In a study published in PLoS Medicine, 'Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure', researchers used data from The Netherlands to simulate the annual and lifetime medical costs attributable to obesity. They also compared these costs to those attributable to smoking as well as to the medical costs associated with healthy persons (defined as non-smokers with a body mass index in the range of 18.5 to 25 kg/m2). The researchers explored the question of whether reducing obesity would lead to reduced or increased healthcare costs.
They found that although annual healthcare costs are highest for obese people earlier in life (until age 56 years), and are highest for smokers at older ages, the ultimate lifetime costs are highest for the healthy (non-smoking, non-obese) people. Hence the authors argue that preventing obesity will not save medical costs.
Their results tell us that that life expectancy from age 20 is reduced by 5 years for obese people and 7 for smokers. The consequence is that healthy people live to incur greater medical expenditure subsequently on average, more than compensating for the earlier excess expenditure related to obesity or smoking.
A Foresight report on obesity in the United Kingdom looks ahead to 2050 and stresses that obesity rates are rising, that the determinants of these rises are complex and go much further than individual control of diet and exercise, and that if nothing changes costs to the health service and society will increase as a direct consequence. Yet this study suggests that obese people cost less to health services than non-obese people. Smokers cost still less. Clearly at a time when obesity is deemed a major health issue, in part because of its putative healthcare costs, the results of this new study sound paradoxical.
How should we interpret these results?
In a sense, the study is a convenient answer to current concerns. But it does not diminish them. Obese people cost less because individuals die younger and consequently with less chronic illness associated with old age. Good to know, but will it affect public health approaches to obesity? Does it mean that concerns about obesity are illogical, at least as far as health-service costs are concerned?
Sadly not. Examine an obese population and a lean population of the same age and sex distribution. The former will incur more healthcare costs throughout the life course. Much more diabetes, and more cardiovascular disease and cancer will occur amongst the obese—even amongst the older obese. Compare healthcare costs now with those thirty years ago, and—holding everything but obesity constant—the current population costs much more to the health sector than it did then.
Furthermore, apart from healthcare costs, the other costs to society from obesity are also greater because of absences from work due to illness and employment difficulties; these costs amount to considerably more than healthcare costs. It is not clear that these extra costs are intrinsically related to healthcare costs, but they are currently estimated to be around four times as great in obese than in lean people.
Quality-adjusted life years
Health expenditure is high amongst the elderly, especially so amongst those who die of old age. This study confirms the high medical costs of living to old age, but the results should not be interpreted as justifying the “cost savings” to society of dying younger. And, as the authors point out, it would be wrong to interpret the findings as meaning that public-health prevention (e.g., to prevent obesity) has no benefits. As the authors say, whilst prevention may not be “a cure for increasing expenditures—instead it may well be a cost-effective cure for much morbidity and mortality and, importantly, contribute to the health of nations”.
Much research is still needed on the costs of being overweight (BMI >25) as opposed to being obese (BMI >30) for both the health sector and society as a whole. Translating individual costs and benefits to societal costs and benefits is never straightforward. People tend to have views about health that relate to their individual experiences, including personal lifetime expenditures. This new study serves to remind us that merely multiplying such estimates by population sizes of several million does not illuminate real public-health dilemmas. And this kind of simplification leaves out the numerous societal implications of obesity, which themselves are massively complex. Governments need to understand that public-health policies affect more than merely the sum of individual health, and sadly require greater courage to implement than does treating the sick.
This article has been edited from the original: "Does Preventing Obesity Lead to Reduced Health-Care Costs?" by Klim McPherson. The original version can be found at PLoS Medicine.