Health-Care Costs for Obesity Top Those Related to Smoking

Health-Care Costs for Obesity Top Those Related to Smoking

Health-care costs linked to obesity -- and resulting conditions such as diabetes and heart disease -- are greater than those related to smoking and problem drinking, a new study finds.

"We get bombarded all the time by health warnings" about everything from sleep apnea to smoking, but "there is never a comparison" to establish policy priorities, says Roland Sturm, the study author who is a senior economist at Rand Corp., a Santa Monica, Calif., think tank. Obesity turns out to be worse than smoking or alcohol abuse and "is like aging 20 years" when measured by the onset of chronic medical problems, he adds.

For obese people, spending on hospital and outpatient care is 36% higher and medication costs are 77% higher than for people in a normal weight range, according to the study, which appears in Health Affairs, a health policy journal published in Bethesda, Md. For smokers, health-care service costs were 21% higher and drug costs were 28% higher than for nonsmokers. Cost increases associated with problem drinking were smaller.

While the findings "confirm the world view" of people in the obesity field, they "put a different perspective on the problem that will help everyone to conceptualize it differently," said Morgan Downey, executive director of the American Obesity Association, a Washington nonprofit advocacy organization. "There has definitely been a feeling that smoking, drinking and substance abuse are bigger problems than obesity. This study and others will be important to clarify that this isn't the case."

Mr. Downey pointed to the proliferation of prevention programs in schools and workplaces that educate people about the risks of smoking and alcohol consumption. "There is so much greater acceptance for the role of those programs. Weight has been seen as a kind of superficial thing that schools and employers don't have to worry about," he said. Such dismissive thinking may be spurred by commercial pitches for weight-loss programs that cater to people seeking a "quick fix," he said.

About one in three Americans is overweight and one in five is obese, based on the body-mass index. The BMI, a common measure of obesity, is an individual's weight in kilograms divided by height in meters squared. Translated into pounds, an individual who is 5 feet 3 inches tall and weighs 169 or more is obese; so is someone who is 6 feet tall and weighs at least 221 pounds. Between 1991 and 2000, obesity in the U.S. rose 60%, while smoking rates have been cut roughly in half since 1964, according to government studies.

The Rand study uses data from a 1997-1998 household telephone survey of about 10,000 adults from age 18 to 65. The participants responded to questions about their smoking and drinking habits, as well as their weight, age, gender, race, household income and education. They were also asked questions about their medical care, such as hospital stays and medical visits during a set period. Dr. Sturm, who has a doctorate in economics, multiplied the self-reported medical utilization information by unit costs from a federal medical expenditure survey.

The study found that obesity is associated with an average increase in hospital and outpatient spending of $395 a year, while smoking is linked with a $230 annual increase and problem drinking with a $150 increase. For all adults in the survey, including those who are obese, average health-care service spending was about $1,500. "We can't nail down costs exactly," but "the very strong effects of obesity are clear," Dr. Sturm said.

Write to Rhonda L. Rundle at rhonda.rundle@wsj.com¹

Updated March 12, 2002