what's for dinner" every night. The best tip I give my clients is to do a “bulk” cook on Sundays. Some of the portions can be frozen for future use and you have a number of meals prepared for that week's lunches or dinners. If you plan to bring your lunch to work, do yourself a favor and pack it at night when you have a few more minutes. Just be sure you put a reminder note on your keys so you do not forget to bring it with you. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Many people these days waste an enormous amount of money on fad-diets and quick fixes instead of taking time to change unhealthy behaviors. The most common unhealthy behaviors/mistakes that I repeatedly see in my clients are:

• Not eating breakfast – even if you are not hungry it is essential to eat as soon as possible after waking up. This is one of the keys to increasing your metabolism.
• Avoiding snacks – "snacking" has become a bad word. The reality, however, is that a nutritious snack prevents you from getting over hungry and making a less healthful choice at the next meal. The hungrier you are, the more likely you are to choose the higher fat, less nutritious, food. It is also helpful for your metabolism to "stoke-the-fire" by eating every 3 to 4 hours.
• Being on a very low calorie diet – the truth is few people should be on a very low calorie diet, (i.e., 1200 calories). A physician or a dietitian should monitor those that need to be. Typically, what happens is someone will follow a low calorie diet during the day, which leads to over-eating/binging at night. This makes weight loss very unlikely. It could also cause weight gain. Those that do lose weight on such a restrictive caloric intake typically cannot sustain it. The weight is often regained with additional pounds.

What is the impact of obesity on the economy and worker productivity? As a registered dietitian in private practice, I do not have access to this data. I do feel, however, it is important to note that people can be healthy at any size. Weight does not determine health. It is only one of the criteria used in a health assessment. It is possible for a person to have a body mass index that indicates they are overweight yet they are very active and have cholesterol, triglycerides, blood pressure and glucose levels that are all within normal limits. Such a person would have no negative impact on productivity or the economy. Should employers play a role in helping workers maintain a healthy weight? How? I believe employers are in a unique position to have a positive impact on their employees’ overall health. I feel this is more critical than helping them achieve a "healthy weight ". Underfed, dehydrated, sleep-deprived employees are likely to be significantly less productive. A few easy and inexpensive ways employers can have a positive impact on their employees’ overall health include:

• Encouraging / insisting that they take lunch breaks and make it acceptable to eat in meetings, if necessary.
• Allowing extra time at lunch for them to go to the gym or for a walk/run.
• Making water coolers easily accessible, to promote good hydration.
• If they have a cafeteria, they should be providing a variety of healthy, nutritious meals and snacks, and make meals available "to go" that can be taken home for dinner. In addition, providing nutrition information on these cafeteria foods can help those struggling with heart disease, high blood pressure or diabetes make a healthful choice.

Tammy Chang Assistant Professor of Family Medicine in the Medical School and Practicing Physician in the Ypsilanti Health Center at the University of Michigan What are some tips for eating healthy without breaking the bank? Healthy eating doesn’t have to cost a lot. Many times it is more about planning ahead. Buying and preparing healthy food like fruits, vegetables, and healthy fats (nuts, avocado, etc.) takes a little more time because you have to wash, cut, or pack the food so they are on-hand when you are hungry. However, this small investment in time can go a long way when you are on the go and want to fuel your body with food that will give you energy and help you feel well. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Some of the biggest mistakes people make when trying to achieve and maintain a healthy weight is to focus just on food or exercise. Sleeping well (at least 6-8 hours a night) and staying well hydrated with water (versus sweetened beverages) can play a big role in weight management. When you are well rested, you not only feel better, you have more energy and can make better decisions regarding your health. Susan E. Swithers Professor and Director of Undergraduate Studies in the Department of Psychological Sciences at Purdue University, College of Health and Human Sciences What are some tips for eating healthy without breaking the bank? Eating healthy might require an investment of time, if not money. The best approach may be to try to avoid heavily processed foods which are very convenient, but which often provide excess calories, sodium, fat and sugar. Purchasing ingredients and preparing foods ourselves can make it easier to be healthy, and can be less expensive than buying prepared foods. What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? One of the biggest mistakes is assuming that things that are labeled “diet’ or “light” are automatically better choices. In many cases, these products provide as many calories as the regular versions, or include ingredients like artificial sweeteners, which don’t appear to actually be very helpful, especially in the long run. A better approach is to try to focus on eating foods that are less heavily processed and to pay attention to portion sizes. Should employers play a role in helping workers maintain a healthy weight? How? Weight matters to employers only because excess weight tends to predict negative health outcomes. We need to make sure we're really focusing on health outcomes and not physical appearance. In the U.S., since many health care costs are borne by employers, investing in strategies that reduce these negative health consequences, which include chronic diseases like type 2 diabetes and cardiovascular disease, makes a lot of sense. For example, providing employees with ready and affordable access to healthy fresh food options, or with the time to get those healthier foods during the work day, and eliminating ready access to junk foods and drinks would be one strategy that could prove useful. What policies should government pursue to combat obesity and rein in the cost of healthcare? One thing that would be useful would be to reconsider how current subsidies contribute to the prevalence of ultra-processed foods, the kinds of foods that provide lots of calories but not many nutrients. One reason these foods are so widely available and heavily consumed is because their ingredients are very inexpensive, while fresh fruits and vegetables that are not as heavily subsidized are relatively expensive. Another clear need is government investment in scientific research. Currently, much nutrition research is funded by food and beverage manufacturers, who have a vested interest in outcomes that benefit their bottom line. This leads to consumer doubt about what the best approaches actually are. Healthcare costs can only be decreased by a commitment to understanding the real factors that drive disease and health. The data show clearly that in many cases, food industry-funded studies contradict independent science, much like we saw with tobacco-industry funded science. Increased government investment in science is one way to combat this influence of industry. Dawn Earnesty Ph.D. Student in the Department of Food Science and Human Nutrition at Michigan State University, and Educator at Michigan State University Extension What are some tips for eating healthy without breaking the bank? Some tips for eating healthy without breaking the bank include planning ahead, preparing meals and snacks at home and sticking to a grocery list when shopping. Specific tips include:

• Pre-planning meals and snacks that include fruits, vegetables, whole grains, low-fat dairy and lean proteins.
• Having a grocery list that include these pre-planned meals and snacks and looking for options that may be on sale are tips for saving money on your grocery bill. Sticking to a food budget is easier when you purchase only what’s on your grocery list and buy store brands. After you write down the week’s meals and snacks, find the ingredients you already have in your kitchen and add the missing ingredients to your grocery list. For example, purchase fresh fruits and vegetables that are on sale, canned or frozen fruits and vegetables.
• Preparing meals and snacks at home instead of eating out is one way to stick to a food budget. Eating out can quickly spend your food budget. As you plan your meals for the upcoming week, find different ways to use ingredients “twice” throughout the week. Take leftovers for your lunch or plan a “leftover night” when you know you won’t have time to cook. Prepare dried beans in batches to freeze in recipe-sized portions (1-2 cups) or purchase beans canned or frozen and use them as a source of protein in place of meat. Plan occasional “no-cook” meals such as salads and sandwiches, which kids can help prepare. When you do have extra time, pre-cook or pre-cut meals and snacks to make available when you are short on time. Prepare double or triple batches of meals and freeze in meal-sized containers or individual portions for lunches or dinners.

What are the biggest mistakes people make when trying to achieve and maintain a healthy weight? Often, people shift toward the “quickest fix” instead of focusing on small, attainable goals that are realistic for their lifestyle. Additionally, often, people try to focus on a goal such as weight loss instead of a behavior that contributes to a healthy weight. An example of a goal that is specific, measurable, attainable, realistic and timely, and contributes to a healthy weight may include: I will pack my lunch from home, 3 days out of five this week rather than eating out. This goal, once accomplished, can then be built upon. For example, in my packed lunch from home, I will include at least 1 cup of fruits and vegetable this week. Making small, sustainable changes that focus on overall health will contribute to having a healthy weight. Dean Sienko Associate Dean for Prevention and Public Health at the Michigan State University College of Human Medicine What is the impact of obesity on the economy and worker productivity? Healthy workers are productive workers. Employees who are obese, generally, have more health problems than those who meet ideal body weight. With more health problems, employers experience higher rates of absenteeism and presenteeism (i.e., being present at the job but not being attentive and productive). Should employers play a role in helping workers maintain a healthy weight? How? Yes, they should. They can set up worksite wellness programs that help keep employees healthy and encourage those who need to lose weight, to do so. Some techniques would be to have wellness coaches, provide time for the employee to exercise, offer gym memberships, and serve healthy foods in worksite cafeterias. What policies should government pursue to combat obesity and rein in the cost of healthcare? Government should promote "health in all policies." Efforts should be made to shape communities so that the default option for community residents is a healthy one. For example, encourage fitness (e.g., walking/biking trails), build complete streets (not just for fast-moving cars), ensure public safety (people won't exercise if their safety is in jeopardy), ensure physical education programming is part of the school experience, and promote farmers’ markets. This effort will take a comprehensive public health approach to make a difference. Ruth E. Grossmann Assistant Professor in the College of Nursing and Research Scientist in the Obesity Education and Research Initiative at University of Iowa What are some tips for eating healthy without breaking the bank?

1. Replacing expensive meat in recipes with legumes is a great way to reduce the cost of food and to improve the quality of the diet. If you cannot replace the meat entirely with legumes, reducing the amount of meat in a meal and adding legumes works as well.
2. Frozen fruits and vegetables are often less expensive than fresh and have the same or better nutritional value.
3. If you can’t afford organic produce, buy the conventionally grown. It is much better to eat a variety of conventional fruit and vegetables than to eat a limited amount of organic.

What are the biggest mistakes people make when trying to achieve and maintain a healthy weight?

1. Forgetting about food quality: It is easy to forget about quality when reducing food intake. Often, I see individuals reducing their portion sizes without improving the quality of their food choices. This increases the possibility of becoming vitamin and mineral deficient. Improving the quality of food intake while cutting calories is a great way to increase your chance of achieving and maintaining a healthy weight. A great way to increase quality while reducing calories is to add nutrient rich vegetables and fruit to the diet. These will fill you up and make you healthier.
2. Going on a diet: “Going on a diet” implies that at some point you will “go off the diet.” It is better to work at improving diet slowly and consistently with the goal of maintaining a healthy diet for the rest of your life. Our culture implies we should be able to eat high calorie, nutrient poor foods without becoming overweight. This is a lie. We need to accept that we cannot eat a diet high in calories and low in nutrients and expect to be healthy and strong. No one would assume that we can skip brushing our teeth and expect to have healthy, strong teeth for the rest of our lives. We accept that we must brush our teeth. I believe we must also accept that if we want to be healthy, we have to make better food and lifestyle choices for the rest of our lives. Don’t “go on a diet,” improve your diet, one day at a time, one choice at a time.
3. Beating yourself up: There are many reasons we overeat. Often we have a positive intent when we overeat; we need something and are trying to get it through food. Food is used for stress-reduction, as a reward, to deal with sadness, to avoid feeling guilty or ashamed and the list could go on and on. The positive intent is often to deal with difficult emotions or allow yourself a much needed celebration. It takes a lot of honesty and a safe place to face these feelings. Sometimes that help comes from a professional or from a friend. Look for the positive intent and use it to discover the skill you need to develop to let go of overeating.

What is the impact of obesity on the economy and worker productivity? According to the statistics, it costs close to $200 billion dollars per year. But I believe the impact is much greater in personal loss of vitality. I have had the privilege of hearing many stories from individuals who have adopted a healthy lifestyle and have regained their energy and zest for life. It is a privilege to help others adopt healthy habits and enable them to pursue their dreams. Should employers play a role in helping workers maintain a healthy weight? How? Yes, I believe that employers have a large interest in maintaining the health of their employees to increase productivity, job satisfaction and reduce healthcare costs. Employers can assist employees by increasing the convenience of living healthy lives. In our busy lives, convenience is the reason many of us adopt the unhealthy habits of sitting too much and eating processed foods. Employers have the opportunity to make physical activity and healthy eating more convenient. For example, companies may build on-site workout facilities and bring in vendors of fresh, pre-prepped foods that are easily used in making healthy dinners at home. Employers can also help develop a culture where health and well-being are encouraged. What policies should government pursue to combat obesity and rein in the cost of healthcare? This is the most difficult question because I do not believe there are clear answers. Some of the components I believe may be a part of the solution are: 1) Education of children, education of teenagers, education of adults and older adults on the impact of diet and lifestyle on the development of disease. I believe we need to teach the majority of our population how to make healthy food and lifestyle choices. 2) Subsidies for more healthy convenience foods and for less expensive vegetables and fruits. I think we should use subsidies to make healthy food convenient and inexpensive. 3) Public campaigns emphasizing the impact that diabetes, hypertension, osteoarthritis and other lifestyle-related diseases have on quality of life. In similar ways in which anti-smoking ads made the long term consequences of smoking real reduced smoking, I think ads making the long term consequences of lifestyle-related diseases real may help individuals improve their choices.

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