Obesity in America is a staggering public health crisis, ravaging our population, hampering the quality of life for millions and wreaking fiscal havoc along the way.

We can rightly place some blame on obvious culprits we encounter every day: super-sized drinks, processed foods and obscene portion sizes. But my time as the Executive Director of the Global Obesity Prevention Center at the Johns Hopkins Bloomberg School of Public Health has led me to a more startling and less apparent conclusion: our health-care system is keeping us from turning back obesity in America.

Each year in our country, the wide variety of obesity-related diseases (ranging from muscle and joint problems to diabetes to heart disease to cancer) result in an estimated 400,000 deaths and $190 billion in health care costs—nearly 21% of all medical spending. In the past 35 years, the prevalence of obesity jumped from 15% of the population to 35%.

An epidemic with such a high impact, in terms of lives and dollars, would seem to demand a clarion call from the White House to Congress to the halls of Health and Human Services and every health-care system, major medical society, employer and insurer. Instead, we’ve seen an approach that is heavy on concern but light on coordinated action. We have no clear plan for battling the obesity epidemic that impacts tens of millions of lives in the U.S. alone.

Any discussion during the 2016 political season that centers on health-care reform, the federal budget or the economy would be incomplete without consideration of the obesity epidemic. If we’re going to move the needle of our obesity scale and create a healthier nation, we must take a closer look at reforming the health-care system itself. I blame the health-care system for three reasons:

1. Failed Incentives

Medicare and insurance reimbursement do not provide strong enough financial incentive for physicians, clinics and hospitals to focus on obesity prevention and control. The average salary of primary care physicians, who are on the front lines on preventing obesity, is less than half that of specialists such as dermatologists ($220,942 versus $471,555, based on a2013 compensation report). This disparity has been steadily widening since the early 1990s.

Primary care physicians also are overloaded and lack the time for obesity prevention. A 2004 American Journal of Public Health study found that primary physicians would require 7.4 hours a day (on top of everything else they need to do, such as diagnose and treat disease and handle paperwork) just to do all the preventive measures that the U.S. Preventive Services Task Force recommends. Since 2004 that list has grown.

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