The prevalence of obesity in the U.S. could rise sharply under a new definition of the condition released earlier this year by the Lancet Diabetes and Endocrinology Commission, according to research co-authored by Harvard-Mass General specialists.
Investigators from Harvard and Mass General Brigham found that when applying the new criteria, which expand upon the traditional use of body mass index (BMI) to include measures of body fat distribution, the prevalence of obesity increased from about 40 percent to about 70 percent among more than 300,000 people included in the study. The rise was more pronounced among older adults.
Not even close, except in the Newspeak used in USA political discussions.
We live in a weird and highly distorted market economy where the “free market” includes the freedom to buy significant control over whole sections of the both the communications and goods economies, via buying Congress and state legislatures and governors and prezzes. Various forms of public health pushback (e.g. prescribing food education and healthful food in schools and public venues) are outlawed or very severely limited.
The European method is to provide “free or low cost education” to the student, financed by taxes upon the citizenry, and then limit the compensation of doctors.
The" free or low cost education" is provided to all students regardless of area of study. The European governments calculate that the taxes pay to educate the population will return in future tax payments from the graduates of the universities.
Of course. But price controls are a much simpler lever, from a policy perspective, than “let’s make the country healthier” is. Especially since in this country, most of the things that affect general public health are administered by state governments - and thus there is no feasible way to have a coherent national policy. It is at least theoretically possible to have federal price controls (though I think that’s still probably infeasible), but not to have any materially significant federal “health” policy to address things like obesity.
To be sure, price controls would affect the economic incentives affecting not just doctors, but every single health care provider. But that’s how nearly every other country manages to keep their health care costs down. They’re not paying half what we pay because they use half the number of health care services due to being X times more healthy. They’re using roughly the same amount of health care services, but paying vastly less for each service or treatment or medication or piece of equipment (overall).
So if you actually want to reduce health care costs to anything approaching international comparison countries, you have to reduce the costs of health care. You can’t get there by reducing the amount of health care people need. You need to make the actual health care cheaper. Nearly all other western developed economies do that by means of the price list. The U.S. will not be the exception - we’re not cutting our health care expenses in half unless we adopt price controls, and pretty stringent ones at that.
Even when we look at the cost of procedures NOT tied to lifestyle, we are still more expensive.
Take brain cancer (just one of a myriad of examples). The cost to treat brain cancer in the US is more expensive than it is in Europe. Changing diet or exercising more will not make that cost per event any cheaper.
How about Type 1 diabetes? Same result - more expensive in the US:
If you don’t get sick you don’t have expensive medical interventions. For the past decade I have only spent a few hundred dollars a year on healthcare. How many elders have expensive medical procedures does not impact people who don’t have to see a doctor.
To bring down healthcare costs people have to be healthy. Obesity and related maladies are mostly self inflicted. Getting healthy eliminated my tooth and eye decay. No new cavities or new glasses in a decade. Got rid of eight medications. Solving societal healthcare is difficult. Taking care of oneself is not.
…and no one has mentioned “end of life” “health care” (snort) costs, and so here is the mention:
USAians facing death — both the dying and their families — cause staggering amounts to be spent to prolong from days into weeks a remorseless natural process in ways that are spiritually, morally, ethically, and — in brass tacks moment to moment terms — IDIOTIC.
I have no solidly researched answer as to why, but having been a death bed attendant hundreds of times (AIDS did that to me), I know that loving baffled families inflect insane amounts of suffering on those they love at Great Cost monetarily and emotionally to all concerned.
I have seen that European death processes almost always can use far more education and gentle nudging to avoid the USAian mess. “Your great grandma is dying, there is nothing we can do now to return her to life, and so now it is time to pour out your love and caring for her, and to say goodbye.”
The U.K. and U.S. have similar obesity rates (64% and 68%). U.K. healthcare spending is half of the U.S. with better life expectancy:
U.K.: 81 years life expectancy, $ 6.4k healthcare spending.
U.S.: 78 years life expectancy, $13.8k healthcare spending.
The U.S. healthcare system has high prices because it has a blank check. Most countries run on a budget, and get better life expectancy.
Obamacare 2026 prices (without subsidies) vary widely by state. For a family of four with $130k income, health insurance premiums: 5 states are above $30k, and 13 states are below $20k. There is a 2.8 ratio between the highest (Vermont) and lowest (New Hampshire). Obamacare premiums:
Besides the expensive pretense of pretending we can hold off death, the USA system was created and is maintained with AMA and associated interests with strong votes and vetos in how it is structrured. Not so much in UKofGB.
Not just USAians, many people of good will want their loved ones to stay as long as possible. The money is not the problem, it’s a form of torture when people have reached the age to leave us. I have some anecdotes but they are too private to tell. People who have lived a fulfilled life don’t fear death, some even welcome it.
There is an anecdote I can tell about Tante Laura. She was in her eighties or early nineties and kept her house spotlessly clean. She bragged that her floors were so clean you could eat from them. In time she was bedridden and needed oxygen which was installed next to her bed. She ripped the mask off her face saying that if she could not live without it she didn’t want to live. And died.
BTW, after a doctor’s visit to her home she commented with a grin, “Did you notice how cute the doctor was?”
Another example of Americans escaping accountability. It has always been known that fresh fruits and vegetables are health, that exercise is healthy, that eating a lot will cause weight gain. The public info on nutrition was less accurate in the 1950s and 1960s when the obesity rates were in the low teens. Today we are at 40% despite the internet, AI search engines, and thousands of books-blogs-magazine articles on nutrition. The American weight problem isn’t about information. It is about culture and character. The WWII generation had culture/character that kept weight gain under control (despite living in the era of Wonderbread, spam, soda, and sugary cereals). The following Boomer generation has a culture/character that leads to obesity.
And again, given its GDP, Europe does not provide nearly as much new drugs and treatments as US companies. From Google AI
The United States is a major source of new drugs, with74% of all new drugs sold being sold in the U.S. by the end of 2022, according to RAND analysis and HHS reports. Furthermore, more than half of new drugs are launched first in the U.S., creating an average lag of about one year before they are launched in other major markets, notes RAND. Another metric shows that 68% of novel drugs approved in 2022 were first approved in the U.S
Higher US drug prices incentivizes drug discovery. Simple economics.
One can do this, but the result will be exacerbating the doctor shortage and reducing the rate of drug innovation and discovery. Maybe it is worth it or maybe not, but to not include these consequences in the discussion is to be woefully naive.
That’s great, but it is not sustainable. UK doctors are leaving the government system because of pay and work conditions. The UK is increasingly dependent on importing doctors from places like India, but as India develops that source will either dry up or require UK salaries to compete. Why I’m disappointed so many of my colleagues are leaving the NHS | The Independent
No one’s suggesting one not include those consequences. But again, given that every other western developed economy has managed to have these kinds of price controls and still have a pretty good health care system, perhaps the magnitude of these impacts just isn’t all that large. Not zero, to be sure - but also not horrendous. As you point out, Europe has managed to attract numerous foreign and foreign-trained health care professionals - so presumably the rates of compensation aren’t so low that they result in material deficiencies in medical care.
There is, of course, absolutely nothing wrong with the goal of trying to get people to be healthier - improving their diet, increasing their physical activity, etc. And Americans’ poor health (relatively speaking) has a huge impact on vast areas of the economy. But it’s probably unrealistic to expect such efforts to have a material impact on health care costs.
From the link: Between 2014 and 2023, the number of new doctors in the European workforce nearly tripled, while the number of nurses rose fivefold, according to the report.
During that time, the number of foreign-trained doctors rose 58 per cent and the number of foreign-trained nurses increased by 67 per cent. Germany and the United Kingdom accounted for most of that growth.
Quite an increase! What is the reason behind that statistic?
Less Europeans studying to be doctors? European demographic issues? Foreign-trained doctors rushing to perceived better income or living conditions?
Yes that could be it. The shift has created a stark divide: countries in eastern and southern Europe are losing health workers to western and northern countries, exacerbating shortages in some areas while filling them in others, the report found.
The US tends to have drug and surgery discovery in the areas of health care that this country requires. We have lots of heart disease and cancer. Thus, we have lots of drugs and treatments for heart disease and cancer. If a foreign country has a much lower problem with these conditions, why would their industry try to solve them?
Seems to me that changing US lifestyle such that preventable chronic diseases are significantly prevented would substantially lower health care costs.
I’m guessing the best foreign-trained doctors will go to places that provide higher incomes. One typically gets what one pays for. Does the quality of doctors matter?
The way the free market determines what is required is by what it can sell the product for. Set the price low and the market sees it as low demand.
Drug discovery is expensive. Lower the potential profits and you reduce the motivation to discover drugs.
For example, estimates vary, but generally the total amount of direct costs to the U.S. health care system of obesity is around $200 billion. In theory, an aggressive approach to fighting obesity might get us down to a general OECD comparison country rate of about half the incidence of obesity - so maybe save $100 billion. Out of annual health care spending of about $4 trillion. Even before taking into consideration any costs in obtaining that obesity reduction.
JAMA’s looked at this, and found that generally preventative programs do not reduce health care costs:
But presently, there is little evidence for lifestyle and behavioral health promotion programs that reduce future health care costs by enough for a large enough share of participants to save money overall—and many may not even improve health outcomes. Ignoring this reality in favor of wishful thinking is, unfortunately, too common. Governments and capitated groups such as accountable care organizations have poured funds into prevention programs to cut costs; ironically, those elevated expectations and higher spending might be exactly why the programs haven’t proved successful in lowering total costs.
Note that your link does not say that 80% of chronic diseases are preventable: it says that “80% of chronic disease and premature death could be prevented by not smoking, being physically active, and adhering to a healthful dietary pattern.” That conjunctive to “premature death” does a lot of heavy lifting. Health living doesn’t near-eliminate chronic disease - even the healthiest comparison countries still have chronic disease rates that are higher than 20% of ours. The U.S. is definitely an outlier to having more chronic disease, but not enough to get us anywhere close to comparison country health care expenses if we could get to their levels of chronic disease.
