Date Published: February 5, 2008
Publisher: Public Library of Science
Author(s): Klim McPherson
Abstract: The author discusses the implications of a new study that used data from The Netherlands to simulate the annual and lifetime medical costs attributable to obesity.
Partial Text: In a study in this issue of PLoS Medicine, Pieter van Baal and colleagues used data from The Netherlands to simulate the annual and lifetime medical costs attributable to obesity . They also compared these costs to those attributable to smoking as well as to the medical costs associated with healthy, living persons (defined as non-smokers with a body mass index in the range of 18.5 to less than 25 kg/m2). The researchers explored the question of whether reducing obesity would lead to reduced or increased health-care costs
The study found that although annual health-care costs are highest for obese people earlier in life (until age 56 years), and are highest for smokers at older ages, the ultimate lifetime costs are highest for the healthy (nonsmoking, nonobese) people. Hence the authors argue that medical costs will not be saved by preventing obesity.
In a sense, Van Baal and colleagues’ study is a useful antidote to current concerns. But let us be clear: it does not attenuate them. Obese people cost less because individuals die younger and hence with less chronic morbidity associated with old age. This is a useful thing to know, but how might it affect public health strategies for obesity? In particular, does it mean that concerns about increasing population obesity are misplaced, as least as far as health-service costs are concerned?
Most people want to live a longer life, and they do not consider the consequences to society. But a major goal of life is to maximise one’s total quality-adjusted life years (QALYs). Unfortunately, this new study provides little insight into the total QALYs associated with obesity and smoking. Certainly those who are obese and those who smoke will live fewer years on average, but will these people be compensated by enriched quality of their fewer years? Available evidence suggests strongly that quality of life, quite apart from increased illness rates, is considerably compromised by obesity .
Much research is still needed, in the United Kingdom at least, on the costs of being overweight (BMI >25) as opposed to being obese (BMI >30) for both the health sector and society as a whole. But van Baal and colleagues have enhanced our understanding of these issues. Translating individual costs and benefits to societal costs and benefits is never straightforward, and their study successfully emphasises the problem. People tend to have views about health that relate to their individual experiences, including personal lifetime expenditures. This new study serves to remind us that merely multiplying such estimates by population sizes of several million does not illuminate real public-health dilemmas. And this kind of simplification leaves out the numerous societal implications of obesity, which themselves are massively complex . Governments need to understand that public-health policies affect more than merely the sum of individual health, and sadly require greater courage to implement than does treating the sick.