Treat Those with Severe Obesity to Save Serious Money

July 31st, 2015 by MorganDowney Leave a reply »

Health economist John Cawley and colleagues have published what might be an extremely important contribution to establishing priorities for interventions in the adult obesity population. Their paper, “Savings in Medical Expenditures  Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes status,” shows that additional  costs associated with increases in body weight are not shared equally but increase exponentially as BMI increases. Likewise, the greatest savings in medical expenditures arise in weight loss among  those with the highest BMI, i.e. persons with Class III  or severe obesity. They write,”The IV model indicates that obesity raises annual medical care costs by $US3,508 per obese individual per year, or $US315.8 billion for the USA as a whole (both measured in 2010 values). The results of IV models are also used to construct detailed tables of the estimated medical care expenditure savings given specific reductions in BMI from specific starting values of BMI; these tables indicate that the savings from a given percent reduction in BMI is greater the heavier the obese individual, and is greater for those with diabetes than for those without diabetes. These estimates of the change in medical care expenditures resulting from weight loss can be used to more accurately calculate the cost effectiveness of interventions to prevent and treat obesity, and can be used by health insurers, employers, and government agencies to determine the societal savings from, and business case for, interventions that generate a specific amount of weight loss.”

Dr. Arya Sharma observes in his post on this paper, “Thus, for e.g. the annual cost savings with a 5% reduction in body weight for someone with a BMI of 30 kg/m2 amounted to a mere $69 per year.

This figure, however, increased exponentially for people with higher BMIs, increasing to $528, $2,137, and $10,030 in an individual with a BMI of 35, 40, and 45 kg/m2, respectively (these figures were somewhat higher, when the individual also has diabetes).

Thus, while treating obesity to achieve a 5% reduction in body weight in someone with a BMI of 30 kg/m2 may never be “cost-effective”, the same amount of weight loss in someone with more extreme obesity, would likely pay for itself or even lead to significant savings.

Because the impact of obesity on mental and physical health, life-expectancy and quality of life is also greatest at higher levels of BMI, one could also make a strong ethical argument for singling out these individuals for priority treatment in the health care system.”

We could not agree more.

Conflict Alert:  I have a great respect for Dr. Cawley’s work on obesity and was pleased to be part of a Point-Counterpoint  debate with him on Employer Wellness programs published in 2014 in the Journal of Policy Analysis and Management.