A study was published the other day that suggests that obese people cost less in medical expenditures than non-obese people. That seems hard to believe given that obesity has been shown to increase the risk of lots of medical conditions, including diabetes, hypertension, high cholesterol, CHD, cancer, osteoarthritis, and lots of others. Given that, it would seem to also cost a lot of money to treat. And in fact, it does. I’ve published numerous papers showing that obese individuals cost more in medical expenditures than non-obese individuals. So what’s going on?

The author's claim is that even though obese individuals have higher medical costs while alive, they end up dying earlier. In other words, normal weight individuals cost less, but for a longer period of time. If the differential in life expectancy is large enough, then normal weight individuals could indeed have greater lifetime medical costs than obese individuals because they are alive for so much longer. That is the conclusion these authors come to. The problem is, at least in the U.S., that claim does not hold true. Several recent papers, including one published by authors of the Centers For Disease Control and one of my own that is not yet published, have shown that overweight and most obese individuals do not have a substantially shorter life expectancy than normal weight individuals. Given that, there is no way they could cost less over the life cycle. It is true that those with a BMI over 35 (for someone 5′10” that would be about 240 lbs) do live, on average 3-5 years less than normal weight adults; however, their medical costs are much higher than normal weight adults. So again, no savings from obesity, even for this small percent of the overweight/obese population. Now, it may be that in the Netherlands, the focus of this paper, that treatment costs are much less and mortality for obese individuals much greater, so that their results are correct, but they certainly do not generalize to a U.S. population. So there are no savings due to obesity. Contrarily, there is a savings from smokers, who die much earlier and never collect on the taxes they pay into Social Security and the Medicare trust fund, let alone all the taxes they pay on cigarettes.  Given these findings, in efforts to save money, should our government give away free cigarettes and tax the Krispy Kremes and Big Macs? What do you think?

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