The Burden of Health outcomes of Obesity
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Introduction
Obesity can be defined as a BMI of 30 or more. It is not merely an appearance of being fat and of enormous size. Obesity is rapidly developing into a critical global health challenge. It is an extremely complex issue to address given the huge economic implications its health outcomes, which are economic-based, exert on major economies of the world. In the United States and other, develop countries, the rates of obesity in childhood almost tripled over the past 20 years while the proportion of obese adults peaked at 30 per cent. Obesity in childhood with adverse economic based health outcomes, obstructive sleep apnea, asthma, mental health problems, otitis media, as well as cardiovascular illnesses all have a link—either direct or indirect---to obesity. Frequently, obesity tracks from one’s childhood into adulthood, increasing the risk factors for development of chronic diseases such as diabetes mellitus type 2, heart disease, as well as some cancers. These economic based health outcomes of obesity place a heavy economic burden on society by raising the cost of health care tremendously (Chou & Rashad, 2009).
Obesity has become a real pandemic. In the United States, it afflicts scores of people, notwithstanding their age, race, and gender. However, statistics released recently from the United State Centers for Disease Control and Prevention (CDC) indicate that minorities experience obesity rates at not only greater levels than their Native American counterparts, but also more instances of diabetes and other chronic conditions.
Obesity is increasingly becoming associated with tremendous economic based health outcomes. Such outcomes can be understood partly by examining a variety of co-morbidities to which obesity has been linked. The understanding precedes a discussion of the economic based health outcomes of obesity. Overt obesity is usually associated with many risk factors for cardiovascular disease including hypertension, dyslipidemia, and diabetes mellitus. Psychological suffering and disability also characterize prolonged obesity, imposing a heavy economic burden on governments. Consequently, there have been calls for quick preventive actions from the government, health insurers, business enterprises, and other stakeholders (Volpp, 2008).
Makers of government policy have long accepted public intervention in controlling obesity. This stems from the fact that obesity is an externality and may lead to substantial impact on the whole society. In economics, an externality is a situation where the repercussions of decisions made by a single person individually gets to be imposed on other people. Through disability payments and health care expenses, obesity imposes substantial external costs on society. The costs are pooled through public programs and group health insurance.
There is rich evidence on the enormous costs of obesity to both individuals and society. Obesity is associated with health care expenses averaging approximately 42 per cent above those for individuals within the normal range of weight. Overall, direct, and indirect obesity-related economic expenses exceed 100 billion U.S. dollars per annum, and the number is expected to rise steadily. The full impact of trends of obesity since the 1980s are not yet apparent fully as health problems stemming from weight gain may take an extremely long time to appear.
Given that obesity places a significant financial burden, companies and other employers have a stake in decreasing obesity in the pool of its workforce. Obese workers cost their employers more in disability and medical as well as employees compensation claims. They also reportedly miss more days of work. As a result, an average-sized firm with workforce of 1,000 employees may face over 285,000 U.S. dollars annually in additional costs associated with obesity among its employees. In addition to the costs obesity imposes to business enterprises, obese workers are subject to a lot of discrimination in the place of work due to weight stigma. Such workers may not be productive as expected because of the stigma (Wolf, 1998).
The high obesity rates and depression, and their link with heart disease have prompted investigations to explore the link between excess weight and psychological problems. On analyzing 18 cross-sectional studies, obese people have been seen to be more likely to become depressed compared to people whose weights are within normal ranges. Discrimination and stigma toward the obese are pervasive in the United States and pose many consequences for their physical and psychological health. Harmful weight-based stereotypes have been documented that obese individuals are unsuccessful, lazy, unintelligent, lack self-discipline, weak-willed, and are poor willed. The stigma, discrimination, and prejudice occur in multiple domains of life, including the workplace, educational institutions, health care facilities, mass media, as well as in interpersonal relationships. As obesity stigma is an acceptable form of bias, employers and coworkers frequently report negative stereotypes and attitudes that affect their performance significantly (Chenoweth, 2005).
Most Americans with obesity also present risk factors for cardiovascular disease like hypertension, dyslipidemia, and diabetes. The comorbidities are known to exert a heavy toll in economic and human terms. Over one-third of nationals of the United States is obese and has low quality of life (QoL). If the obesity is severe, QoL scores are comparable only to QoL scores linked to laryngeal cancer and diabetes. Obesity-related comorbidities have been estimated to cost the government 209.7 billion dollars per annum in the United States. For instance, as far as pharmaceutical costs are concerned, the cost of antidiabetic drugs increases by more than 13-fold due to obesity. The cost of employee absenteeism has been estimated to be over 4.3 billion dollars per year. Successful, cost-effective treatments for obesity in the short run are readily available and have been associated with a reduction in the risk factors for cardiovascular disease. For example, in patients with glucose intolerance, lifestyle interventions with the objective of losing approximately 7 per cent of baseline weight resulted in a 60 per cent decrease in the risk of developing diabetes. In various clinical trials, improvements in other risk factors for cardiovascular diseases like high blood pressure and elevated triglycerides have also been seen to aid in the loss of 5 to 10 per cent of baseline weight. As severe obesity becomes a greater and greater public health concern, interventions that have long-term efficacy need to be initiated in order to cut excess body weight while maintaining a modest loss (Bhattacharya, 2004).
Impact and Effects of Economic Based Health Outcomes of Obesity
Literature Review
There is a growing body of medical and economic literature on the impact of obesity on the economic health based outcomes. Nevertheless, differences in financing the health care and the heterogeneity in the approaches of costing were hampered comparisons across the states as well as call for state-specific reviews. In the United States, specifically, the single-payer and the publicly funded system of health care facilitate comprehensive and easy access to health care. While scaling up the economic measures is an important thing, policy makers are also interested in the returns of resource allocation. Little evidence exists about the cost-savings and cost-effectiveness of the programs in American settings. The present investigation is a part of greater efforts to come up with a framework for the economic evaluation of obesity interventions.
Some studies use dynamic models for estimation of health care costs associated with obesity over a substantial period. With the aid of a dynamic model of the relationship between obesity and risk for diseases linked strongly to weight, Thompson generates associated costs at each stage of his model. They find obesity increases costs for the diseases by over 50 per cent, and when severe, the obesity can virtually double the costs (Thorpe, 2005).
Rather than coming up with a point-estimate of the impact of the economic based outcomes of obesity on spending, Thorpe et al (2009) assess the link between the increase in the prevalence of obesity and the rise in health related expenditure over time. With self-reported data on BMI and medical conditions, they constructed a regression that controlled for key variables including demography, insurance status, and smoking. The estimates suggested that portion of per-capita income attributable to obesity increased to 28 per cent 1990 and 1999, with 10 per cent due to increases in the incidence of obesity. The larger proportion of the increase was attributed to spending on hypertension or diabetes, both of which are obesity-associated. When the study started in 1990, per capita health spending was approximately 15 per cent higher for obese individuals than healthy ones. By 1999, this gap had risen to over 40 per cent. The growth rate in per capita spending among the obese was higher than per capita spending.
Roy Wada and Erdal Tekin sought to establish whether obese individuals are penalized by getting smaller wage rates than other people in the American workforce. They pointed out that studies done previously in the area depended on the weight or BMI (body mass index). BMI is defined as one’s weight of the body in kilograms over the height in square meters. They measured trends of obesity using these non-specific parameters, despite the unanimous agreements in the literature of medicine that these parameters represent degrees of obesity that may be misleading. The unreliability of body weight and body mass index is due in part to the inability to differentiate between body mass with fat and body mass that is fat-free. With these two distinct variables, they establish that a high quantity of fat in their bodies is associated with low wages unambiguously for both men and women. This result sharply contrasts the inconsistent and mixed findings from the earlier investigations that used BMI. New evidence suggested that a high body mass that is fat-free might be associated consistently with high hourly pay. The measures of body composition the two employed represented critical changes over the measures that had been used previously because they allowed for the separation of identification of fatty and non-fat body components (Heshmat, 2005).
Obesity carries an obviously high health cost at the individual level. In addition, a social cost it carries is sufficiently high to make debates about its eradication a public policy concern. The government has intervened to influence the choices of food of its nationals in some places. In other areas, consumers are considered responsible fully to take account of any costs arising from their choice of food. More strict policies exist in some states where obese people pay higher health expenditures, whether in terms of hospital bills or insurance premiums. This differential payment scheme for medical care and insurance are playing a significant role of encouraging people to maintain optimal body weight. The result has been making decisions on weight; these are greatly adaptive to the increasing costs of quality health care that come with increased prevalence of obesity (Wolf, 1998).
Jessica P. Vistnes, Jeannette A. Rogowski, and Alan C. Monheit looked at some consequences of obesity on the costs of medical care as well as the effect of the same parameter on an insurance policy. In their report, which focused on adolescents, interesting findings were laid out as discussed in the next section. In privately owned health plan groups, the projected health plans to be paid for obese girls are about 1,400 U.S. dollars higher than that of optimal weight girls. No differences were reported for obese children with public coverage in these plans.
Bhattacharya (2008) considers the cost of health care externality linked to obesity in adults. She estimates that obese individuals impose an additional cost of 250 U.S. dollars on people with normal weight. Bhattacharya, however fids that these incremental costs of healthcare with which obesity are associated are transmitted to the obese working with employers who sponsor the health insurance of their staff as reduced cash benefits. Obese employees in companies that lack these sponsored insurance schemes lack a salary offset from the relatives to the non-obese individuals. The wage estimate offset they get usually exceeds the estimates of one projected incremental cost of health care for obese females, but not men.
In the researches previously discussed, none has empirical estimates based on the impact of some insurance policies on outcomes of body weight. Bhattacharya, Pace Naomi, and Bundorf provide some of the missing bits by suggesting that individuals with Medicaid insurance coverage as well as those who are privately insured have a higher likelihood of being overweight and have more mass index compared to people who lack a health insurance scheme. Sara Markowitz and Rashad have reported similar findings for mass index have not talked about the likelihood of developing obesity. Both investigations take into account the endogeneity health insurance may carry.
Research by Shin Yi-Chou and Inas Rashad shows that genetic factors have failed to explain the radical increase in the prevalence of obesity since 1980; genetic factors change gradually. Consequently, health economists play an important role in examination of the causes and impact of increasing cases of obesity. The policy prescriptions have never been straightforward, but the factors that come into play are extremely complex. Obesity that occurs during childhood is extremely detrimental as its consequences carry over easily into old age. Shin Yi-Chou and Inas Rashad I estimated the impact of promotion of fast foods on television on childhood and adolescent. The results show that a total ban on such advertisement strategies would reduce the incidence of childhood obesity by over 20 per cent in a fixed United Sates population. The ban would also reduce the incidence of adolescent obesity by more than 15 per cent. Eliminating the tax deductibility of this type of promotion would lead to small declines in these outcomes of between 6 and 8 per cent. However, this would impose a much lower cost on children and adolescents who consume fatty foods in moderation as promotional information about fast food restaurants would not be banned from television advertisements completely.
The association between participation of girls in school sports and the weight, body mass and body composition, and physical activity of a number of adolescent females was examined during the 1970s. Around this time, participation of girls in sports was increasing dramatically because 1972 Title IX of the Educational Amendments had just been made. Title IX required that activities and programs that got funding from the Department of Education operate without discriminating any student. It was found out that that increases in participation of high school girls in sports, a proxy meant to expand athletic chances for adolescent girls, are usually associated with increased physical activity and in extension an improvement in body mass and weight among the girls. On the contrary, male adolescents experienced a reduction in physical activity and a consequent increase in body mass and weight during the time when the athletic opportunities for girls were expanding. If taken together, the findings show that Title IX and the increased athletic opportunities among girls at the adolescent stage came with a beneficial impact on the overall physical health of these girls (Wada, 2007).
With regard to the effectiveness of nutrition programs in schools to combat childhood obesity, Shin Yi-Chou, Inas Rashad, and I provide conflicting pieces of evidence. They suggest that the breakfast program in schools is an invaluable tool for fighting against obesity currently. The newly introduced national School Lunch Program, on the other hand, works to exacerbate the already overwhelming epidemic.
It can be a daunting task to attempt to capture the full economic impact of the health outcomes of obesity. An ideal approach to studying obesity-related expenditures compares the expected costs among individuals of weight that is within the normal range with those observed. After this, there is an attempt to arrive at a relative change in per capita expenditure, which results from obesity-related commodities. In 2006, it was found that medical expenditures in obese individuals hit a startling 42 per cent higher compared to the expenditure in patients whose weight was within the normal range. This amounted to a per capita deviation of 1429 U.S. dollars. Breaking down the annual costs by type of insurer raises the costs of obesity-related outcomes by approximately 60 per cent, which is an equivalent of 1140 U.S. dollars for the privately insured individuals. For Medicare patients, it rose by 41 per cent and 43 per cent for Medicaid ones.
Economic based health outcomes with risk rates for the obese are found in studies involving large populations. Over a 10-year period, men observed indicated that the risk of Coronary Heart Disease (CHD) was 50 per cent higher in overweight individuals and thrice as high in those who were obese. For women, analysis found the relative risk to develop diabetes type 2 was 40 for women whose BMIs were between 30 and 33, compared to individuals whose BMI was less than 21. Analysis of cross-sectional data obtained for both males and females established the risk of diabetes and hypertension to be between 3.0 and 2.8 times.
Methods and Discussion
This study entailed searching for research reports, journal papers, organization, and/or government websites, conference abstracts, regardless of the status of publication. The investigators also consulted with health and economics experts in order to identify extra reports or studies. The titles and abstracts of the publications were retrieved for screening. A list of references of the studies included was searched for additional studies that were potentially eligible.
To inform the design of economic obesity evaluations, interventions have always evaluated not only the costs of obesity and prevention programs in the United States. The findings always point out that the economic burden of obesity is quite significant and requires comprehensive, swift public health action. The proportion of the total costs of health care attributable to obesity in the United States was estimated to rise to as high as 10 per cent. By contrast, sufficient data on the costs of prevention interventions of obesity in the United States is available to aid decisions of resource allocation while helping to inform economic evaluations. The comprehensive cost analysis of a health program in one school suggested that such interventions were not resource-intensive unlike the costs of programs undertaken in other countries.
It is crucial to emphasize that the cost of treatment of obesity and the associated co-morbidities is higher than the cost of prevention by far. An estimate of the former states 650 to 31,553 U.S. dollars, depending on the form of therapy adopted. There is established heterogeneity in the analyses of cost-effectiveness and quality of study of obesity interventions. These hamper comparison of data collected from various settings. Consequently, costing ought to be integrated during the stage of implementation of the projects. The data so obtained should be availed for analyses of cost-effectiveness.
There are direct medical costs associated with obesity-related diseases. These costs are meant for treatment and diagnosis but also for the co-morbidities. Many studies estimate such costs using various methodologies like case studies, cohort studies, dynamic models, regression analyses, simulation forecasting, and nationwide representative surveys.
The cohorts used to estimate relative costs for the obese were drawn from care organizations. By so doing, it became possible to study individual medical histories directly. These cohorts were not necessarily nationally representative. The estimates were based on a retrospective study whose 1,200 subjects responded to a random sample survey. Participants were aged between 35 and 64 years and were nonsmokers. In addition, they had no history of cardiovascular disease and possessed self-reported mass index of more than 20. The subjects were sorted into three categories – obese, overweight, and healthy. Each group was followed for over ten years. Records and retail prices were used to tally costs for prescriptions, inpatient care, as well as outpatient services. The findings suggested that the accumulated costs for those who were obese as well as those who were overweight were higher compared to the ones for the healthy group. The proportions of the estimated costs included the health care costs for the obese, which were 32 per cent higher than the healthy group. The prescription costs for the obese were 107 per cent higher and primary health care costs 39 per cent higher than the healthy group. Compared to the overweight group, the prescription costs of the healthy group were 35 per cent lower and primary health care costs 13 per cent lower.
Adverse economic based health outcomes do not blow medical costs in adult populations only. Children are also affected, with the annual costs of obesity in childhood in the United States presently estimated at approximately 14.3 billion dollars. Apart from these direct costs, childhood obesity currently implies increased future indirect costs because overweight children may end up being obese adults. The future economic burdens will likely result from the present high rates of excessive weight in adolescents. The costs of obesity and related health outcomes among adults aged 36 to 65 years has been estimated from the year 2020 onwards. Findings indicate that the existing levels of overweight currently will result in over 45 billion U.S. dollars in medical costs over this duration. This cost will affect young and middle-aged adults. Some of these costs will be unavoidable, as current technologies cannot decrease the potential future consequences of obesity significantly (Alan & Monheit, 2007)
Concerning the ultimate bearer of medical costs related to obesity, data from the National Longitudinal Survey of Youth (NLSY) was used. Worker wage information was obtained to capture health care expenditure information. The subsequent analysis of regression concluded that health costs related to obesity are passed on to individual obese employees with company-sponsored insurance schemes.
Obesity may cause an increase in disability. Disability comes with increased disability payments and insurance premiums. The increase is a reflection in loss of productivity beyond absenteeism data can capture if recipients are not in a position to hold a position altogether. In addition, a rise in the rolls of disability represents extremely high fiscal expenses to the federal government of the United States of America (Bhattacharya, 2004).
Self-reports of impairment in work and those from the Social Security Disability Insurance have shown how detrimental effects of obesity outcomes can be. However, potential biases due to self-reporting of changes in weight need to be regulated. Control variables like gender, education, race, marital status, as well as children in all households are all important factors that influence the extent of this impact. Consistent findings have been robust as far as specification of changes for receiving disability income is concerned. For most men in the working class, obesity increases the possibility of getting disability income by over 7 per cent, an equivalent of a loss of 16 years of education. This is not the case for female workers; women have an increased possibility of getting disability of 5.63 percentage points. This is an equivalent of a loss of 17 education years. Thus, controlling a list of endogeneity of weight and covariates may cause a significant effect of obesity outcomes on receipt of disability premiums (AbdukadiRov, 2012).
Conclusion
The gradually evolving obesity pandemic has exacted a heavy toll on all the affected. The increase in the incidence of obesity has increased startled world governments over the last 3 decades. Public health measures have failed largely to prevent obesity and therefore there is a growing disease and disability burden. Obesity related cancers, cardiovascular disease, diabetes type-2, osteoarthritis, as well as psychological disturbance are all economic based health outcomes. These outcomes have exerted a heavy toll on the economies of countries worldwide. They generate a lot of morbidity as well as many lost years of life. Obesity has been associated with a measurable impact on mental and physical health as well as health related quality of life. These generate many direct and indirect costs.
The risk of health problems begins when a person is only slightly overweight, and this is not widely known. The likelihood of potentially adverse health outcomes increases as weight becomes more and more. Most of these outcomes cause long-term economic losses for individuals and society. Additionally, the direct and indirect costs for the health care system are extremely high. The good news is that this impact can be reduced to manageable levels because obesity is largely preventable.
Looking at obesity closely, one will notice that it harms almost every aspect of health, which is based on the economy. This ranges from shortened life spans to chronic conditions like diabetes and heart disease. In addition, obesity can interfere with one’s sexual function, mood, social interactions, and breathing. All these come with significant economic implications. To reduce the economic burden of obesity, diet, medications, exercise, and even surgery can be tried, instead of waiting to treat the adverse outcomes that take a heavy toll on the coffers of any nation. Obesity is not a permanent problem. In fact, it is much easier to gain weight than to lose it. Obesity prevention, starting at a tender age and extending through one’s life span could improve both individual and public health vastly. This could decrease human suffering and save the government billions of U.S. dollars used in health care costs each year.