Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status

Abstract

BackgroundThe prevalence of obesity has more than doubled in the USA in the past 30 years. Obesity is a significant risk factor for diabetes, cardiovascular disease, and other clinically significant co-morbidities. This paper estimates the medical care cost savings that can be achieved from a given amount of weight loss by people with different starting values of body mass index (BMI), for those with and without diabetes. This information is an important input into analyses of the cost effectiveness of obesity treatments and prevention programs.MethodsTwo-part models of instrumental variables were estimated using data from the Medical Expenditure Panel Survey (MEPS) for 2000–2010. Models were estimated for all adults as well as separately for those with and without diabetes. We calculated the causal impact of changes in BMI on medical care expenditures, cost savings for specific changes in BMI (5, 10, 15, and 20 %) from starting BMI levels ranging from 30 to 45 kg/m2, as well as the total excess medical care expenditures caused by obesity.ResultsIn the USA, adult obesity raised annual medical care costs by $US3,508 per obese individual, for a nationwide total of $US315.8 billion (year 2010 values). However, the relationship of medical care costs over BMI is J-shaped; costs rise exponentially in the range of class 2 and 3 obesity (BMI ≥35). The heavier the obese individual, the greater the reduction in medical care costs associated with a given percent reduction in BMI. Medical care expenditures are higher, and rise more with BMI, among individuals with diabetes than among those without diabetes.ConclusionsThe savings from a given percent reduction in BMI are greater the heavier the obese individual, and are greater for those with diabetes than for those without diabetes. The results provide health insurers, employers, government agencies, and health economists with accurate estimates of the change in medical care expenditures resulting from weight loss, which is important information for calculating the cost effectiveness of interventions to prevent and treat obesity.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-014-0230-2) contains supplementary material, which is available to authorized users.

For a Step Change to Curb the Obesity Epidemic

“…Corica et al [3] review evidence on the impact of obesity and age on quality of life, highlighting the lesser-studied effect of obesity on the elderly. Cawley et al [1] and Li et al [4] use different approaches and data sources to estimate the medical care costs (and savings) associated with weight/body mass index (BMI)-and potential weight loss-for patients with and without diabetes. Allen et al [5] highlight the impact that obesity has had on Medicare expenditures for certain chronic conditions-such as diabetes, heart disease, hypertension, and hyperlipidemiaover nearly a quarter century .…”

“…First, the prevalence of obesity is extremely high, with one in three adults worldwide being overweight or obese [1,2]. In the USA alone, 80 million adults (35 %) and 12.7 million children (17 %) suffer from obesity [2,7,8].…”

“…Notably, obesity accounts for 42.3, 30.9, 22.4, and 9.8 % of the increase in the number of cases of diabetes, heart disease, hypertension, and hyperlipidemia, respectively, in the past quarter century [5]. Finally, obesity has a large impact on patient wellness, productivity [12][13][14], and quality of life [2,3], and is associated with significant costs to healthcare payers and society [1,4,5,15].…”

“…As shown by Cecchini and Sassi [18] and others [17], initiatives to tackle obesity generally have positive returns, suggesting underinvestment in this area. While in the USA more than a quarter of healthcare costs are driven by obesity [1], investments in obesity treatments are surprisingly low, with only 0.2 % of total healthcare spending accounted for by bariatric surgery costs (author calculations based on figures in [48][49][50]) and only 0.04 % of total drug expenditure spent on anti-obesity drugs [1].…”

“…Rising obesity levels worldwide have been of increasing public concern since the late 1990s and are now responsible for over one-quarter of total healthcare expenditures in the USA [1]. This special issue of PharmacoEconomics examines a particularly challenging set of issues, with an economic focus: why is the obesity epidemic and its unique burden still growing uncontrolled?…”