Since I was inspired by Dr. Berry to tackle a complex problem I was losing sleep last night about the question of obesity. In recent years Americans have been getting progressively fatter. This is nicely illustrated in the following map. The resulting complications of obesity are higher likelihood of diabetes, hypertension, coronary artery disease, and ultimately chronic heart failure – the big chronic diseases that people should be afraid of. The government pays for care of a lot of the obese with chronic conditions through Medicare and Medicaid so it strikes me that getting obesity under control in America would be a very good and strategic thing. Here are some thoughts on potential solutions that I could come-up with.

1. Exercise is not in the current American way of life, especially for men with slight to major obesity. These people aren’t really marketed exercise as either an activity or a product. Gyms currently target healthy fit people who want to improve performance or go the extra 10% because those people seem to be the folks who will sign-up for long-term gym memberships and keep paying for them over time. For the fatter people they need to show-up at the gym once in a blue moon and then are self-conscious and decide not to risk more embarrassment in sweat suits. The only marketing I can see really targeting obese men is Subway and that’s for eating sandwiches not exercise BUT was very successful. I am also thinking along the lines of the Netflix guys who basically started the company because the founder hated late fees on videos. It bugged him so he started Netflix. On my end I hate the fact that I pay for the gym even though I don’t show-up. So my concept is for a gym that was focused on weight loss and that charges members based on usage rather than membership periods. The system might even be able to provide pay for performance fees to pay for additional weight loss over a period of time for people with a BMI over a certain number. This would align the incentives of the trainers and the folks visiting the gym so that the trainers would need to work for the core hope that the people investing in the exercise would find. Secondarily I think the pay for performance gym could also be tied into insurer policies and workplace health initiatives better than the monthly memberships. In a measured membership system you could only get the benefits FREE if you meet your usage quota. This would reward use and discourage non-use. But it would still allow the individual to choose to pay if all they were going to use was a small amount of the service. It’s my contention that people who currently subscribe to big name gyms like BSC (Boston Sports Clubs) could be wooed away from these with a different and disruptive business model. The one above may not be right but the right one could be worked out by delivering a service and taking care to integrate feedback in terms of how people spend their dollars and what they are looking for in a new service. The investment into the market is a good timing. Look at the map. The obese are a growing market and they are huge.

2. There must be a pill that can safely suppress people’s appetites. The gastric bypass surgeries have been thought to limit hunger not necessarily by making the stomach smaller but by disrupting the primitive nervous system of the gut which is the predecessor to the more advanced nervous system of the brain. If marijuana can give you the munchies and folks on heroin don’t need to eat for days then there must be something in between that has a focused effect on just hunger/satiation. Let’s finally find this thing and give it to people so that they aren’t hungry all the time. It could make lots of money as a blockbuster drug too. Hopefully the drug isn’t nicotine.

3. Our culture is sick. One physician I met with at a conference of medical informatics executives let me know that we often confuse healthcare problems with health problems. A healthcare problem relates to how we care for diabetics. A health problem is that people despite it being bad for them continue to get obese and cause their risk for diabetes to get dangerously high. In other countries this isn’t happening. Folks in Europe despite having access to unlimited food like we do have been able to keep their weights in check because they culturally have a healthy lifestyle involving exercise and portion control (and some would say smoking). To fix our culture will take some overhauls somewhere but some ideas would be to bring health into the workplace as an issue just like we bring health insurance into the workplace. The two are connected. I went to a company a few years back that was founded by a man very into health and he had a large gym at the center of his building. It sounds stupid but having corporate sponsored gyms built into campuses and planned during working hours sporting events could be very helpful for employees. While productivity may go down the benefits would be to have lower long term health costs and better strength and conditioning in employees that could lead to better performance mentally and physically. Another option would be a national health initiative to build thousands of facilities for people to exercise more readily. Build more parks for kids. Have more little leagues sponsored by the Federal and local governments. I’d rather pay for sports than for dialysis, heart surgeries, and gastric bypasses.

4. Let’s figure out why people are obese in America rather than figure out that they are becoming more obese. Someone should pay for this research and figure out the answers to the top questions: Why are American’s becoming more obese? Which American’s are becoming more obese? Are any American population segments becoming less obese? Are there any factors in recovering from obesity to become non-obese? Can these factors be promoted? Is that guy from Freakanomics just going to tell us that we weren't measuring anything other than that the baby boomers are getting older so the whole population is getting fatter showing the whole obesity trend is a hoax? If we figured out some causes and scientific conclusions maybe something can be done that we haven’t thought about.