WASHINGTON (The New York Times News Service) -- Obesity is the elephant in the room of health care reform, a public health catastrophe that kills well over 100,000 Americans a year.

It costs the country $147 billion a year in health care for overweight adults and promises to shorten U.S. life expectancy for the first time since the Civil War.

Whatever Washington does this year to try to lower medical spending almost certainly will be swamped by the nation's rising weight. Obesity lurks behind the top chronic illnesses -- heart disease, diabetes, stroke and colon, breast and prostate cancers, among many others. Treatment of each individual case routinely costs hundreds of thousands of dollars.

In two decades the obesity rate has more than doubled.

Obesity strikes hardest at the poor and minorities; black women are nearly 40 percent more likely to contract heart disease than white women. Every third child born in 2000 is likely to wind up diabetic. Two out of three American adults are overweight or obese.

Southern and Appalachian states are Ground Zero for the obesity epidemic. The nation's fattest states are Mississippi, Alabama and West Virginia, according to the federal Centers for Disease Control. The thinnest states are Colorado, Massachusetts and Connecticut.

But the problem is significant and growing in all 50 states.

Obesity is causing "death and illness on a massive scale," according to a new study by University of Virginia and Urban Institute researchers. But the United States also is feeling a rapidly escalating economic burden directly related to the obesity epidemic.

"Rising obesity rates are increasing health care expenditures per person in a way that is going to be very difficult to finance," said Jay Bhattacharya, a doctor and health economist at Stanford University's Center for Primary Care and Outcomes Research. "Unless there is some vast improvement in the efficiency of the health care system -- and I mean vast -- we're going to be spending a lot more just because a lot more people will have diabetes" and other obesity-related diseases.

Prevention is the only cure. Yet while health care legislation in Congress would increase spending on prevention of chronic disease, it does little to tackle the underlying obesity epidemic directly; in fact, most of the bills are silent on what many contend would be one of the most effective weapons: a tax on soda.

Junk food taxes are part of a growing consensus among public health experts to adapt the successful fight against tobacco to the more complex obesity epidemic. States around the country have created commissions to battle obesity. Legislatures have taken varied approaches.

Connecticut, for example, adopted stricter nutritional standards for school lunches. New York now requires school districts to report on students' Body Mass Index and weight status reports as part of student health appraisals in Kindergarten, 2nd, 4th, 7th and 10th grades.

The California legislature, with the blessing of body-builder Gov. Arnold Schwarzenegger, has mandated calorie labeling on chain-restaurant menus. And Texas has launched "Bringing Healthy Back," which sends money to communities for vegetable gardens and worksite wellness programs and to hospitals to make them baby-friendly so more mothers will breastfeed -- a proven way to reduce the risk of obesity in children.

But most attention is focusing on Washington, where Congress is struggling to craft comprehensive health-reform legislation. New York Sen. Kirsten Gillibrand plans to introduce the Lowering Urban Nutrition Costs for Healthy Eating at Schools (LUNCHES) Act to make free and nutritious meals more accessible to students. Also, the New York city council is organizing urban leaders from across the country to help lobby Congress for improvements to the Child Nutrition Act.

"As Congress debates how to improve health care access and lower health care costs, we must also pursue a strategy to tackle childhood obesity and improve the health of our future generations," said Gillibrand, a first-term Democrat.

Anti-obesity activists also encourage an emphasis on physical activity among children. Republicans on the U.S. House Energy and Commerce Committee, however, mocked proposed jungle gyms and bike trails in health reform legislation, yet studies show such efforts help.

"It doesn't sound crazy if you start looking at the causes of the problem," said Kelly Brownell, an obesity researcher at Yale University's Rudd Center for Food Policy and Obesity. "In poor neighborhoods there is low access to healthy foods, high access to calorie-dense, nutrient-poor foods, and when healthy foods are available, they're more expensive."

The same holds for physical activity, where crime, poor facilities and parents working multiple jobs limit opportunities for safe play. "You put all this together," Brownell said, "and you have a picture that is maximizing calorie intake and minimizing calorie output, and there's your recipe for obesity."

Life expectancy in the nation, rising since the Civil War to nearly 78 years old now, could be halted or even rolled back as a result of Americans' weight gain and the chronic diseases that accompany it, many experts believe.

The obesity problem took hold in just one generation, a stunningly short period in the history of public health.

"We know exactly what to do about the obesity epidemic," said Harold Goldstein, executive director of the California Center for Public Health Advocacy. "Every successful public health movement, whether it was sanitation or air pollution or drunk driving or tobacco, has shown that people can only be healthy if there are policies in place that support them in making healthy choices."

Imagine a vast national experiment to encourage weight gain, he said.

"We put fast food on every corner, we put junk food in schools, we got rid of PE, we put candy and soda at the checkout stand of every retail outlet you can think of," he said. "The results are in. It worked."

Obesity statistics

If current trends continue, in six years, 40 percent of adults will be obese.

Sixty-six percent of Americans are overweight or obese.

Obesity rates have doubled among adults within the last generation, and quadrupled among children.

U.S. obesity-related medical spending: $147 billion in 2008; over ten years, with rising health care costs, that translates to $2.1 trillion.

Per capita medical spending for the obese was 42 percent or $1429 higher than for a normal weight person.

After age 70, medical costs are $39,000 higher.

Sources: Government, academic and research institute reports.

Copyright 2009 The New York Times News Service. All rights reserved.