Food for Thought

Brad Cain, for HCPro, Inc., February 6, 2008

Considering the current health status of the nation, I doubt I'm alone when I say I could stand to lose a couple of pounds.

Like many, I gained a little weight over the holidays and I'm sure all the chips and dip I consumed during the Giants' improbable Super Bowl victory did little to help the weight-loss cause. But even with an extra pound or two of winter insulation, my weight has never become a health issue.

For about a quarter of the American population, however, weight is a significant health concern for themselves and their physicians. And increasingly, obesity has become a major issue for their employers, insurers and even their government--i.e. those who receive the bill for all those obesity-related conditions.

With this in mind, it's not surprising that obese Americans have become the target of millions of dollars worth of programs and initiatives focused on helping them lose weight while keeping those who are at risk from becoming obese. Like the ongoing smoking cessation and prevention campaigns, obesity treatment and prevention is viewed as a way to rein in healthcare costs.

But are we really saving money with these programs? A group of Dutch researchers says that in many cases we're not.

According to a study published this week in the Public Library of Science Medicine journal, thin and healthy individuals cost the healthcare system more in the long run than either those who are obese or are smokers.

The researchers created a model to compare the lifetime healthcare costs for the three groups of adults. While those in the obese category generated the greatest expenditures between the ages of 20 and 56, the researchers found that their shorter life expectancy decreased the overall outlay for healthcare costs during their lifetime. Researchers found a similar story for smokers who on average only live to about age 77, compared to 84 for those in the healthy category. Obese people live to around 80 years, according to the researchers who based the study on Dutch residents.

"Obesity prevention, just like smoking prevention, will not stem the tide of increasing healthcare expenditures," the authors wrote. "The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases."

Now the findings are not the end-all to the debate over prevention, cost effectiveness and how we should address broader public health issues.

The study avoids ascribing a value to any improvement in an individual's quality of life when obesity-related diseases are prevented--something that is tough to put a dollar sign on but is invaluable to the individual. The authors, in fact, freely admit that obesity prevention can be a cost-effective way of improving overall public health. They primarily urge advocates and other supporters of these programs to be cautious when assigning any real-world savings to the efforts--as their data shows that any actual savings are illusory.

Savings or not, the results provide some food for thought as the nation continues its debate over healthcare reform and where to focus our scarce resources. How should we weigh the value of getting people to stop smoking or lose weight versus providing broader access to healthcare services to the uninsured or underinsured? We would love to do both, but can we?

Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at
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