Contents
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Obesity:
Facts, Figures, Guidelines
Section One - Continued
THE ECONOMIC COSTS OF OBESITY
There have been numerous estimates of the economic costs of overweight and
obesity. Among the most frequently cited are the direct and indirect health
care costs calculated by Wolf and Colditz and published in Obesity Research
in 1998 (69). The researchers based their estimates on weighted data from
the 1988 and 1994 National Health Interview Surveys, inflating the results
to reflect 1995 dollars. These estimates were those utilized by the National
Institutes of Health at the time this report was undertaken.
To estimate health care costs attributable to obesity, Wolf and Colditz used a prevalence-based approach including the obesity-related diseases of type 2 diabetes, coronary heart disease, hypertension, gallbladder disease, colon, breast, and endometrial cancers, and osteoarthritis. The total costs of each of these diseases to the economy were divided among direct medical costs (i.e., preventive, diagnostic, and treatment services such as personal health care, physician visits, hospital care, medications, nursing home care, and the like) and indirect health care costs (i.e., costs resulting from a reduction or cessation of productivity due to disease such as lost wages, lost future earnings, etc.).
The total cost of overweight and obesity to the U.S. economy in 1995 dollars was $99.2 billion, approximately $51.6 billion in direct costs and $47.6 billion in indirect costs. By disease, the authors estimated the following breakdowns:
- Type 2 diabetes: $63.1 billion
direct cost: $32.4 billion
indirect cost: $30.7 billion - coronary heart disease: $7.0 billion (direct cost)
- colon cancer: $2.8 billion
direct cost: $1 billion
indirect cost: $1.8 billion - post-menopausal breast cancer: $2.3 billion
direct cost: $840 million
indirect cost: $1.5 billion
- endometrial cancer: $790 million
direct cost: $286 million
indirect cost: $504 million - hypertension: $3.2 billion (direct cost)
- osteoarthritis: $17.2 billion
direct cost: $4.3 billion
indirect cost: $12.9 billion
Using 1994 NHIS data, Wolf and Colditz estimated that nationally 39.3 million workdays were lost annually to obesity-related causes; in addition, obesity was responsible for 239.0 million restricted-activity days, 89.5 million bed-days, and 62.7 million physician visits. Compared with the 1988 NHIS data, the number of restricted-activity days increased 36%, bed-days increased 28%, lost work days increased 50%, and physician visits increased by 88%.
While Wolf and Colditz estimated that the $51.6 billion in direct medical costs attributable to obesity represented 5.7% of total health care expenditures in 1995, researchers from Columbia University have recently refuted their statistics, estimating direct health care costs at approximately $39 billion, or 4.3% of total annual U.S. health care expenditures (70). They point out that the higher mortality rates of obese persons decrease direct medical costs; because of this, however, the indirect costs of obesity may be larger than originally estimated due to lost productivity.
Two related studies have been conducted using data from Kaiser Permanente, a large health maintenance organization operating in nine states and the District of Columbia at the time of this report. In a 1993 analysis by Quesenberry et al. of cost and service utilization of 17,118 members of Kaiser Permanente, Northern California Region, significant associations were found between having a BMI of 30 or greater and higher inpatient and outpatient costs, increased physician visits, medication costs, laboratory services, and number of inpatient days (71). Total excess costs to the health plan among obese participants amounted to $220 million, or about 6% of the total outlay for all plan members.
A 1998 retrospective cohort study by Thompson et al. examined future
health care costs among 1,286 members of Kaiser Permanente Northwest who,
when surveyed in 1990, were 35 to 64 years old, had a BMI of 20 or greater,
did not smoke cigarettes, and did not have a history of cancer, AIDS,
stroke, or coronary heart disease (72). Health care costs were then tallied
for these subjects over the nine-year period from 1990-98 and compared
by 1990 BMI category (20-24.9, 25-29.9, and 30+). The researchers found
that cumulative total health care costs over the time period increased
with BMI. Total costs for subjects having BMIs of 20-24.9 were $15,583,
compared with $18,484 and $21,711 for subjects with BMIs of 25-29.9 and
30+, respectively. Higher cumulative costs were
found among obese plan members for pharmacy services, outpatient services,
and inpatient care.
Health economist Roland Sturm of the Rand Corporation compared the effects of obesity with those of smoking, heavy drinking, and poverty on chronic health conditions and health care expenditures. His results, published in the April 2002 issue of Health Affairs, showed obesity to be the most serious health problem both in terms of chronic illness and health spending (73). Sturm’s findings were based on data obtained from approximately 10,000 respondents to Healthcare for Communities, a national household telephone survey conducted in 1998. Obese persons, those having a BMI of 30 or greater, reported an increase in chronic conditions (diabetes, hypertension, asthma, heart disease, and/or cancer) of 67% compared with normal-weight persons with similar social demographics. Normal-weight smokers reported 25% more chronic conditions, while normal-weight heavy drinkers reported 12% more chronic conditions. Living in poverty came closer to the effect created by obesity, resulting in an increase of chronic conditions of 58%. Only aging from 30 to 50 resulted in a comparable number of chronic conditions being reported.
Health care expenditures included health services such as inpatient hospital care and physician visits and medications, both prescription and over-the-counter drugs. Obese respondents reported spending approximately 36% more on health services and 77% more on medications than normal-weight individuals. In contrast, smokers spent 21% more on services and 28% more on medications. Only aging resulted in higher expenditures on medications than did being obese.
The economic burden imposed by obesity on U.S. businesses was assessed by David Thompson of Policy Analysis, Inc., in terms of increased health insurance costs, disability insurance, sick leave, and higher life insurance premiums (74). In a 1998 article in the American Journal of Health Promotion, Thompson estimated the annual total cost of obesity to the American business economy to be $12.7 billion. The largest share of this amount was $7.7 billion in increased health insurance premiums, with $2.4 billion in paid sick leave, $1.8 billion in higher life insurance premiums, and $0.8 billion in disability insurance.
Wang and Dietz analyzed data from the National Hospital Discharge Survey from 1979-99 to estimate the increasing economic burden of obesity in youths aged six through 17 (75). Principal diagnoses of diabetes, obesity, sleep apnea, and gallbladder disease were examined, as well as other diseases for which obesity was listed as a secondary diagnosis. The percentage of discharges with obesity-related diagnoses increased in every category from 1979-81 to 1997-99. Discharges with diabetes as the principal diagnosis nearly doubled, obesity and gallbladder diseases tripled, and sleep apnea diagnoses increased fivefold over the 20-year period. The associated hospital costs more than tripled, from $35 million in 1979-81 to $127 million in 1997-99.
The significant increase in the number of morbidly obese patients has
put additional strains on the health care system, many of which have not
yet been studied. Injuries among physical therapists, nurses, and other
hospital staffers are on the rise, as well as hospital expenditures for
special beds, lifts, scales, operating tables, wheelchairs, and other
equipment that will accommodate very heavy patients (76). Some diagnostic
facilities are not able to serve the morbidly obese, resulting in a lack
of preventive and imaging services available to a portion of the bariatric
population. The rapid rise in the numbers of morbidly obese patients has
caught many sectors of the health care system unable to provide appropriate
and sufficient services.
Continue with Section One: