A new report from the Robert Wood Johnson Foundation finds that “adult obesity rates increased in 28 states in the past year, and declined only in the District of Columbia.” And “more than two-thirds of states (38) have adult obesity rates above 25 percent,” a figure practically unheard of 20 years ago when “no state had an obesity rate above 20 percent.” Other key findings:

- Adult obesity rates for Blacks topped 40 percent in nine states, 35 percent in 34 states, and 30 percent in 43 states and D.C. Rates of adult obesity for Latinos were above 35 percent in two states (North Dakota and Tennessee) and at 30 percent and above in 19 states. No state had rates of adult obesity above 35 percent for Whites. Only one state-West Virginia-had an adult obesity rate for Whites greater than 30 percent.

- The number of states where adult obesity rates exceed 30 percent doubled in the past year, from four to eight –Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee and West Virginia.

- Ten of the 11 states with the highest rates of diabetes are in the South, as are the 10 states with the highest rates of hypertension. Northeastern and Western states had the lowest adult obesity rates; Colorado remained the lowest at 19.1 percent.

Look at their colorful map of childhood obesity rates (which is interactive on their website):

The report also finds that the public is fairly receptive to using taxpayer dollars to help bring down obesity rates. For instance, 56% says that “a comprehensive program to combat childhood obesity is worth the financial investment, even if it would increase government spending by billions of dollars a year (and this during a difficult economic period in which many voters have been hesitant to support more government spending).” (The very same ‘difficult economic period’ that may have pushed some consumers towards cheaper and less healthy foods). Fifty-eight percent believe preventing childhood obesity is “a very important” priority.

This all sounds good, but it’s easy to support general obesity reduction efforts that don’t have any specific proposals or cost estimates attached to them — particularly when you see the whole thing as someone else’s fault. The survey also found that 84% of parents believe their children are at a healthy weight, “but research shows nearly one-third of children and teens are obese or overweight.”

The city of San Francisco requires employers with “at least 20 workers that do not provide health care” to “give part of each employee’s wages to the city as a fee to help pay for the $200 million program.” The mandate is part of the city’s Healthy San Francisco program, which like national reform, seeks to expand universal coverage to lower income Americans.

For the last four years, the requirement has been the subject of a legal battle, with business groups accusing the City of overstepping its authority and violating the federal Employee Retirement Income Security Act (ERISA). The 9th U.S. Circuit Court of Appeals in San Francisco had ruled in favor of the city and yesterday the Supreme Court refused to take up the case, effectively preserving the City’s mandate. As Emma Sandoe observes, the decision marked an important victory not just for the city, but also for local rights and authority:

The fact that the Court defended state law over federal restrictions does not hurt the proponents of health reform and the constitutionality of national reform.  These are separate questions on federal versus state powers.  In fact, a repeal of the San Francisco employer mandate would have hurt the case for the Attorney Generals.  It would have been a blow to the health insurance regulatory power of the states, in favor of federal law. So in this case, conservatives hoping for a repeal of health reform should have been rooting for San Francisco. I imagine that image does not appear likely.

In other words, if the Supreme Court had accepted the case and then ruled that the power to mandate employers to pay a fee for failing to provide health insurance coverage rested with the federal government, it could have bolstered the fed’s standing in the cases challenging the individual insurance mandate.

The other point worth noting — and this is what makes this case so uncomfortable for conservatives — is that in San Francisco, the employer mandate has not resulted in the kind of job loss that Republicans are pinning on national reform’s far more limited free-rider requirements. Some restaurants have added “a four percent health care surcharge on menus” but there is no evidence that the provision is adversely affecting employment. In fact, “Neighborhood restaurants, where restaurants tend to be affordable and supported by locals, have generally received pretty good acceptance of the program,” while “restaurants in tourist and business travel areas are getting a lot more negative push-back.” Even so, they have not reported a decline in sales.

Ian Millhiser argues that during the first day of Elena Kagan’s Senate confirmation hearing, conservatives tried to paint her as a “judicial activist” and if they can convince her to overturn the health care law, then she will be. Republicans have made the nomination’s view of the individual health insurance mandate a litmus test and are expected to ask Kagan if she believes Congress has the authority to impose an individual mandate under its authority to regulate interstate commerce. As Sy Lazarus argues in today’s Politico, the GOP’s preferred answer would have the effect of reversing years of precedent and lead to some very far-ranging ramifications:

Technically, the cases challenge just the health reform law. But the radical legal theories they advance can extend much further. If accepted by the Supreme Court, these theories could shatter the constitutional foundations of landmark programs like Social Security, Medicare, civil rights and environmental protections. [...]

Sessions and other Republican Senate leaders recently disavowed Rand Paul’s distaste for half-century-old Civil Rights Act protections. But the health reform lawsuits they support, in effect, comprise a second front in which Paul and his libertarian allies hope to bypass the political majorities that overwhelmingly oppose their rollback agenda.

Legal experts, including prominent conservatives, scoff at the merits of Cuccinelli’s case and of Florida Attorney General Bill McCollum’s similar challenge on behalf of 20 other Republican top state lawyers. Yet if the Supreme Court’s right-leaning majority grants the opponents’ claims, or any part of them, then challenges might be filed against other major statutes.

Logically, the next domino targeted could be the guarantees against private discrimination that Paul discussed. For the legal argument devised to strike down health reform could, if accepted, imperil those other laws..

In other words, redefining how the Supreme Court has interpreted Congress’ authority under the commerce clause would bring about the very kind of activism conservatives condemned during the first day of hearings.