We all know how it works: There’s the healthcare debate going on in Washington, which is almost impossible to follow.

Then there’s real life. In real life, there are millions of Americans who are badly overweight. They are obese. They know about the struggle. They are very aware of the high cost to their own lives.

Tonight, someone has finally put a price tag on the cost of obesity to this country and this is part of the healthcare debate going on right now.

This time the experts are raising the alarm about our ever fatter nation by focusing on cost, in a new partnership between former President Clinton’s foundation and the CDC.

A report out today concludes America now spends an alarming $147 billion a year on obesity related health care. Type 2 diabetes is by far the most costly fat -related disease but overweight also increases the risk of heart disease, cancer and many other ailments. The report concludes that an obese person spends $1,400 more a year in health costs on average, compared to someone whose normal weight.

Why have Americans gained so much weight in the past decade?

Thirteen-year-old William Miles is working to change his environment. He gets medical care thorough Medicaid. Last year, when his mom Ann took him to his primary care doctor and got bad news; he was so overweight that he was pre-diabetic and had high cholesterol.

The doctor enrolled him in what is called the Children’s Healthy Lifestyle Program. Run by Duke University and paid by Medicaid, it is teaching him to spend less time with video games and TV, more time exercising, and mom is learning to stock the house with healthy foods.

“We just decided to do it as a family and I think that will motivate all of us to lose weight and eat great.”