Obesity's Economic Burden on the US Healthcare System

Introduction

Obesity is a major public health concern that affects millions of people in the United States. In addition to its impact on individual health and well-being, obesity also has significant economic implications, particularly for healthcare systems. The economic burden of obesity on healthcare systems includes direct costs associated with treating obesity-related diseases and conditions, as well as indirect costs such as lost productivity and absenteeism. This paper explores the economic burden of obesity on the US healthcare system, highlighting the significant costs associated with obesity-related chronic diseases and the toll it takes on healthcare providers.

Brief History of Obesity in the US

Obesity in the US has largely been a phenomenon of the second half of the 20th century into the 21st. In 1962, for instance, the prevalence of obesity in the US was only 3.4% of the population; but by 2016, it had risen to 39.8% — indicating that nearly 40% of the population was either obese or overweight (Waters & Graf, 2020). Prior to the second half of the 20th century, obesity was almost unheard of in the US: there was simply more physical activity and less material stability. The Great Depression had ended the Roaring Twenties, and the 1930s were not a life of plenty for many Americans. Most people before the 1920s were laborers — urban and rural — or factory workers, and neither pay nor work afforded the kind of comforts Americans would come to take for granted from the 1960s onward.

What happened from the 1960s onward is mostly attributable to a change in the American lifestyle, beginning with the arrival of fast food, drive-throughs, and soda pop culture. Brands like Pepsi and Coca-Cola began sponsoring everything and were found everywhere — from ball games to movie theaters. A more sedentary lifestyle emerged as white-collar jobs replaced field work and blue-collar labor. The family unit itself began to change in the 1970s as more women sought employment outside the home; by extension, this meant fewer home-cooked meals of the kind common in earlier decades when gender roles were more strictly enforced by societal standards. With more people eating meals not prepared at home, there was a greater tendency to consume food that was not as wholesome as it would have been had it been made by a careful parent or guardian.

Additionally, propaganda put out by benefactors of the sugar industry helped divert attention away from sugar as a potential health problem. At various points throughout the decades it was claimed that red meat was the culprit, that bread was to blame, or that other dietary concerns were more pressing. Rarely was it acknowledged that sugar — and too much of it — was deadly. Yet, sugar intake in the US skyrocketed at the same time and at the same rate as obesity rates (Mozaffarian, 2022). Others have noted that a rise in living standards has coincided with a rise in obesity rates (Lei et al., 2022). Correlation does not mean causation, but the implication is significant nonetheless: the country had, in important ways, grown sedentary.

Contributing Factors to the Rise of Obesity

Poor diet is the most significant contributor to obesity — or what Gearhardt and Hebebrand (2021) call "food addiction" (p. 274). The prevalence, availability, and affordability of highly processed and fast food, sugar-laden substances particularly loaded with high-fructose corn syrup, and a dietary lifestyle divorced from organic and natural food items have made it genuinely challenging for people to eat healthily (Wang et al., 2022). A diet high in calories, sugar, and saturated fats and low in fruits, vegetables, and whole grains can lead to weight gain and a host of other health problems.

Sugar addiction is widely regarded as a primary culprit (Throsby, 2020). Americans developed a strong preference for sweets in the second half of the 20th century, just as the middle class emerged from the post-war economic order of the 1940s. Prior to the war, the middle class was hardly what it became from the 1950s onward. Suddenly, people had access to credit, owned homes, drove cars, held steady jobs, and enjoyed greater access to goods and services than ever before (Lei et al., 2022). As business boomed, so too did sugar output and sugar intake.

Sedentary lifestyles have also become more common in the US. Many Americans lead desk-bound lives, spending long hours sitting in front of a screen or commuting by car. Lack of physical activity can lead to weight gain and other health problems. Environmental factors further contribute to obesity — for example, the design of cities can make it difficult for people to walk or bike to work or school, and the widespread availability of cheap, high-calorie food can encourage overeating. Socioeconomic factors also play a role: people who live in low-income communities may have limited access to healthy food options or safe places to exercise, contributing to higher obesity rates. These are part of what researchers call the social determinants of health (Yusuf et al., 2020).

How Obesity Contributes to Chronic Conditions

As Cawley et al. (2021a) point out, much research has shown "correlation between obesity and higher medical costs for a variety of U.S. subpopulations and specific categories of care" (p. 354). Obesity is strongly linked to the development of type 2 diabetes. The accumulation of excess fat in the body can cause insulin resistance, which impairs the body's ability to use insulin effectively. Insulin is the hormone that regulates blood sugar levels, and when it does not function correctly, it can lead to elevated blood sugar and eventually to type 2 diabetes.

Obesity also increases the risk of cardiovascular disease — a group of conditions that affect the heart and blood vessels. Excess fat in the body can cause a buildup of plaque in the arteries, narrowing them and reducing blood flow to the heart (Cawley et al., 2021a). This can lead to chest pain, heart attacks, and strokes. Additionally, obesity has been linked to an increased risk of several types of cancer, including breast, colon, and kidney cancer. The exact mechanisms are still being studied, but it is believed that excess fat cells can produce hormones that promote the growth of cancer cells.

Obese individuals are also more likely to experience respiratory problems such as sleep apnea, asthma, and shortness of breath, because the extra weight in the chest and abdomen can put pressure on the lungs and airways (Cawley et al., 2021a). Obesity places significant strain on the joints — especially the knees and hips — which can lead to arthritis and related conditions causing pain, stiffness, and difficulty with movement. It also increases the risk of non-alcoholic fatty liver disease, where fat accumulates in the liver and can lead to inflammation, scarring, and eventually liver failure. Finally, obesity can negatively affect mental health, contributing to depression, anxiety, and low self-esteem, as well as social isolation and discrimination that can further compound these issues. As Sarma et al. (2021) note, however, the relationship between obesity and mental health is complex, and mental health can have an enormous impact on obesity "and vice versa" (p. 5). Because obesity is linked to so many chronic diseases, the actual cost of obesity in the US is extraordinarily difficult to quantify — though some researchers have nonetheless attempted to do so.

Conclusion

The economic burden of obesity on the US healthcare system is significant and has far-reaching implications for both individuals and healthcare providers. The high prevalence of obesity-related chronic diseases places a considerable burden on healthcare providers, contributing to burnout and turnover. Furthermore, the high healthcare costs associated with obesity limit the availability of resources for other healthcare needs. Addressing the obesity epidemic through prevention and effective management of related chronic diseases is essential to reducing the burden on the healthcare system and improving the overall health and well-being of individuals and communities. By investing in prevention and treatment efforts, the nation can reduce the costs associated with obesity and help ensure that healthcare providers are able to deliver quality care without experiencing burnout or other damaging outcomes.