COLUMBIA -- South Carolina has one of the highest obesity rates in the country, a growing problem that leaves many with multiple medical problems and costs the state more than $1 billion each year.

Still, the state invests virtually nothing in direct intervention and prevention outside of public schools. And the amount the state does invest has dropped even more with the recession.

Obesity runs up the cost of health care by causing diabetes, heart attacks, strokes and other related diseases. Obesity ultimately leads to early deaths, contributes to a less productive workforce and inhibits the earning potential of South Carolina employees.

Health care officials praise efforts in the public schools to create healthier habits in students, but they say that's part of a long-term solution to a current health crisis that involves one out of every three South Carolinians. It's a crisis that demands attention now, advocates say.

The argument from many is that government should help deter bad habits, perhaps with public relations campaigns such as those aimed at curbing smoking. A more direct approach would be using pocketbook methods, such as taxing sugary sodas or charging obese state workers more for insurance. Other proposed methods include paying for weight loss surgery and creating more outdoor exercise spots like the pedestrian lane on the Ravenel bridge.

Many think that personal responsibility is the key to reversing South Carolina's obesity rate, which is 13th-highest in the nation. But Republican Rep. Tracy Edge of North Myrtle Beach points out that the state is already on the hook to pay for the consequences for those who don't take personal responsibility or can't overcome obesity.

"I didn't write the rules," Edge said. "If we're going to be held responsible for paying the health care bills of some of these people then it is up to us to provide money for prevention."

Joseph Nadglowski, president of the Obesity Action Coalition, said South Carolina's investment in obesity prevention and intervention compares to other states -- but to lower the number of people who are overweight and obese, the country has got to start doing more.

"The approach taken to date is to blame individuals, penalize them and leave them struggling to access help because 'it's all their fault,' " Nadglowski said. "Obviously, (that) hasn't worked."

Obesity is not a lifestyle choice but a complicated medical and societal problem, he said. Decisions made by legislators influence lifestyles and can give people an honest chance of improving their health.

"We are all not lazy, poorly disciplined or people trying to milk the system," Nadglowski said.

Government investment or not?

Edge, who writes the first version of the state's budget for health care, said paying for obesity intervention and prevention with tax dollars is not a hard sell, even in the GOP-controlled Legislature. Lawmakers can see a direct correlation between money spent on helping people become healthier and lower Medicaid bills, he said.

Edge said the state had begun putting direct dollars in programs to combat the state's nearly 30 percent rate of obesity, but those dollars went away when the economy tanked.

"I hate that," he said. "You feel like you made progress. Now, all of sudden all that progress has been reversed."

The most significant initiatives outside of public schools that exist in South Carolina to address obesity are the division of Nutrition, Physical Activity and Obesity at the state Department of Health and Environmental Control and the South Carolina Eat Smart Move More Coalition. Neither entity received any direct state dollars this year.

The obesity division in the state Health Department runs on $750,000 from the federal government, and directs $170,000 of that cash to the coalition to keep it operating.

For years, the Health Department has asked the Legislature for money to help people lose weight and stop them from gaining it. Most of the requests were denied.

But when the economy was strong, the state did provide money to address obesity- related matters, such as $500,000 in 2008 to treat patients with diabetes in the Lowcountry and Pee Dee and help them manage the disease.

Among the only obesity-related funding from the state this year -- if not the only direct funding -- is $26.3 million for public school gym teachers and nurses and $2.4 million for a controversial pilot program to pay for 100 obese state workers to receive weight loss surgery.

Money put in public schools to help kids stay healthy has been scaled back since 2005 when the Legislature passed the Student Health and Fitness Act, introduced by House Speaker Bobby Harrell, a Charleston Republican. The goal was to reduce the number of children who are overweight and obese, in part by putting more physical education teachers and nurses in elementary schools.

The schools also are preparing more baked items rather than fried and offering more fruits and vegetables.

But those direct dollars are a fraction of the more than $1 billion in obesity-related medical costs that tax the state each year, officials said.

Obesity is the leading cause of chronic illness in the country, but Dr. Patrick M. O'Neil, said the impact that weight has on the lives of South Carolinians is also measured in others ways.

O'Neil, director of the Medical University of South Carolina Weight Management Center, said obese people are less likely to be hired and more likely to earn less than their peers. Obesity also costs the state in the loss of productivity, he said.

Indirect investments

Still, Erika Kirby, director of the Health Department's obesity division, said any direct dollars government puts into the cause are multiplied with indirect investments. State government works together with outside partners to increase access to healthy foods and safe places for people to be active, she said. For example, the farmer's market in Kershaw County now accepts food stamp cards.

Two significant indirect investments to combat obesity are in research and outreach performed by the Arnold School of Public Health at the University of South Carolina, a state-supported school, and the partnership between state agencies and the Eat Smart Move More Coalition.

The state also has an official obesity action plan, developed in 2005 to meet a federal funding requirement. The plan has long-range goals such as lowering the cost of treating chronic diseases and increasing the number of people at healthy weights. The Health Department monitors the changes that affect obesity, but officials say it will be years before the state sees a significant change to really know if the multiple undertakings have worked.

Government can't do it all

The Rev. Joe Darby, pastor of Morris Brown AME Church and vice president of the Charleston chapter of the National Association for the Advancement of Colored People, said churches and the federal government are among the entities that have stepped up to address the matter. For instance, Darby's church received a $20,000 federal grant to offer a fitness program for seniors that also helps them eat healthier.

But those efforts aren't enough and the state must do more, Darby said.

Russell Pate, a professor at Arnold School of Public Health and the director of the Children's Physical Activity Research Group, said South Carolina is not alone in under-investing programs to combat obesity. Even so, what the state has invested is trivial compared to the problem, he said.

"I think there is absolutely a need for government leadership on this issue," Pate said. "That does not in any (way) absolve parents and school leaders to do what they need to help address this issue.

"I don't think that government investment alone can be expected to solve the problem, but I think government leadership will be important."

By the numbers

65.8 percent: The rate of South Carolina adults who are overweight or obese in 2008, a rate that has doubled since 1990.

One-third: The percentage of high school students who are overweight or obese.

29.4 percent: The rate of obesity in South Carolina adults in 2009. That's compared with 18.6 percent in Colorado, which had the lowest percentage of obese adults.

More than $1 billion: The annual amount obesity costs the state for medical treatment. Spending reached $1 billion in 2003 and has continued to rise since then.

2nd: The rate obesity ranks nationally for leading causes of unnecessary deaths.

$1,429: The extra money per year obese individuals spend in medical costs above the costs for a person of normal weight.

Defining obesity

For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the 'body mass index' (BMI). BMI is used because, for most people, it correlates with their amount of body fat.

Overweight: An adult who has a BMI between 25 and 29.9 is considered overweight.

Obese: An adult who has a BMI of 30 or higher is considered obese.

See the following table for an example.

Height Weight Range BMI Considered

5' 9' 124 lbs or less Below 18.5 Underweight

125 lbs to 168 lbs 18.5 to 24.9 Healthy weight

169 lbs to 202 lbs 25.0 to 29.9 Overweight

203 lbs or more 30 or higher Obese

Source: Centers for Desease Control

Reach Yvonne Wenger at 803-926-7855 or ywenger@postandcourier.com.