The Correlation between Obesity and Increased Health Care Costs

Abstract
Obesity is a medical diagnosis determined when an individual has accumulated enough weight to cause adverse health effects; usually recognized by Body Mass Index (BMI) as a number of thirty or higher on a height compared to a weight scale. It is a result of an imbalance between energy intake and energy expenditure. There are several notable health consequences directly linked to obesity, such as: hypertension, type 2 diabetes, stroke, osteoarthritis, cardiovascular disease, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, endometrial, breast, prostate, and colon cancer (National Institutes of Health, 1998). The correlation of obesity’s effect on healthcare costs can be assessed in both direct (actual medical treatment costs) and indirect (financial loss due to the result of the condition) aspects. In 2008, the estimated capital loss due to obesity and its detrimental effects on the quality of life and health totaled to about $147 billion; thus equating to being the most costly preventable expense in health (Center for Disease Control, 2012).
Introduction
As a nation becoming more fixated on culinary adventures, cooking shows, and innovative concoctions, we at the same time, are watching the prevalence of our obesity rates grow tenfold. American’s caloric intake has increased 15% 1984 to 1997. It is likely that this upward trend has continued due to the growing portion sizes of food at dining restaurants as well as increased processing and artificial additives introduced in our food. Another contributing factor is the glamorization of food and food products. Constant updates via social media websites like Instagram or Facebook present recipes, pictures of colorful and savory fare, which present an over stimulation possibly causing eliciting an over eating response.
In 1960-1962 the occurrence of obese men in the United States was 11% of the population. In 2010, this increased to 34% of the population. Furthermore in women, the National Health and Nutrition Examination Survey found a 16% occurrence of obese women in 1960-1962 increased to 38% of the population in 2010 (Center for Disease Control, 2012). Obesity is a growing challenge for public health officials; it has increased in every state, in both genders, among all socioeconomic groups, ages, and races. The condition has even plagued America’s youth, with 17% of children now identified as obese (Budd & Hayman, 2008). If the current statistics are a predictor of future trends, our cost of healthcare expenditures from obesity and it’s associated conditions will also increase to unpredictable heights. These statistics are significant concerns for public health officials because obesity is an extremely preventable condition. Physical activity and proper nutrition is a fundamental counter measure to battle obesity and its related conditions. Obesity has far reaching effects on one’s life, for example, at work. In one study during a four-year period, researchers found that those who participated in sports took 20 days less sick leave than their non-sporting workers. There has also been a relation to physical activity and work productivity (Blatter, et al., 2005). Thus, contributing to the wealth of the community and economy instead of promoting extensive health care costs in the United States. Obesity has direct and indirect effects on healthcare and a nation. The loss of productivity previously stated is an indirect cost. The U.S. Surgeon General recognized that approximately $56 billion was lost in 2000 due to indirect costs of obesity. Although, $61 billion was lost due to direct costs that same year, some researchers believe that indirect costs exceed the direct yet are far too extensive or complex to accurately measure (National Institute of Health, 1998).
Defined, indirect costs of obesity on healthcare are recognized as the gross financial loss due to the condition. It can be assessed through value of lost work, increase in insurance coverage, and reduction of wages (Harvard School of Public Health, 2012). In the United States, absenteeism due to obesity cost employers $2.4 billion in 1998 and has further increased to $6.2 billion in 2012. Additionally, a more recent statistic from the 2002 National Health Interview Survey found that workday loss among the very obese was estimated to 4 days a year for men and 5.5 days a year for women. From a financial perspective, obese men accumulate an approximate $3,792 per month in lost productivity, while obese women accumulate $3,037 a month (Hu, F., 2012). In America’s current economic state and competitive occupation market, the perception that weight has an influence on productivity can lead to one person keeping, losing, and receiving employment over another.
Insurance companies promote are a bucket for groups of people to have a shared cost of economic burden for healthcare costs. When an obese individual begins to suffer from one of the associated causes or even just obesity itself, the premiums for members within that insurance pool goes up. Recent reforms to healthcare is attempting to mitigate such an issue by allowing employers to charge obese employees 30-50% more in what they contribute toward their health insurance benefit. Especially, if the individual refuses to participate in a qualified wellness program devised to help them with weight loss. Another noteworthy component to Obama’s Affordable Care Act is the community/ employment programs designed to assist people in losing weight as well as the incentives provided for Medicare/ Medicaid beneficiaries to seek a primary care physician in order to discuss and execute a weight loss program (Unger, 2012). Implementing such policies is a fundamental measure to combat the obesity epidemic and stifling the ever-growing costs in healthcare.
The social stigmatism of obesity has ignited an association between obese weight and reduction in wages. The fact is that there is a decrease in years of disability-free life and increase in mortality rate before retirement when someone is viewed as obese. This may cause an organization, it’s managers, or supervisors to subconsciously recognize this and offer compensational wages equal to what they believe they will receive in quality and output from the employee. In one study, there was a relational assessment based on BMI vs. salary and obese subjects tended to have lower salary (Hu, 2012). While indirect costs have a substantial effect on financial costs of obesity, direct costs have a more quantifiable loss. Direct costs are defined as the actual cost of the condition on healthcare. It can be portrayed through diagnostic tests, emergency services, treatment programs or visits, inpatient, outpatient, surgery, radiological tests, and pharmaceuticals (Harvard School of Public Health, 2012).
As recognized before, obesity presents several detrimental and expensive conditions. Such health risks are hypertension, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, respiratory problems, and some types of cancer (colon, prostate, endometrial, and breast). Other associated complications from obesity are complications in pregnancy, menstrual irregularities, hirsutism, stress incontinence, and psychological disorders (depression) (National Institute of Health, 1998).
In the case of hypertension, a co-factor for cardiovascular disease, which is also the leading cause of death for both men and women in the United States (Center for Disease Control, 2012). The average cost to treat hypertension in 2008 was $47.3 billion, with $21.3 billion spent on prescription medications, $13 billion was spent on doctor’s office and outpatient visits, $13 billion spent for hospitalizations, emergency department, and home health visits (Agency for Healthcare Research and Quality, 2011). That is a 32% contribution to the total healthcare expenditure on obesity in America ($147 billion).
The pathophysiology for the development of hypertension is sodium retention that increases vascular resistance, blood volume, and cardiac output. Yet when someone is obese, this sodium retention is increased therefore insulin resistance increases, sympathetic nervous system output is increased, and alterations of the renin-angiotensin occurs. All of this comes together, specifically when you factor in the effect of weight loss. As someone reduces their body weight there is a reduction in vascular resistance, total blood volume, cardiac output, as well as an improvement in insulin resistance, a reduction in sympathetic nervous system activity, and suppression of the activity of the renin angiotensin system (National Health Institute, 1998). When reviewing the cost of treating hypertension through doctor’s office visits, pharmaceuticals, home health visits or emergency care, it negates to recognize the underlying cause- obesity.
Diabetes is another chronic condition associated with obesity. In recent studies, the relative risk of developing type 2 diabetes has been found to increase by 25% for each additional unit of BMI over 22kg/m2. In a prospective study that is representative of the U.S. population, noted that 27% of new diabetes cases were attributable to weight gain in adulthood (National Institute of Health, 1998). Diabetes currently affects 25.8 million children and adults in the United States. Of that population, many are also suffering from obesity. It costs $245 billion dollars in 2011 to treat diabetes (Center for Disease Control, 2012). That is $98 billion more than the approximated amount that is spent on obesity. Since not all citizens who are suffering from Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes or other forms are not all obese, we can adequately assess the direct reduction of costs if we were to emphasize the prevention or treatment of diabetes. However, we can understand the underlying connection between obesity and diabetes therefore focusing our efforts on preventing one disease from causing more extensive damage to the body.
Fat tissue is a metabolically active endocrine system that secretes hormones and inflammatory cytokines. One of the hormones secreted in excess fat tissue (specifically abdominal fat) is leptin. This hormone tells your brain that your body is full, increase metabolic rate, and increase physical activity. In obesity, one has continually high levels of leptin and therefore causes a leptin resistance in the body. This leads to free fatty acid spill over into tissues other than fat cells, such as: liver, pancreas, and heart. Also in obesity, it causes an increase of fat growth through hypertrophy (larger fat cells) and hyperplasia (increase in fat cell quantity). This whole chain of events leads to these numerous and overgrown fat cells to becoming unstable and rupturing, thus, releasing their contents and increasing further inflammation. Most times, the ultimate conclusion leads to lipotoxicity and inflammation that is insulin resistant, which is a principal factor of diabetes and metabolic syndrome (Hu, F. 2008). Obesity has an incredible effect on the human body. Its associated conditions are numerous and contribute substantially to the direct cost of healthcare. Each disease requires different treatments, different tests, and different medication therefore incurring comprehensive bills. However, one key relation is obesity and therefore should be treated as primary concern to relieve the multi-faceted issue. The last contribution to the correlational costs (and future costs) between health care and obesity is the proliferation to America’s youth. A child is considered obese if they have a Body Mass Index that is higher than the 95th percentile for their age and gender. In 2004, the Progress Review 2010 found that there is an increase in the prevalence of obesity for all age groups in the United States. In the past three decades the numbers have tripled causing a growing concern for healthcare members, families, and public health officials. The most recent study for that 17 % of children are obese (Budd & Hayman, 2008). This figure is a predetermination of the future crisis if current public health officials do not sufficiently address this problem plaguing our youth. Currently the United States’ First Lady, Michelle Obama has initiated a program called “Lets Move,” which is aimed curing the obesity epidemic in children within one generation. It is a comprehensive model that incorporates facts on healthy living, simple steps for success, nutrition information, and activity ideas to increase physical activity. Since the enactment, the accomplishments of this program are approved legislations such as, Healthy, Hunger-Free Kids Act, which aids American public schools in offering healthier meals for tens of millions of American children. Concurrently, the U.S. Department of Agriculture outlined a new school meal regulation that boosts the quality and nutrition of national school lunch and breakfast programs. Lastly, Walgreens, Supervalu, and Walmart released a new commitment to build or expand stores in communities with limited or absolutely no access to healthy nutrition (Let’s Move, 2013). In conclusion, America’s economic crisis creates a higher scrutiny on every dollar spent. Obesity has far reaching consequences, whether it’s the epidemic’s effect on future generations, the direct loss due it’s many interrelated conditions, or indirect costs due it’s influence on the country’s work force. Obesity has incurred a $147 billion dollar tab on the American all-encompassing and soon to be maxed out credit card. Yet it could be easily prevented through adequate nutrition and appropriate physical exercise.
Works Cited
Agency for Healthcare Research and Quality [AHRQ]. (September 2011). One in Four Americans Treated for Hypertension. Advancing Excellence in Healthcare. Retrieved on 27 October 2013 from http://www.ahrq.gov/news/newsroom/news-and-numbers/092811.html
Blatter, et al. (March 2005). Effect of sporting activity on absenteeism in a working population. US National Library of Medicine National Institutes of Health. Retrieved on 07 October 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492021/#ref9
Budd, G. & Hayman, L. (2008). Addressing the Childhood Obesity Crisis. A Call to Action. Retrieved on 24 October 2013 from https://edge.apus.edu/access/content/group/234804/PDF%20Files/AddressingChildhoodObesity.pdf
Center for Disease Control and Prevention [CDC]. (September 2012). Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960- 1962 Through 2009- 2010. NCHS Health E Stat. Retrieved on 07 October 13 from http://www.cdc.gov/nchs/data/hestat/obesity_adult_09_10/obesity_adult_09_10.htm
Center for Disease Control and Prevention [CDC]. (April 2012). Causes and Consequences: What Causes Overweight and Obesity? Overweight and Obesity. Retrieved on 13 September 2013 from http://www.cdc.gov/obesity/adult/causes/index.html.
Harvard School of Public Health. (2012). Paying the Price for the Extra Pounds. The Obesity Prevention Source. Retrieved on 25 September 2013 from http://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/
Hu, F. (2008). Obesity Epidemiology. New York: Oxford Press, Inc. Retrieved on 23 October 2013 from sgh.org.sa/Portals/0/Articles/Obesity Epidemiology - Methods and Applications.pdf
Let’s Move. (2013). About Let’s Move. America’s Move to Raise a Healthier Generation of Kids. Retrieved on 27 October 2013 from http://www.letsmove.gov/accomplishments
National Institutes of Health [NIH]. (September 1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Obesity Education Initiative. Retrieved on 13 September 2013 from http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf
Unger, R. (2012). Obesity Now Costs Americans More in Healthcare Spending than Smoking. Forbes. Retrieved on 24 October 2013 from http://www.forbes.com/sites/rickungar/2012/04/30/obesity-now-costs-americans-more-in-healthcare-costs-than-smoking/

Cited: Agency for Healthcare Research and Quality [AHRQ]. (September 2011). One in Four Americans Treated for Hypertension. Advancing Excellence in Healthcare. Retrieved on 27 October 2013 from http://www.ahrq.gov/news/newsroom/news-and-numbers/092811.html Blatter, et al. (March 2005). Effect of sporting activity on absenteeism in a working population. US National Library of Medicine National Institutes of Health. Retrieved on 07 October 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492021/#ref9 Budd, G. & Hayman, L. (2008). Addressing the Childhood Obesity Crisis. A Call to Action. Retrieved on 24 October 2013 from https://edge.apus.edu/access/content/group/234804/PDF%20Files/AddressingChildhoodObesity.pdf Center for Disease Control and Prevention [CDC]. (September 2012). Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1960- 1962 Through 2009- 2010. NCHS Health E Stat. Retrieved on 07 October 13 from http://www.cdc.gov/nchs/data/hestat/obesity_adult_09_10/obesity_adult_09_10.htm Center for Disease Control and Prevention [CDC]. (April 2012). Causes and Consequences: What Causes Overweight and Obesity? Overweight and Obesity. Retrieved on 13 September 2013 from http://www.cdc.gov/obesity/adult/causes/index.html. Harvard School of Public Health. (2012). Paying the Price for the Extra Pounds. The Obesity Prevention Source. Retrieved on 25 September 2013 from http://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/ Hu, F. (2008). Obesity Epidemiology. New York: Oxford Press, Inc. Retrieved on 23 October 2013 from sgh.org.sa/Portals/0/Articles/Obesity Epidemiology - Methods and Applications.pdf Let’s Move. (2013). About Let’s Move. America’s Move to Raise a Healthier Generation of Kids. Retrieved on 27 October 2013 from http://www.letsmove.gov/accomplishments National Institutes of Health [NIH]. (September 1998). Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Obesity Education Initiative. Retrieved on 13 September 2013 from http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf Unger, R. (2012). Obesity Now Costs Americans More in Healthcare Spending than Smoking. Forbes. Retrieved on 24 October 2013 from http://www.forbes.com/sites/rickungar/2012/04/30/obesity-now-costs-americans-more-in-healthcare-costs-than-smoking/