Less than two decades ago, in the early 1990s, only 2 to 3 percent of Americans considered obesity to be a major health problem.

Then along came the 2001 publication of the U.S. Surgeon General’s report on the obesity “epidemic” as well as a slew of related studies and reports, and the percentage of Americans for whom obesity became a major health issue skyrocketed — to 67 percent by 2006.

A study published Monday by the journal Health Affairs will undoubtedly raise that percentage even higher. It found that the medical costs of an obese person averages $1,400 more each year than for someone of normal weight. That’s roughly 42 percent higher.

Overall, obesity-related health spending has doubled from what it was a decade ago — to an annual cost of $147 billion. That’s 9.1 percent of all medical spending in the United States, up from 6.5 percent a decade ago. The money is mostly spent not on helping people reduce their weight, but on chronic conditions that are more common among the overweight, such as diabetes and heart disease, the study reported. The leading driver of those excess costs: prescription drugs.

What to do about it?
The numbers from this study, along with the somber fact that two-thirds of Americans are now either overweight or obese, will undoubtedly feed the current debate over the rising cost of medicine and, more importantly, what we should do about it.

But what should we do about the obesity part of it?

On Monday, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, outlined his ideas at his agency’s first conference on obesity prevention and control.

Wrote Lauren Neergaard, who covered the speech for the Associated Press:

Whether the public will go along with those strategies remains to be seen. But according to intriguing research published by the Yale School of Public Health earlier this year, much will depend on what we perceive (or are told) are the causes of America’s growing weight problem.

Blaming
The Yale study found that an individual’s personal beliefs about why people become obese help predict which public policies that person will support to fix the problem.

For example, if you agree with Frieden and view obesity mostly as the consequence of external, societal factors out of an individual’s control — such as the lack of healthful, affordable food in certain neighborhoods — you’re likely to support government efforts to devise new policies and programs that address those factors.

But if you see obesity as a matter of personal responsibility and liken it to other “bad” or “sinful” behaviors (say, sloth and gluttony), you’re less likely to back public anti-obesity policies — except for supporting a policy that would require people who are overweight or who refuse to exercise to pay higher health-insurance premiums.

Interestingly, the study found that political ideology (conservative, moderate, liberal, Republican, Democrat, Independent) was not a key predictor of whether people would support government intervention to combat obesity — except when it came to policies that increased taxes.

Another surprise was that people’s own personal health status, including whether they were themselves overweight or obese, failed to play much of a role in their support or nonsupport of various obesity policies.

Framing
So, how we tackle the rising costs and health dangers of obesity may depend, as it does with so many other issues, on how the problem is framed. Here's the Yale researchers' description of the two most probable framing approaches:

As the debate over health reform continues, see if you can tell who’s winning this particular framing-of-the-issue struggle. It might be a clue as to who’s ahead on the broader issue of health-care reform.