Health care in America costs too much. We all know this. Typically, the reasons for high costs are put down to inefficient care, mis-managed medicine, waste, fraud, etc. Most of the dialogue focuses on the supply side of the question: health care is too expensive because of defects in how it is supplied. But, what about demand for health care? Do Americans need more health care than people in other countries? Are we, in fact, sicker?
If sickness is in any way tied to fatness, or obesity, then we must surely be sicker. The obesity epidemic in America has reached impressive proportions. According to the Centers for Disease Control (CDC), fully 33% of Americans are obese – not just overweight, but obese. In contrast, the World Health Organization notes that obesity rates for adults in European countries such as Germany, Italy, Switzerland and Sweden range from 7% to 14%. This means that there are 2 to 5 times as many obese people, per capita, in the US, as compared to most of Europe. Unfortunately, having many more fat people per capita means that we have many more sick people per capita, too.
The impact of overweight and obesity is felt in every aspect of medicine. The CDC estimates that obesity increases the rates of several types of common cancers, such as colon and breast cancers, by 25-30%. Fully half of all cases of diabetes in America are caused by overweight and physical inactivity. And overweight contributes to the majority of heart disease. In fact, men who are both obese and diabetic have a 90% chance of developing heart disease in their lifetimes. Extra pounds around the American waistline are causing huge increases in many types of disease, and are drastically driving up health care costs.
To put the real costs of obesity into perspective, we need to add up the costs of diseases that are affected by obesity. The total annual costs of cardiovascular disease, diabetes and cancer are $475 billion, $174 billion, and $228 billion, respectively. On top of this, the costs treating of obesity per se are roughly $117 billion annually. These costs total about $1.0 trillion, which is a sizable chunk of the $2.4 trillion total spent on health care in the US. If we were to eliminate obesity in this country, or simply drive the obesity levels down to what they were in the 1970’s, then simple calculations show that we would save roughly $500 billion each year – nearly 20% of all that we spend on health care today. In other words, if Americans weren’t so overweight, our health care would be approximately 20% cheaper. Said another way, fully 20% of what we spend on health care right now is entirely preventable, and is due principally to the fact that we consume too much food.
In light of all this, it seems obvious that one of most sane approaches to decreasing health care costs to make Americans healthier – and less overweight. Discussions regarding obesity and personal responsibility for health have not yet reached the level of national dialogue that they should. Similar to the national crusade against smoking in the 1960’s, a crusade against overweight and obesity needs to be front and center in the dialogue on health care. In addition, direct incentives to lose weight, and to maintain a healthy weight, should be part of the solution. For example, direct insurance rebates each year, to persons who maintain a weight in the normal range, could provide huge incentives for people to shed pounds and to improve their health. Such initiatives would improve health and quality of life for many Americans, and could be a big part of the answer to the current health care “crisis”.
Dr. Niklason is a Professor of Anesthesia and Biomedical Engineering at Yale University. She is a world leader in the development of advanced cell therapies for cardiovascular disease.
