According to background information, obesity is associated with increased risk of high blood pressure, diabetes, and certain cancers, and has been identified as a major risk factor for coronary heart disease (CHD). Approximately 130 million U.S. adults are currently overweight or obese, defined as having a body mass index (BMI: weight in kilograms divided by height in meters squared) of 25 – 29.9, or 30 and greater, respectively. The proportion of U.S. adults aged 65 years and older is estimated to increase from 12 percent currently to 20 percent by 2050. Obesity and this rising number of older persons in the U.S. is a concern to health care professionals, policy makers, and the U.S. public. However, little is known about the relation of overweight or obesity in young adults to long-term medical care expenditures.
Martha L. Daviglus, M.D., Ph.D., from the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues examined the relationship between BMI in young adulthood and middle age to Medicare spending at ages 65 years and older. Between 1967 and 1973, BMIs and overall health were measured in 9,978 men (average age, 46 years) and 7,623 women (average age, 48 years) participating in the Chicago Heart Association Detection Project in Industry (CHA). Individuals were classified as being nonoverweight (BMI, 18.5 – 24.9), overweight (25 – 29.9), obese (30.0 – 34.9), or severely obese (35 and greater). The participants were free of coronary heart disease, diabetes, and major electrocardiographic abnormalities and were not underweight (BMI less than 18.5). Researchers then examined Medicare claims data for these participants from 1984 through 2002.
The researchers found that annual average Medicare charges for severely obese men were $6,192 more (84 percent higher) than for nonoverweight men. For severely obese women, annual average charges were $5,618 more (88 percent higher) than for nonoverweight women. The total average annual Medicare charges for nonoverweight, overweight, obese, and severely obese men were, respectively, $7,205, $8,390, $10,128, and $13,674. The total average annual charges for nonoverweight, overweight, obese, and severely obese women were, respectively, $6,224, $7,653, $9,612, and $12,342.
"In conclusion, our findings demonstrate the adverse impact of high BMI in young adulthood and middle age (irrespective of changes in weight that may have occurred over the years) on future Medicare expenditures. With current trends of increasing overweight and obesity afflicting all age groups, urgent preventive measures are required not only to lessen the burden of disease and disability associated with excess weight but also to contain future health care costs incurred by the aging population," the authors write.
(JAMA. 2004; 292: 2743-2749. Available post-embargo at www.jama.com)
Editor's Note: This study was supported by grants from the National Heart, Lung, and Blood Institute, the Illinois Regional Medical Program, the Chicago Health Research Foundation, and private donors.
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JAMA