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Study: Obesity adds $190 billion in health costs

Posted by on Apr. 30, 2012 at 9:27 AM
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updated 2 hours 41 minutes ago

U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960.

The nation’s rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows.

Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops.

The startling economic costs of obesity, often borne by the non-obese, could become the epidemic's second-hand smoke. Only when scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air did policymakers get serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also spurred action. Now, as economists put a price tag on sky-high body mass indexes (BMIs), policymakers as well as the private sector are mobilizing to find solutions to the obesity epidemic.

"As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, 'what policy knob can I turn to stop this hemorrhage?'" said Michael O’Grady of the National Opinion Research Center, co-author of a new report for the Campaign to End Obesity, which brings together representatives from business, academia and the public health community to work with policymakers on the issue.

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The U.S. health care reform law of 2010 allows employers to charge obese workers 30 percent to 50 percent more for health insurance if they decline to participate in a qualified wellness program. The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.

Such measures do not sit well with all obese Americans. Advocacy groups formed to "end size discrimination" argue that it is possible to be healthy "at every size," taking issue with the findings that obesity necessarily comes with added medical costs.

The reason for denominating the costs of obesity in dollars is not to stigmatize plus-size Americans even further. Rather, the goal is to allow public health officials as well as employers to break out their calculators and see whether programs to prevent or reverse obesity are worth it.

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Because obesity raises the risk of a host of medical conditions, from heart disease to chronic pain, the obese are absent from work more often than people of healthy weight. The most obese men take 5.9 more sick days a year; the most obese women, 9.4 days more. Obesity-related absenteeism costs employersas much as $6.4 billion a year, health economists led by Eric Finkelstein of Duke University calculated.

Even when poor health doesn’t keep obese workers home, it can cut into productivity, as they grapple with pain or shortness of breath or other obstacles to working all-out. Such obesity-related “presenteeism,” said Finkelstein, is also expensive. The very obese lose one month of productive work per year, costing employers an average of $3,792 per very obese male worker and $3,037 per female. Total annual cost of presenteeism due to obesity: $30 billion.

Decreased productivity can reduce wages, as employers penalize less productive workers. Obesity hits workers' pocketbooks indirectly, too: Numerous studies have shown that the obese are less likely to be hired and promoted than their svelte peers are. Women in particular bear the brunt of that, earning about 11 percent less than women of healthy weight, health economist John Cawley of Cornell University found. At the average weekly U.S. wage of $669 in 2010, that's a $76 weekly obesity tax.

The medical costs of obesity have long been the focus of health economists. A just-published analysis finds that it raises those costs more than thought.

Obese men rack up an additional $1,152 a year in medical spending, especially for hospitalizations and prescription drugs, Cawley and Chad Meyerhoefer of Lehigh University reported in January in the Journal of Health Economics. Obese women account for an extra $3,613 a year. Using data from 9,852 men (average BMI: 28) and 13,837 women (average BMI: 27) ages 20 to 64, among whom 28 percent were obese, the researchers found even higher costs among the uninsured: annual medical spending for an obese person was $3,271 compared with $512 for the non-obese.

Nationally, that comes to $190 billion a year in additional medical spending as a result of obesity, calculated Cawley, or 20.6 percent of U.S. health care expenditures.

That is double recent estimates, reflecting more precise methodology. The new analysis corrected for people’s tendency to low-ball their weight, for instance, and compared obesity with non-obesity (healthy weight and overweight) rather than just to healthy weight. Because the merely overweight do not incur many additional medical costs, grouping the overweight with the obese underestimates the costs of obesity.

<snip>

 “Where healthcare costs really take off is in the morbidly obese.”

Those extra medical costs are partly born by the non-obese, in the form of higher taxes to support Medicaid and higher health insurance premiums. Obese women raise such “third party” expenditures $3,220 a year each; obese men, $967 a year, Cawley and Meyerhoefer found.

One recent surprise is the discovery that the costs of obesity exceed those of smoking. In a paper published in March, scientists at the Mayo Clinic toted up the exact medical costs of 30,529 Mayo employees, adult dependents, and retirees over several years.

“Smoking added about 20 percent a year to medical costs,” said Mayo’s James Naessens. “Obesity was similar, but morbid obesity increased those costs by 50 percent a year. There really is an economic justification for employers to offer programs to help the very obese lose weight.”

For years researchers suspected that the higher medical costs of obesity might be offset by the possibility that the obese would die young, and thus never rack up spending for nursing homes, Alzheimer’s care, and other pricey items.

That’s what happens to smokers. While they do incur higher medical costs than nonsmokers in any given year, their lifetime drain on public and private dollars is less because they die sooner. “Smokers die early enough that they save Social Security, private pensions, and Medicare” trillions of dollars, said Duke’s Finkelstein. “But mortality isn’t that much higher among the obese.”

Beta blockers for heart disease, diabetes drugs, and other treatments are keeping the obese alive longer, with the result that they incur astronomically high medical expenses in old age just like their slimmer peers.

Some costs of obesity reflect basic physics. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.

“Growing obesity rates increase fuel consumption,” said engineer Sheldon Jacobson of the University of Illinois. How much? An additional 938 million gallons of gasoline each year due to overweight and obesity in the United States, or 0.8 percent, he calculated. That's $4 billion extra.

Not all the changes spurred by the prevalence of obesity come with a price tag. Train cars New Jersey Transit ordered from Bombardier have seats 2.2 inches wider than current cars, at 19.75 inches, said spokesman John Durso, giving everyone a more comfortable commute. (There will also be more seats per car because the new ones are double-deckers.)

The built environment generally is changing to accommodate larger Americans. New York’s commuter trains are considering new cars with seats able to hold 400 pounds. Blue Bird is widening the front doors on its school buses so wider kids can fit. And at both the new Yankee Stadium and Citi Field, home of the New York Mets, seats are wider than their predecessors by 1 to 2 inches.

The new performance testing proposed by transit officials for buses, assuming an average passenger weight of 175 instead of 150 pounds, arise from concerns that heavier passengers might pose a safety threat. If too much weight is behind the rear axle, a bus can lose steering. And every additional pound increases a moving vehicle’s momentum, requiring more force to stop and thereby putting greater demands on brakes. Manufacturers have told the FTA the proposal will require them to upgrade several components.

Hospitals, too, are adapting to larger patients. The University of Alabama at Birmingham's hospital, the nation's fourth largest, has widened doors, replaced wall-mounted toilets with floor models able to hold 250 pounds or more, and bought plus-size wheelchairs (twice the price of regulars) as well as mini-cranes to hoist obese patients out of bed.

The additional spending due to obesity doesn’t fall into a black hole, of course. It contributes to overall economic activity and thus to gross domestic product. But not all spending is created equal.

“Yes, a heart attack will generate economic activity, since the surgeon and hospital get paid, but not in a good way,” said Murray Ross, vice president of Kaiser Permanente’s Institute for Health Policy. “If we avoided that heart attack we could have put the money to better use, such as in education or investments in clean energy.” 

The books on obesity remain open. The latest entry: An obese man is 64 percent less likely to be arrested for a crime than a healthy man. Researchers have yet to run the numbers on what that might save.

Is anyone here concerned that our gov't is going to more closely watch and attempt to regulate the people they deem to be obese?


by on Apr. 30, 2012 at 9:27 AM
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Replies (1-10):
rotPferd
by Silver Member on Apr. 30, 2012 at 9:43 AM

 My first initial reaction is good, another group of ppl are gonna be shunned and looked upon with disgust just as smokers have for years. Only difference is, accomodations are being made for obese ppl, while smokers were just bullied and told when and where they could smoke.

fatcat0908
by Bronze Member on Apr. 30, 2012 at 9:46 AM
1 mom liked this
Yet, we have to continue with this "Big is Beautiful" campaign to be P.C. when in fact, it's having a large negative impact on our society.
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katzmeow726
by Platinum Member on Apr. 30, 2012 at 9:51 AM
Yeah. But my oversized rear doesn't give other people cancer from second hand exposure. It doesn't cause people who don't smoke to have respiratory issues. Smokers are a risk to others when there is risk of second hand exposure.

Quoting rotPferd:

 My first initial reaction is good, another group of ppl are gonna be shunned and looked upon with disgust just as smokers have for years. Only difference is, accomodations are being made for obese ppl, while smokers were just bullied and told when and where they could smoke.

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PamR
by Pam on Apr. 30, 2012 at 11:04 AM


Quote:

Yeah. But my oversized rear doesn't give other people cancer from second hand exposure. It doesn't cause people who don't smoke to have respiratory issues. Smokers are a risk to others when there is risk of second hand exposure.


This is true, however, it's costing everyone in the form of higher medical costs.  Our children's generation is not expected to have a life expectancy as high as this one because of obesity.  Children have hypertension and type 2 diabetes, which was almost unheard of just a few years ago.  So these costs are just going to keep rising, not to mention compromising the quality of life for obese people. 

The problem is, you can't regulate when, where and what people eat, as you can to some extent with smoking. 

nb34
by Gold Member on Apr. 30, 2012 at 11:19 AM
3 moms liked this

I hope some one does something about the obesity pandemic in this country. I also think money is better spent in trying to get obese people to normal weight, rather than changing the size of everything. I was honestly shocked when I found out the oversized chairs in my Dr's office were not for two people, but for one obese person.

This is funny coming after the article on breastfeeding. We tend to punish nursing moms for doing the best they can to insure a healthy child and eventually save our society millions of dollars in health costs, yet we go out of our way to accommodate obese people who have such negative effects on our pockets.

Ziva65
by Gold Member on Apr. 30, 2012 at 11:19 AM
1 mom liked this

I read most of it but not all of it. I'd bet the increased cost r/t obesity isn't offset by them dying earlier either. I've not seen really old (90 +)  morbidly obese people, just like I've not seen really old smokers... I'd surmise that for the most part they don't make it that far due to all the related health conditions, or chronic disease.

There are billable physician codes for calculating BMI and doing related health education. Obesity, espcially morbid obesity is a huge risk factor in so many diseases.

For the most part though, being in health care, I see that people do know what is needed to lose weight and be healthy, it's more complex than simply health education, it's a whole lifestyle and cultural change that's needed along with internal motivation... that's hard, sort of a downward spiral.

chelsieb84
by on Apr. 30, 2012 at 11:24 AM

I agree most morbidly obese people do know what they need to do to lose weight.  They just choose to keep living their life the way they were.  It's easier to keep old habits than it is to break them.  \

Quoting Ziva65:

I read most of it but not all of it. I'd bet the increased cost r/t obesity isn't offset by them dying earlier either. I've not seen really old (90 +)  morbidly obese people, just like I've not seen really old smokers... I'd surmise that for the most part they don't make it that far due to all the related health conditions, or chronic disease.

There are billable physician coldes for calculating BMI and doing related health education.

For the most part though, being in health care, I see that people do know what is needed to lose weight and be healthy, it's more complex than simply health education, it's a whole lifestyle and cultural change that's needed along with internal motivation... that's hard, sort of a downward spiral.


"History, despite its wrenching pain, cannot be unlived, but if faced with courage need not be lived again."

Maya Angelou

chelsieb84
by on Apr. 30, 2012 at 11:25 AM

I do think obesity is a huge problem. I honestly didn't know that it was such a financial problem for the country though.  Interesting article.  

Ziva65
by Gold Member on Apr. 30, 2012 at 11:28 AM


Quoting chelsieb84:

I agree most morbidly obese people do know what they need to do to lose weight.  They just choose to keep living their life the way they were.  It's easier to keep old habits than it is to break them.  \

Quoting Ziva65:

I read most of it but not all of it. I'd bet the increased cost r/t obesity isn't offset by them dying earlier either. I've not seen really old (90 +)  morbidly obese people, just like I've not seen really old smokers... I'd surmise that for the most part they don't make it that far due to all the related health conditions, or chronic disease.

There are billable physician coldes for calculating BMI and doing related health education.

For the most part though, being in health care, I see that people do know what is needed to lose weight and be healthy, it's more complex than simply health education, it's a whole lifestyle and cultural change that's needed along with internal motivation... that's hard, sort of a downward spiral.

 

It's hard too, knees hurt, joints ache. It takes an effort, and often with programs like swimming exercise dance programs (hip hop/ zumba, etc.) you need to be in a group of people. That's really difficult. I see it with my mom. She was normal size, then broke a knee, sat too much, stopped exercising, now getting arthritis, and gaining weight. A lot. Now, hypertension and diabetes later, and still not exercising, it's not a good mix. Now, risk factors such as obesity, diabetes, hypertension, begets more health problems... :(

I'm not super fit, but have a good BMI, I'm uncomfortable in a swim exercise class, I can't imagine how much guts it takes for someone really large. I admire that.... I guess home videos are good, but that takes a lot of motivation without peers helping to spur you on.

Veni.Vidi.Vici.
by on Apr. 30, 2012 at 11:36 AM

I've been obese. I know how hard it is to lose the weight and keep it off. I've been gaining lately for what seems to be no real reason. I suspect I will gain and become overweight, if not obese again.

The only thing that is changing in my life is my age. I've tried to be more mindful of my calorie consumption. I haven't stopped moving or doing anything I normally do, but I ache more. I've definitely slowed down.

Since my weight loss 5 years ago I had healthy pregnancies and didn't keep any baby weight. In the past 6 months I've gained 12 lbs. I'm not diabetic, my thyroid is fine, my arthritis is getting worse and my blood pressure is going up.

My doctors tell me not to worry. How can I not worry?

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