Did you see this story in the Star Tribune? The gist is that smokers and the obese actually have less health care costs, overall, than non-obese, non-smokers.

http://www.startribune.com/lifestyle/health/15291036.html

Counterpoint to this is an article from the AP released today, 2/5/08, and printed in the StarTrib:

"Fat people, smokers cheaper to treat than long-living healthy people, study says"

http://www.startribune.com/lifestyle/health/15291036.html

I just read the interesting suggestion that the society-wide decrease in sleep is a major factor in the society-wide increase in obesity. (It was in the book Sex Sleep Eat Drink Dream: A Day in the Life of Your Body, by Jennifer Ackerman)

I agree Victoria that sleep does seem to be an issue. (When I fall behind I tend to gain weight more easily.)

Also -- I tried talking to Julie Sonier, an expert on healthcare data a the MN Dept. of Health and a member. She thought the data coming out of the studies on obesity and cost savings were dubious, but hadn't looked closely at them. She agreed that these studies often don't look at issues like lost productivity.

And this week there is news that the State Parks have seen a drop in visitors; people are too time stressed to go to the parks, apparently.

Factors I suspect are involved in the rise of obesity:
- high stress levels; "always on" (blackberries, pagers, phones) stress leads to snacking/overeating
- work that is not physical for most people (desks, meetings, computers)
- sharp and persistent rise in carbohydrates in our diets

It shold be obvious (despite previous posts) that healthier people need less medical care. But the singular emphasis on smoking/obesity misses the fact that the US spends more on trauma care each year than on heart disease (Robt Wood Johnson Fd). Let's make a real dent and take on trauma as a preventable cause of high health care costs.