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March 9, 2004
If obesity continues rising at its current rate in the United States, by 2020 about one in five health care dollars spent on people ages 50-69 could be consumed by obesity-related medical problems -- up about 50 percent from 2000, according to a RAND Corporation study issued today.
The proportion of health care expenditures associated with treating the consequences of overweight and obesity would increase from 14 percent in 2000 to 21 percent in 2020 for 50-69 year-old men, and from 13 percent to 20 percent for women in the same age group, according to the study published in the March/April edition of Health Affairs (View abstract from healthaffairs.org).
In addition, many of the improvements in health achieved by middle-aged and older Americans in recent decades as a result of medical advances could largely be erased over the next two decades if population weight continues to increase, according to the study.
If obesity trends continue through 2020, without other changes in health behaviors or medical technology, the study predicts that the proportion of people 50-69 with disabilities (those who are limited in their ability to care for themselves or perform other routine tasks) will increase by 18 percent for men and by 22 percent for women between 2000 and 2020.
“Improvements in medical care, public health, and other health behaviors have dramatically reduced disability among older Americans in the past. But the continuing increase in unhealthy weight has the potential to undo many of these health advances,” said Roland Sturm, a RAND Health senior economist and lead author of the study.
Researchers define obesity as a body mass index (BMI, a ratio of weight to height) of more than 30, or at least 30 pounds overweight for a woman and 35-40 pounds overweight for a man of average height.
Sturm and colleagues found the greatest health and cost consequences among even heavier weight groups, which are increasing the fastest.
The proportion of Americans with a BMI of at least 40 based on self-reported height and weight — roughly 90 pounds or more overweight for a woman and 100 pounds or more overweight for a man of average height– has quadrupled between 1986 and 2000, increasing from 1 in 200 to 1 in 50. In contrast, the proportion of Americans with moderate obesity has doubled.
Annual average health care costs for moderately obese people were about 20-30 percent higher than health care costs for normal weight people, according to the RAND analysis. A BMI over 35 is associated with an increase of more than 60 percent in health care spending, while a BMI of at least 40 doubles health care expenditures, RAND researchers concluded.
These health care costs reflect differences in health status. Among moderately obese Americans (BMI between 30 and 35) ages 50-69, about 11 percent report some limitation in activities of daily living such as walking across a room or getting dressed, according to the study. That number nearly doubles with a BMI of over 35, the report says.
Similarly, about 27 percent of moderately obese Americans in the age group studied report that their health limits their ability to work, compared with nearly 46 percent of Americans with a BMI over 35, the report says.
The RAND study analyzed data from two national surveys. The relationship between obesity and costs or health limitations was based on the Health and Retirement Study, a national panel survey of 9,825 people born between 1931 and 1941.
Trends on weight are estimated from the 1985-2002 Behavioral Risk Factor Surveillance Survey. By extrapolating trends in different weight groups to 2020 and combining them with the estimated health effects, the authors were able to project the effects of continuing weight increases at the population level.
“Even though disability rates among the oldest Americans have continued to decline, there is no reason to be complacent about obesity,” said Sturm. “Severe obesity rates among Americans over 70 have increased by only half the increase among Americans 50-69. But today’s 60-year-old is getting older and our results anticipate the obesity consequences among the elderly by a decade.”
Other authors of the study are RAND economist Jeanne S. Ringel and Tatiana Andreyeva, a fellow at the Pardee RAND Graduate School.
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Research Brief: Obesity and Disability: The Shape of Things to Come