CBO: Obesity Pumps Up Healthcare Costs

During the past two decades, the adult population in the United States has become not only far more heavy but far more expensive when it comes to providing healthcare coverage, according to a new Congressional Budget Office (CBO) issue brief.

From 1987 to 2007, the percentage of adults who were overweight or obese increased from 44% to 63%, with almost two-thirds of the adult population now falling into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13% to 28%.

That sharp increase in the percentage of adults who are overweight or obese pose "an important public health challenge," the CBO analysts note. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension—a trend that also affects healthcare spending.

This corresponding healthcare spending per adult (in 2009 dollars) rose almost 80% from 1987 to 2007, from about $2,560 to $4,550—led in part by the "development and diffusion" of new medical technology, more extensive insurance coverage, the aging of the population, and rising inflation-adjusted prices for healthcare services. That spending grew among all weight categories, but in the data that CBO analyzed, the rate of growth was much more rapid among the obese population.

For example, between 1987 and 2007, per capita spending grew by 65% for normal-weight adults and by 61% for overweight adults. However, it grew much faster for obese adults—by 111%. As a result, obese adults had per capita spending that was far higher when compared to spending for normal-weight adults in 2007 than it was in 1987: that difference rose from 8% in 1987 to 38% 20 years later.

CBO looked at several future scenarios to determine the impace of weight on the healthcare system. For one scenario, no future changes would be anticipated in the distribution of adults by body weight—the prevalence of obesity would remain at the 2007 rate of 28%. In this situation, per capita spending on healthcare for adults would rise by 65%—from $4,550 in 2007 to $7,500 in 2020—"largely as a result of rapidly increasing healthcare spending for all adults regardless of weight," the CBO analysts say.

In another alternative scenario, CBO assumed a rising prevalence of obesity, matching recent trends. In that scenario, the prevalence of obesity would rise to 37% by 2020, with per capita spending increasing to $7,760—about 3% higher than spending in the first scenario.

CBO also assesses the impact of a reversal in recent trends—with obesity dropping. In that scenario, the prevalence of obesity among adults would decline to 20% by 2020. Per capita spending would increase to $7,230 about 4% lower than spending in the first scenario.

Since lower rates of obesity are associated with better health and lower healthcare spending per capita, devising policies that would reduce the fraction of the population that is obese is a consideration. However, the challenges are significant.