More than a quarter of the phenomenal growth in health care spending over the past 15 years is attributable to obesity, Emory University researchers reported yesterday.
With 60 percent of the U.S. population deemed overweight or obese, study author Kenneth Thorpe said the only way to control soaring medical costs is to begin targeting prevention efforts and treatment on the most costly weight-related illnesses, such as diabetes, high cholesterol and heart disease.
"We've got to find ways to get the rates of obesity stabilized or falling," he said in an interview. "We need to find effective interventions to deal with this on multiple levels -- the schools, at home, in the workplace -- because clearly this is a major driver in terms of growth in health care spending."
From 1987 to 2001, medical bills for obese people constituted 27 percent of the growth in overall health care spending, he found. The jump in spending was attributable to both a rise in the number of obese Americans and higher costs for treating those patients.
Treating obese patients was 37 percent more expensive than medical care for normal-weight people, Thorpe and colleagues wrote in the journal Health Affairs. Put another way, obesity accounted for an extra $301 per person in medical spending over the 15-year study period.
"The actual numbers are probably higher," Thorpe said, because his team relied on people who self-reported their weight and height.
Obesity is determined by body mass index or BMI (a formula in which a person's weight in kilograms is divided by the square of his or her height in meters). A score higher than 30 is deemed obese; 25-30 is considered overweight. By those standards, a six-foot man weighing 225 pounds is categorized as obese.
Federal officials have estimated that treating obesity-related illnesses costs about $93 billion a year, but Thorpe is the first to examine the impact on the overall growth in health spending. The Emory team based its analysis on inflation-adjusted federal data on medical spending and health status.
"These numbers show that the prevailing approach for dealing with obesity, which is to blame people who have the problem and hope the situation will disappear, is a fantasy," said Kelly Brownell, director of the Yale Center for Eating and Weight Disorders. "Something dramatic needs to be done to change the environment in order to prevent this problem from occurring in the first place."
Before 1980, obesity in the United States remained fairly stable, at about 15 percent of the population. In the following two decades, however, the problem reached epidemic proportions, fueled primarily by a more sedentary lifestyle, processed foods and extra-large portions.
Brownell advocates creation of a $1.5 billion "Nutrition Superfund" raised by imposing a 1-cent federal tax on each can or bottle of soda. The money could be used for a massive advertising and education program, especially aimed at children, he said.
"Once you are obese, it is very hard to treat, so prevention makes sense," he said. "And when you focus on children, you get away from the libertarian arguments that adults are just doing this to themselves."
The financial toll is pronounced in people with diabetes, high cholesterol or heart disease, researchers said. Forty-one percent of the rise in spending on heart disease was obesity-related.
The data come as insurers and some government agencies have begun adopting broader reimbursement policies for treating weight-related illnesses. The federal Medicare program announced in July it would begin considering requests to cover weight-loss therapies, and three months later Blue Cross and Blue Shield of North Carolina said it will provide special services to more than 1 million members with weight problems.
Earlier this month, a panel of the National Academy of Sciences called for numerous changes, including mandatory exercise for all schoolchildren, nutrition standards for school cafeteria food and new limits on the marketing of junk food to children.
A spokeswoman for the Centers for Disease Control and Prevention said its budget for nutrition, physical activity and obesity for fiscal year 2004 is $45 million, up from $34 million the previous year.