PUBLISHED: 08:38 EST, 30 April 2012 | UPDATED: 09:51 EST, 30 April 2012
The nation’s rising rate of obesity has been well-chronicled, but now businesses, governments and individuals are coming to grips with the costs of those extra pounds.
U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients.
The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960.
The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows.
Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes are coming into the overall scenery as wider seats are used in public places like sports stadiums and bus stops.
The startling economic costs of obesity, often borne by the non-obese, could become the epidemic’s second-hand smoke.
Only when scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air did policymakers get serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also spurred action.
Now, as economists put a price tag on sky-high body mass indexes (BMIs), policymakers as well as the private sector are mobilizing to find solutions to the obesity epidemic.
These concerns come stem from the fact that the percentage of obese Americans- which is qualified as those with a Body Mass Index of 30 or higher- has tripled since 1960, coming in at 34 per cent. The incidence of extreme or ‘morbid’ obesity (BMI above 40) has risen sixfold, to 6 per cent.
The percentage of overweight Americans (BMI of 25 to 29.9) has held steady: It was 34 per cent in 2008 and 32 per cent in 1961.
Precautions: some hospitals have swapped wall mounted toilets (right) for floor mounted ones (left) to prepare for obese users who may be too heavy for the wall mounted ones
What seems to have happened is that for every healthy-weight person who ‘graduated’ into overweight, an overweight person graduated into obesity.
‘As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, ‘what policy knob can I turn to stop this hemorrhage?’ said Michael O’Grady of the National Opinion Research Center.
The U.S. health care reform law of 2010 allows employers to charge obese workers 30 per cent to 50 per cent more for health insurance if they decline to participate in a qualified wellness program.
The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.
Such measures do not sit well with all obese Americans.
Advocacy groups formed to ‘end size discrimination’ argue that it is possible to be healthy ‘at every size,’ taking issue with the findings that obesity necessarily comes with added medical costs.
Some costs of obesity reflect basic physics. It requires twice as much energy to move 250 pounds than 125 pounds. As a result, a vehicle burns more gasoline carrying heavier passengers than lighter ones.
‘Growing obesity rates increase fuel consumption,’ said engineer Sheldon Jacobson of the University of Illinois.
By how much? An additional 938 million gallons of gasoline each year due to overweight and obesity in the United States, or 0.8 per cent, he calculated: That’s $4billion extra.
Not all the changes spurred by the prevalence of obesity come with a price tag.
Train cars New Jersey Transit ordered from Bombardier have seats 2.2 inches wider than current cars, at 19.75 inches, said spokesman John Durso, giving everyone a more comfortable commute.
The built environment generally is changing to accommodate larger Americans. New York’s commuter trains are considering new cars with seats able to hold 400 pounds.
Blue Bird is widening the front doors on its school buses so wider kids can fit.
Funeral homes are now accustomed to ordering oversized coffins to accommodate their obese clients in death.
Wider: Now larger coffins are becoming a more common site at funeral homes
And at both the new Yankee Stadium and Citi Field, home of the New York Mets, seats are wider than their predecessors by 1 to 2 inches.
The new performance testing proposed by transit officials for buses, assuming an average passenger weight of 175 instead of 150 pounds, arise from concerns that heavier passengers might pose a safety threat. If too much weight is behind the rear axle, a bus can lose steering.
Every additional pound increases a moving vehicle’s momentum, requiring more force to stop and thereby putting greater demands on brakes. Manufacturers have told the FTA the proposal will require them to upgrade several components.
Hospitals, too, are adapting to larger patients.
The University of Alabama at Birmingham’s hospital, the nation’s fourth largest, has widened doors, replaced wall-mounted toilets with floor models able to hold 250 pounds or more, and bought plus-size wheelchairs (twice the price of regulars) as well as mini-cranes to hoist obese patients out of bed.
The additional spending due to obesity doesn’t fall into a black hole, of course. It contributes to overall economic activity and thus to gross domestic product. But not all spending is created equal.
‘Yes, a heart attack will generate economic activity, since the surgeon and hospital get paid, but not in a good way,’ said Murray Ross, vice president of Kaiser Permanente’s Institute for Health Policy. ‘If we avoided that heart attack we could have put the money to better use, such as in education or investments in clean energy.’
The reason for denominating the costs of obesity in dollars is not to stigmatize plus-size Americans even further. Rather, the goal is to allow public health officials as well as employers to break out their calculators and see whether programs to prevent or reverse obesity are worth it.
Because obesity raises the risk of a host of medical conditions, from heart disease to chronic pain, the obese are absent from work more often than people of healthy weight.
‘Smokers die early enough that they save Social Security, private pensions, and Medicare’ trillions of dollars, but mortality isn’t that much higher among the obese.’
-Duke University’s Eric Finkelstein
The most obese men take 5.9 more sick days a year; the most obese women, 9.4 days more. Obesity-related absenteeism costs employers as much as $6.4billion a year.
Even when poor health doesn’t keep obese workers home, it can cut into productivity, as they grapple with pain or shortness of breath or other obstacles to working all-out.
The very obese lose one month of productive work per year, costing employers an average of $3,792 per very obese male worker and $3,037 per female. Total annual cost of such ‘presenteeism’ due to obesity: $30billion.
Decreased productivity can reduce wages, as employers penalize less productive workers.
In addition to lost wages and new public seating plans, there remains the well-documented medical costs of obesity.
Obese men rack up an additional $1,152 a year in medical spending, especially for hospitalizations and prescription drugs. Obese women account for an extra $3,613 a year.
Nationally, that comes to $190billion a year in additional medical spending as a result of obesity, or 20.6 percent of U.S. health care expenditures.
Those extra medical costs are partly born by the non-obese, in the form of higher taxes to support Medicaid and higher health insurance premiums. Obese women raise such ‘third party’ expenditures $3,220 a year each; obese men, $967 a year, a new study found.
One recent surprise is the discovery that the costs of obesity exceed those of smoking.
‘Smoking added about 20 per cent a year to medical costs,’ said the Mayo Clinic’s James Naessens.
‘Obesity was similar, but morbid obesity increased those costs by 50 per cent a year. There really is an economic justification for employers to offer programs to help the very obese lose weight.’
For years, researchers suspected that the higher medical costs of obesity might be offset by the possibility that the obese would die young, and thus never rack up spending for nursing homes, Alzheimer’s care, and other pricey items, since similar outcomes are seen with smokers.
While they do incur higher medical costs than nonsmokers in any given year, their lifetime drain on public and private dollars is less because they die sooner.
‘Smokers die early enough that they save Social Security, private pensions, and Medicare’ trillions of dollars,’ said Duke University’s Eric Finkelstein. ‘But mortality isn’t that much higher among the obese.’
Beta blockers for heart disease, diabetes drugs, and other treatments are keeping the obese alive longer, with the result that they incur astronomically high medical expenses in old age just like their slimmer peers.
While new research has provided a series of negative findings for the effects of obesity, there has been one positive: An obese man is 64 per cent less likely to be arrested for a crime than a healthy man. Researchers have yet to run the numbers on what that might save.
SOARING COSTS OF INCREASED OBESITY: BY THE NUMBERS
$190billion in annual medical costs due to obesity, double earlier estimates.
$1,850 more per year in medical costs for an overweight person than for someone of healthy weight, among employees at the Mayo Clinic and their adult dependents. $3,086 more per year in medical costs for a Mayo worker with a body mass index (BMI) of 35 to 40.
$5,530 more per year in medical costs for a Mayo worker with a BMI above 40. By comparison, smokers’ medical costs were only
$1,274 a year higher than nonsmokers’, who generally die earlier.
$5billion annually for additional jet fuel needed to fly heavier Americans, compared to fuel needed at 1960 weights.
$4billion annually for additional gasoline as cars carry heavier passengers.
$1,026: annual cost of absenteeism per very obese male worker (BMI > 40). $1,262: Annual cost of absenteeism per very obese female worker.
$277: annual cost of absenteeism per mildly obese (BMI 25 to 29.9) male worker.
$407: annual cost of absenteeism per mildly obese female worker.
$1,056: cost of a ‘bariatric chair’ able to hold 500 pounds.
$1,049: cost of a bariatric toilet rated at 700 pounds
Obesity hits workers’ pocketbooks indirectly, too: Numerous studies have shown that the obese are less likely to be hired and promoted than their svelte peers are.
Women in particular bear the brunt of that, earning about 11 per cent less than women of healthy weight, health economist John Cawley of Cornell University found.
At the average weekly U.S. wage of $669 in 2010, that’s a $76 weekly obesity tax.