Study examines health care costs for obese and smokers

A new University study revealed that health care costs among the obese and smokers are substantially higher than for their non-obese and non-smoking counterparts. In addition, it suggests health care expenses associated with obesity and smoking were considerably larger among women, non-Hispanic whites and older patients.

The 13-year-long study tracked annual per-capita health care expenses made by U.S. adults who either had a BMI greater than or equal to 30, or smoked more than 100 cigarettes in their lifetime.

“We tested the hypothesis that people with higher body weight and people who are smokers tend to have more, additional health care costs compared to their peers who are similar to them in terms of individual characteristics,” said Ruopeng An, head of the study and professor of kinesiology and community health.

Nationally represented data sets from the National Health Interview Survey from 1996 to 2010 and the Medical Expenditure Panel Survey from 1996 to 2011 were analyzed in this study. From that data, An was able to see how much the obese and smokers spent on prescription medicines, emergency room services, office-based medical provider services, hospital inpatient care, hospital outpatient care and out-of-pocket expenses.

As expected, the added costs were higher than those of their peers. Many similar studies have proven this, but they tended to only look at the costs of obesity or smoking separately. This particular study utilizes a cross section of data that analyzes the effects of obesity and smoking together.

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Flavia Andrade, assistant professor in kinesiology and community health, said that the two national data sets An used to estimate trends in the costs associated with obesity and smoking in the U.S. “demonstrate the increasing medical costs associated with these conditions.”

A finding of the study An stressed is that obesity could potentially tax our health care system more than smoking in the long run.

“For most categories of health care costs, the cost of obesity is even larger than the cost of smoking, which is striking,” An said.

An said smokers tend to die earlier compared to non-smokers due to lung disease and cancer.

“But obesity is a disabling disease, so people with obesity are not necessarily dying sooner compared to people who are not obese,” An said. “People who are older and disabled because of type 2 diabetes and other associated chronic diseases tend to spend the most on health care costs. So if you consider from the life perspective, people with obesity are costing the health system even more compared to people who are smokers.”

The prevalence of smoking has continuously decreased since the 1960s, as the rise in obesity has dramatically soared since the 1980s. Obesity rates seem to be leveling off, but they remain prevalent. About one-third of Americans are considered obese. Two-thirds, or a majority of the U.S. adult population, are either obese or overweight, An said.

“To this day, there really is no concrete evidence for why obesity rate increased so dramatically, but people guess that there might be some gene-environment interaction in this situation,” An said. “Nevertheless, people can’t modify their genes, but they can modify their behavior through eating healthily according to the American Dietary Guidelines and also doing at least 150 minutes of moderate to rigorous physical activity on a weekly basis.”

An said this would help them avoid weight gain and manage their weight properly so that in the long run they will really benefit from this healthy behavior.”

The other finding that can be pulled from this study is the driving force behind high health care costs for the obese and smokers: prescription drugs. People who are obese and smokers spend a majority of their health care costs on medicine. It is the category with the most dramatic spike in spending from 1998 to 2011.

“One possible reason might be there are many more available treatments that are effective to patients, so they can reduce their symptoms and increase their quality of life, but at a huge cost expenditure on this new innovative treatment in drugs,” An said.

“So in the long run, I think the key message is we need to think about … how to prevent people from smoking and prevent people from being obese, rather than waiting until they are already obese or already are longtime smokers,” An said. “Treatment is very expensive compared to prevention.”

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