High costs of combatting the obesity epidemic

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People wait in line at an open casting call for the 11th season of "The Biggest Loser" television show in Broomfield, Colorado on 17 July 2010. Photo - Rick Wilking/Reuters

Obesity is reaching epidemic levels and no country seems to be immune to this disease. Though the concern for health is evident for many, the financial burden on a country’s economy could be crippling. The US has just started to grapple with the impact of obesity on its finances.

A new study has shown that the additional medical spending due to obesity is double the previous estimates and exceeds even that of smoking. The additional costs are not only in the form of higher health insurance premiums but also in the form of building wider seats in public places and sports stadiums to bus stops. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking.

Secondhand obesity

The discovery made by scientists with regard to serious health effects of second hand smoking woke up the policymakers. People were developing lung cancer and other diseases from breathing smoke filled air. The whole world decided to fight the habit by establishing nonsmoking zones.

Just like the added cost of smoking spurred action, many people are expecting the same effect with regard to obesity. As economists put a price tag on the alarming increase in people’s body mass index (BMI’s), policymakers are joining hands with the private sector to find solutions to epidemic obesity.

“As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, ‘what policy knob can I turn to stop this hemorrhage?'” said Michael O’Grady of the National Opinion Research Center, co-author of a new report for the Campaign to End Obesity, which brings together representatives from business, academia and the public health community to work with policymakers on the issue.

These extra medical costs are partly borne by the non-obese, in the form of higher taxes to support medical expenses and higher health insurance premiums. Cawley and Meyerhoefer found that obese women raise such “third party” expenditures $3,220 a year each while obese men, $967 a year.

The cost of obesity exceeds that of smoking. Scientists at the Mayo Clinic totaled up the exact medical costs of 30,529 Mayo employees, adult dependents and retirees over several years. “Smoking added about 20% a year to medical costs,” said Mayo’s James Naessens. “Obesity was similar, but morbid obesity increased those costs by 50% a year. There really is an economic justification for employers to offer programs to help the very obese lose weight.”

Family Time

“Obesity does not have an adverse affect on the individuals health but in many cases on the whole family,” Dr. Fathima Shaheed, a psychologist based in Colombia told Arabian Gazette. “People who are obese end up missing out quality time with their kids, like playing football with their children because they find movement difficult.”

On a more financial level, obesity hinders an individual’s productivity. As obesity raises the risk of many medical conditions, the obese have a higher absenteeism record compared to those who are fit. Obesity-related absenteeism costs employers as much as $6.4 billion a year, health economists led by Eric Finkelstein of Duke University calculated. Most obese men take 5.9 more sick days a year; whereas obese women, 9.4 days more. Therefore, decreased productivity reduces wages and affects the individual’s personal financial status.

Low productivity

Even when poor health does not keep obese workers home, it can cut productivity, as they grapple with pain, breathing problems or other weight-related issues. According to Duke Finkelstein, obesity-related “presenteeism” is also expensive. The very obese lose one month of productive work per year, costing employers an average of $3,792 per obese male worker and $3,037 per female. Total annual cost of presenteeism due to obesity is no less than $30 billion.

Fossil strain

The strain on the world’s fossil energy due to obesity is becoming more and more acute. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.

“Growing obesity rates increase fuel consumption,” said engineer Sheldon Jacobson of the University of Illinois. How much? An additional 938 million gallons of gasoline is consumed each year due to obesity in the United States, or 0.8%, estimates suggest. That’s $4 billion extra.

Lost opportunities

Numerous studies have shown that the obese are less likely to be hired and promoted than their slimmer counterparts. Women in particular bear the brunt of that, earning about 11% less than women of healthy weight, health economist John Cawley of Cornell University revealed. At the average weekly US wage of $669 in 2010, that is $76 weekly obesity tax.

According to the Texas Tribune, a hospital in Texas refused to hire people who had a BMI of 36 and above. The Citizens Medical Center in Victoria established a policy that requires potential employees to have a body mass index of less than 35 a little more than a year ago.

The hospital says that employees “should fit with a representational image or specific mental projection of the job of a healthcare professional,” as well as possessing an appearance “free from distraction” for the hospital’s patients.

A study conducted by Slimming World in 2010 found that employers often refrain from hiring overweight people because they are assumed to be lazy. A survey of 200 employers, 25% of men said they would turn down a candidate purely on their weight, and 10% admitted that they have already done so. Overweight people are also more likely to be anxious about applying for a new job, the study revealed.

worldwide obesity infographic
Courtesy - Infographipedia.com

Reforms

Big is not always beautiful. Therefore, the 2010 US healthcare reform law allows employers to charge obese workers 30% to 50% more for health insurance if they decline to participate in a qualified wellness programme. The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programmes for weight loss.

Such measures do not sit well with all obese Americans. Advocacy groups formed to “end size discrimination” argue that it is possible to be healthy “at every size” taking issue with the findings that obesity necessarily comes with added medical costs.

“Obesity is measured based on the BMI, but can be misleading,” said Dr. Joanna Atkinson, a clinical homeopath based in Johannesburg, South Africa. “The number does not distinguish between muscle and fat. I have seen many cases especially with men, the BMI would be higher than normal but further investigation would reveal that it is muscle and not fat.”

Obesity writes off

For many years researchers and doctors lived beyond the myth that higher medical costs of obesity might be offset by the possibility that obese people would die young. Thus the additional cost incurred on old age nursing homes, Alzheimer’s care and other care-homes would not be required. This assumption was derived from the life span of smokers. Whilst smokers incur higher medical costs than nonsmokers in any given year, it was assumed that the affect would be less as they die sooner. “Smokers die early enough that they save social security, private pensions, and Medicare trillions of dollars,” said Duke’s Eric Finkelstein. “But mortality isn’t that much higher among the obese.”

Beta blockers for heart disease, diabetes drugs, and other treatments are keeping the obese alive longer, with the result that they incur astronomically high medical expenses in old age just like their slimmer peers.

Enablers

“The society is slowly turning into enablers,” Dr Shaheed said while adding: “As a society, we want to accommodate all types of people and sizes, thereby altering our environment.”

Dr Shaheed also referred to changes taking place in public transport and at hospitals. Train cars New Jersey Transit ordered from Bombardier have seats 2.2 inches wider than current cars, at 19.75 inches, said spokesman John Durso, giving everyone a more comfortable commute. (There will also be more seats per car because the new ones are double-deckers.)

New York’s commuter trains are considering new cars with seats able to hold 400 pounds.Blue Bird is widening the front doors on its school buses so wider kids can fit. And at both the new Yankee Stadium and Citi Field, home of the New York Mets, seats are wider than their predecessors by 1 to 2 inches.

The University of Alabama at Birmingham’s hospital, the nation’s fourth largest, has widened doors, replaced wall-mounted toilets with floor models able to hold 250 pounds or more, and bought plus-size wheelchairs (twice the price of regulars) as well as mini-cranes to hoist obese patients out of bed.

“We need to help people attain and maintain a healthy weight. Becoming enablers would not help the obese nor will it help the government,” Dr Shaheed insisted.

The additional spending due to obesity doesn’t fall into a black hole, of course. It contributes to overall economic activity and thus to gross domestic product. But not all spending is created equally.

“Yes, a heart attack will generate economic activity, since the surgeon and hospital get paid, but not in a good way,” said Murray Ross, vice president of Kaiser Permanente’s Institute for Health Policy. “If we avoided that heart attack we could have put the money to better use, such as in education or investment in clean energy.”

The upside to obesity is that an obese man is 64% less likely to be arrested for a crime than a healthy man. However, researchers are yet to ascertain on what that might save.

Source: Reuters, Medical Daily

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