Economic burden of cardiovascular disease associated with excess body weight in U.S. adults

BACKGROUND: Excess body weight (EBW), which continues to become more prevalent, is a clear contributor to cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with EBW is lacking, however. OBJECTIVE: To estimate the direct medical costs of CVD associated with EBW. METHODS: We conducted a population-based analysis of direct medical costs by linking the 1995 National Health Interview Survey and the 1996 Medical Expenditure Panel Survey. The study subjects are adults (aged > or =25 years, excluding pregnant women) in the non-institutionalized, civilian population in 1996. RESULTS: The prevalence of CVD among people in the normal weight (body mass index [BMI] > or =18.5 to <25), overweight (BMI > or =25 to <30), and obese (BMI > or =30) groups was 20%, 28%, and 39%, respectively. There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity. This extra disease burden led to $22.17 billion in direct medical costs in 1996 ($31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD). CONCLUSIONS: The strong positive association between EBW and CVD, and the significant economic impact of EBW-associated CVD demonstrate the need to prevent EBW among U.S. adults.     

The Burden of Obesity on Diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012

Background

Diabetes is one of the most prevalent and costly chronic diseases in the United States.

The Burden of Obesity and Its Sequelae

Obesity [body mass index (BMI) ≥30 kg/m²] is common in many parts of the world, especially in the established market economies, formerly socialist economies of Europe and Latin America and the Caribbean, as well as the Middle Eastern Crescent. Worldwide, as many as 250 million people may be obese (7% of the adult population) and 2 to 3 times as many may be considered overweight (BMI 25 to 30 kg/m²). The prevalence of obesity seems to be increasing in most parts of the world, even in areas where obesity used to be rare.A waist circumference greater than 102cm in men and 88cm in women may be a more sensible classification than BMI to identify individuals who are at increased health risk because of obesity, but information on this point is still scarce.Increased fatness measured by a high BMI, large waist circumference or high waist/hip circumference ratio is associated with many chronic diseases as well as poor physical functioning. These all contribute to the costs associated with excess bodyweight. The economic costs of obesity can be broken down into 3 levels Direct costs: costs to the community related to the diversion of resources to the diagnosis and treatment of diseases directly related to obesity as well as the treatment of obesity itself. These costs have been estimated to account for 2 to 8% of total healthcare costs of various countries. Indirect (or societal) costs: these costs are related to the loss of productivity caused by absenteeism and premature death and disability pensions. There is a lack of good economic analysis in this area, although research from Sweden, Finland and The Netherlands has clearly shown that obesity is associated with increased sick leave and the need for disability pensions. Personal costs: obese individuals may earn less than their lean counterparts because of job discrimination (related to the stigma associated with obesity or because of diseases and disabilities caused by obesity). Many insurance companies (particularly life insurance) charge higher premiums with increasing degrees of overweight.In conclusion, there is much indirect information that obesity and overweight are important and growing public health concerns that contribute substantially to healthcare-related costs. Effective strategies for the prevention and management of obesity are needed.     

Federal budgetary costs of blindness.

Federal expenditures for blindness-related disability among Americans are examined. The government, rather than the private sector, frequently bears the economic consequences of visual disability through entitlement and public assistance programs. Findings suggest an average $11,896 federal cost of a person-year of blindness for a working-aged American, which includes income assistance programs (SSDI/SSI), health insurance programs (Medicare/Medicaid), and tax losses resulting from reduced potential earnings. Almost 97 percent of the aggregate annual federal costs of blindness in 1990, which totaled approximately $4 billion, is accounted for by working-aged adults, who represent less than one-third of the total blind population. Approximately 25 percent of all blindness is attributed to preventable causes.     

Health care expenditures associated with overweight and obesity among US adults: importance of age and race

OBJECTIVES: We estimated health care expenditures associated with overweight and obesity and examined the influence of age, race, and gender. METHODS: Using 1998 Medical Expenditure Panel Survey data, we employed 2-stage modeling to estimate annual health care expenditures associated with high body mass index (BMI) and examine interactions between demographic factors and BMI. RESULTS: Overall, the mean per capita annual health care expenditure (converted to December 2003 dollars) was $3338 before adjustment. While the adjusted expenditure was $2127 (90% confidence interval [CI]=$1927, $2362) for a typical normal-weight White woman aged 35 to 44 years, expenditures were $2358 (90% CI=$2128, $2604) for women with BMIs of 25 to 29.9 kg/m(2), $2873 (90% CI=$2530, $3236) for women with BMIs of 30 to 34.9 kg/m(2), $3058 (90% CI=$2529, $3630) for women with BMIs of 35 to 39.9 kg/m(2), and $3506 (90% CI=$2912, $4228) for women with BMIs of 40 kg/m(2) or higher. Expenditures related to higher BMI rose dramatically among White and older adults but not among Blacks or those younger than 35 years. We found no interaction between BMI and gender. CONCLUSIONS: Health care costs associated with overweight and obesity are substantial and vary according to race and age.     

Estimated savings in U.S. dental expenditures, 1979-89.

The American public saved more than $39 billion (1990 dollars) in dental expenditures from 1979 through 1989 in contrast to the substantial increases in expenditures in other sectors of the U.S. health care system that have pushed the system to the brink of major reform. The dental savings were estimated after controlling for the influence of economic factors, such as changes in prices, insurance, and income, as well as noneconomic factors that could influence the extent of dental disease in the U.S. population. Results of the analysis confirm the importance of both economic and noneconomic factors in the determination of the savings in dental expenditures.     

Cost of obesity in the workplace

As the prevalence of obesity increases, its economic consequences must be understood. This review summarizes published literature on the costs and resource use associated with obesity in the workplace. A Medline literature search was conducted for English-language publications. References from identified articles were also reviewed for relevance. The identified studies evaluated several cost components, including absenteeism, sick leave, disability, injuries, and claims data. Overall, overweight or obese employees had higher sick leave or disability use. Workplace injuries were higher among overweight or obese employees. Health care costs, based on claims data analyses, were also consistently higher for employees with higher body mass indices. Obesity is an important driver of costs in the workplace. These findings quantify the costs and can help employers consider whether to introduce workplace interventions or provide coverage for weight loss programs.     

Obesity among people with and without mental retardation across adulthood

OBJECTIVE: This study was designed to explore obesity during adulthood and the likelihood of moving out of obesity among 1809 adults without disability and 680 adults with mental retardation who received care at the same primary care practices during the period of 1990 to 2003. Research Method and Procedures: A retrospective observational design using medical records first identified patients with mental retardation (MR) and age-matched controls without disabilities. Data on BMI collected during each primary care visit allowed exploration of obesity at three levels. Moving out of obesity was defined as having a BMI <25 kg/m(2). We also abstracted data on age, sex, race, and other medical conditions. RESULTS: For adults 20 to 29 years of age, 33.1% of patients without disability and 21% of patients with MR had a BMI >30 kg/m(2). Between the ages of 50 and 59 years, 40.5% of the patients without disability and 35.2% of the patients with MR had a BMI >30 kg/m(2). Patients with mild MR had similar prevalence rates of obesity and patients with severe MR had significantly lower prevalence of obesity compared with the patients without disability through 50 years of age. Throughout the period from 20 to 60 years of age, between 15% and 40% of individuals with and without MR, who were previously obese, were not currently obese. DISCUSSION: Throughout the adult years, an increasing proportion of individuals with and without MR are obese. However, obesity is not a chronic state; many people transition back to a normal body weight.     

State-level estimates of annual medical expenditures attributable to obesity

OBJECTIVE: To provide state-level estimates of total, Medicare, and Medicaid obesity-attributable medical expenditures. RESEARCH METHODS AND PROCEDURES: We developed an econometric model that predicts medical expenditures. We used this model and state-representative data to quantify obesity-attributable medical expenditures. RESULTS: Annual U.S. obesity-attributable medical expenditures are estimated at $75 billion in 2003 dollars, and approximately one-half of these expenditures are financed by Medicare and Medicaid. State-level estimates range from $87 million (Wyoming) to $7.7 billion (California). Obesity-attributable Medicare estimates range from $15 million (Wyoming) to $1.7 billion (California), and Medicaid estimates range from $23 million (Wyoming) to $3.5 billion (New York). DISCUSSION: These estimates of obesity-attributable medical expenditures present the best available information concerning the economic impact of obesity at the state level. Policy makers should consider these estimates, along with other factors, in determining how best to allocate scarce public health resources. However, because they are associated with large SE, these estimates should not be used to make comparisons across states or among payers within states.     

New Drug Therapies for the Treatment of Overweight and Obese Patients

Background

Obesity is a serious and costly disease that is growing in epidemic proportions. Obesity-related hospitalizations have nearly tripled from 1996 to 2009. If the current trend in the growth of obesity continues, the total healthcare costs attributable to obesity could reach $861 billion to $957 billion by 2030. The American Medical Association has officially recognized obesity as a disease. Obesity is a public health crisis affecting approximately more than 33% of Americans and costing the healthcare system more than $190 billion annually.

Objectives

To review the 2 new drugs that were recently approved by the US Food and Drug Administration (FDA) for the treatment of obesity, lorcaserin HCl (Belviq) and phentermine/topiramate (Qsymia) and their potential impact on the treatment of obese patients.

Discussion

Lifestyle modification is the first and mainstay treatment for obesity. Antiobesity drugs are indicated as adjuncts to a healthy, low-fat, low-calorie diet and an exercise plan. Currently, 4 drugs are approved by the FDA for the treatment of obesity, 2 of which were approved after June 2012. These 2 drugs, Belviq and Qsymia, have added new tools for the treatment of obesity. In addition to reducing body mass index, these drugs have been shown to reduce hemoglobin A_1c levels in patients with diabetes and blood pressure levels in patients with hypertension, as well as to decrease lipid levels in patients with hyperlipidemia. This article reviews the drugs'' mechanisms of action, evaluates landmark clinical studies leading to the FDA approval of the 2 drugs, their common side effects, and the benefits these new drugs can provide toward the management of the obesity epidemic that are different from other medications currently available.

Conclusion

The weight loss seen in patients who are using the 2 new medications has been shown to further improve other cardiometabolic health parameters, including blood pressure, blood glucose levels, and serum lipid levels. Based on clinical trials evidence, it is likely that many obese patients could benefit from these therapies, if used appropriately.Obesity is a serious and costly disease, and 154.7 million Americans aged ≥20 years are obese or overweight.1 Of these, 78.4 million US adults are categorized as having a body mass index (BMI) of ≥30 kg/m².1 Worldwide, the rate of obesity has nearly doubled since 1980.2 According to the World Health Organization estimates, in 2008 more than 1.4 billion adults aged ≥20 years were classified as overweight (BMI, 25–29.9 kg/m2), and more than 200 million men and nearly 300 million women were classified as obese.2     

Repeated measures of body mass index and risk of health related outcomes

Most studies examining the association between body mass index (BMI) and mortality neglected changes in weight over time, which may have led to underestimation of the true association. The aim of this study is to examine the relationship between BMI and health related outcomes while accounting for variations of BMI over time. The association between BMI and both mortality and occupational disability was examined in a follow-up of 5,554 male construction workers in Württemberg/Germany, who participated at least two times in routine occupational health examinations between 1986 and 2005. Using Cox proportional hazards model with time dependent variables, hazard ratios were calculated with normal weight (<25 kg/m2) as reference after adjustment for potential confounding factors. Overall, an U-shaped association between baseline BMI and mortality (370 events) as well as occupational disability (658 events) was observed, with lowest risk at BMI levels between 25 and 30 kg/m2. Men with a baseline BMI ≥ 30 kg/m2 experienced a 10% higher mortality and disability risk than normal weight men. The association between BMI and occupational disability became stronger after accounting for temporal variability of BMI with a significant increased risk of 1.26 (95% confidence interval: 1.01–1.56) among obese men. In contrast, the association between BMI and mortality did not materially change after accounting for time dependent effects. Stable obesity as defined by a BMI of 30 kg/m2 and above increases risk of disability in male construction workers. Accounting for changes of BMI over time is crucial for disclosing full impact of obesity.     

Costs of smoking among active duty U.S. Air Force personnel--United States, 1997

Smoking is the leading cause of preventable disease and death in the United States (1). The health consequences of smoking impose a substantial economic toll on persons, employers, and society. Smoking accounts for $50-$73 billion in annual medical-care expenditures, or 6%-12% of all U.S. medical costs (2-5). The costs associated with lost productivity also are extensive (2). In 1997, approximately 25% of male and 27% of female active duty Air Force (ADAF) personnel aged 17-64 years were smokers (6). A 1997 retrospective cohort study was conducted among ADAF personnel to estimate the short-term medical and lost productivity costs of current smoking to the U.S. Air Force (USAF). This report summarizes the results of the study, which indicate that current smoking costs the USAF approximately $107.2 million per year: $20 million from medical-care expenditures and $87 million from lost workdays.     

State-specific prevalence of obesity among adults--United States, 2005

Obesity, one of the 10 leading U.S. health indicators, is associated with increased risk for hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, and certain cancers. A Healthy People 2010 objective is to reduce to 15% the prevalence of obesity among adults in the United States (objective 19-2). Both national-level data from the National Health and Nutrition Examination Survey (NHANES) and state-level data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that the prevalence of obesity among adults continued to increase during the past decade. In 2003, one study estimated that state-specific, obesity-attributable medical expenditures ranged from $87 million in Wyoming to $7.7 billion in California. To assess the prevalence of obesity among adults by state and demographic characteristics since 1995, data were analyzed from the 1995, 2000, and 2005 BRFSS surveys. The results of these analyses indicated that 23.9% of U.S. adults were obese in 2005, and the prevalence of obesity increased during 1995-2005 in all states. To reverse this trend, a sustained and effective public health response is needed, including surveillance, research, policies, and programs directed at improving environmental factors, increasing awareness, and changing behaviors to increase physical activity and decrease calorie intake.     

Prevalence of obesity among adults with arthritis --- United States, 2003--2009

Obesity and arthritis are critical public health problems with high prevalences and medical costs. In the United States, an estimated 72.5 million adults aged ≥ 20 years are obese, and 50 million adults have arthritis. Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year (1-3). Obesity is common among persons with arthritis (2) and is a modifiable risk factor associated with progression of arthritis, activity limitation, disability, reduced quality-of-life, total joint replacement, and poor clinical outcomes after joint replacement (4,5). To assess obesity prevalence among adults with doctor-diagnosed arthritis, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for the period 2003-2009. This report summarizes the results of that analysis, which determined that, among adults with arthritis, 1) obesity prevalence, on average, was 54% higher, compared with adults without arthritis, 2) obesity prevalence varied widely by state (2009 range: 26.9% in Colorado to 43.5% in Louisiana), 3) obesity prevalence increased significantly from 2003 to 2009 in 14 states and Puerto Rico and decreased in the District of Columbia (DC), and 4) the number of U.S. states with age-adjusted obesity prevalence ≥ 30.0% increased from 38 (including DC) in 2003 to 48 in 2009. Through efforts to prevent, screen, and treat obesity in adults, clinicians and public health practitioners can collaborate to reduce the impact of obesity on U.S. adults with arthritis.     

Attempting to lose weight: specific practices among U.S. adults

BACKGROUND: Americans spend over $33 billion annually on weight-loss products and services. Although weight-control methods are of considerable public health interest, few national data on weight-loss practices are available. This paper examines the prevalence of specific weight-loss practices among U.S. adults trying to lose weight. METHODS: Data from the 1998 National Health Interview Survey, which was conducted through face-to-face interviews of a nationally representative sample of U.S. adults (n =32,440), were analyzed in 2003. RESULTS: Twenty-four percent of men and 38% of women were trying to lose weight. Attempting weight loss was less common among normal weight (body mass index [BMI]<25 kg/m(2)) people (6% men, 24% women) than overweight (BMI>/=25 to 30 kg/m(2)) people (28%, 49%) or obese (BMI>/=30 kg/m(2)) people (50%, 58%). Among those trying to lose weight, the most common strategies were eating fewer calories (58% men, 63% women); eating less fat (49%, 56%); and exercising more (54%, 52%). Less frequent strategies were skipping meals (11% men, 9% women); eating food supplements (5%, 6%); joining a weight-loss program (3%, 5%); taking diet pills (2%, 3%); taking water pills or diuretics (1%, 2%); or fasting for >/=24 hours (0.6%, 0.7%). Only one third of all those trying to lose weight reported eating fewer calories and exercising more. CONCLUSIONS: Increased efforts are needed among all those trying to lose weight to promote effective strategies for weight loss, including the use of calorie reduction and increased physical activity.     

High obesity incidence in northern Sweden: How will Sweden look by 2009?

The study objective was to evaluate the incidence of overweight and obesity in two rural areas of Sweden and the U.S. Previously collected data were used from 1990 to 1999 Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) studies in northern Sweden. Health censuses of adults in Otsego County, New York were collected in 1989 and 1999. Adults aged 25–64 year in 1989 with reports from both surveys were included. The 10-year change in body mass index (BMI), overweight (BMI 25–29.9 kg/m²) and obesity (BMI ≥ 30) were obtained from panel studies. Incidences of overweight and obesity were calculated and compared between countries. The 10-year incidence of obesity was 120/1000 in Sweden and 173/1000 in the U.S. (p<0.001 for difference between countries). In 1999, prevalence of obesity rose to 18.4% (Sweden) and 32.3% (U.S.). Cumulative distribution curves show that the BMI distribution in Sweden during 1999 is nearly identical to the U.S. during 1989. The obese proportions of these rural populations increased from 1989 to 1999. Sweden’s obesity epidemic has a progression similar to that of the U.S., implying that by 2009, the prevalence of obesity in rural northern Sweden may mimic that present in rural New York during 1999. Attention should be paid to the increased obesity rates in rural areas.     

Body weight,blood pressure,and mortality in a cohort of obese patients

The associations between body weight, raised blood pressure, and mortality remain controversial. The authors examined these relations by considering all degrees of obesity in the Düsseldorf Obesity Mortality Study (1961-1994). Among 6,193 obese German patients aged 18-75 years and having a body mass index (BMI) of > or =25 kg/m(2), 1,059 deaths were observed after a median follow-up of 14.8 years. The entire cohort was grouped into quartiles according to BMI (25-<32, 32-<36, 36-<40, > or =40 kg/m(2)) and systolic blood pressure (SBP) (<140, 140-<160, 160-<180, > or =180 mmHg). Cox proportional hazards analyses were performed to adjust for age. For women, the mortality risk curves for the four BMI groups in relation to SBP were flat without crossing, whereas the risk curve for moderately obese men (BMI 25-<32 kg/m(2)) crossed the risk curves for the higher BMI groups. In the group of patients with very high blood pressure (SBP > or = 180 mmHg), moderately obese subjects (BMI 25-<32 kg/m(2)) had a higher mortality risk for men when compared with the BMI group 32-<36 kg/m(2) (hazard ratio =1.62, 95% confidence interval: 1.0, 2.7) but not for women (hazard ratio = 0.71, 95% confidence interval: 0.4, 1.2). These findings support previous observations that the risk of death is lower for hypertensive men in high compared with low BMI groups.     

Changes in distribution of Medicare expenditures among aged enrollees, 1969-82.

In this article, we examined the concentration of Medicare expenditures among the aged for 1969, 1975, and 1982 to determine if expenditures have become more concentrated among a few heavy users of service over time. Despite an increase in reimbursements for the aged from $6.0 billion in 1969 to $41.8 billion in 1982, the distribution of those expenses remained remarkably stable, with a slight lessening in the concentration of reimbursements in 1982. Patterns were similar for both Part A (hospital insurance) and Part B (supplementary medical insurance) services. The concentration of expenditures was much greater among survivors than among people who died in both 1975 and 1982, with little change in the distribution of expenditures within either group.     

Obesity: addressing a multifactorial disease

An estimated 30% of the U.S. population is obese, totaling more than 120 million Americans. This figure represents 5.7% of the entire national health expenditure at an annual cost of more than $100 billion.