The rapidly rising number of Americans with obesity and overweight impose a very significant toll on their health and the health of the U.S. economy―and this impact will increase in the near future. Obesity causes a wide range of chronic diseases and medical conditions (23 in total) ranging from diabetes to Alzheimer’s―leading to extensive direct health-care costs as well as indirect costs in terms of lost work time, lower productivity, and premature death.
The total cost to treat health conditions related to obesity plus obesity’s drag on the economy exceeds $1.4 trillion annually. That doesn’t even include the lost potential economic growth due to more than 320,000 people dying each year from diseases linked directly to obesity. That’s more than twice what the U.S. spends on national defense. The total, based upon 2014 data, was equivalent to 8.2 percent of U.S. GDP, and it surpasses the economies of all but three U.S. states and all but 10 countries.
In 2014, 98.7 million U.S. residents had obesity, and another 89.9 million were overweight. In all, 188.6 million people―or 60.7 percent of the population ages 2 and above―either had obesity or were overweight. Obesity rates in the U.S. have increased steadily. Among adults, the prevalence of obesity has climbed from 13.4 percent in 1960-62 to 36.4 percent in 2014. By 2014, no state had an obesity prevalence below 20 percent.https://www.cdc.gov/obesity/data/databases.html
The Milken Institute study, “Weighing Down America,” calculates the costs of direct medical treatment for heath conditions causally tied to obesity and overweight to be $427.8 billion in the U.S. in 2014, representing 14.3 percent of total health-care spending. http://www.milkeninstitute.org/publications/view/833Indirect costs including absenteeism, or lost workdays, and presenteeism (productivity loss or underperformance at work) amounted to $988.8 billion, leading to a total of $1.42 trillion.
Among those medical conditions attributable to obesity, type 2 diabetes had the highest treatment costs, at $111.9 billion in 2014, accounting for 26.1 percent of total direct medical costs for the diseases caused by obesity and being overweight. In 1962, the nation spent just $1 billion in 2014 dollars on treatments for diabetes, with 700,000 cases attributable to obesity and overweight. In 2014, there were 16.8 million cases of diabetes caused by obesity and overweight. Alzheimer’s disease and vascular dementia were next, with $56.0 billion in direct treatment costs. Gallbladder disease was third with $43.9 billion, followed by osteoarthritis at $42.1 billion. The costs of treating a number cancers and heart conditions are high as well.
Such economic losses are preventable. For example, a recent review of interventions designed to reduce obesity concluded that for individuals with BMIs of 40 or greater―extreme obesity―, a 5 percent weight reduction would save $2,137 in medical costs annually, https://www.ncbi.nlm.nih.gov/pubmed/25381647 or $37.5 billion for all adults with extreme obesity. A 5 percent reduction in weight would amount to 14 lbs. for an American man of average height and a BMI of 40, or 12 lbs. for a woman.
Many argue that people have the right to behave as they choose in a free society because they harm only themselves. However, government and society at large bear much of the cost through higher insurance premiums and Medicare and Medicaid spending. The costs of obesity are not fully self-contained.
There is no magic bullet, and no single tactic, to address the obesity epidemic because multiple factors are responsible for its rise.
The actions that are required include:
• Individuals affected by obesity and being overweight must accept some personal responsibility to modify their behavior;
• Employers should recognize that they have a vested interest in providing behavior modification counseling and offering financial and other incentives to employees and their families to lose weight;
• Public health groups should be engaged at the community level to raise awareness about the scourge of obesity;
• The food and beverage industry should continue transparency efforts around nutrition and continue investment in providing and marketing healthy choices;
• The federal government should launch and support an anti-obesity campaign through the media and other means, like the anti-smoking campaign launched in the 1970s;
• Greater clarity should be brought to the reimbursement rules for health practitioners who provide weight-loss advice and counseling; and
• More research on the most cost-effective obesity interventions is necessary.
If we fail to alter the trajectory we are on, then higher medical costs, lost work time and productivity, unnecessary premature death, and slower long-term economic growth will weigh down America. If the incoming Trump administration were serious about reducing the growth in healthcare costs, reforming the health care system and paying for expanding coverage to more Americans, I can’t think of a better place than addressing the obesity crisis head-on.