If only solving the obesity problem were so simple. As a consequence of the expanding girth of our nation, particularly among middle-aged folks, the annual cost of treating obesity-related conditions will rise from $361 per American today to $1,425 in 2018, a recent Emory University study estimates. And the obesity spike is expected to contribute to a doubling in the number of people with diabetes in the next 25 years; obese middle-aged people, research reveals, also have a much greater than average risk of Alzheimer's later in life. "Some people may not live as long as their parents because of this epidemic," says Caleb Finch, a professor of gerontology and neurobiology at the University of Southern California.
While attention is certainly being paid, the remedies have been paltry. New York, for example, last year required restaurants to post calorie counts on their menus, a move that might have some impact, according to a Stanford University study that found a 6 percent drop in calorie consumption at the city's Starbucks. (A similar provision was put forth by healthcare reformers.) Small pilot exercise initiatives such as AARP's 10-week walking program geared to those over 50 simply aren't widespread enough to have much of an effect. What the country needs, Rother says, are big national changes. The healthcare reform legislation sets aside $1 billion for obesity prevention programs; another potential weapon is a "sin tax" on soda, candy bars, and chips. A recent analysis published in the New England Journal of Medicine showed that adding a 1-cent-per-ounce tax on sugar-sweetened beverages could generate $14.9 billion in the first year alone for obesity prevention even as it theoretically encourages folks to drink fewer calories.
Independence. The ultimate goal of all these efforts is to keep the elderly living independently for as long as possible. Traditionally, many well-heeled seniors have turned to one of more than 2,000 continuing-care retirement communities, which charge an entry fee ranging from $70,000 to several million dollars as well as monthly fees to cover housing, transportation, meals, and nursing care for the rest of their lives (the entry fee is partially refunded to heirs when a resident dies). Now, those who don't have the money or desire to move are increasingly creating their own communities. In New York and a few other states, about 300 apartment complexes and communities with high concentrations of seniors have been transformed into "naturally occurring retirement communities" that provide residents with financial planning services, meal deliveries, disease-prevention programs, and other services. Elsewhere, seniors have organized "intentional communities" in their own neighborhoods, co-ops that provide discounted home repair services, social activities, home nursing care, and a community of friends for an annual membership fee of around $800. To date, 48 are up and running, from Palo Alto, Calif., to Boston, and an additional 80 are planned for the next year. Geraldine Zetzel, 82, knows she can simply call the office staff of Cambridge at Home, a co-op she helped found three years ago in her hometown of Cambridge, Mass., whenever she needs, say, a recommendation for a personal trainer to alleviate her hip bursitis or a tree trimmer. And the social activities, like her poetry group and art museum outings, are a big plus. "I've met neighbors that I never knew in my 40 years living here," she marvels. (They may be invited to a reading when Zetzel's first book of poetry is published this winter.)
While these villages may seem utopian, they don't address the exorbitant cost of serious long-term care, which now averages $70,000 a year in a nursing home. The government currently foots the bill for citizens without savings who qualify for Medicaid, costs projected to double to $90 billion a year by 2030. A federal law passed in 2006 has had some success in getting low-income nursing home residents back into independent living by allowing coverage for home healthcare services and subsidizing adaptations to houses and apartments. At NewCourtland Square in Philadelphia, which opened in December 2008 with 26 subsidized apartments designed for former nursing-home residents, every unit is outfitted with a state-of-the-art monitoring system that will alert a staff member if, say, a resident hasn't gotten out of bed that morning or has been in the bathtub for too long. But residents make their own meals and bathe themselves, paying an average of just $218 per month in rent. "I'm feeling the best I've felt in a long time," says Jesse Carter, 68, who moved into NewCourtland from a nursing home six months ago after becoming dependent on a wheelchair because of a painful nerve condition. "I can go wherever I want to go," he says, but he can also call for assistance if he needs it.