Maine is one of only three states without a local public health department system. Therefore, many of our most significant public health efforts — safe drug disposal, substance abuse prevention, tobacco cessation and obesity prevention — are either implemented or coordinated through the Healthy Maine Partnerships, which are supported by tobacco settlement funds, not taxpayer dollars.

We are concerned about the current lack of state-supported public health infrastructure and baffled by the governor’s proposal to all but eliminate our already fragile public health system. As clinical and population health professionals, we know this dismantling will have grave consequences.

We already have seen the impact on employment. The Maine Center for Disease Control and Prevention and the Department of Health and Human Services, together, have 36 unfilled positions. The governor is proposing to cut 56 more, resulting in a total loss of 92 positions at two of the most important public health agencies in the state. Most of these positions are federally funded, so cutting them will not save the state money.

The impact of these losses on the health of Mainers will be even more profound than the impact on the economy.

Obesity is the most prevalent public health problem in Maine. The most recent data show that nearly 30 percent of our adult population is obese, making Maine the most obese state in the Northeast, and costing the state $453 million annually.

Obesity is associated with several other chronic health conditions, including high blood pressure, type 2 diabetes and cardiovascular disease, which can lead to drastic losses in productivity and wages, and an increased reliance on state aid. Efforts to reduce access to social safety nets, such as the Supplemental Nutrition Assistance Program, further contribute to the obesity epidemic by limiting low-income families’ access to affordable, healthful food.

Residents of rural areas are at even greater risk for chronic illness because they’re less likely to have access to affordable, healthful foods and adequate health care than Mainers living in suburban and urban areas.

Another cost of obesity is stigma. The likelihood of being bullied is 63 percent higher for obese children compared to their healthy-weight peers. Even worse, 92 percent of overweight or obese youths report being made fun of, and 85 percent are teased during physical activity. In Maine, 44 percent of our fifth-graders are classified as overweight or obese, much higher than the national average.

Obesity is a problem often characterized as a consequence of individual choice. However, medical and public health research has shown consistently that obesity is caused by the interaction of our genes with our environment.

The same way that some individuals are born with blue eyes or brown eyes, some individuals are born with a greater likelihood of storing calories instead of burning them.

Research also has shown that attributes such as friends and family, neighborhood safety, food access and walkability are strong determinants of weight status. These qualities help to explain why individuals living in wealthier communities are less likely to be diagnosed with obesity than individuals living in lower-income communities.

Collectively, medical and public health science demonstrate the complexity of obesity. So our response, as individuals, communities and health professionals, needs to be equally complex. Reversing the trend of increasing weight in Maine and the nation will require multi-tiered approaches at the individual, community and policy levels.

Effective interventions vary, from individual efforts, focusing on treatment with weight-loss medications, devices and surgeries, to community efforts, such as SNAP-Ed cooking classes and school-based running clubs, to policy levers including healthy school vending, food and beverage marketing legislation, Complete Streets policies, trans fat bans and taxes on sugar-sweetened beverages.

It does not matter who we compare ourselves to — other New England states, the national average — more Mainers are obese, and the epidemic exists at a disproportionately higher level among our most disadvantaged populations.

Successful approaches to reversing the trend of obesity in Maine must occur at a systems level — addressing population health as well as clinical interventions, and focusing, specifically, on our high-risk populations.

Restricting access to affordable, healthful food and dismantling Maine’s public health infrastructure only perpetuates the social and economic costs of obesity.

Instead, efforts should be led by strong, state-supported public health programming and legislation, ensuring that all Maine children lead long, healthy lives.

Rebecca J. Boulos, M.P.H., Ph.D., is a resident of Cape Elizabeth, and Allen J. Browne, M.D., is a resident of Falmouth.

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