The impact of weight loss among seniors on Medicare spending

Abstract

ObjectiveTo examine the impact of temporary and permanent weight loss of 10% and 15% on 10-year and lifetime Medicare spending among adults with overweight and obesity aged 65 years and older. Weight loss of this magnitude is consistent with next generation anti-obesity medications recently approved by the Food and Drug Administration.MethodsWe follow the approach of a longitudinal dynamic aging process model developed by our research team. This model considers the dynamic relationships between weight, chronic disease, acute medical events, functional status, mortality, health care utilization and spending among Medicare beneficiaries from age 65 until death. Using this model, we estimate baseline Medicare spending over the next decade and then over the lifetime of seniors with a body mass index (BMI) ≥ 27 with at least one weight-related comorbidity (overweight), and seniors with obesity having a BMI ≥ 30 and ≥ 35. We then estimate Medicare spending for this population between ages 65 and 70 over the course of a year, assuming 10% and 15% weight loss under alternative scenarios: with and without weight regain. (Weight regain is assumed to be 90% over a 10-year period.) The difference in spending between baseline (no weight-loss intervention) and the alternative scenarios represent potential gross savings to the Medicare program.ResultsPermanent weight loss of 10 to 15% will yield $9,445 to $15,987 in gross per capita savings throughout their lifetime, and $8,070 to $13,474 over ten years. Similarly, initial weight loss of 10 to 15% followed by 90% weight regain will result in gross per capita savings of $7,556 to $11,109 over their lifetime, and $6,456 to $8,911 over ten years. Targeting weight loss medications to adults with obesity (BMI ≥ 30) produces greater savings to the Medicare program.ConclusionMedicare can realize significant cost savings through anti-obesity medications that produce substantial weight loss, and as a result, reduce the progression to type 2 diabetes, and improve blood pressure and glycemic indicators in hypertensive and diabetic patients, respectively. Medications are currently excluded from coverage in the Medicare program, however, in light of potential savings and health benefits, may warrant consideration.

Fit and Strong! Plus: Design of a comparative effectiveness evaluation of a weight management program for older adults with osteoarthritis

“…Plus may be substantial. It is estimated that a 10–15% weight loss by overweight/obese adults at age 65 results in a decrease in lifetime Medicare expenditures ranging from $9,445 to $15,987 [74]. …”

New Tools for Weight-Loss Therapy Enable a More Robust Medical Model for Obesity Treatment: Rationale for a Complications-Centric Approach

“…Such a model will promote the cost-effectiveness of medical care for the obese patient. Studies in middle-aged adults (75) and in the older Medicare population (76) have demonstrated cost savings resulting from both transient and permanent moderate weight loss equal to what can often be achieved with the combination of lifestyle intervention plus weight-loss medications. In addition, the cost of quality-of-life year gained as a result of weight loss achieved through diet and exercise was shown to be favorable in the Diabetes Prevention Program (77).…”

Inpatient obesity intervention with postdischarge telephone follow‐up: A randomized trial

“…Obesity‐related medical care remains a substantial driver in escalating healthcare costs. Not surprisingly, healthcare costs for obese patients are 40% higher annually than those for normal‐weight individuals . In 2002, the morbidity attributable to obesity was calculated to equal, if not exceed, that associated with smoking .…”

“…To date, little is known about the effectiveness of such programs in the inpatient setting, though research has shown that obese inpatients are receptive to weight loss initiatives . Accomplishing even modest weight reductions in such patients has the potential to lead to significant health and cost benefits …”

“…Not surprisingly, healthcare costs for obese patients are 40% higher annually than those for normal-weight individuals. 1 In 2002, the morbidity attributable to obesity was calculated to equal, if not exceed, that associated with smoking. 2 Though inpatient outcomes appear similar for obese individuals, nearly all obesity-related comorbidities can lead to hospitalization, and obesity has been linked to early mortality.…”