Higher body mass leads to higher health care costs

Consumers worried about the rising cost of health care may have even greater reason for concern these days, as a result of a new study that shows just how much increases in body mass affect how much people pay annually for treatment – even at relatively low levels.

In most cases, a body mass index of 19 means that a person is at the lowest level of a “healthy” weight, but it is at that point that health costs will begin to grow, according to a report from Claims Journal, based on a new study published in the medical journal Obesity. The average annual health costs for a person with a BMI of 19 came to $2,368, and grew for every uptick in that level. By the time someone reaches a BMI of 45, their costs have ballooned to an average of $4,880 per year. Those who were considered underweight – that is, with BMIs of 18 or less – were not considered for this study, as this may be a sign of ongoing illness that would raise annual expenditures on treatment.

These costs were gradual, as those with BMIs of 20 paid only slightly more for doctors' visits and prescriptions than those who were at 19, but among men in particular the cost increases by level were steeper, the report said. Truls Østbye, M.D., Ph.D., who was lead author on the study and is a professor of community and family medicine at Duke University, noted that this therefore means having any extra fat is detrimental to health “at any level.”

No change over time
The study examined insurance claims submitted by Americans between 2001 and 2011, and during that time there seems to have been no change in the overall relationship between obesity and health care costs, the report said. Marissa Stroo, another investigator on the study, told the site that this suggests that it might be wise for consumers to do more to ensure that they're avoiding fat in any way possible, including through weight-loss programs that are now being offered by many workplaces across the country.

We note that the article provides no discussion of adjustments for age in the study.  Anecdotal evidence suggests that for the typical American BMI rises with age from young adulthood through middle age. Given the strong correlation between health care cost and age, results need to be normalized by age.

Studies such as this one showing correlation between weight and health care costs, together with other studies showing the socially contagious nature of obesity, and the overall societal impact of rising health care costs highlight that expanding American waistline is a societal issue as well as an individual issue.  Østbye suggests that “Employers should be interested in these findings, because, directly or indirectly, they end up paying for a large portion of these health care costs.”  I would go further and contend that we all need to address this issue due to societal costs of care and lost productivity.  The ACA takes steps to encourage employer action. Let us hope the rest of us follow suit.

Health insurance issuers may likewise want to do more to highlight the findings of this new study when offering coverage to consumers, as it may help them to see the value that such plans can provide them not only in the short term – by lowering their care costs – but over their lifetimes. Lowering costs for treatments may lead to more care, which promotes better health.