That $200B number I believe represents the how much more the obese population will spend on healthcare compare to the normal weight population. That is different from the overall impact of obesity on national health care costs, which includes costs paid for by insurance and medicare. One way to estimate that is to go back to the statistic that 90% of the $4.1Trillion annual US health care cost is due to the treatment of chronic diseases.
We know that obesity significantly increases the probability of getting many such diseases. The obese compared to normal weight have 2x-3x higher probability of heart disease, 65% higher frequency of hypertension, about a 5-fold higher likelihood of diabetes, and a 60% increased risk of arthritis as well as stroke. About 80% of obese will develop liver disease and there are studies suggesting that obesity is responsible for 30% of chronic kidney disease. Obesity also substantially increases the risk for several types of cancers. The list goes on.
And this is just obesity. Being overweight also increases the frequency of these chronic diseases.
Given these numbers, I think it fair to say that since 70% of American are overweight with over half of these in the obese extreme that above normal weight is the primary cause of the high cost of American health care.
Because promotion programs don’t work. It’s like the effectiveness of “Just say no” was to the drug problem. What does work is economics. Put a big tax on sugar-supplemented drinks and use the revenue to subsidize fresh fruits/vegetables and organic farming. Extend the tax to foods with high salt or high fructose or that are otherwise highly processed if necessary. Also if necessary, find ways to financially penalize obesity (irresponsible eating) in the same way we penalize irresponsible driving.
Certainly will be a burden to the overweight, perhaps even unjust, but a necessity I think if one wants to control health care costs. Every health system or country that I know of with a growing obesity problem has a health care cost crisis.
Yeah, I looked at that article - but he provides no support his claim at all that 90% of all U.S. annual health care cost is due to the treatment of chronic disease. He just states as fact, with a dead link to a CDC page that is labeled “overview” - so itself probably not much of an in-depth analysis.
Do you have any other cites for the proposition that 90% of health care costs are for chronic diseases? I tried to find something close to that, but most searches end up returning either that one article or things that mistake the fact that 90% of health care costs go to a person with at least one chronic condition to a claim that this means that 90% of health care costs are treating chronic conditions. To the contrary, the CDC reported that in in 2016, actual medical expenditures on all chronic diseases were about $1.1 trillion, which was about 30% of health care expenditures that year:
…which would put the expenses of treating preventable chronic diseases at an event lower percent, and the delta in costs that could be achieved in preventing those chronic diseases to comparable other countries (no one has no chronic disease) at far, far less indeed.
If you can find any actual analysis that backs that up, I’d be curious to see it. Again, almost every resource I found that tried to put a number on how much of U.S. health care costs are due to obesity were all around that $200 billion - nowhere near the $2 trillion that your back-of-envelope analysis suggests. International analyses suggest the same thing - the OECD put the health care costs of obesity at around 8% of total health care spending:
And this article says that 10% is spent on end-of-life care, which leaves zero for everything else.
In 2021, Americans spent a staggering $4.3 trillion on healthcare. A significant portion of this expenditure, approximately 10% ($430 billion), was spent on end-of-life care and hospice costs [1].
In case you are thinking that “mental health” might provide a way out, consider that the CDC found about a 30% increased frequency of depression among the obese compared to normal weight adults. This was true for every age group. Another study put estimated 55% higher risk.
Obesity significantly increases the risk of most of the most common chronic diseases, including all the ailments listed in the CDC link. In addition to what I listed previously, there is evidence of a 30% higher risk for dementia for the obese, obesity is a major risk factor for epilepsy, and there is even a link between obesity and tooth decay.
And again, this is just the obese who make up 40% of the US population. Another 30% are overweight (but not obese) who also have higher frequencies of these chronic conditions than normal weight.
A quick scan of the literature suggests to me that given (1) 90% of health care costs are due to chronic diseases, (2) the overweight have about 20-60% higher incidence of most chronic conditions including the most expensive, and that (3) a large and growing majority of the US population is overweight (30% overweight but not obese + 40% obese), excess weight is the primary driver of high healthcare costs.
A quick back-of-the-envelop estimate suggests if we could push US obesity rates back to where it was in the 1960s (13% vs 40+%) we could reduce US health care costs by as much as 40%. This would put our per capita health care cost close to Canada.
If you don’t know how that number was calculated you don’t really know what that number means. Again, to my knowledge that is the extra health care expenditure of an obese American compare to a normal weight American. It does not include the cost born by insurance companies and medicare.
For example, it is estimated that an obese American spends about $2500 more than a normal weight American and there are about 100M obese Americans. That gives you your $200B estimate. That doesn’t tell you how much insurance companies and medicare have to pay for treating the obese. Direct medical costs of obesity in the United States and the most populous states - PMC
Which is not the same thing as saying that 90% of the nation’s health care expenditures are for the treatment of chronic and mental health conditions. Just that 90% of the treatment goes to people who have one or more chronic and mental health conditions. Again, the estimates that I’ve found (also by that obscure agency called the CDC, linked above) put it closer to a third that’s actually spend on the chronic condition - the link above, and:
Is that math right? Even if the obese population had 60% higher incidence of chronic diseases, and if you can reduce the obese population by 27 percentage points (40 to 13), even if chronic illnesses were 100% of health care costs you would end up reducing health care expenditures by “only” 16%. Or am I missing something? I went to law school so I wouldn’t have to do math….
Sigh, it just takes too much effort to explain complicated stuff. Again, one has to look at the methodology to understand what the numbers mean. Your $1T number for chronic diseases is derived from estimates of how much it costs to treat each individual chronic illness and then adding them all together. This leaves out the fact that people with multiple chronic diseases incur greater health costs than would be predicted by treating each disease separately. This is probably because having multiple chronic diseases increases the likelihood and length of expensive hospital stays. This the stat used by the CDC when claiming that 90% of health care costs is due to chronic disease and is supported by this paper.
Some relevant quotes:
The population of older adults in the United States living with multiple chronic conditions (MCC) continues to grow, with recent estimates exceeding 70% [1]. MCC, often termed multimorbidity, is defined as the occurrence of two or more chronic diseases and is associated with reduced quality of life [2] increased mortality [3], and accounts for 84% of total health care expenditures [4, 5]…
…The rise in the prevalence of MCC can be attributed, at least partially, to the rapid rise in the epidemic of obesity [9].
Highmark medical puts it explicitly: The total cost of managing and treating chronic conditions is staggering. The Centers for Disease Control and Prevention (CDC) estimates that 90% of all health care costs in the U.S. go toward treating chronic disease and mental health — about $3.7 trillion a year. Any efforts to reduce total health care costs in the U.S. must address these chronic health conditions.Chronic Disease Costs a Lot: How Care Management Can Help | Highmark
I also took into account a similar reduction in the number of overweight individuals and gave myself a fudge factor of “as much as 40%”.
Again, Highmark is reading the sentence as saying something it doesn’t. 90% of all health care costs go towards treating a patient that has a chronic disease or a mental health condition - not necessarily towards treating the chronic disease.
No one’s saying that making people healthier can’t reduce health care expenses - if you get people to stop smoking, they’ll both have longer lifespans and avoid health care expenses due to smoking-related illnesses. But the magnitude of that effect isn’t as large as you’re suggesting, and certainly not for just obesity.
It’s why you also don’t see as much variation within comparison countries on health care costs, even though their obesity rates are vastly different from each other, as you would expect if obesity is such a large driver of health care costs. Sweden spends roughly the same amount on health care as the UK, despite having one of the lowest obesity rates in Europe compared to the UK’s highest; Australia’s health care expenditures are roughly the same as Denmark or Germany or Norway or Switzerland, even though Australia’s got the second-highest obesity rate of developed countries after the U.S. Etc. Obesity correlates to overall health care spending, but it’s a modest factor in determining health care costs.
Cross-country analyses of the health cost impacts of both obesity and being overweight put the OECD average at around 8.1% - with the U.S. being an obvious outlier of having about 14% of costs being due to overweight. Which indicates - again - that reducing the incidence of obesity and overweight in the U.S. down to “average” might shave off about 6% or so (give or take) of health care costs. That ain’t nothin’, but it’s not what accounts for other countries’ lower health care costs. It’s price controls.
You just don’t understand. I linked a paper you ignored that found that 84% of US health care costs comes from treating patients with more than one chronic disease. That’s called multimorbidity. Multimorbidity substantially increases the cost of treatment well beyond what one would expect from treating each disease singly. You ignore this because it is inconvenient to your position. Again, the CDC is not wrong, nor is the Highmark interpretation. You just don’t get it.
No doubt you will ignore this next paper too, but it describes the “super-additivity” of costs resulting from interactions between diseases that occurs with multimorbidity.
The costs of the 10 selected chronic diseases were substantially higher for individuals with comorbidity, demonstrating the pattern of super-additive costs in cases of diseases interaction. For instance, the cost associated with diabetes for people without comorbidity was estimated at 1776 €, whereas this was 2634 € for people with heart disease as a comorbidity. Overall, we detected 41 cases of super-additivity over 45 possible comorbidities. The extra cost of comorbidity: multiple illnesses and the economic burden of non-communicable diseases | BMC Medicine | Full Text
That’s why the more relevant data for extrapolating the real cost of chronic disease treatment is the cost of treating patients with one or more chronic diseases. Far better than a simple summation of the cost of treating each chronic disease separately. That’s because a majority US adults (51%) and a large majority of seniors (79%) have two or more chronic conditions. Until you understand this you are missing the point. Trends in Multiple Chronic Conditions Among US Adults, By Life Stage, Behavioral Risk Factor Surveillance System, 2013–2023
No real-world correlations are perfect so you finding exceptions between countries is not a big deal. The important thing is that there is an overall strong positive correlation between obesity and health costs.
And the impact of obesity is not modest if you understand the data. To summarize, 84% of US health care spending is due to treating patients with multiple chronic diseases. Obesity and being overweight significantly increases the frequency of such multimorbidities, as much as 2-fold. Over 70% of the US population is overweight or obese. Therefore, the high cost of US health care is primarily due to excess weight.
I don’t ignore it because it’s inconvenient to my position. I ignore it because it’s already accounted for in the analyses I posted.
Again, as noted in the study upthread, only about 1/3 of U.S. health spending is spent on treatment of chronic illnesses. All chronic illnesses. So whatever the impact is of “super additivity” from multi-morbidity, it’s already captured in that analysis. Even if there are costs to obesity that would show up in the “hypertension” column or the “diabetes” column rather than the costs of obesity, they would still be reflected in the overall total. If all the chronic illness treatments are only about a third of health care spending, cutting obesity in half can’t possibly result in a ~40% reduction in health care costs. It’s just literally not possible.
And in the OECD study of obesity costs, they explicitly took into account the higher costs that obesity imposes on other illnesses:
The publication highlights that obesity is responsible for 70% of treatment costs for diabetes, 23% for cardiovascular diseases and 9% for cancers.
So put me in the “extraordinary claims require extraordinary evidence” team here. If you’re suggesting that the actual costs of obesity to the health care system are close to 40% or so of total expenditures, I’d want to see something that specifically makes that finding. You’re arguing that all of the public health professionals, scientists, and health care economists that have been deliberately studying the costs of obesity and chronic diseases have somehow completely missed something that made their assessments off by an order of magnitude. Even though the something isn’t exactly unknown, or even counterintuitive - and even as they are trying to capture every possible remote impact of obesity on costs to both the health care system and society at large, both direct and indirect. But whether it’s in the U.S., or the OECD, or the EU, they all find that the health care costs associated with obesity are significant but not anywhere as big as you suggest. Which is why obesity correlates with health care spending, but does not dominate it - countries with very high rates of obesity can have lower costs of health care spending than those with very low rates of obesity, and vice versa.
Reducing obesity - like reducing smoking - would definitely reduce health care costs by some amount. But it won’t be, it can’t be, anywhere near the magnitude of what you’re suggesting.
I think lawyers should be mentioned. Threats to sue make health care providers cautious. Easier to order additional procedure or test than risk a law suit.
Liability insurance is a major cost at all levels.
Boy, are you misinformed. There are many examples due to the complexity and limitations of the medical coding system, but I’ll choose one that should be easy to understand. It is well known that many chronic diseases negatively impact the immune system. Diabetes for example. Folks with diabetes are more likely to get infected and with more severe symptoms. This means that a lot of folks hospitalized for severe covid would not have been if not for their diabetic condition. Nevertheless, these folks are coded for treatment for Covid, not diabetes.
So when future researchers go through the computer records to figure out the cost of diabetes, the involvement of diabetes in covid hospitalizations will not be included. And again, this is but one of many such examples. That’s why researchers also look at the health care cost of patients with one or more chronic diseases because this better captures the impact of chronic diseases on the overall health outcome. Patients with chronic diseases and especially with multimorbidity are much more likely to come down with other diseases or face complications from other health issues. The cost of treating these complications rarely get attributed to the chronic condition despite the clear connection.
That’s why looking at the cost of treating patients with chronic diseases is the best way to estimate their cost to healthcare. That is why 80-90% of healthcare expenditures involve chronic diseases.
This is just the ravings of a lunatic. The CDC is the best record keeper of health care costs and has consistently made the same statements I am making for decades. For example, this paper referenced a 2009 CDC report:
According to Centers for Disease Control and Prevention (CDC), chronic diseases are responsible for more than 75 percent of the $2.5 trillion spent annually on health care (CDC, 2009). https://pmc.ncbi.nlm.nih.gov/articles/PMC3983726/
About 90% of the annual $4.1 trillion health care expenditure is attributed to managing and treating chronic diseases and mental health conditions. https://www.cdc.gov/pcd/issues/2024/23_0267.htm
For a nonCDC reference, this paper cited a 2014 database and concluded:
The high prevalence of chronic diseases is a key driver of total U.S. healthcare costs; in 2010, 86% of healthcare spending was for patients with at least one chronic condition, and 71% of spending was for patients with multiple conditions. https://www.ajpmonline.org/article/S0749-3797(17)30426-9/fulltext
United Health Care estimated that even for workers on employer health plans, who typically are at ages where chronic diseases are less frequent,…
Not surprisingly, the economic impact of chronic conditions is far more profound with older Americans, at least according to a report by the senate Joint Economic Committee:
This is only controversial to you. Medical data is complicated and there are different ways to look at that data. If you don’t understand what the data means perhaps one should be more circumspect about making conclusions. The simple fact is that rising health care costs is being driven primarily by a sharp rise in patients with multiple chronic diseases. Therefore, reducing the frequency of chronic diseases is necessary to reduce healthcare costs. One way to do this is to greatly reduce the percentage of overweight individuals.
And with this massive post I endeth my contributions to this thread.