A new report from Cornell University finds that obesity now accounts for almost 21% of US health care costs with a separate study finding that excess weight adding more costs to our health care than smoking. And unfortunately, the epidemic could get worse as researchers report that how we currently view obesity is incorrect – meaning more people should be classified with the condition.
The first study, published in the January issue of the Journal of Health Economics, reports that an obese person incurs medical costs that are $2,471 higher than if they were normal weight. Nationwide, that translates into $190.2 billion per year, or 20.6 percent of national health expenditures. Previous estimates had the cost of obesity at $85.7 billion, or 9.1% of health care dollars.
“Historically we’ve been underestimating the benefit of preventing and reducing obesity,” said lead author John Cawley, Cornell professor of policy analysis and management and of economics. “Obesity raises the costs of treating almost any medical condition. It adds up very quickly.”
Tobacco use has historically been the trigger for greater health care costs, prompting insurance companies to begin charging smokers more for their health premiums. However, a second study, conducted at the Mayo Clinic and published in the Journal of Occupational and Environmental Medicine, finds that obesity adds more to health care costs than smoking does.
Using data that included more than 30,000 Mayo Clinic employees and retirees between 2001 and 2007 who had continuous health insurance, both obesity and smoking were associated with excess costs. Compared to nonsmokers, average health costs were $1,275 higher for smokers. The incremental costs associated with obesity were even higher: $1,850 more than for normal-weight individuals. For those with morbid obesity, the excess costs were up to $5,500 per year.
However, this may actually underestimate true costs, since obesity is a risk factor for other chronic conditions such as cardiovascular disease, diabetes, and cancer, says James P. Moriarty MSc. Researchers with Weill-Cornell Medical Center say that the obesity rate (and therefore costs) could go up even further if body fat was measured instead of the current standard – body mass index, or BMI.
About 39% of all Americans who are currently classified as slightly overweight should actually be called “obese” say researchers Eric R. Braverman MD and Nirav R. Shah MD MPH. They say that using a more accurate method of measuring body fat is the dual-energy X-ray absorptiometry (DXA) scan which measure muscle mass, bone density and body fat. But unfortunately, such methods are costly for general screening use
BMI is a cheap, easy way to measure excess body weight for a person’s height, but perhaps the scale should be adjusted to more accurately reflect those outside of the normal range. Drs. Braverman and Shah suggest that a better cut off point for obesity might be 28 for adult males and 24 for adult females (instead of 30 for both).
Measuring blood levels of leptin is another method that could be added to BMI screening to provide a better assessment of weight status. Leptin is a hormone produced by fat cells that regulates hunger and energy expenditure. Increased levels correlated well with DXA screens and the test is not expensive to obtain.
All of the above research provides evidence that something needs to be done to better promote obesity prevention. “Fat is costing the country a fortune,” concludes Dr. Braverman.
- John Cawley, Chad Meyerhoefer. The medical care costs of obesity: An instrumental variables approach. Journal of Health Economics, 2012; 31 (1): 219. DOI:10.1016/j.jhealeco.2011.10.003
- Shah NR, Braverman ER (2012) Measuring Adiposity in Patients: The Utility of Body Mass Index (BMI), Percent Body Fat, and Leptin. PLoS ONE 7(4):e33308. doi:10.1371/journal.pone.0033308
- James P. Moriarty, Megan E. Branda, Kerry D. Olsen, Nilay D. Shah, Bijan J. Borah, Amy E. Wagie, Jason S. Egginton, James M. Naessens. The Effects of Incremental Costs of Smoking and Obesity on Health Care Costs Among Adults. Journal of Occupational and Environmental Medicine, 2012; 54 (3): 286 DOI:10.1097/JOM.0b013e318246f1f4