Prevention Makes Common "Cents". Overweight and Obesity

09/01/2003

Public health officials refer to obesity as an epidemic. The prevalence of overweight and obesity has increased dramatically in recent years, doubling since 1980,and now is seen by the CDC as one of the top threats to the health of the Nation.(7) Weight gain is a direct function of an imbalance between the amount of calories consumed and the amount of calories expended by an individual. While there are some genetic determinants of obesity, much, if not most, of the recent increase in prevalence of obesity in the U.S.population stems from changes in people's diets and the level of their physical activity. To some extent, these dietary changes may reflect the greater availability of pre-packaged foods, low-cost-big-portion restaurant meals, and soft drinks, all of which may be high in sugar, calories, and/or fat. This increase in obesity has occurred even though the public generally is more educated about what constitutes a healthy diet and ingredients in food products have become more clearly identified on labels.

On the other side of the equation, changing people's habits related to physical activity has proved to be a challenging task. Individuals who want to be more physically active, often find it difficult to do so because of demands, and other constraints associated with their work, family, and community. According to a recent study by the National Center for Health Statistics (NCHS), less than a third of US adults engage in regular leisure-time physical activity, and only about one-fifth of adults engage in a high level of overall physical activity.(8) One study looked at adults who were trying to lose or not gain weight and found that less than 20 percent of the individuals were following recommendations about increasing physical activity and reducing calories.(9) Also notable is a finding that only 42.8 percent of obese people who had routine checkups in the past months had been urged during those visits to lose weight.(10)

The current widely-used definition for overweight in adults is a body mass index (BMI) of 25 to 29.9, and for obesity in adults, a BMI of 30 or over. BMI is calculated solely on the basis of the height and weight of an individual; the calculation does not take into consideration the sex of the individual, the proportion of fat and muscle, or different body shapes. Waist circumference is also an independent predictor of risk factors and morbidity.(11) Overweight and obesity are defined differently for children and adolescents; they are considered to be overweight at or above the 95th percentile of the sex-specific BMI for age growth charts. Obesity in children is not specifically defined.

Motorola

Forty-five thousand U.S. employees, family members, retirees benefit from Motorola's wellness programs. Motorola invests $6 million annually in wellness and work/life programs. Motorola's Long-term wellness program goals include: enhance education, prevention, and wellness strategy; demonstrate return on investment; advocate healthy culture. Support programs include disease management (asthma, cancer, depression, diabetes, infectious diseases); flu immunizations, cancer screenings, smoking cessation; health screenings and health risk appraisals; 24/7 nurse telephone line; health fairs; back care; on-site/external wellness centers; children's aerobics and nutrition; stress management, and shiftwork wellness.

Evidence of the program's cost-effectiveness include: for every $1 invested in wellness benefits, $3.93 saved; a 2.4% increase in annual aggegate health care costs for participating employees compared with 18% increase for non-participants; $6.5 million annual savings in medical expenses for lifestyle-related diagnoses (e.g., obesity, hypertension, stress) compared with non-participants; and $6.5 million annual savings in medical expenses for lifestyle-related diagnoses (e.g., obesity, hypertension, stress) compared with non-participants.

To contact Motorola for more detailed information, see: www.motorola.com.

Table 1: Body Mass Index for Adults
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
HGTa Body Weight (pounds)
  Normal Overweight Obese
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312
Source: www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm
a HGT refers to height in inches

As displayed above, an individual who is 5 feet 10 inches and weighs 195 pounds would have a BMI of 28 and would be considered overweight. An adult who is 5 feet 10 inches and weighs 250 pounds would have a BMI of 36 and would be considered obese.

The Prevalence of Overweight and Obesity

Recent estimates indicate that more than129 million U.S. adults are considered to be overweight or obese.(12) Approximately two-thirds of the adult population are either overweight or obese, and slightly less than one-third are obese.(13)[Note: While there have been lower estimates of the proportions of overweight and obese individuals recently, they were based on self-reported measures of height and weight and consequently are most likely under-estimates.(14)] Even though their specific prevalence estimates may differ somewhat, all studies in recent years have shown dramatic increases in the prevalence of overweight and obesity, with one study determining that obesity rose from 22.9 percent to 30.5 percent between 1988 and 2000, while extreme obesity, defined as a BMI of 40 or over, increased from 2.9 percent to 4.7 percent over this period.(15)

Figure 1. Prevalence of Obesity by Age

Figure1. Source of data:1991-2001 Prevalence of Obesity Among U. S. Adults, by Characteristic; Behavioral Risk Factor Surveillance System; Self-reported data.

While the prevalence of overweight and obesity is high and increasing in all ages, in men and women, across different racial and ethnic groups, and across education and income levels, it does vary somewhat. Among adults, the age group with the smallest proportion of obese people is ages 18 through 29 years. However, this same age group has shown the largest percentage increase in obesity of all age groups, rising from 7.1 percent in 1991 to 14 percent in 2001-a 97 percent increase.(16),(17)

Dramatic increases in the prevalence of overweight and obesity also have occurred in children and adolescents of both sexes, with approximately 15.3 percent of children aged 6 to 11 years and 15.5 percent of adolescents aged 12 to 19 years considered to be overweight.(18) The prevalence in adolescents has almost tripled in the past twenty years.(19) More than 10 percent of children aged 2 through 5 years are overweight.(20) As is the case with adults, children and adolescents have become less physically active and are consuming more calories. They also have greater access to increasingly larger portions of foods high in calories, fat, and sugar. Research has shown that children will eat more when served large portions than they will when they serve themselves,(21) and when adolescents eat on their own and not with their families, they are less likely to eat healthy food including fruits and vegetables.(22)

The Effects of Overweight and Obesity

Overweight and obesity significantly affect the health, quality of life, and life expectancy of the U.S. population. Excess weight is a risk factor for a large number of diseases and chronic conditions; it can contribute to the onset of these disorders and it can make them worse. Conversely, overweight individuals can reduce the risk for some chronic disorders by losing as little as 5 percent to 15 percent of their weight. (23) Obesity is believed to be associated with more chronic disorders and worse physical health-related quality of life than is smoking or problem drinking.(24) Estimates of the deaths of U.S. adults due to causes related to obesity range from 280,000 to 325,000 each year.(25),(26),(27) There is evidence that overweight and obesity raise the risk for a wide variety of medical conditions.

Overweight and obesity raise the risk for:
  • type 2 diabetes
  • high blood pressure
  • high cholesterol levels
  • coronary heart disease
  • congestive heart failure
  • angina pectoris
  • stroke
  • asthma
  • osteoarthritis
  • musculoskeletal disorders
  • gallbladder disease
  • sleep apnea and respiratory problems
  • gout
  • bladder control problems
  • poor female reproductive health
    – complications of pregnancy
    – menstrual irregularities
    – infertility
    – irregular ovulation
  • cancers of the
    – uterus
    – breast
    – prostate
    – kidney
    – liver
    – pancreas
    – esophagus
    – colon and rectum

It is estimated that 47 million U.S. adults have a cluster of medical conditions, referred to as the "metabolic syndrome," characterized by insulin resistance and the presence of obesity, abdominal fat, high blood sugar and triglycerides, high blood cholesterol, and high blood pressure.(28) Recent research also suggests that obesity increases the risk for progression to advanced stages of age-related macular degeneration, a disorder affecting a large proportion of the elderly.(29) Overweight and obesity also can reduce mobility and physical endurance, can lead to psychological disorders, and can result in social, academic, and job discrimination.(30),(31),(32),(33),(34),(35),(36)

Estimates of the number of years of life lost as a result of overweight and obesity range as high as 20 years of life lost for certain age and racial/ethnic groups. For example, a 20-year-old white male could realize a 17 percent reduction in life expectancy due to obesity.(37) Years of life lost is a simple measure of mortality, and does not reflect the fullimpact of obesity on morbidity and quality of life. It has been suggested that measuring the number of healthy, disability-free years of life lost might be more informative than focusing only on actual years lost.(38) Researchers have suggested that in terms of the physical quality of life, the effect of obesity can be the equivalent of aging as much as 30 years.(39)

 Figure 2. Life Expectancy

Figure 2. Source of data: Ref.37.

The Costs of Overweight and Obesity

Over the last several decades, researchers have provided many estimates of the costs of overweight and obesity. These estimates differ according to their scope (e.g., the individual person, a particular company or health plan, or the Nation as a whole), the timeliness of the data, and the methods used to derive them, including how obesity is defined, how the prevalence of obesity is determined, what associated disorders are included, the degree to which these disorders and obesity are considered to be associated, how costs are defined, and the assumptions used in calculating those costs. As with other chronic conditions, estimates may focus on direct costs to the community, including the costs of health care services, physicians and other health care professionals, hospital admissions, and medicines; indirect costs, such as loss of productivity caused by absenteeism, disability, and premature death; or personal costs, such as reduced earnings, higher insurance costs, reduced quality of life, and out-of-pocket expenses for individuals.(40) These cost estimates are approximations, and it becomes even more difficult to estimate the costs of the effects of obesity over very long periods of time.

Health Care Utilization-Research has shown that as body mass increases, so too do health care utilization and costs.(41) Obesity may account for as much as a 36% increase in costs for inpatient and ambulatory care for individuals-a greater increase than that attributed to aging 20 years, smoking, or problem drinking.(42) In addition to using more physician and hospital services, obese individuals have high annual costs for medications, particularly those for diabetes and cardiovascular disease (CVD). One researcher estimated that obese individuals may pay as much as 77 percent more for medications compared to non-obese individuals.(43) Conversely, there is evidence that patients who lose weight reduce their use of these kinds of medications, and even modest sustained weight loss (a reduction of 10 percent in body weight) may reduce expected lifetime health care costs for major obesity-related diseases by $2,200 to $5,300, depending on age, gender, and initial BMI.(44),(45),(46),(47)

Personal Costs-Even the financial well-being of individuals may be associated with their weight. Researchers analyzed data from the University of Michigan Health and Retirement Study on more than 7,000 men and women between the ages of 57 and 67, and found that heavier women had significantly smaller individual net worth, even after controlling for health, marital status and other demographic factors.(48) (The association between obesity and the net worth of the men were smaller and not statistically significant.)

Significant Costs-Most estimates of total (direct and indirect combined) costs of overweight and obesity to the Nation range from $69 billion per year to $117 billion per year.(49),(50),(51),(52),(53) This estimated $117 billion includes $61 billion for direct costs and $56 billion for indirect costs. One study of the costs of treating major disorders relating to obesity estimated that obesity cost the Nation as much as $102 billion for direct costs alone in 1999. (These amounts represent 27 percent to 31 percent of the total costs of treating these disorders, regardless of obesity.)(54) Included in this $102 billion were:

  • $6.7 - $7.4 billion for arthritis;
  • $25.5 - $30.6 billion for heart disease;
  • $18.4 - $20.5 billion for type 2 diabetes;
  • $8.3 - $9.6 billion for hypertension; and
  • $6.1 - $8.1 billion for stroke.

Contributing to the overall trends, annual hospital costs for obesity-related disorders in children ages 6 to 17 years increased from $35 million to $127 million between 1979 and 2000.(55)

DaimlerChrysler

DaimlerChrysler is an international automotive and transportation company with over 95,000 employees throughout the United States. Its National Wellness Program began in 1985 and is a negotiated benefit between DaimlerChrysler Corporation and the International Union, UAW. All U.S. sites with 500+ employees have on-site contracted health and fitness business partners (over 100 FTEs) to administer program. The program has voluntary participation. Key components of the National Wellness Program includes: targeted education programs, based on identified health risks and interests; focused education programs which support employees throughout process of lifestyle change; smoking cessation, weight management, cholesterol management, and fitness activities; one-time workshops, multi-session classes, individual counseling, and self-directed modules; maintenance strategies which include ongoing awareness, interactive campaigns, group support with on-site services (e.g., fitness facilities, cafeteria/vending programs, walking routes);

Savings estimates revealed that participation in the National Wellness Program was associated with significant savings in dollars per employee from 1991 to 1995, with the highest dollar savings achieved in 1995 ($16 per employee per month). Evaluation of the program showed that health risk assessment was associated with significant and substantial reductions in healthcare costs. Employees who completed one, two, or three health risk assessments on average had lower 1997 health care costs of $112.89, $134.22, and $152.29, respectively. Employees who had completed at least one health risk assessment and participated in an additional wellness activity had an average cost savings of $200.35 per year.

To contact DaimlerChrysler for more detailed information, see: www.Chrysler.com.

Increasing U.S. Health Care Costs-The direct health care costs of overweight and obesity represent a significant portion of total annual U.S. health care expenditures, with estimates ranging from 4.3 percent of total expenditures to as much as 9.1 percent.(56),(57) Moreover, Medicare and Medicaid may finance as much as half of these costs, with Medicare covering the larger share due to the more substantial medical problems associated with obesity in the elderly. Researchers have found that obese people who reach 65 years of age have much larger annual Medicare expenditures than non-obese people. For the period between 1996 and 1998, a 15 percent increase in annual per capita Medicare spending is attributable to being overweight, and a 37 percent increase is attributed to being obese. (58)

Figure 3. Per Capita Medicare Spending, 1996-1998

Figure 3.Source of data: Ref. 54.

Impact on Businesses-Employers and businesses bear a sizable portion of costs associated with treating obesity-related conditions, primarily in terms of lost productivity and the increased cost of health and disability insurance. Studies of overweight and obese employees have shown that obese employees take more sick leave than non-obese employees and are twice as likely to have high-level absenteeism (seven or more health-related absences during the last six months).(59),(60) In addition, another study found a reduction in the use of sick leave and disability pension by obese employees in the second and third years following surgical treatment of their obesity.(61) An analysis of business costs in the late 1980s through the mid-1990s found that in 1994, due to conditions associated with obesity:

  • employees lost 39.3 million workdays (a 50 percent increase since 1988);
  • made 62.7 million visits to physician offices (a 88 percent increase);
  • had 239 million restricted activity days (a 36 percent increase), and
  • 89.5 bed-days (a 28 percent increase).(62),(63)

The costs to U.S.businesses of obesity-related health problems in 1994 added up to almost $13 billion, with approximately $8 billion of this paying for health insurance expenditures, $2.4 billion for sick leave, $1.8 billion for life insurance, and close to $1 billion for disability insurance.(64)

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