Tuesday, November 9, 2010

Health and economic burden of obesity

As the prevalence of overweight and obesity continues to climb, the challenges of quantifying the impact of this epidemic to inform public policies and health services becomes more pressing. The consequences of obesity on population health are far-reaching—as demonstrated in extensive analyses of health and economic consequences. For example, Calle and colleagues reported data from over 900,000 men and women in the American Cancer Society Cancer Prevention Study II showing excess mortality from cancer among obese men and women 1. Stewart and colleagues project the effects of obesity on life expectancy in the US and note that the adverse effect of obesity will outweigh any gains from smoking cessation 2. Fontaine and colleagues estimate that obesity substantially lessens life expectancy for US adult. For those age 20 expectancy can be reduced by up to 17% 3. In sum, excess mortality observed with increasing levels of obesity can be summarized in a number of ways to guide polices and practices that may prevent weight gain in adult years and reduce the burden of obesity.

Who Bears the Economic Costs of Obesity?
Most of the early cost estimates took a societal perspective; nonetheless, partitioning the total burden of obesity to different sectors that share the costs provides incentives to address the distribution issue and adopt preventive strategies. In particular recent work by Finkelstein and colleagues shows just how much of the burden is carried through to payers who support medicare where obese individuals have higher costs than normal weight individuals 4. 

Costs for employers have been reported by Finkelstein et al. 5 and by Thompson et al.6. Finkelstein et al. used data from two national samples of full-time employed adults 5. They estimated that overweight- and obesity-attributable costs ranged from $175 to $2485 dollars per year depending on the degree of overweight and gender, approximately 30% of these costs result from increased absenteeism. Although those with Class-III obesity represent only 3% of the employed population, they account for 21% of the costs. Another important work by Finkelstein et al. quantifies the costs to tax payers. They found that, in 1998, total medical bill due to overweight and obesity might have been as high as $78.5 billion in the United States. Medicare and Medicaid finance approximately half of these costs, private insurance pays 30%-40%, and roughly, 15% paid out of pocket7. The increase in the medical conditions (such as hypertension and hyperlipidemia) treated among obese individuals has been suggested to be a key determinant of increased spending from private health insurance 8.

Using the 2006 medical expenditure panel survey, Finkelstein and colleagues show that the annual cost of obesity among full time employed individuals is $73.1 billion. 61% of these costs are incurred by those over a BMI of 35 kg.m2, who represent just 37% of the obese population 9.

The evidence is overwhelming that excess weight is associated with increased morbidity and mortality. Current estimates of economic expenses related to excess weight clearly underestimate the true costs to society. To date, the majority of these estimates have evaluated only a narrow range of overweight- and obesity-related illness; they have not included factors, such as the impact of reduced physical functioning 10-12; and many have not accounted for the effects on those who are overweight but not obese. With the rising prevalence of overweight and obesity, we will continue to see growing effects and mounting costs on the individual, our communities, and our society as a whole. Finkelstein argues that obesity results from market forces, technologic advances that lower the cots of behaviors that promote obesity (inactivity at work, TV viewing, etc), and that obesity prevention efforts therefore must make it easier and cheaper to follow a healthy diet and engage in regular physical activity 13. 

Related CNiC post

Literature cited

2.         Stewart ST, Cutler DM, Rosen AB. Forecasting the effects of obesity and smoking on U.S. life expectancy. N Engl J Med. Dec 3 2009;361(23):2252-2260.
3.         Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. Jan 8 2003;289(2):187-193.
4.         Finkelstein EA, Trogdon JG, Brown DS, Allaire BT, Dellea PS, Kamal-Bahl SJ. The lifetime medical cost burden of overweight and obesity: implications for obesity prevention. Obesity (Silver Spring). Aug 2008;16(8):1843-1848.
5.         Finkelstein E, Fiebelkorn C, Wang G. The costs of obesity among full-time employees. Am J Health Promot. Sep-Oct 2005;20(1):45-51.
6.         Thompson D, Edelsberg J, Kinsey K, Oster G. Estimated economic costs of obesity to U.S. business. Am J Health Promot. 1998;13:120-127.
7.         Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much, and who's paying? Health Aff (Millwood). Jan-Jun 2003;Suppl Web Exclusives:W3-219-226.
8.         Thorpe KE, Florence CS, Howard DH, Joski P. The impact of obesity on rising medical spending. Health Aff (Millwood). Jul-Dec 2004;Suppl Web Exclusives:W4-480-486.
9.         Finkelstein EA, DiBonaventura M, Burgess SM, Hale BC. The costs of obesity in the workplace. J Occup Environ Med. Oct 2010;52(10):971-976.
10.         Coakley E, Kawachi I, Manson J, Speizer F, Willett W, Colditz G. Lower levels of physical functioning are associated with higher body weight among middle-aged and older women. Int J Obesity. 1998;22:958-996.
11.         Fine J, Colditz G, Coakley E, et al. A prospective study of weight change and health-related quality of life in women. JAMA. 1999;282:2136-2142.
12.         Fontaine K, Cheskin L, Barofsky I. Health-related quality of life in obese persons seeking treatment. J Fam Pract. 1996;43:265-270.
13.         Finkelstein EA, Strombotne KL. The economics of obesity. Am J Clin Nutr. May 2010;91(5):1520S-1524S.

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