Health Care Charges Associated With Physical Inactivity, Overweight, and Obesity

Introduction Physical inactivity, overweight, and obesity are associated with increased morbidity and mortality. The objective of this study was to estimate the proportion of total health care charges associated with physical inactivity, overweight, and obesity among U.S. populations aged 40 years and older. Methods A predictive model of health care charges was developed using data from a cohort of 8000 health plan members aged 40 and older. Model cells were defined by physical activity status, body mass index, age, sex, smoking status, and selected chronic diseases. Total health care charges were estimated by multiplying the percentage of the population in each cell by the predicted charges per cell. Counterfactual estimates were computed by reclassifying all individuals as physically active and of normal weight while leaving other characteristics unchanged. Charges associated with physical inactivity, overweight, and obesity were computed as the difference between current risk profile total charges and counterfactual total charges. National population percentage estimates were derived from the National Health Interview Survey; those estimates were multiplied by the predicted charges per cell from the health plan analysis. Results Physical inactivity, overweight, and obesity were associated with 23% (95% confidence interval [CI], 10%–34%) of health plan health care charges and 27% (95% CI, 10%–37%) of national health care charges. Although charges associated with these risk factors were highest for the oldest group (aged 65 years and older) and for individuals with chronic conditions, nearly half of aggregate charges were generated from the group aged 40 to 64 years without chronic disease. Conclusion Charges associated with physical inactivity, overweight, and obesity constitute a significant portion of total medical expenditures. The results underscore the importance of addressing these risk factors in all segments of the population.

[1]  W. Dietz The obesity epidemic in young children , 2001, BMJ : British Medical Journal.

[2]  J. Seidell,et al.  The public health impact of obesity. , 2001, Annual review of public health.

[3]  D. Allison,et al.  Years of life lost due to obesity. , 2003, JAMA.

[4]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[5]  The Diabetes Prevention Program (DPP): description of lifestyle intervention. , 2002, Diabetes care.

[6]  C. Quesenberry,et al.  Obesity, health services use, and health care costs among members of a health maintenance organization. , 1998, Archives of internal medicine.

[7]  W. Manning,et al.  The logged dependent variable, heteroscedasticity, and the retransformation problem. , 1998, Journal of health economics.

[8]  W H Foege,et al.  Centers for Disease Control , 1981, Journal of public health policy.

[9]  R S Paffenbarger,et al.  The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. , 1993, The New England journal of medicine.

[10]  P. Williams,et al.  Physical activity and public health. , 1995, JAMA.

[11]  D. Dillman Mail and telephone surveys : the total design method , 1979 .

[12]  J. Mullahy Much Ado About Two: Reconsidering Retransformation and the Two-Part Model in Health Economics , 1998, Journal of health economics.

[13]  M. Thun,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[14]  P. O’Connor,et al.  Smoking Cessation Attempts in Relation to Prior Health Care Charges: The Effect of Antecedent Smoking-Related Symptoms? , 2003, American journal of health promotion : AJHP.

[15]  Michael J. Goodman,et al.  Relationship between modifiable health risks and short-term health care charges. , 1999, JAMA.

[16]  J. Manson,et al.  Obesity in the United States: a fresh look at its high toll. , 2003, JAMA.

[17]  T. Gilmer,et al.  Cost Effectiveness of Diabetes Mellitus Management Programs , 2003 .

[18]  N. Duan Smearing Estimate: A Nonparametric Retransformation Method , 1983 .

[19]  Michael Pratt,et al.  Higher Direct Medical Costs Associated With Physical Inactivity , 2000, The Physician and sportsmedicine.

[20]  Ralph B D'Agostino,et al.  Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. , 2002, Archives of internal medicine.

[21]  T. Valle,et al.  Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. , 2001, The New England journal of medicine.

[22]  K. Flegal,et al.  Prevalence and trends in obesity among US adults, 1999-2000. , 2002, JAMA.

[23]  R. Sturm,et al.  The effects of obesity, smoking, and drinking on medical problems and costs. , 2002, Health affairs.

[24]  K. Weick Mail and telephone surveys: The total design method. , 1978 .

[25]  E. Finkelstein,et al.  National medical spending attributable to overweight and obesity: how much, and who's paying? , 2003, Health affairs.

[26]  G. Oster,et al.  Body mass index and future healthcare costs: a retrospective cohort study. , 2001, Obesity research.