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Top Ten in Healthcare Spending: Little for Obesity Care

Top Ten Health Conditions by SpendingYou can look at healthcare spending in two different ways. One way is to ask, “What are we buying?” The alternative is to ask, “What are we paying for?”  A new study published this week in JAMA shows that we’re buying very little obesity care, but paying a lot for untreated obesity.

Of the top ten conditions for healthcare spending, all but one are linked to untreated obesity. Diabetes tops the list. Spending for diabetes and back pain – both closely linked to obesity – is growing faster than anything else in the top ten. In the top 20, only high cholesterol (also linked to obesity) is growing faster.

Even pregnancy, which obesity certainly does not cause, becomes more expensive for people who have obesity.

Joseph Dieleman and colleagues, who authored the study, point out the discrepancy in spending on obesity care:

Although a great deal of health burden is attributable to obesity and tobacco, the treatment of these 2 risk factors was not among the top 20 conditions of spending. 

Why are we spending so little on obesity care when the complications of obesity cost so much?

One factor is bias in the way these authors and most everyone thinks about obesity. They classify obesity care as “treatment of risk factors,” just like high blood pressure and high cholesterol. We’re still in a weird world where many otherwise smart people keep thinking obesity itself is not a disease. The American Medical Association got over that three years ago.

Anyone who actually has severe obesity or cares for those who do can tell you. It’s not silent risk factor. The suffering it causes is profound and often lifelong. Some people hide or ignore the suffering because it’s so highly stigmatized. Others are callous about it. They make false, harsh judgements about the character of people with obesity. They tell themselves obesity is voluntary and easily reversible. They’re terribly wrong.

Either way, the result is unmistakable. Obesity is becoming ever more common. People who need evidence-based obesity care often can’t get it. Most people report that their health insurance won’t pay for obesity care.

So, the disease progresses. Complications of untreated obesity destroy a person’s health. Then, and often only then, they receive medical care for diseases that could have been prevented by treating the primary disease, obesity.

Thus, we are buying very little obesity care but spending a fortune on untreated obesity.

Click here for the study and here for more perspective from HealthDay.

Pay Little, photograph © Todd Lappin / flickr

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December 29, 2016

2 Responses to “Top Ten in Healthcare Spending: Little for Obesity Care”

  1. December 29, 2016 at 1:00 pm, Stephen Phillips said:

    Ted, here is the conundrum
    Obesity is a physical condition characterized by is an excess of adipose tissue indexed by some standard of measurement. The standard that is globally most used is the Body Mass Index (BMI)
    Obesity is also often highly correlated with diseases and disorders of the mind and body. We lump these correlations into risk factors related to obesity
    As we all well know correlation is not causation
    This is clearly evident in obesity since many individuals that are diagnosed with obesity are free of any of the correlated risk factors..
    Diagnosing obesity as a disease is a double edged sword.
    For those with risk factors related to their obesity this diagnosis can be advantageous for treatment and care.
    However for the millions people that are diagnosed with obesity that are risk free, we are stigmatizing them a disease that do not have?

    Prudent practitioners and both private and public policymakers might consider the unintended consequences of relying solely on BMI before diagnosing obesity as a disease

    “Obesity creates an enormous psychological burden. In fact, in terms of suffering, this burden may be the greatest adverse effect of obesity.” NIH Consensus Report Health Implications of Obesity 1985

  2. December 29, 2016 at 3:22 pm, Ted said:

    Right, Stephen. BMI is just a screen for obesity, not a definitive diagnosis. A smart clinician knows that someone with a high BMI and no symptoms whatsoever does not have obesity. They just have a high BMI. http://conscienhealth.org/2014/04/bmi-obesity-excess-adiposity/