A Heavy Burden

September 23, 2010

By Anna Miller

When Chaz Merkel’s mother suffered several massive strokes, he moved to Florida to become her full-time caregiver, pledging to stay by her side as long as he was physically able. But at 435 pounds, Mr. Merkel’s promise was easier said than done.

“I found out in short order that at 435 pounds with the kinds of comorbidities that I was experiencing—the angina, the back pain, the knee pain and everything else—that I was not going to be able to fulfill my promise if I didn’t do something,” he recalled Sept. 21 at the release of a report from GW’s Department of Health Policy that calculated the individual costs of obesity for Americans.

While Mr. Merkel—who eventually underwent bariatric surgery and has since shed 215 pounds—experienced firsthand the physical, emotional and financial toll of obesity, the report, “A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States,” is the first to quantify these costs through rigorous academic research.

Authored by Avi Dor, professor of health economics and director of GW’s Economics and Health Policy Program, Christine Ferguson, professor of health policy, and graduate students Casey Langwith and Ellen Tan, the report employed a series of measures—including indirect costs like lost productivity and direct costs like obesity-related medical expenditures—to estimate the price tag of obesity at the individual level.

The research team found that the annual individual cost of being obese is $4,879 for women and $2,646 for men. When the value of lost life is added, the results are even more dramatic: $8,365 and $6,518 for women and men respectively, they said at the release, which included a panel of esteemed obesity experts moderated by former U.S. Surgeon General David Satcher.

“These data, coupled with the widely reported costs of obesity to society, continue to highlight the enormous overall financial impact of this epidemic,” said Ms. Ferguson. “Being able to quantify the individual’s economic burden of excess weight may give new urgency to public policy discussions regarding solutions for the obesity epidemic.”

The analysis also showed that it is not just whether or not an individual is overweight or obese that matters but in fact how overweight or obese he or she is. For instance, costs for obese women and men (defined as having a Body Mass Index, BMI, of more than 30) are nine and six times higher respectively than they are for an overweight person (defined as having a BMI between 25 and 29). The data demonstrate that incremental increases in weight correlate with increases in personal cost. Likewise, even incremental weight loss can save money.

The report also revealed significant gender differences in terms of the impact of obesity when it comes to job-related costs, including lost wages, absenteeism and disability. Perhaps most startlingly, said Dr. Dor, was the finding that 38 percent of these costs for women resulted from lower wages, while there was virtually no penalty found in this area for men.

“This disparity around wages, I think, represents the stigmatization and discrimination against obese individuals, and particularly Caucasian females,” said William Dietz, director of the Division of Nutrition, Physical Activity, and Obesity at the U.S. Centers for Disease Control and Prevention, who sat on the panel. “This stigmatization is pervasive and longstanding.”

Turning the report’s findings into plans for action became a critical component of the conversation. The speakers emphasized the importance of promoting “health at any weight,” noting that even slight weight loss can help individuals save money. They also stressed the promotion of policy interventions that create safe and healthy communities. “People can’t make good choices unless there are good choices to make,” said Dr. Deitz.

Added Joseph Nadglowski Jr., president and chief executive officer of the Obesity Action Coalition, another member of the panel, “I think we have to have comprehensive approaches, everything from dietary counseling, physician-supervised weight loss with and without pharmaceuticals and bariatric surgery. People need all of those options because everyone is different and everyone reacts in a different way.”

Finally, the presenters called for continued research. Dr. Satcher highlighted the need to study why incremental costs of African American men and women may be lower than those of white men and women.

Dr. Dor endorsed research exploring other non-medical costs of obesity. “With the exception of fuel costs, no published academic research offers insight into consumer-related costs, such as clothing, air travel, automobile size or furniture,” he said, suggesting that these additional costs could make the personal financial burden of obesity even greater.

“I urge you to really think about these issues proactively, particularly about the combination of prevention, intervention and treatment because we have a long way to go in this country to really create an environment that is conducive to being a healthy weight,” concluded Ms. Ferguson. “And unless we all act collectively…we are not going to be successful.”