CHICAGO (Reuters) - Even as the Obama administration recognizes obesity as one of the nation's top health threats, any efforts to reform the U.S. healthcare system will likely not go far enough to combat the condition.
"Obesity is one of many competing demands placed on the healthcare system. It has got our attention, but there just aren't great ideas about what to do about it," said Eric Finkelstein, a health economist at RTI International and author of "The Fattening of America: How the Economy Makes Us Fat."
"It's individual behavioral changes that are needed and that's difficult to deal with on a federal level," he said.
Two-thirds of adults and almost a third of American children are either overweight or obese.
While there is a consensus on the need for reform, combating obesity will be tough because the problem is so complex and treatments are not very effective.
President Barack Obama and Tom Daschle, his pick for health secretary, have both stressed that the new system must focus on prevention as a way both to improve health and save money.
But the leading proposals likely to come forward in Congress maintain the existing insurance model, which does not encourage prevention.
"Offering government subsidies to employers for insurance does not promote preventative health programs because people switch jobs and change insurance. It's a bad model," Finkelstein said.
Continuous insurance from birth to death would encourage prevention, he said.
"We need a more longitudinal view. Insurers need to care about the patient's health at 26 and 66," added Jeff Korsmo, executive director of the Mayo Clinic Health Policy Center.
A bill from Sen. Tom Harkin, an Iowa Democrat, focuses on prevention by removing barriers, like copayments, for health screening. He calls on more government agencies to get involved.
Jeff Levi, executive director of Trust for America's Health, a non-profit group focused on prevention, echoed the view of broad government involvement.
"It's not just the Department of Health and Human Services, it's the Agriculture Department and its food stamps program, school lunch, it's the Education Department in terms of what kind of physical activity occurs in the schools, and it's the Transportation Department and making sure that when we're building roads that we're also making sure we are creating more walkable communities and bike paths," Levi said.
An aide for Harkin said that "everything is on the table" as options, including changes to the current insurance model.
Sen. Max Baucus, a Montana Democrat, calls on Congress to explore approaches for obesity prevention and treatment. Government must encourage insurance plans to focus on prevention, he says.
Ken Thorpe, a healthcare policy scholar at Emory University who has advised Obama as well as other Democratic politicians, maintains dramatic improvements are possible without overhauling the insurance model.
Thorpe says combating obesity should be part of the economic stimulus package. For example, the federal government could grant funds to communities to establish nutrition and exercise programs.
The rise in obesity accounts for 15 percent to 27 percent of growth in overall healthcare spending and that rate could be reduced in just a couple of years, Thorpe said.
Thorpe praise employer-sponsored programs, like Johnson & Johnson's "Live for Life", which includes voluntary risk appraisals and incentives for healthy living.
"I think we'll see more incentives used," Thorpe said. "I don't think we'll see a command and control approach to this."
In its 2008 report, 'F as in Fat: How Obesity Policies are Failing America,' the Trust for America's Health recommended the federal government partner with state and local governments, businesses, communities and schools to offer prevention programs that promote more exercise and better nutrition.
"Though many promising policies have emerged to promote physical activity and good nutrition in communities," the report said, "they are not being adopted or implemented at levels needed to turn around this health crisis."
Reporting by Debra Sherman; Editing by Eddie Evans