A Dutch group did a study on the long-term health expenditures associated with obese, smoker, and non-obese/smoker individuals. While smoking in the developed world is on the decline (at least in public places), obesity is on a drastic rise. Many governments have enacted anti-obesity campaigns in order to rein in the problem, to hopefully save their citizenry and national treasuries billions in health care costs and quality of life losses. In Singapore, they even segregate the skinny and fat school kids during physical education (to focus their efforts on the pudgy kids and hopefully get them to change), which causes some kids a lot of grief and ridicule as one would expect.
But this research group basically concluded that the short-term health savings of avoiding smoking/obesity are offset by the larger costs associated with longer life spans and elderly care. As we all know, overweight and smoking people are more likely to die younger from diabetes, heart disease, cancer, and respiratory problems, to name a few. The medical costs associated with treating such patients are enormous. But the costs of supporting a 95-year-old healthy person are also huge, especially on a European socialized national health system with a shrinking, aging populace. Assisted living, medicines, and routine checkups are all very common and costly for seniors, even if they're mostly healthy. Within the Netherlands, their mathematical model suggested that obese people are costlier than non-obese until the age of 56. Then healthy people cost the state even more due to their extended longevity. Smokers cost the most per unit time, but their earlier deaths make them a "bargain" versus the healthy old dodgers. I haven't really scrutinized their study methods, so if any of you would like to challenge their findings, I'm all ears. Of course the authors think that obesity/smoking-related disease prevention is the right thing to do from a quality of life standpoint, but we may be mistaken to think that such initiatives provide cost savings for the nation in the long run.
So if anyone complains to you about your overeating and smoking, just tell them that you're trying to be a good citizen.
Editors' Summary
Background.
Since the mid 1970s, the proportion of people who are obese (people who have an unhealthy amount of body fat) has increased sharply in many countries. One-third of all US adults, for example, are now classified as obese, and recent forecasts suggest that by 2025 half of US adults will be obese. A person is overweight if their body mass index (BMI, calculated by dividing their weight in kilograms by their height in meters squared) is between 25 and 30, and obese if BMI is greater than 30. Compared to people with a healthy weight (a BMI between 18.5 and 25), overweight and obese individuals have an increased risk of developing many diseases, such as diabetes, coronary heart disease and stroke, and tend to die younger. People become unhealthily fat by consuming food and drink that contains more energy than they need for their daily activities. In these circumstances, the body converts the excess energy into fat for use at a later date. Obesity can be prevented, therefore, by having a healthy diet and exercising regularly.
Why Was This Study Done?
Because obesity causes so much illness and premature death, many governments have public-health policies that aim to prevent obesity. Clearly, the improvement in health associated with the prevention of obesity is a worthwhile goal in itself but the prevention of obesity might also reduce national spending on medical care. It would do this, the argument goes, by reducing the amount of money spent on treating the diseases for which obesity is a risk factor. However, some experts have suggested that these short-term savings might be offset by spending on treating the diseases that would occur during the extra lifespan experienced by non-obese individuals. In this study, therefore, the researchers have used a computer model to calculate yearly and lifetime medical costs associated with obesity in The Netherlands.
What Did the Researchers Do and Find?
The researchers used their model to estimate the number of surviving individuals and the occurrence of various diseases for three hypothetical groups of men and women, examining data from the age of 20 until the time when the model predicted that everyone had died. The "obese" group consisted of never-smoking people with a BMI of more than 30; the "healthy-living" group consisted of never-smoking people with a healthy weight; the "smoking" group consisted of lifetime smokers with a healthy weight. Data from the Netherlands on the costs of illness were fed into the model to calculate the yearly and lifetime health-care costs of all three groups. The model predicted that until the age of 56, yearly health costs were highest for obese people and lowest for healthy-living people. At older ages, the highest yearly costs were incurred by the smoking group. However, because of differences in life expectancy (life expectancy at age 20 was 5 years less for the obese group, and 8 years less for the smoking group, compared to the healthy-living group), total lifetime health spending was greatest for the healthy-living people, lowest for the smokers, and intermediate for the obese people.
What Do These Findings Mean?
As with all mathematical models such as this, the accuracy of these findings depend on how well the model reflects real life and the data fed into it. In this case, the model does not take into account varying degrees of obesity, which are likely to affect lifetime health-care costs, nor indirect costs of obesity such as reduced productivity. Nevertheless, these findings suggest that although effective obesity prevention reduces the costs of obesity-related diseases, this reduction is offset by the increased costs of diseases unrelated to obesity that occur during the extra years of life gained by slimming down.
http://www.npr.org/templates/story/story.php?storyId=18711498
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