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."