Reducing Number of Fat People Would Cut Per Capita Health Spending 4% in 10 Years, Says CBO

September 10, 2010 - 4:39 PM

Obesity-Weight Circumference

( -- Reducing the number of Americans who have a Body Mass Index that rates them as "obese" would cut per capita health care spending by 4 percent in the United States over the next 10 years, says a new study from the Congressional Budget Office (CBO).

"Because lower rates of obesity are associated with better health and lower health care spending per capita, there is considerable interest in devising policies that would reduce the fraction of the population that is obese," said the CBO in the report released this week.  The report is entitled, How Does Obesity in Adults Affect Spending on Health Care?

The CBO used federal studies conducted in 1987, 2001, and 2007 to quantify what it described as a national trend toward obesity as measured by Body Mass Index (BMI), and a corollary trend of increased per capita health care spending on American adults who were rated as obese.

"Over the past two decades, the adult population in the United States has, on average, become much heavier," concluded the CBO. "From 1987 to 2007, the fraction of adults who were overweight or obese increased from 44 percent to 63 percent; almost two-thirds of the adult population now falls into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13 percent to 28 percent. That sharp increase in the fraction of adults who are overweight or obese poses an important public health challenge. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension. As a result, that trend also affects spending on health care."

Specifically, CBO discovered that while health care spending has risen sharply across the board for all American adults, it has risen more sharply for obese adults.

"According to CBO's analysis of survey data, health care spending per adult grew substantially in all weight categories between 1987 and 2007, but the rate of growth was much more rapid among the obese (defined as those with a body-mass index greater than or equal to 30)," states the report. "Spending per capita for obese adults exceeded spending for adults of normal weight by about 8 percent in 1987 and by about 38 percent in 2007."

The CBO attributed the more dramatic increase in health care spending for obese people both to the relative health of the people involved and to advances in dealing with obesity-related health problems.

"That increasing gap in spending between the two groups probably reflects a combination of factors, including changes in the average health status of the obese population and technological advances that offer new, costly treatments for conditions that are particularly common among obese individuals," states the report.

The CBO then looked at three scenarios to project the impact of obesity rates on health care costs by 2020. If the adult obesity rate remains at 28 percent, said the CBO, per capita health care spending will rise 65 percent, from $4,550 in 2007 to $7,500 in 2020.

If the trend toward obesity continues over the next 10 years on the path it followed from 1987 to 2007, 37 percent of American adults will be obese in 2020, the CBO predicted. That would cause per capita health care spending to rise to $7,760 in that year, 3 percent higher than it otherwise would be.

Then there were potential savings to be had, the CBO concluded, if Americans could be made to return to their 1987 level of obesity.

"CBO also assessed the impact of a possible reversal in recent trends by assuming that, by 2027, the distribution of adults' body weight will return to the 1987 distribution (essentially reversing what happened from 1987 to 2007)," said the report. "In that scenario, the prevalence of obesity among adults would drop to 20 percent by 2020. Per capita spending would increase to $7,230 in 2020 -- about 4 percent lower than spending in the first scenario."

However, reducing obesity may impact health care spending in other ways, said the CBO. Although per person spending would go down, the number of persons might increase, requiring spending later in life on people who would otherwise have died earlier in life.

"How reducing obesity would affect both total (rather than per capita) spending for health care and the federal budget over time is less clear," said the report. "To the extent that people, on average, lived longer because fewer individuals were obese, savings from lower per capita spending would be at least partially offset by additional expenditures for health care during those added years of life. Moreover, the impact on the federal budget would include not only changes in federal spending on health care but also changes in tax revenues and in spending for retirement programs such as Social Security, for which costs are directly tied to longevity. As a result, the net impact of reductions in obesity rates on national health care expenditures and on federal budget deficits would depend on the magnitude of those various effects."

On balance, the CBO concluded that the cost benefits "might" make it worthwhile to use public money to pursue policies aimed at making Americans lose weight.

"However, designing public policies to reduce health care spending by preventing future cases of obesity or achieving significant and sustained weight loss among overweight and obese adults is difficult," said the CBO. "In many cases, obesity is the result of poor diet and lack of exercise, both of which can be hard to change. Indeed, the evidence on the impact of various approaches to weight loss suggests that most adults who lose weight have a difficult time maintaining the weight loss without continued intervention, such as a program for improving nutrition or increasing exercise."

"The costs of ongoing interventions are likely to offset at least part of any reductions in health care spending attributable to weight loss, although the improvements in health that would result might still make the interventions an appropriate use of public or private funds," said the CBO.

As previously reported, the Department of Health and Human Services issued regulations in July that require the electronic health records all Americans are supposed to have by 2014 (under the terms of the economic stimulus law signed by President Barack Obama last year) to include each individual's Body Mass Index.

Currently, the Centers for Disease Control and Prevention, collects Body Mass Index scores from state health agencies every year to monitor obesity nationwide.