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Daniel Engber: Shut up about 'the cost of obesity'
12:08 PM CDT on Sunday, March 30, 2008
Barack Obama and Hillary Clinton may differ (slightly) on health-care policy reform, but at least they agree on how to pay for it. At one debate, Mr. Obama announced that "if we went back to the obesity rates that existed in 1980, that would save the Medicare system a trillion dollars." Mrs. Clinton mirrors the claim on her Web site: "Medicare could save over a trillion dollars over 25 years if obesity among seniors could be returned to levels in the 1980s."Some fact checking revealed that their numbers (apparently taken from a RAND Corp. study) were a bit off. According to Eric Finkelstein, a widely cited authority on the economic cost of obesity, they should have said the savings would be $200 billion.
[Click image for a larger version] DAN PAGE/Special Contributor
DAN PAGE/Special Contributor
This figure has led lawmakers to view fat people as a cash cow. If we rein in those profligate heavyweights, the thinking goes, we'll save billions in taxpayer money.
But a pair of new epidemiological studies reveals that these attempts to wring money out of the obese are misleading and misguided. Worse, the obesity cost estimates used to justify them are a danger to public health.
The first paper, published by a Dutch team in the journal PLoS Medicine, challenges the basic assumption that fat people are more expensive to treat. It's true that if you compare two people of the same age and wealth, one slim and the other obese, you can expect the fatter one to have more chronic diseases. The fatter patient will also make more visits to the doctor, buy more prescription drugs, and otherwise ring up higher medical bills.
But this analytical approach ignores one important fact: Obese people have shorter life spans. Since the elderly are by far the costliest patients, it's possible that early deaths save taxpayers money in the long run. In fact, fatal diseases almost always return net-cost savings to public health care. Smoking, which causes a host of particularly deadly conditions, turns out to be especially cheap which is to say, government attempts to curb nicotine addiction have actually cost the United States money.
That's how the numbers played out in the Dutch study. If we somehow figured out a way to "cure" obesity, we'd increase the burden on taxpayers. More people would make it to old age, hastening the Social Security crisis and pushing up the costs of Medicaid. Indeed, the analysis in PLoS Medicine revealed that lifetime health expenditures were highest for healthy-living people of optimum weight.
This finding has sent some anti-fat crusaders into retreat, but health economists are undeterred. The PLoS paper looks only at the direct costs of obesity i.e., the amount spent on specific medical treatments. That leaves out a huge volume of indirect costs to society unemployment, missed days of work and lowered on-the-job productivity. According to Dr. Finkelstein, these losses add up to more than $40 billion a year: One-third of that comes from absenteeism (people are too sick or lethargic to come to work) and the remainder from something called "presenteeism" (people at work are too fat to get anything done).
Meanwhile, a plague of ridiculous productivity-cost estimates in other spheres diminishes the obesity sticker shock. If we believe that extra pounds result in $40 billion of lost business, what are we to make of the claim that negativity in the workplace costs a whopping $350 billion? Spam e-mails eat away another $20 billion. Even the NCAA basketball tournament costs us $3.8 billion. With all these other numbers floating around, the cost of obesity loses all meaning.
But these estimates are more than meaningless they actually make the problem worse.
A second study, published in the American Journal of Public Health , looked at the relationship between body image and health. The authors compared people of similar age, gender, education level and rates of diabetes and hypertension, then examined how often they reported feeling under the weather over a 30-day period. It turned out that body image had a much bigger impact on their health than body size.
In other words, two equally obese women would have very different health outcomes, depending on how they felt about their bodies. Likewise, two women with similar insecurities would have more similar health outcomes, even if one were fat and the other thin.
These results suggest that the stigma associated with being obese feeling fat is a major contributor to obesity-related disease and ill health.
Politicians love to throw around cost-of-obesity numbers as support for fat-prevention programs, overeating legislation or, in the case of Mr. Obama and Mrs. Clinton, massive health care reform. These shocking statistics are also supposed to guilt-trip consumers into pursuing a healthier lifestyle. Putting on weight is as much a social decision as a personal one: When we overeat, we're killing ourselves and the economy.
This chew-and-screw narrative feeds on itself. First, it inflates the numbers by ignoring the real effects of an aging population. Then it promotes bias by supplying phony evidence that heavy people are lazy, useless and a drag on the nation. This in turn makes anyone who thinks he's a little chubby feel even fatter, which worsens his health and increases his medical bills.
And guess what? All of this only increases the cost of obesity!
We're all interested in the most efficient ways to extend life spans and improve our quality of life. But the rhetoric of wasted fat dollars does little for our health; the claim that obesity costs the government $1 trillion is absurd at best and self-fulfilling at worst.
Instead, presidential candidates should pledge support for a federal ban on weight-based discrimination. If we stop blaming fat people for our problems, they might start feeling better and start saving us money.
Daniel Engber is an associate editor at Slate. His e-mail address is [email protected].
Daniel Engber: Shut up about 'the cost of obesity'
12:08 PM CDT on Sunday, March 30, 2008
Barack Obama and Hillary Clinton may differ (slightly) on health-care policy reform, but at least they agree on how to pay for it. At one debate, Mr. Obama announced that "if we went back to the obesity rates that existed in 1980, that would save the Medicare system a trillion dollars." Mrs. Clinton mirrors the claim on her Web site: "Medicare could save over a trillion dollars over 25 years if obesity among seniors could be returned to levels in the 1980s."Some fact checking revealed that their numbers (apparently taken from a RAND Corp. study) were a bit off. According to Eric Finkelstein, a widely cited authority on the economic cost of obesity, they should have said the savings would be $200 billion.
[Click image for a larger version] DAN PAGE/Special Contributor
DAN PAGE/Special Contributor
This figure has led lawmakers to view fat people as a cash cow. If we rein in those profligate heavyweights, the thinking goes, we'll save billions in taxpayer money.
But a pair of new epidemiological studies reveals that these attempts to wring money out of the obese are misleading and misguided. Worse, the obesity cost estimates used to justify them are a danger to public health.
The first paper, published by a Dutch team in the journal PLoS Medicine, challenges the basic assumption that fat people are more expensive to treat. It's true that if you compare two people of the same age and wealth, one slim and the other obese, you can expect the fatter one to have more chronic diseases. The fatter patient will also make more visits to the doctor, buy more prescription drugs, and otherwise ring up higher medical bills.
But this analytical approach ignores one important fact: Obese people have shorter life spans. Since the elderly are by far the costliest patients, it's possible that early deaths save taxpayers money in the long run. In fact, fatal diseases almost always return net-cost savings to public health care. Smoking, which causes a host of particularly deadly conditions, turns out to be especially cheap which is to say, government attempts to curb nicotine addiction have actually cost the United States money.
That's how the numbers played out in the Dutch study. If we somehow figured out a way to "cure" obesity, we'd increase the burden on taxpayers. More people would make it to old age, hastening the Social Security crisis and pushing up the costs of Medicaid. Indeed, the analysis in PLoS Medicine revealed that lifetime health expenditures were highest for healthy-living people of optimum weight.
This finding has sent some anti-fat crusaders into retreat, but health economists are undeterred. The PLoS paper looks only at the direct costs of obesity i.e., the amount spent on specific medical treatments. That leaves out a huge volume of indirect costs to society unemployment, missed days of work and lowered on-the-job productivity. According to Dr. Finkelstein, these losses add up to more than $40 billion a year: One-third of that comes from absenteeism (people are too sick or lethargic to come to work) and the remainder from something called "presenteeism" (people at work are too fat to get anything done).
Meanwhile, a plague of ridiculous productivity-cost estimates in other spheres diminishes the obesity sticker shock. If we believe that extra pounds result in $40 billion of lost business, what are we to make of the claim that negativity in the workplace costs a whopping $350 billion? Spam e-mails eat away another $20 billion. Even the NCAA basketball tournament costs us $3.8 billion. With all these other numbers floating around, the cost of obesity loses all meaning.
But these estimates are more than meaningless they actually make the problem worse.
A second study, published in the American Journal of Public Health , looked at the relationship between body image and health. The authors compared people of similar age, gender, education level and rates of diabetes and hypertension, then examined how often they reported feeling under the weather over a 30-day period. It turned out that body image had a much bigger impact on their health than body size.
In other words, two equally obese women would have very different health outcomes, depending on how they felt about their bodies. Likewise, two women with similar insecurities would have more similar health outcomes, even if one were fat and the other thin.
These results suggest that the stigma associated with being obese feeling fat is a major contributor to obesity-related disease and ill health.
Politicians love to throw around cost-of-obesity numbers as support for fat-prevention programs, overeating legislation or, in the case of Mr. Obama and Mrs. Clinton, massive health care reform. These shocking statistics are also supposed to guilt-trip consumers into pursuing a healthier lifestyle. Putting on weight is as much a social decision as a personal one: When we overeat, we're killing ourselves and the economy.
This chew-and-screw narrative feeds on itself. First, it inflates the numbers by ignoring the real effects of an aging population. Then it promotes bias by supplying phony evidence that heavy people are lazy, useless and a drag on the nation. This in turn makes anyone who thinks he's a little chubby feel even fatter, which worsens his health and increases his medical bills.
And guess what? All of this only increases the cost of obesity!
We're all interested in the most efficient ways to extend life spans and improve our quality of life. But the rhetoric of wasted fat dollars does little for our health; the claim that obesity costs the government $1 trillion is absurd at best and self-fulfilling at worst.
Instead, presidential candidates should pledge support for a federal ban on weight-based discrimination. If we stop blaming fat people for our problems, they might start feeling better and start saving us money.
Daniel Engber is an associate editor at Slate. His e-mail address is [email protected].
