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As obesity-related health costs rise, experts warn of far-reaching complications
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Obesity-related health care costs in the United States rose 29% between 2001 and 2015, and new data from the most populous states reveal that the cost burden varies throughout the country, according to research published in Clinical Chemistry.
In the analysis of Medical Expenditure Panel Survey (MEPS) data for the U.S. overall and 18 individual states, researchers found that the share of obesity-related expenditures ranged from 3% to 6% for California, Florida and New York, to 8% to 14% for Illinois, North Carolina, Ohio, Virginia and Wisconsin. The study included the first state-level estimates of obesity-related health care costs based on state-specific microdata, as opposed to national data with state-level fractions.
“The overall percentage of total health care costs rose from 6.13% in 2001 to 7.91% in 2015, and that’s because of the increase in obesity, but also because of the change in the way obesity is treated,” John Cawley, PhD, assistant professor in the department of policy analysis and management at Cornell University, told Endocrine Today. “If you look at the Medicare and Medicaid expenditures — those are things that we all pay for. So, this is something everyone should care about.”
For the analysis, Cawley and colleagues estimated models of medical care costs associated with obesity using MEPS data for 334,297 adults between 2001 and 2015 (30% with obesity). Medical expenditures in each year were converted to 2015 dollars, and total medical expenditures included inpatient care, ambulatory care, prescription drugs and other care, including dental, vision, home health care services and medical equipment. Researchers assessed total medical expenditures as well as results for ambulatory, inpatient and prescription drug categories. Researchers also examined medical expenditures by payer, including private health insurance, Medicare, Medicaid, all third-party payers combined and patient out-of-pocket expenditures. MEPS data were collected through a stratified multistage probability design. Researchers also conducted a literature review on the economic impact of obesity.
Cawley and colleagues found that, between 2010 and 2015, the average percentage of expenditures devoted to obesity was 9.21% for private payers, 6.86% for Medicare, 8.48% for Medicaid and 4.74% for out-of-pocket payments by patients.
Several states, including Kentucky, Virginia and Wisconsin, devoted more than 20% of Medicaid spending to obesity-related illness, the researchers wrote, whereas in Arizona, Illinois, Pennsylvania and Virginia, more than 10% of Medicare spending was related to obesity.
The share of spending devoted to obesity-related illness was higher for prescription drugs between 2010 and 2015 than for ambulatory care or inpatient care (13% vs. 6.97% and 7.38%, respectively).
Excess weight, health complications
The findings add to recent research that shows BMI is associated with increasing health care costs. In a systematic review of 75 studies assessing individual patient data published in Obesity Reviews, researchers found that increasing BMI is associated with elevations in both total health care costs and individual health care services, including prescription drug costs and inpatient care.
“Collectively, fat represents an endocrine organ that secretes hormones,” Cawley said in an interview. “When you look at the top two causes of death in the U.S. — heart disease and cancer — obesity contributes to both. It’s not only these conditions that we think of as potentially fatal, but obesity also contributes to things like degenerative joint disease. The sheer weight causes sleep apnea, pneumonia, arthritis. It’s a breathtakingly broad set of things that can be affected.”
Scott Kahan, MD, MPH, FTOS, director of the National Center for Weight and Wellness and medical director of the S.T.O.P. Obesity Alliance at the George Washington University Milken Institute School of Public Health, said there are more than 200 diseases associated with excess weight.
“That is far more than what had been reported in the past,” Kahan, who presented his findings at ObesityWeek 2016, told Endocrine Today. “On one hand, we know that there are a number of diseases and health conditions that are very strongly associated with obesity and have long been known to be associated with obesity — diabetes, high cholesterol, heart disease, sleep apnea. What hasn’t been reported until now is that the range of health conditions associated with obesity go way beyond those very common ones. There are at least two dozen types of cancer associated with obesity. There are diseases in every single organ of the body, every single system of the body that have been shown to be associated with obesity.”
He said the findings show the limitations of the current research on the cost burden of obesity.
“Researchers are modeling those costs based on the most strongly associated conditions, like diabetes,” Kahan said. “But if you’re not considering another 50, 100, potentially even 200 diseases that are related to obesity, then you may be underestimating the cost burden of obesity complications.”
New research also suggests a strong link between obesity and cancer. As Endocrine Today previously reported, approximately 5.6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors. The findings, published in The Lancet Diabetes & Endocrinology, showed that overweight and obesity (BMI 25 kg/m²) were responsible for twice as many cancer cases as diabetes (544,300 vs. 280,100 cases).
Reshmi Srinath, MD, assistant professor of endocrinology, diabetes and bone disease and director of the weight and metabolism management program at the Icahn School of Medicine at Mount Sinai, said obesity puts a patient at risk for multiple conditions, ultimately increasing the health care cost burden.
“Our biggest concern as endocrinologists is the risk for heart disease and complications related to metabolism, such as diabetes,” Srinath told Endocrine Today. “There’s a greater risk for cancer, and then, endocrine-wise, we see obesity is directly tied to fertility. Men present with low testosterone, and women present with conditions such as polycystic ovary syndrome, which is associated with infertility. We also see a greater risk for sleep apnea, which is also tied in with metabolic complications and risk for hospitalization with heart and lung disease.
“Weight also puts more pressure on the joints, and there is greater risk for chronic joint pain,” Srinath said. “You can outline any organ in the body and link complications to obesity.”
Changing policy
The trend of increasing health care costs, Kahan said, is driven by obesity prevalence. An October report from the CDC’s National Center for Health Statistics revealed obesity rates in the U.S. were approaching 20% in children and 40% in adults for 2015-2016.
“We need to address the rise in obesity rates overall and the obesity epidemic,” he said. “In contrast to some, I am somewhat optimistic about this. I believe we have been making quite impressive strides, in that over the last decade, we are now talking about and prioritizing obesity as a major public health, clinical medicine and policy issue — that was not the case even 10 years ago.That’s very important progress.”
Srinath said obesity must be addressed as a chronic disease.
“There needs to be more awareness of obesity as a chronic disease that needs screening, diagnosis and monitoring,” Srinath said. “This should start with a patient's primary care physician or internist with close monitoring of a patient's weight and BMI and screening for appropriate comorbidities.”
Kahan said more resources should be devoted to scientific research to better understand what influences the risk for obesity and elucidate better individual treatments for obesity.
“That research should bookend research on a public health and population level to better understand what influences the growth in obesity across localities, states and countries,” he said, “And then devise, test and implement population level treatments that can start to stem the rise in obesity rates.”
Additionally, Kahan said, a greater focus should be placed on adults with severe obesity, or those with BMI of at least 40 kg/m².
“When we look at that population, the prevalence rates are still staggeringly increasing, health complications are increasing and costs are increasing,” he said. “So, we must prioritize this unique population of patients with severe obesity.” – by Regina Schaffer
References:
Hales CM, et al. NCHS Data Brief. 2017;288:1-8.
Kent S, et al. Obes Rev. 2017;doi:10.1111/obr.12560.
Pearson-Stuttard J, et al. Lancet Diabetes Endocrinol. 2018;doi:10.1016/s2213-8587(17)30366-2.
For more information:
John Cawley, PhD, can be reached at johncawley@cornell.edu.
Scott Kahan, MD, MPH, FTOS, can be reached at kahan@gwu.edu.
Reshmi Srinath, MD, can be reached at Reshmi.Srinath@mssm.edu.
Disclosures: Cawley, Kahan and Srinath report no relevant financial disclosures.
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