How times change! Wasn’t it just in April that the media and food and beverage lobby ran riot over a single study claiming that being overweight is actually good for you? I was among the few who pointed out that this utterly contradicted a mass of previous research, along with what’s known of human biology. Now a new study shows that the burden excess fat exacts on insurance costs comes from the burden it exacts on our bodies.
That study in the July Health Affairs classified people as obese (Body Mass Index above 30), overweight (above 25), and normal (below 25). Granted that “normal” is something of misnomer in a country where only a third of adults are below that 25 BMI level. It then compared medical expenditures for these three categories in 1987 and 2002.
To do so it looked at nine physical conditions aggravated by extra poundage, plus “mental disorders.” For all nine of the physical conditions in 2002, “overweight” persons fared WORSE than “normal” ones. They were almost three times likelier to have type 2 diabetes and well over twice as likely to have high cholesterol and high blood pressure.
But the obese suffer far more. They were more than twice as likely to suffer arthritis, asthma, heart disease, and upper gastrointestinal problems compared to “normal” persons. They were more than six times likelier to suffer diabetes and more than four times likelier to have hypertension.
So much for those grabby April headlines like the New York Times’s “Some Extra Heft May Be Helpful,” and AP’s “Study: Being Overweight Isn't So Deadly After All.” The old message was right all along – excess fat kills and cripples. It also costs us big bucks, the main message of the Health Affairs article.
How many bucks isn’t entirely clear. Health Affairs calculated that spending on private health insurance paid for by employees and families for fat-related illness jumped tenfold from 1987 to 2002, from $3.6 billion (adjusted for inflation) to $36.5 billion. In 1987 it was 2% of total health care spending on obesity; in 2002 11.6%.
But probably much of that increase is because we have a lot more treatments for fatter people now than we did then. Drugs and surgeries unavailable or little-used in 1987 have become routine.
Further, as one of nation’s top medical bloggers Medpundit has noted: “Since 1987 we have lowered the thresholds for diagnosing and treating high cholesterol and diabetes,” essentially broadening the definition of “illness.” Still, because so much more of the population has become overweight and obese (from 47.4% in 1976-80, to 56.0% in 1988-94, to 65.2% in 1999-2002), clearly the use of cholesterol and diabetes treatments would have soared anyway.
Medpundit also observed that all of the obesity-related disorders are age-related as well; hence expenditures for these will increase regardless of the fattening of the population.
Yet WE ARE becoming progressively porky and Health Affairs calculated that health care spending “among obese adults average $1,244 higher per person than normal weight adults.” Part of this is paid by the families of the overweight, but most is paid through increased premiums by their employers and fellow employees. Thin workers subsidize heavy ones.
That’s one response to those who attack groups and government health agencies they label “food police” and “nannies,” who insist that fatness is strictly a personal issue. Another is that a Health Affairs study two years ago found that taxpayer-funded insurance –Medicare and Medicaid – cover about half the extra costs of burgeoning bellies.
Yet another response is that fatness is a sociogenic illness in that, like unmarried mothers, the more you have the more you get. Increased visibility makes something more socially acceptable. We’re growing fatter in part because we’re growing fatter.
Even national defense is threatened. With
It’s long past time to accept not just that being overweight and obesity is bad for individuals, but for all of us.