Swollen Waistlines, Swollen Costs

Obesity Worsens Disabilities and Weighs on Health Budgets

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Obesity and Disability

Figure 6
Figure 7

Weight has a dramatic effect on people’s ability to manage five basic activities of daily living: bathing, eating, dressing, walking across a room, and getting in or out of bed. Men with moderate obesity are 50 percent more likely to have limitations in these activities; men with a BMI of 35 or more are 300 percent more likely to have limitations. Obesity is even more likely to be disabling among women, for whom the probability of having the limitations doubles with moderate obesity and quadruples with a BMI of 35 or more.

The relationship between obesity and disability may now be playing out on the national stage. Disability rates have spiked, especially for people aged 30–39. The number of people in this age group unable to care for themselves or to perform other routine tasks grew by more than 50 percent from 1984 to 1996—from 118 to 182 people per 10,000 (see Figure 6).

For people aged 40–49, the number rose from 212 to 278 people per 10,000. There were smaller but still significant increases for those aged 18–29 and 50–59. In contrast, disability declined slightly for people aged 60–69.

All possible explanations for the increasing disability rates have not yet been exhausted. However, obesity appears to be the only trend that is commensurate in size with what we see happening with disability. Although mental health is among the most prevalent causes of disability among the nonelderly, the fastest growing causes are diabetes and musculoskeletal problems (primarily back problems), conditions that are associated with obesity. Since 1984, the proportion of diabetes-related disability cases has doubled.

Heavy Load on Health Care

If historical obesity trends continue through 2020 without other changes in behavior or medical technology, the population would become sicker than it is today. The proportion of individuals aged 50–69 who would report only "fair" or "poor" health would rise by 12 percent among men and 14 percent among women, compared with the year 2000. This age group represents those who were born between 1951 and 1970.

The medical care cost consequences could be dramatic: One in five health care dollars for this age group could be consumed by treating only the consequences of obesity, up from less than one in ten dollars in 1985 (see Figure 7). Rising disability rates among the future elderly would wipe out recent reductions in disability among today’s elderly, who have benefited from reduced exposure to disease, better medical care, and reduced smoking.

Diabetic

Iris Caballero fixes a nutritious lunch at her home in Cutler, Calif., on Feb. 11. Caballero, who suffers from diabetes, has learned to prepare low-fat meals to help her lose weight.

Sustained increases in disability rates would swell the ranks of residents in nursing homes in the United States. During the past 20 years, the rate of institutionalization among the elderly has fallen dramatically. But it appears that the recent increases in obesity among young to middle-aged adults will reverse the downward trend. By 2016, the nursing home population is likely to grow by 10–25 percent more than historical trends would predict.

Such growth would impose a heavy burden on Medicaid, the source of funding for more than threequarters of nursing-home care in the country. If the nursing home population grows by 10–25 percent, then Medicaid spending on long-term care could also rise by 10–25 percent.

This prediction might even be a rosy scenario. Another possibility is that the price of nursing home care will rise sharply (to meet demand) and that Medicaid eligibility will simultaneously contract (to limit the growth in nursing home residence). In this case, the greatest costs would be borne not by governments but by the sick and disabled individuals who might be unable to afford the higher price of a nursing home.

Obese individuals face greater burdens in terms of disabilities and chronic diseases than do other people. However, the sum of the individual burdens imposes major social burdens on health budgets and on health care delivery in general.

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