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High Obesity Rates Stress U.S. Health Care Budgets

July 27, 2009 at 12:00 AM EDT
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A new study finds that obesity rates grew 37 percent from 1998 to 2008 and account for 10 percent of the nation's health care spending. The author of the report speaks with Gwen Ifill about health concerns in the U.S.

GWEN IFILL: The skyrocketing cost of getting and staying healthy has emerged as a key issue in the ongoing congressional debate over health care reform.

The journal Health Affairs reports today that nearly 10 percent — or $147 billion — of the nation’s health care spending can be traced to one factor: obesity.

We’re joined now by the author of that report, Eric Finkelstein, the director of health economics at the research institute RTI International.

Welcome, Mr. Finkelstein. In 1998, you wrote a report in which you said that the health care costs attributed to obesity was at about $78 billion?

ERIC FINKELSTEIN, RTI International: That’s correct.

GWEN IFILL: It’s doubled now. What happened?

ERIC FINKELSTEIN: That’s right. Well, between 1998 and 2006, which is the year our study is based on, the prevalence of obesity actually increased by 37 percent. And so along with population growth, we just have a lot more obese individuals.

GWEN IFILL: So is it prevalence or is it cost that’s driving this big new number?

ERIC FINKELSTEIN: It’s mostly prevalence. We show that about 85 percent of the increasing cost resulting from obesity is due to rising obesity prevalence.

GWEN IFILL: And explain what we mean when we say “prevalence.”

ERIC FINKELSTEIN: Prevalence is essentially the number of individuals in the country who are obese. And obesity is pretty much defined by body mass index, but basically what it means is, if you’re about 35 pounds above your ideal weight, you’d be classified as obese.

GWEN IFILL: And the reason why there has been this increase in prevalence, is it because of diet? Is it because of lack of exercise? Or just because what?

ERIC FINKELSTEIN: Well, we argue it’s because of economics. Essentially, the calculus has changed so it’s just easier and cheaper to engage in behaviors that promote obesity and more difficult to engage in those behaviors that are associated with fitness.

GWEN IFILL: OK. So when you make the connection then between obesity and medical care and the cost of medical care, what are the weight-related diseases that then drive up the costs that we’re talking about?

ERIC FINKELSTEIN: Well, unfortunately, excess weight impacts nearly every system of the human body, but some of the significant drivers are associated with diabetes and hypertension and heart disease and high cholesterol.

And certainly one of the things that we saw in our study was that prescription drug expenditures were a significant driver. And all of the diseases that I just mentioned, once you get them, you tend to get prescribed medications, and you stay on those medications for most of your adult life, if not all of it.

Measuring the costs of obesity

GWEN IFILL: Now, when we talk about cost, sometimes we're talking about dollars and sometimes we're talking about costs in lives and costs in mortality. How do you measure it?

ERIC FINKELSTEIN: Well, with respect to the cost in medical expenditures, we're actually talking about dollars. But when I talk about the behavioral costs associated with maintaining a healthy weight, we're talking about what economists call opportunity costs or essentially what you have to give up to engage in those behaviors that are associated with good health.

And so, for example, you know, if you want to take a job that has a lot of calories burned or that's physically demanding, you're probably going to have to take a low wage as a result of it, because most good-paying jobs today burn almost no calories.

GWEN IFILL: So what are the risk factors, then, that drive this? It's being sedentary in your job, as well as in your life. What else?

ERIC FINKELSTEIN: Absolutely. It's being sedentary. If you look at the data on caloric consumption, what we've seen is that people have consumed about 200 calories more per day today than we did a few decades back.

And so that increase in calories consumed is certainly consistent with falling food prices and increased convenience of fast food. And, in fact, that's enough to drive the obesity rates that we've seen.

But as you mentioned, we certainly aren't burning off the same number of calories that we did a few decades back, either.

GWEN IFILL: Well, but, for instance, it's also -- you mentioned fast food. It's sometimes cheaper just to get a burger and fries on the way home than it is to think, "I think I'll grill a nice chicken breast and get some fresh, you know, picked greens from the garden."

ERIC FINKELSTEIN: It's absolutely cheaper. It's cheaper in terms of the financial outlay, but it's also much more convenient. And so those types of foods have become increasingly sought after, especially in an economy where, you know, lots of people are penny-pinching, and so those are very affordable options.

GWEN IFILL: So when you look at this from an economist point of view, as you do, people who are at the lowest end of the economic scale, because the food is more affordable that's worse for you, are more likely to be the people who therefore become obese and drive up the costs or have the greater costs for health care?

ERIC FINKELSTEIN: Well, it's complicated. In fact, obesity is very prevalent among low-income populations, but, in fact, if you look at trends in obesity rates over the past few decades, believe it or not, wealthier subsets of the population have actually seen obesity rates increase at a faster rate. And so while you're certainly correct that low-income individuals tend to have fairly poor diets and be fairly inactive, wealthier people are, too.

A public policy imperative

GWEN IFILL: Is there anything in this current health care debate that we're following so closely in Washington which would speak to any of this? For instance, there's been discussion and some pushback on things like a tax on sugary drinks and sodas?

ERIC FINKELSTEIN: Well, there are some things to think about. I mean, to a large extent, the health care debate is mostly around who pays, right? Is it the government who's going to pay? Is it private industry?

But I think the debate really needs to shift and talk about, how can we reduce the cost? And I would argue, you're not going to reduce the cost unless you reduce the prevalence of obesity and related behaviors.

GWEN IFILL: Where do you begin with this? Do you begin with childhood? Do you begin -- or is it too late, just start with people who are adults?

ERIC FINKELSTEIN: I would begin with kids. My belief is that, for the same reason that we don't let kids smoke cigarettes and we don't let kids consume alcohol and we force them to go to school, we should encourage them to maintain healthy behaviors related to diet and exercise.

And this is irrespective of the costs. I mean, we do these things not because it saves money, but because we think it's appropriate public policy. And I think there are lots of opportunities to put healthy foods in the schools or to encourage physical activity in schools and communities.

And so I think that's where you have your best chance of success, and that's where you have your clearest public policy imperative.

GWEN IFILL: But how much of this is about public policy imperatives and how much of this is about individual behavior? People know the right thing to do and just don't do it.

ERIC FINKELSTEIN: Well, we've created an environment where it's extremely difficult for individuals to engage in behaviors that are associated with maintaining a healthy weight.

GWEN IFILL: An environment such as?

ERIC FINKELSTEIN: The prevalence of fast food, the technology. I mean, for example, microwaves were essentially unavailable three decades ago and now every home has one. Computers, cable TV, video games, Internet access, low-cost, convenient foods.

And so it's just very, very hard for individuals to make the choices that they might want to make. And so, if we really want to address obesity rates, we as employers or as governments need to help them make those behaviors.

GWEN IFILL: Dr. Eric Finkelstein, thank you for depressing us and informing us at the same time. Thank you.

ERIC FINKELSTEIN: Thanks for having me.