The Burden of Healthy Living

A Dutch study reported yesterday in the online journal PLoS Medicine undermines the fiscal argument for a government-led War on Fat, which says how much you weigh is everyone else's business because other people have to pick up the tab via taxpayer-funded health care programs. The researchers found that eliminating obesity would, over the long term, increase medical spending instead of reducing it:

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures….

Obesity prevention, just like smoking prevention, will not stem the tide of increasing health-care expenditures. The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases.

The researchers compared the medical expenses of three hypothetical cohorts: obese people, smokers, and thin nonsmokers. They found that annual costs were highest among obese people until age 56, after which smokers were the most expensive group. But because both groups had lower life expectancies (80 and 77, respectively) than the "healthy-living" cohort (84), they had lower lifetime health care costs as well. Taking the long view, the thin nonsmokers cost the most, followed by obese people and smokers, in that order:

At discount rates of, respectively, 3% and 4% successful smoking prevention would result in additional health-care costs of €7.1 and €3.4 million (assuming costless intervention). For obesity prevention these figures would amount to €1.8 and €1.0 million. Only for discount rates above 4.7% would costless obesity prevention be cost saving. For smoking prevention to be cost saving, the discount rate for costs should be at least 5.7%.

The authors note that they considered only health care costs, leaving out "other potentially substantial costs and consequences" of obesity, such as reduced productivity and "the reduced well-being of family members due to morbidity and premature death." But the former cost would be borne mainly by obese people themselves through reduced earnings, and the latter should be internalized to the extent that obese people care about their family members. (If the government did not force some people to pay for other people's health care, medical costs would be internalized as well.) Notably, the study also left out taxpayer-funded pensions, which increase the burden that healthy-living people impose on the rest of society.

In my 2004 reason article about the War on Fat, I noted that research might find that obesity, like smoking, saves taxpayers money.

[via The Freedom Files]