If Obesity Saves Taxpayers Money, Should It Be Encouraged?

An article published online today by Health Affairs concludes that "the annual medical burden of obesity has risen to almost 10 percent of all medical spending and could amount to $147 billion per year in 2008." Based on data from the Medical Expenditure Panel Surveys, economist Eric Finkelstein (who published a similar study in 2003) and his co-authors calculate that in 2006 medical spending for people with body mass indexes of 30 or more was, on average, $1,429 higher than for people of "normal" weight. Finkelstein et al. say almost all of the extra money went to treat not obesity itself but the diseases associated with it, such as diabetes. Prescription drugs accounted for two-fifths of the difference. The study finds that obesity-related health care represented 8.5 percent of Medicare spending and 11.8 percent of Medicaid spending. "The connection between rising rates of obesity and rising medical spending is undeniable," Finkelstein and his co-authors conclude. "Without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future." 

Far be it from me to deny the undeniable, but the fact that obese people have higher annual health care costs does not mean they have higher lifetime costs. It therefore does not follow that reducing obesity would reduce total medical spending in the long run. In fact, a study published last year in PLoS Medicine reached the opposite conclusion: Because obese people tend to die sooner than thin people do, the researchers found, eliminating obesity would increase spending on health care. "Although effective obesity prevention leads to a decrease in costs of obesity-related diseases," the authors wrote, "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" (emphasis added). Overeating, like smoking, seems to be one of those risky habits that saves taxpayers money (especially when you take into account not only health care but Social Security spending). If reducing demands on the public treasury is the aim, such habits should be encouraged.

Fat warriors who push the fiscal argument, of course, are not willing to follow it to its logical conclusion when the data don't go their way. They are committed to discouraging sloth and gluttony even if doing so will cost taxpayers more money than it saves them. All the talk about the burden on taxpayers is just a way of distracting attention from of the paternalism of the "public health" agenda.

Finkelstein, by the way, did not even bother to look at medical costs for the merely "overweight" because in his earlier study "the overweight expenditure variable was not statistically different from normal-weight spending." Indeed, judging from mortality rates, people in the "overweight" range (BMIs between 25 and 30) seem to be healthier than people with "normal" or "healthy" BMIs. 

Just to be clear, I don't think the government has a legitimate interest in discouraging risky habits even when they do, on balance, increase spending on taxpayer-funded health care programs. Even if we accept the legitimacy of those programs, the totalitarian implications of this argument are scarier than any alleged "costs on the health system."

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  • ||

    Even if we accept the legitimacy of those programs, the totalitarian implications of this argument are scarier than any alleged "costs on the health system."


    To the statists, this is a feature, not a bug. I'll bet that statists of all stripes are salivating over the extra leverage that government-run healthcare will give them.

  • hmm||

    I hear all GM and Dodge vehicles will be built specifically to not be able to fit in a McD's drive through and that the onstar/gps will automatically alert the DHS that the vehicle is at a McD's and a SWAT team will be dispatched immediately.

    The fat fighters are annoying to say the least.

  • ||

    Put the fucking fork down.

  • hmm||

    I also can't stand the fat ass doctor on TV telling me I should be thin or eat better or blah blah blah. You damn well better be able to follow your own Rx or don't bother preaching to me about it.

  • ||

    Oh, if America could only stay wealthy long enough to have obesity solve the social security problem. Unfortunately obesity will be the least of our concerns as we're rummaging through government employee's dumpsters seeking a few calories to sustain us.

  • Jimmy||

    Your article is terribly inaccurate. Before obese people pass on, the healthcare costs associated with treating them as they fight heart problems, join pains and other afflictions that are worsened by excess bodyweight are the primary contributors to the strain on our healthcare system in America. Many older people let themselves go and forget that its even more important to maintain good dieting habits and a good lifestyle, so you often see grandparents and other elderly people who are obese who think that its "ok" because they are old. Thats erroneous and detrimental for society.

  • Jimmy||

    whoops! i meant the research, not ur blog post =)

  • ||

    Jimmy hates fat people.

  • JB||

    In the end, most Leftists want government programs to be concentration camps. Only then will paradise be achieved.

    There is a reason Stalin is their hero.

  • hmm||

  • ||

    Jimmy hates fat people.

    He also has no negative externialities that impose costs on other people. This man is truly an island.

  • ||

    Many older people let themselves go and forget that its even more important to maintain good dieting habits and a good lifestyle, so you often see grandparents and other elderly people who are obese who think that its "ok" because they are old. Thats erroneous and detrimental for society.

    You and I are in total agreement Jimmy. My solution is that we eliminate programs such as Medicare that enable the federal government to impose the costs of their detrimental personal decisions onto society. That way people still have freedom. What is your solution?

  • Tomcat1066||

    As a fatass, I hope everyone appreciates the sacrifice I'm making to help keep your healthcare costs low!

  • ||

    Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures

    OK, if obesity prevention as preventive medicine tactic actually increases health expenditures, what basis is there for saying its a cost-effective way of improving health?

    I also can't stand the fat ass doctor on TV telling me I should be thin or eat better or blah blah blah.

    I didn't even know our new Surgeon General had taken office yet.

  • ||

    You wanna save money on health care?
    Free cigarettes for the bottom 20% of earners.

  • short, fat bastard||

    You can pry my twinkies from my cold, dead fingers . . . . .

  • MRK||

    Or we could just stop subsidizing corn and let the price of food (especially junk food) go up to levels that a normal market would support.

    Without subsidies it would no longer be economical to put High Fructose Corn Syrup in everything for starters.

  • IceTrey||

    The article is totally correct. If the Gubmint really wanted to lower costs they would encourage heavy smoking, drinking and drug taking. The sooner you die the less you're lifetime health care costs are. I think it's something like %75 of all costs occur in the last year of life (if you life to old age).

  • Robert Enders||

    Am I the only who has noticed that the violent crime rate has gone down as the obesity rate has gone up? I think it's because violence requires you to get off the couch in order to hurt somebody.

  • ||

    It is the government's responsibility to see that all good Americans join to do calisthenics in the town square and get fit and healthy so they can serve in the military and if anyone argues or protests, we should drive tanks over them in the middle of the square...
    Also, good tasting food should be outlawed.

  • ||

    An unseen culprit in the obesity fudging of health nazis is the recent change in the definition of obesity according to the BMI. Just for fun I looked up my weight (180 lbs for 6'4") from when I was in high school when I was so thin my nickname was Skeletor. Guess what? I was in the high end of the normal weight range! Then in my senior year I took a bodybuilding course and put a little meat on my bones and that was it, I was into the overweight range (210 lbs) after that.

  • ||

    It is the government's responsibility to see that all good Americans join to do calisthenics in the town square and get fit and healthy so they can serve in the military and if anyone argues or protests, we should drive tanks over them in the middle of the square...



    I haven't exercised since they took the 20 Minute Workout off the air. The government should do something about that.

  • ||

    In case the health care reform provides the general public with peace of mind, the rising mental stress or illness caused by financial instability may bend the curve surprisingly,
    in combination with kicking out the 'keep eating habit' to forget the deep-seated instability and apprehension, I guess.
    'Work or Break' health system with no brake or safety system might be one of the biggest hidden causes of mental stress, obesity or overweight threatening the overall economy, I cautiously suppose.

  • Rich||

    > Unfortunately obesity will be the least of our concerns as we're rummaging through government employee's dumpsters seeking a few calories to sustain us.

    Forward thinking, those "fatties"! Darwin strikes again!

  • T||

    So, in addition to all being criminals, now we're all overburdening the health system because BMI says we're fat? Damn, it's a wonder the country hasn't collapsed into anarchy yet.

    I need another twinkie.

  • hmm||

    My $5 off Crispy Creme appreciation coupon is in the mail.

  • BMI Obesity||

    Obesity is such an easy thing to remedy. Education on living a healthy lifestyle will help many people but is not implemented.

  • ||

    Easy to remedy? About as easy as stupidity.

    Sorry, but, by and large, you are what your genes made you...

  • Jay Weiser, Assoc. Prof. of La||

    The PLOS study also suggested that reducing obesity (if such a thing is possible) could be a net cost-saver, despite the higher lifetime costs of longer life. That's because, as the authors demonstrate, under a discounted cash flow approach, medical costs today have a much bigger impact than medical costs in 50 years. (They didn't run numbers comparing the net present value of the high near-term health care costs of obese people with shorter lifespans against non-obese people whose health costs were pushed out decades further, however.) Furthermore, they note that obesity is also associated with higher morbidity. In US terms, you may hang on for many working-age years as a disabled diabetic on dialysis, getting your Social Security disability and Medicaid payments while paying nothing into the system.

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    With many new announcement about the wizard of oz movies in the news, you might want to consider starting to obtain Wizard of Oz book series either as collectible or investment at RareOzBooks.com.

  • wait a sec||

    If we are going to factor in how non-obese people have higher lifetime health care costs, shouldn't we also factor in how they have more productive (tax-paying) years in which to repay those costs?

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