Illustration by Darren Gygi
Back in 1975, Minnesota was the first state to adopt a Clean Indoor Air Act, launching anti-smoking efforts that put us at the cutting edge of tobacco control. Now Minnesota is at the forefront of preventing another epidemic—obesity—using a uniquely granular, data-driven approach to fighting fat.
In spite of Minnesota’s leadership, the state still has a long way to go. We can pat ourselves on the back that obesity is not as bad here as in other states, says Lisa Harnack, co-director of the University of Minnesota’s Obesity Prevention Center, but our rates are still plenty alarming. Some 27.6 percent of us are in the Body Mass Index range defined as obese (the national rate is nearly 35 percent). That’s an increase from 15.3 percent in 1995.
The payoff in reducing Body Mass Index is significant. By one estimate, dropping the average BMI in the state by five percent could lead to savings of more than $4 billion in health care costs over the next decade. It’s an “all hands on deck” situation, says Julie Myhre, director of Minnesota’s Statewide Health Improvement Program (SHIP). “Stabilizing is the first step,” she says. The state’s been ranked fourth for “overall health,” due in part to the fact that, in recent years, Minnesota’s average BMI numbers haven’t gone up.
Public awareness and health measures by the federal government, the Minnesota Department of Health, and private employers have all contributed to this limited success. But as with any behavioral health issue, it’s difficult to sort out what changes are most effective.
Clues lie in what Minnesota is doing differently than other states. The SHIP program is unique in that it gives grants (currently totaling $27. 2 million) directly to local communities to implement obesity prevention strategies. Knowing what works on a reservation in Beltrami County may not help a suburb of St. Paul. No other state is tackling the problem at such a micro level.
This year, the MDH is banking that more data will help pinpoint exactly what is working, and where, when every county in Minnesota starts tracking its own obesity data. The new system will allow local SHIP programs to hone in on whether it would be more helpful to add exercise opportunities for kids, or access to fresh produce, for example.
Another difference seems obvious, but some mandates nationwide have ignored it: following evidence-based best practices. Take menu labeling. An analysis by Harnack showed that calories on restaurant menus don’t tend to impact what people order, making it unlikely that an effort to post nutrition information would gain much traction here (while the FDA will require restaurant chains include this data on menus by the end of this year, such measures in New York and Seattle have seen little impact).
In Minnesota, interventions that tend to get implemented rely on research and trials. One pilot SHIP program is measuring how giving kids more chances to exercise will impact everything from fitness levels to classroom behavior to test scores. When the two-year program in 14 schools across central and northern Minnesota ends this summer, MDH researchers will analyze the data to determine whether the program should be replicated at other schools.
Many in the field are hopeful that a granular approach will make a big impact on the macro level. Since excess weight has been linked to an increased likelihood of a multiplicity of health issues, including type 2 diabetes, heart disease, stroke, and some cancers, the reduction of obesity, and the demands it places on the system, is essential to healthcare reform.