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The Cost of Obesity in the United States

The cost of obesity within the United States has been on a constant rise since the 1970s.

Since 1975, the obesity rate has tripled; in 2016 more than 1.9 billion adults (18 years and older)

were classified as overweight, and of those, 650 million were obese (WHO, 2018). Obesity is a

leading cause of other chronic health issues such as type two diabetes, stroke, and cardiovascular

disease. Obesity also could be linked to other health issues like depression, high blood pressure,

and high cholesterol.

Obesity within the United States has been on a steady rise since the 1970’s and are key

characteristics of other chronic health issues such as diabetes, cardiovascular diseases, and

cancer. A key factor to the increase of obesity within the U.S. are the nutritional changes

Americans have undergone over time. Since 1975, the obesity rate has tripled; in 2016 more than

1.9 billion adults (18 years and older) were classified as overweight, and of those, 650 million

were obese (WHO, 2018). Before going further, a definition must be given to the terms “obesity”

and “overweight”. According to the World Health Organization, obesity and overweight are

defined as “abnormal or excessive fat accumulation that may impair health” (WHO, 2018).

According the World Health Organization’s definition of obesity we must look at how

obesity is measured in America and how it affects the data gathered by other organizations.

According to the Center for Disease Control, “Body Mass Index, or BMI is used as a screening

tool for overweight and obese individual” (CDC, the problem is BMI does not account for the

difference in muscle and fat mass which the World Health Organization uses in its definition of
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overweight and obesity. Based on the CDC’s method of measuring overweight and obese

individuals the following data was collected in 2010.

There is a significant difference between the amount of money a healthy individual

spends on health care, as opposed to an obese or out of shape individual. To compare, a healthy

individual and an obese individual may have the same symptoms walking into a healthcare

facility, but the obese individual will pay more at the hospital than the healthy individual.

According to findings from the CDC (Center for Disease and Control) in 2003, “obesity-

attributable medical expenditures reached $75 billion…” (Rohrich, 2004). To further emphasize

the cost of obesity for an individual, an estimated average as reported by the Fiscal Times states

that “...the lifetime societal and public health cost of obesity is on average $92,235 per person

when compared with the costs associated with a person of normal weight” (The Fiscal Times.

2015). Furthermore, according to the World Health Organization, “Costs for patients presenting

at emergency rooms with chest pains are 41 percent higher for severely obese patients, 28

percent higher for obese patients and 22 percent higher for overweight patients than for healthy-

weight patients.” (Health care cost of Obesity, 2018). Common medical means of dealing with

obesity such as liposuction (the surgical removal of fat), have been estimated between $2,000

and $3,900 just for the procedure, not to include the cost of the hospital stay, anesthesia, or other

fees incurred according to findings from the American Society of Plastic Surgeons.

Americans now, however, have the option of becoming “medical tourists”, a term that

simply means individuals have the ability (perhaps not physically due to health and weight

issues) to travel to other countries to have operations such as liposuction or abdominoplasty (also

referred to as “tummy tucks”) performed at a lower cost and with the same if not better care than

that of their residing country. However, due to the potential financial ramifications, coupled with
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the physical restrictions that could make traveling difficult or nearly impossible, the availability

of non-medical options such as diets (Atkins, Paleo, etc.), diet pills, meal suppressants, gym

memberships, home workout regimens (P90X), and pre-made healthy home delivery meal

services (Blue Apron, Purple Carrot, Green Blender, etc.) is far more plentiful and cost-effective

than that of liposuction or tummy tucks. As stated, there has been in increase in diets within the

United States that focus on one or more solutions to combating the obesity epidemic. However, a

lot of these diets have been terms or labeled as “fad” diets, because they are “…high-protein,

low-carbohydrate diets that attempt to manage the symptoms but do not address the

overwhelming problem…” (Rohrich, 2004). Furthermore, “quick-weight-loss diets that over

emphasize one food or type of food, such as the infamous cabbage soup diet, violate the first

principle of good nutrition: Eat a balanced diet with a variety of foods” (Rohrich, 2004). Due to

the ever-growing technological advances in the world today, accessibility to services such as

healthy meal home delivery services, fitness trackers, GPS fitness watches, etc… are but a few

applications that more and more individuals rely on a more frequent basis. Of those mentioned,

the average cost for a healthy home delivered meal is between $45 and $70 for three (3) meals

that contain two (2) servings. To further exemplify this, we will run the numbers for

(hypothetically) an overweight or obese individual who has a short term goal to lose twenty (20)

pounds over a four (4) month time period, who chooses to eat these meals three (3) times a day

for five (5) days a week (in conjunction with appropriate exercise), would spend approximately

$3,600 total over the course of the four (4) months. (Note: this figure was arrived at using the

lowest average cost for a meal delivery service at $45, for three meals that contain two servings).

In addition, the average cost for a local gym membership is between $40 and $60, not to include

fitness centers available in apartment complexes, school campuses, or home fitness programs.
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Using the same hypothetical example as discussed earlier, an overweight or obese individual can

spend a total of $160 over a four-month period. (Note: this total was arrived at using the lowest

average cost for a local gym). From the two discussed avenues of approach to combating obesity

(proper eating and routine exercise), an individual who decides to take matter in their own hands

when facing obesity would look to spend approximately $3,760 over a four-month timeframe.

This option would be preferable according to doctors, trainers, nutritionists, and so forth because

of the long-term health benefits which outweigh those of the medical approaches such as that of

liposuction or tummy tucks.

There are many different direct and indirect costs that are affected by obesity in the

United States. Direct costs tend to include medications, personal healthcare and hygiene, and

physician services. Obesity causes a lot of chronic illnesses, just a few to name are type 2

diabetes, heart disease, and stroke. The cost of treatment and diagnosis of these conditions are

included in the direct costs. Since obesity in the United States continues to rise, so does the direct

costs of healthcare. Wolf and Colditz estimated the direct health care costs attributable to obesity

to be 5.7% of the total direct health care costs. This is equivalent to saying "If there were a

treatment that made all obese people who are not obese and equivalent in health to people who

had never been obese, and if this treatment cost nothing to apply, and if it were given to all obese

people, then in the immediately subsequent time period, direct health care costs would be

reduced by 5.7%."( The Direct Healthcare Cost of Obesity in the United States). This article is

showing that a significant amount of healthcare costs is directly related to obesity. At Kaiser

Permanente in Oregon, a random sample was done with 1,286 students. Nonsmokers with BMI’s

greater than 20 were used in this experiment. They were divided into healthy, overweight, and

obese groups and followed around for nine years. After the nine years were over the results were
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recorded and it proved how much higher the cost for health care was for the obese and

overweight group compared to the healthy weight group. “The obese (BMI ≥ 30) had 36% higher

average annual health care costs than the healthy-weight group, including 105% higher

prescription costs and 39% higher primary-care costs. The overweight (BMI 25–29) had 37%

higher prescription costs and 13% higher primary-care costs than the healthy-weight group.”

(The Economic Impact of Obesity in the United States)

When we talk about indirect costs of obesity, we are basically talking about the cost of

inactivity due to illness and disability. Taking off sick days indirectly costs a person money as

well as an employer money. Whether a person gets paid for sick days or not, an employer loses

money by paying an employee who is not there, or a person would lose money by taking time

off. “The direct costs of lack of physical activity, defined conservatively as absence of leisure-

time physical activity, are approximately 24 billion dollars or 2.4% of the U.S. health care

expenditures.” (Economic Cost of Obesity and Inactivity)

The direct cost of obesity in United States is related to the diseases that is causes. Two of

the more common diseases associated with obesity, cardiovascular disease and Type 2 diabetes,

cost the healthcare system approximately 800 billion dollars combined, whereas cardiovascular

diseases such as coronary heart disease (CHD) have been estimated at a cost of 1.1 trillion

dollars by 2035 according to the American Heart Association (AHA/ASA 2017). Least

commonly known conditions such as osteoarthritis also add to the rising cost of obesity.

According to the Center for Disease Control (CDC), 140 billion dollars were spent treating

osteoarthritis due to obesity (CDC 2018). While cardiovascular diseases are the costliest,

diabetes has become the most common among Americans. According to the CDC, 23.1 million

are diagnosed with diabetes at a cost of more than 245 billion dollars per year. Another 7.2
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million Americans are undiagnosed which means the cost of diabetes should be higher. There are

so 84.1 million Americans over the age of 18 years old who have been diagnosed as prediabetes.

Numbers of this nature will only increase the cost of obesity related diseases.

Although not directly associated, concerned cancers such as endometrial (cancer in the

lining of the uterus), breast, and colon cancer have been linked to obesity. Hypertension (high

blood pressure), stroke, sleep apnea, high cholesterol, and mental illness are also known

symptoms of obesity and add to the cost of obesity in America. Although obesity is linked to a

myriad of diseases they are preventable through proper education about nutrition and daily

physical activity.

Non-profit organizations such as the Obesity Action Coalition (OAC), Obesity Medicine

Association (OMA), The Obesity Society (TOS), Strategies To Overcome and Prevent (STOP)

Obesity Alliance and, as we previously mentioned above, the American Hospital Association

(AHA) all have a similar mission: to help reduce the growing national percentage of obesity in

the U.S. It is a common fact that obesity can contribute to increasing the chance of mortality with

one who has a life-threatening disease (e.g. heart disease). Non-profit organizations, largely

depend on donations to sustain their business, but often we forget that there are other healthcare

divisions within the government, paid by taxes, that are there to promote healthier diets and more

physical activity of Americans from all ages and backgrounds. For example, the CDC’s Division

of Nutrition, Physical Activity and Obesity (DNPAO) is a department within the CDC that,

according to their website, is the “forefront” of decreasing obesity in the U.S. (CDC 2017).

Healthcare in the United States is provided by distinct number of organizations.

Healthcare facilities mostly owned and operated by private sector businesses. According to the

American Hospital Association, 58% of U.S. community hospitals are non-profit, 21% are
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government owned, and 21% are for-profit (AHA 2008). The World Health Organization

(WHO) also states that the United States has spent more on health care per capita ($9,403), and

more on health care as percentage of its GDP (17.1%), than any other nation in 2014. In 2013,

64% of health spending was paid for by the government, and funded via programs such as

Medicare, Medicaid, the Children's Health Insurance Program, and the Veterans Health

Administration. Government spending for health continues to be on a rise, we seek to find ways

to improve health, but it comes at a cost to the government. “The Current State of Obesity

Solutions in the United States”, written by Steve Olsen, is a book that acknowledges the problem

of obesity in America, and he expounds on the government’s role in helping to lower it. Olsen

mentions that some of the U.S. Department of Agriculture (USDA) programs that have

contributed to the improvement in obesity rates seen in recent years such as the Special

Supplemental Nutrition Program for Women, Infants, and Children (WIC), which now serves 53

percent of all infants in the United States, including 75 percent of Hispanic infants (52). The

program is having a major effect in promoting more breastfeeding, particularly among lower-

income women (52). The program’s implementation of a new food package that includes more

fruits, vegetables, and whole grains also has had an impact on WIC households across the

country (52). The Supplemental Nutritional Assistance Program (SNAP) also is undergoing

changes designed to combat obesity. SNAP also has an education component, funded at about

$400 million annually, which focuses on nutrition. For example, it teaches people about the

MyPlate program developed at USDA’s Center for Nutrition Policy and Promotion. Three

million people have signed up on the center’s website to receive direct advice about their diet

and their nutritional progress (53). The Healthy, Hunger-Free Kids Act of 2010, enacted with the

support of former First Lady Michelle Obama, also has been making a difference in the lives of
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students across the country. It continues to be countless of Government-led organizations that

can become extremely costly, but they all are there to try to promote a healthier lifestyle for the

population.

The obesity epidemic has been on an exponential rise for the last three decades, which

has caused the healthcare system to increase awareness of the problem in turn (a “cause-and-

effect” situation through and through). Over the last several years, plans to combat obesity

through movements against and to raise awareness for the epidemic, diets (both tried and true,

and quick-fix fads), the “one pill fixes all” diet pills, and home delivery meal services have found

their place in the fight against obesity. Organizations such as the World Health Organization

(WHO), Center for Disease Control (CDC), and other programs such as the Supplemental

Nutritional Assistance Program (SNAP), the Special Supplemental Nutrition Program for

Women, Infants, and Children (WIC), and the First Lady led Healthy, Hunger-Free Kids Act of

2010, spearheaded and enacted by Michelle Obama, have all boomed in response to the rise of

obesity in our society.

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