Obesity Associated with Increased Health Services Use and Costs
ABSTRACT & COMMENTARY
Synopsis: An association between obesity and increased health services uses plus costs was observed in a cross-sectional study of a large close panel HMO.
Source: Quesenberry CP, et al. Arch Intern Med 1998; 158:466-472.
Obesity is a well known risk factor for a variety of cardiovascular diseases, diabetes, and degenerative joint disease. In addition, a disturbing temporal trend is the relative number of the population at all ages that are overweight to morbidly obese. Many health care planners consider the trends in obesity to be a major public health problem that is a paradoxical problem, given the media obsession with thinness.
Changes in the "system"-wide use of health care resources due to obesity have received little attention. The majority of prior work has been cross-sectional, that is not based on identified patients. The work of Quesenberry and colleagues from the Northern California Kaiser plan reports on a cohort of more than 17,000 members who completed a 1993 health survey. They subsequently monitored health care utilization and costs during the next year.
Body mass index (BMI) was associated with diabetes, hypertension, musculoskeletal pains, and coronary artery disease plus, surprisingly, depression. The relative rates of outpatient and inpatient services and total costs increased with weight for all ages and was particularly striking for the younger age cohorts (20-39, 40-59). Mean average annual total costs were 25% greater among those with BMI of 30-35 and 44% greater if BMI was greater than 35.
COMMENT BY BRUCE E. HILLNER, MD
Although patients were followed only for one year, the magnitude of the additional costs incurred due to obesity is substantial. If additional work in other cohorts and longer follow-up of this one confirm these trends, obesity itself could and probably should be considered a "pre-existing" condition. Health plans may find that the return of investment is rapid, if weight loss programs can reduce the subsequent utilization rates.
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