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Published Wednesday October 20, 2004 Obesity increasingly weighs down health care costs
THE WASHINGTON POST

WASHINGTON - More than a quarter of the phenomenal growth in health care spending over the past 15 years is attributable to obesity, Emory University researchers reported Tuesday.

With 60 percent of the U.S. population deemed overweight or obese, report author Kenneth Thorpe said, the only way to control soaring medical costs is to begin targeting prevention efforts and treatment on the most costly weight-related illnesses, such as diabetes, high cholesterol and heart disease.

"We've got to find ways to get the rates of obesity stabilized or falling," he said in an interview. "We need to find effective interventions to deal with this on multiple levels - the schools, at home, in the workplace - because clearly this is a major driver in terms of growth in health care spending."

From 1987 to 2001, medical bills for obese people constituted 27 percent of the growth in health care spending, he found. The increase in spending was attributable to a rise in the number of obese Americans and to higher costs for treating those patients.

Treating obese patients was 37 percent more expensive than medical care for people of normal weight, Thorpe and colleagues from the Atlanta school wrote in the journal Health Affairs. Put another way, obesity accounted for an extra $301 per person in medical spending over the 15-year study period.

"The actual numbers are probably higher," Thorpe said, because his team relied on people who self-reported their weight and height.

Obesity is determined by body mass index, a formula in which a person's weight in kilograms is divided by the square of his or her height in meters. A score over 30 is deemed obese; 25 to 30 is considered overweight. By those standards, a 6-foot man weighing 225 pounds is obese.

Federal officials have estimated that treating obesity-related illnesses costs about $93 billion a year, but Thorpe is the first to examine the effect on the overall growth in health spending. The Emory team based its analysis on inflation-adjusted federal data on medical spending and health status.

"These numbers show that the prevailing approach for dealing with obesity, which is to blame people who have the problem and hope the situation will disappear, is a fantasy," said Kelly Brownell, director of the Yale Center for Eating and Weight Disorders.

"Something dramatic needs to be done to change the environment in order to prevent this problem from occurring in the first place."

Before 1980, obesity in the United States remained fairly stable at about 15 percent of the population. In the following two decades, however, the problem reached epidemic proportions, fueled primarily by a more sedentary lifestyle, processed foods and extra-large portions.

Brownell advocates creation of a $1.5 billion "Nutrition Superfund" raised by imposing a 1-cent federal tax on each soft drink can or bottle. The money could be used for a massive advertising and education program, especially aimed at children, he said.

"Once you are obese it is very hard to treat, so prevention makes sense," he said. "And when you focus on children you get away from the libertarian arguments that adults are just doing this to themselves."

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