State-level obesity-attributable expenditures - Weight Loss

Nutrition Research Newsletter, Feb, 2004

Results from the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES) indicate that an estimated 64% of U.S. adults are either overweight or obese. In addition, recent studies have documented the impact that obesity has on annual medical expenditures among adults. One study found that obese adults have 36% higher average annual medical expenditures compared with those of normal weight. However, to date, no estimates are available that document obesity-attributable medical expenditures at the state level, including the amount of state Medicare and Medicaid expenditures attributable to obesity. This recent study aims to provide state-level estimates of total, Medicare, and Medicaid obesity-attributable medical expenditures. These estimates will assist state policy makers in determining how best to allocate scarce public health resources and provide information concerning the economic impact of obesity on states.

No single data set exists that allows for directly quantifying state-level expenditures attributable to obesity (BMI > 30 kg/[m.sup.2]). Finkelstein et al. then used the 1998 Medical Expenditure Panel Survey (MEPS), linked to the 1996 and 1997 National Health Interview Surveys (NIHSs), to develop a national model for predicting obesity-attributable medical expenditures. The authors then used this model and state representative data to quantify total obesity-attributable medical expenditures for each state, and Medicare and Medicaid expenditures within each state. The Behavioral Risk Factor Surveillance System (BRFSS) is a state representative telephone survey of the adult non-institutionalized population that tracks health risks in the United States. To increase the precision of the predictions, three years of BRFSS data was pooled (1998-2000).

Based on 1998 to 2000 BRFSS self-reported data, obesity prevalence is estimated at 20% for the total US adult population, 21% for Medicare recipients and 30% for Medicaid recipients. Approximately 6% of total adult expenditures, 7% of Medicare expenditures and 11% of adult Medicaid expenditures are attributable to obesity. Percentages range from 4% (Connecticut) to 7% (Alaska, Washington DC). Medicare percentages range from 4% (Arizona) to 10% (Delaware), and Medicaid expenditures range from 8% (Rhode Island) to 16% (Indiana). For the United States as a whole, obesity-attributable medical expenditures are estimated at $75 billion, with $17 billion financed by Medicare and $21 billion financed by Medicaid. State-level estimates range from $87 billion (Wyoming) to $7.7 billion (California). Obesity attributable Medicare estimates range from $15 billion (Wyoming) to $1.7 billion (California), and Medicaid expenditures range from $23 million (Wyoming) to $3.5 billion (New York).

The findings show that obesity imposes a substantial drain on health care resources across states, averaging ~6% of adult medical expenditures, and that roughly one-half of these expenditures are financed by Medicare and Medicaid. Obesity prevalence among Medicare recipients and the percentage of Medicare expenditures attributable to obesity are similar to those for the privately insured population. However, as a percentage of the total, Medicaid enrolls a more obese population and incurs greater obesity-attributable costs. Two limitations for this analysis are that both BRFSS and MEPS rely on self-reported data, and that both BRFSS and MEPS are limited to the non-institutionalized population. Policy makers should consider these estimates along with other factors, in determining how best to allocate scarce public health resources.

Eric A. Finkelstein, Ian C. Fiebelkorn, and Guijing Wang. State-level estimates of annual medical expenditures attributable to obesity, Obesity Research 12(1): 18-24 (January 2004) [Correspondence: Eric A. Finkelstein, RTI International, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709. E-mail: finkelse@rti.org.]