Financial Impact of Being Overweight

Obesity

It is well established that obesity is a major public health epidemic and that its consequences impact all areas of the healthcare system. When discussing the issue of obesity, the focus is usually on the health impact of obesity on the patient and how that impacts not only the patient, but also others in society. Less frequently discussed, but of critical importance in healthcare planning, is the fact that obesity is taking a tremendous financial toll upon the American healthcare system. Obesity is linked to a number of diseases that are not only dangerous, but also costly. These diseases include, but are not limited to: hypertension, heart disease, Type II diabetes, and hormonal imbalances. Obesity-linked diseases can create significant financial hardships for their sufferers, but they can also take a tremendous financial toll on society.

From an individual perspective, the financial health costs of obesity can be so overwhelming that they lead to obese people being unable to afford treatment for the associated conditions. "At the individual level, obesity is associated with health care costs that average about 40% above those for normal weight individuals. Overall, obesity-related direct and indirect economic costs exceed $100 billion annually, and the number is expected to grow" (Yale Rudd Center, 2013. These costs are not limited to the healthcare sector, but expand into other areas of society. For example, obese employees miss more days at work than non-obese employees. They also filed more medical claims, disability claims, and workers compensation claims. "As a result, an average firm with 1,000 employees faces $285,000 per year in extra costs associated with obesity" (Yale Rudd Center, 2013).

Furthermore, it is important to consider that the financial costs of obesity may extend far beyond health care costs. For example, obese students may be viewed unfavorably by educators, which impacts school performance and can adversely impact their lifetime earning potential (Bowden, 2014). Furthermore, once in the workplace, the obese face discrimination, not only in hiring but in wages. The annual wage loss for a female full-time employee is $1,855 per year; while the loss for males is less; obese males lose $75 in annual wages (Bowden, 2014). "Being an obese individual in the U.S. costs $4,879 for women and $2,646 for men each year. The overall annual costs of being overweight are $524 for women and $432 for men" (Dykman, 2011). The obese may need to buy second seats on airlines and may end up spending more on gasoline than the non-obese (Bowden, 2014). Even at death, the obese may pay greater expenses, as funeral expenses are higher for the obese (Bowden, 2014). Furthermore, it is important to consider that there are financial costs associated with the shorter lifespan that often accompanies obesity; "Adding the value of lost life to these yearly costs makes the price tag even higher: $8,365 and $6,518 for women and men, respectively" (Dykman, 2011).

Finkelstein et al. discovered a link between rising obesity rates and rising medical spending. They believed that as early as 1998, the cost of overweight and obesity could have been as high as $78.5 billion, with approximately half of that total spending financed by Medicare and Medicaid (Finkelstein et al., 2009). Of course, in the face of rising medical costs during that same time period, it may be inappropriate to suggest that those rising rates are necessarily indicative of obesity and overweight taking a higher toll in medical costs than it would have previously. Even with the increase in overall medical costs and adjusting for inflation, Thorpe et al. discovered that obesity was responsible for 27% of the increase in health coasts costs between 1987 and 2001 (Thorpe et al., 2004).

While the public sector bears a large part of the financial burden for paying for obesity-related diseases, it is actually the private sector that spends the most on treating or preventing obesity, rather than treating obesity-related diseases. Part of this is due to the fact that medical interventions for obesity, though available, remain relatively rare. Even rarer are medical interventions with long-term positive health impacts. ." As a result, the costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes" (Finkelstein et al., 2009). These medical conditions may not be solely caused by obesity; for example, while obesity is the biggest predictor of developing type II diabetes not all diabetics are obese and not all of the obese develop diabetes. The same can be said for other obesity-related diseases like hypertension and heart disease.

In fact, the high failure rate of obesity interventions and the high associated costs of treating obesity-related diseases suggest that there should be a paradigm shift in the treatment of obesity. Greater efforts and expense should be concentrated on prevention in order to help reduce the overall money spent on obesity-related health care expenses. The growing availability of bariatric surgery and the associated reduction in obesity-related illnesses gives rise to the belief that bariatric surgery while expensive initially, may be a cost-effective means of reducing obesity-related health care expenses. This belief may not be true. Maciejewski and Arterbum devised a longitudinal study examining health-care costs for obese patients who had undergone bariatric surgery and compared them to costs for obese patients who had not undergone surgery. They found an increase in health costs in second and third years following surgery, and similar health care costs in the subsequent years of the study (2013). They concluded that bariatric surgery does not reduce overall health care costs in the long-term (Maciejewski & Arterbum, 2013). However, their conclusion seems faulty. The costs of obesity increase as a person ages, as age is also a risk factor for many obesity-linked diseases, such as high blood pressure, heart disease, and diabetes. Their study only followed patients for a six-year period after surgery. One would anticipate higher health care costs in the period immediately following surgery and for an indefinite period afterwards, as most patients who receive such surgery receive significant monitoring from their doctors. In addition, while losing the excess weight, it might be expected that patients with chronic managed diseases, such as hypertension, would require greater doctor supervision because of the medication changes necessitated by fluctuating weight. It appears that a more reasonable study would have followed patients over a longer period of time, but given that weight loss surgery has only recently become a widespread medical treatment, there may be insufficient subjects for that type of longitudinal study in the United States.