A series of new studies paint a stark picture of the impact of obesity and obesity-related complications on health care costs. New research suggests that approximately three-quarters of total obesity-related health care costs are accounted for by the 20% of highest-cost cases.
That determination is based on a series of five studies recently presented at the European Congress of Obesity in Maastricht, Holland. The studies spanned an eight-year period ending in 2020 and included 28,583 people living with obesity in the United States. Three cohorts were formed based on BMI: Class I (between 30 and 35), Class II (between 35 and 40), and Class III (more than 40).
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"Health care costs and rates of hospitalization are greater for individuals in higher compared with lower obesity classes," the studies' authors concluded. "Our results highlight the relationship between body mass index (BMI) and increasing use of health care resources, and suggest that obesity progression may contribute significantly to the economic burden of the disease."
Researchers evaluated obesity-related complications (ORCs) — such as obstructive sleep apnea, type 2 diabetes, and several other conditions — in each cohort and total per-person direct health care costs (inpatient, outpatient, and pharmacy costs) in both the baseline year and in Year Eight. High-cost cases were defined as the 20% of cases with the highest total costs in the final year; the remaining cases were designated in the low-cost category.
A second study of the same population estimated how many ORCs were present in people living with obesity at the start of the study. Of the 28,583 individuals, 12,686 (44%) had no ORCs, 7,242 (25%) had one ORC, 4,180 (15%) had two ORCs, and 4,475 (16%) had three or more ORCs. The more ORCs an individual had, the higher their health care costs were at the start of study. Average costs increased for all groups across the study's eight years — indicating a worsening of ORCs or development of additional ones in all categories, according to researchers.
A third analysis revealed a general trend for increasing cumulative per-patient costs with increasing obesity class for most ORCs, while yet another study looked at the prevalence of certain ORCs across obesity classes. In all three classes, type 2 diabetes was approximately twice as common at the end of the eight-year study period as it was at the start.
The fifth and final analysis studied differences in hospitalizations and hospital costs between obesity classes and how these costs progressed. Mean health care costs increased across the study period for all three classes of obesity, but more so for those with Class III obesity (36%) and Class II obesity (41%) compared with Class I obesity (24%).
"These findings provide clear evidence that people living with obesity face a broad range of comorbidities [that] tend to increase over time and with obesity severity, with a substantial impact on health care resource usage and cost implications for health care systems," study co-author Jonathan Pearson-Stuttard, head of health analytics at the London-based data company Lane Clark & Peacock LLP, said in a statement.
"The implications are that effective weight management to prevent obesity or its progression is likely therefore both to reduce morbidity and reduce cost pressures on health care systems," added co-author Marc Evans, a doctor at University Hospital in Llandough, Penarth, UK.
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