Medical Costs Associated With Obesity At $147 Billion

Tim Casey

The increasing number of obese people in the United States has led to serious health conditions, reduced quality of life, and escalating costs, according to a study released by the Centers for Disease Control and Prevention (CDC) in August. The study, “Vital Signs: State-Specific Obesity Prevalence Among Adults—United States, 2009,” revealed that medical costs associated with obesity in 2006 were approximately $147 billion (in 2008 dollars).

In addition, diseases associated with obesity accounted for 27% of the increases in US medical costs from 1987 to 2001. Compared to people of normal weight, the estimated medical costs for obese persons were $1429 higher.

The authors estimated that in 2009 there were 72.5 million obese adults in the US or approximately 26.7% of the adult population (95% confidence interval [CI], 26.4%-27.0%). The percentage of obese adults was 25.6% (95% CI, 25.3%-25.9%; P<.001) in 2007, 23.9% (95% CI, 23.6%-24.1%; P<.001) in 2005, and 19.8% (95% CI, 19.5%-20.1%; P<.001) in 2000.

“We knew the prevalence was high, but you always hope you will see a decline,” Bettylou Sherry, PhD, RD, and the study’s lead author, said in an interview with First Report – Managed Care (FR-MC). “In order to get a decline, you need to change individual’s behavior as well as the environment and the policies. It takes time to do that.”

Dr. Sherry, the lead epidemiologist for research and surveillance for the CDC’s obesity prevention and control branch, said the statistics are likely underestimated because the results were based on a self-reported telephone survey and not on measured heights and weights. Men and women tend to overestimate their height and women tend to underestimate their weight, according to Dr. Sherry, who also mentioned that the heaviest people tend to underestimate their weights to the highest degree.

A total of 405,102 people participated in the Behavioral Risk Factor Surveillance System (BRFSS) survey, an annual, state-based, random-digit-dialed landline telephone survey of US adults. The body mass index (BMI; kg/m2) was calculated for each participant, with a BMI ≥30 considered obese. People who reported themselves as ≥500 pounds as well as ≥7 feet or <3 feet were excluded. Of the 158,455 male participants, 27.5% were obese (95% CI, 26.9%-27.8%). Of the 246,646 women, 26.0% reported they were obese (95% CI, 25.7%-26.4%).

The study had a sampling protocol representative of each individual state, rather than the entire United States. The Council of American Survey and Research Organizations (CASRO) response rates for the states ranged from 37.9% for Oregon to 66.9% for Nevada (median: 52.9%), and cooperation rates ranged from 55.5% for California to 88.0% for Kentucky (median: 75.0%).

Each state failed to meet the target of ≤15% obese adults, which was set by Healthy People 2010, a 10-year health promotion program spearheaded by the US Department of Health and Human Services. Colorado had the lowest percentage of obese adults (18.6%), while Mississippi had the highest at 34.4%. Only Colorado and Washington, DC (19.7%) had rates <20%.

Whereas no state in 2000 had an adult obesity rate ≥30% and only 3 had prevalences ≥30% in 2007, there were 9 states in 2009 with ≥30% adult obesity rates (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia).

The BRFSS study indicated that the following groups had the highest obesity rates: non-Hispanic blacks (36.8%), Hispanics (30.7%), those who did not graduate from high school (32.9%), and persons aged 50-59 years (31.1%) and 60-69 years (30.9%). The authors mentioned obese adults are at increased risk for serious health conditions such as coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death.

Other studies indicate a higher prevalence of obesity, according to Dr. Sherry. For instance, the National Health and Nutrition Examination Survey (NHANES) showed that 33.8% of adults age ≥20 years were overweight (BMI ≥30) in 2007-2008, including 32.2% of males and 35.5% of females. Participants in the NHANES study had their heights and weights measured and recorded, leading to more accurate results than the BRFSS survey.

In addition to the fact that self-reported heights and weights may underestimate the results, the authors mentioned other limitations to the BRFSS trial. The study excluded people who did not have landline telephones. Adults with only wireless telephones tend to be younger, black or Hispanic, and have lower incomes and no health insurance. Further, because the CASRO response rate was only 52.9% and varied by state, there may be a bias if the participants had different characteristics related to obesity than nonrespondents.

Dr. Sherry said several steps are being taken to help lower obesity rates. On a national level, First Lady Michelle Obama launched the “Let’s Move!” campaign in February focused on childhood obesity, while President Barack Obama created the Task Force on Childhood Obesity. The programs focus on the following areas: empowering parents and caregivers; providing healthy food in schools; improving access to healthy, affordable schools; and increasing healthy activity.

The Obama administration’s economic stimulus package also included money to fight obesity. The CDC is running a state-based physical activity, nutrition, and obesity prevention program. The organization provides money to communities for several initiatives, including having healthier foods in schools and building infrastructure such as sidewalks and parks so people can walk and exercise.

For example, the city of Philadelphia received $15 million from the CDC earlier this year to battle obesity. The Philadelphia Inquirer reported that the city’s Department of Public Health will work with a nonprofit organization called Food Trust and use some of the stimulus money toward a program aimed at 1000 corner stores in low-income areas. The stores will be asked to sign an agreement to offer at least 2 categories of healthy foods, according to the newspaper story.

Dr. Sherry said the states receiving stimulus money will have to show improvement in their obesity rates over a 2-year period. If they fail to do so, they will not continue to receive the funds.

“I think these are wonderful steps,” Dr. Sherry said. “(Obesity) has to be addressed. There has to be work across multiple sectors and settings. All of these programs are helping to do this. We’re trying to push environmental changes.”—Tim Casey