Sunday, November 28, 2010

The Costs of Obesity

Two recent studies try to determine the costs associated with a population that seems intent on growing ever more obese. The Congressional Budget Office issued a report: How Does Obesity in Adults Affect Spending on Health Care? This report was focused on costs incurred by the nation. A second study by George Washington University addressed costs in the context of the obese individual.

The CBO presented this summary statement.
“Over the past two decades, the adult population in the United States has, on average, become much heavier. From 1987 to 2007, the fraction of adults who were overweight or obese increased from 44 percent to 63 percent; almost two-thirds of the adult population now falls into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13 percent to 28 percent. That sharp increase in the fraction of adults who are overweight or obese poses an important public health challenge. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension. As a result, that trend also affects spending on health care.”
This table summarized the data they had to work with.

The CBO then considered three scenarios to project health care cost forward to the year 2020. The steady state or baseline solution with obesity ratios staying constant at the 2007 values would see costs increase by 65% due to the basic trend towards increased medical costs. The second scenario assumed
“....a rising prevalence of obesity—namely, that recent trends (from 2001 to 2007) in adults’ body weight will continue. In that scenario, the prevalence of obesity would rise to 37 percent by 2020, and per capita spending would increase to $7,760—about 3 percent higher than spending in the first scenario.”
The final case assumed a reversal of the trend toward obesity, returning to the 1987 levels by 2027.
“In that scenario, the prevalence of obesity among adults would drop to 20 percent by 2020. Per capita spending would increase to $7,230 in 2020—about 4 percent lower than spending in the first scenario.”
These results were somewhat surprising in that a significant change in the health status of a large fraction of the population yielded such a small effect. Actually, the effect is not small in terms of dollars—we’re talking a swing of $100 billion here—but it is small compared to the overall inflation in medical costs.

The CBO study was limited to adults. During this time period childhood obesity increased dramatically. Data is available here.
“Among pre-school age children 2-5 years of age, obesity increased from 5 to 10.4% between 1976-1980 and 2007-2008 and from 6.5 to 19.6% among 6-11 year olds. Among adolescents aged 12-19, obesity increased from 5 to 18.1% during the same period.”

“Obese children and adolescents are at risk for health problems during their youth and as adults. For example, during their youth, obese children and adolescents are more likely to have risk factors associated with cardiovascular disease (such as high blood pressure, high cholesterol, and Type 2 diabetes) than are other children and adolescents.”

“Obese children and adolescents are more likely to become obese as adults. For example, one study found that approximately 80% of children who were overweight at aged 10–15 years were obese adults at age 25 years. Another study found that 25% of obese adults were overweight as children. The latter study also found that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe.”
This information leaves one wondering if there is not perhaps an explosion of obesity-related issues in our future that is not considered in the CBO study.

The CBO report points out that health care costs alone do not measure the cost of obesity to society. Things like life-expectancy and retirement costs would have to be considered.

The George Washington University study looks at costs from the individual’s perspective. They include the effects of wage differentials, productivity, and absenteeism, as well as health care costs, but not all related costs could be accounted for.
“The picture we have created is only a partial look at the individual costs related to obesity. Existing literature provides information on health- and work-related costs, but with the exception of fuel costs, there is no published academic research that gives us insight into consumer-related costs, such as clothing, air travel, automobile size or furniture. Anecdotal evidence suggests these costs could be significant.”
The following summary is provided.

Ignoring the study’s attempt to assign a cost to decreased life expectancy, the cost for obese women is $4,879 per year and for obese men it is $2,646. Direct medical costs are the same for each at $1,474 (consistent with the CBO report). The difference for women is mainly due to work-related factors. Obese women apparently earn considerably less than non-obese women and take more sick leave. One can only guess that this is probably more a discrimination issue than a productivity concern.

This table also hides the disparity in costs between differing levels of obesity.
“....where we were able to break down the costs by class of obesity, we found the incremental costs of morbid obesity are much higher than the incremental costs of moderate obesity. We observed this trend in direct medical costs, premature mortality, absenteeism, and fuel consumption. For example, the direct medical costs for morbid obese individuals are 3.5 times higher than the direct medical costs for moderately obese individuals. As a result, Allison (1999) estimates one-fifth of total incremental costs of obesity at the societal level are due to morbidly obese patients, although the morbidly obese comprise only 5.7% of the population (Flegal et al., 2010).”
These results indicate that while obesity is not a dominant driver in national costs, for individuals the opposite conclusion can be drawn. Obesity-related costs almost doubled for men when non-medical factors are considered; they more than tripled for women.

Obesity is a national problem, but it is a personal tragedy. We should support efforts to diminish the prevalence by encouraging healthier lifestyles.

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