SANTA MONICA, Calif., March 12 - Obesity
contributes to higher cost increases for health care
services and medications than do either smoking or problem
drinking, a RAND researcher concludes in a report published
in the journal Health Affairs being released today.
In fact, the report finds that obesity has roughly the
same association with chronic health conditions as a
person who has gone from age 30 to age 50.
The study compares the effects of obesity,
smoking and problem drinking on health care utilization
and health status, using national survey data. Obesity
is associated with a 36% increase in inpatient and outpatient
expenditures and a 77% increase in medication costs
than people falling within a normal weight range, while
current smokers see increases of only 21% for services
and 28% for medications over those of non-smokers, and
problem drinkers see an even lesser effect for both.
Meanwhile, aging from 30 to 50 is associated with a
20% hike in service costs, but a 105% increase in medication
The study reinforces growing concerns
about how dramatically increasing obesity in the U.S.
will negatively affect health care costs as well as
overall public health.
"Obesity appears to have a stronger association
with the occurrence of chronic medical conditions, reduced
physical health-related quality of life, and increased
health care and medication expenditures than smoking
or problem drinking. Only 20 years aging has similarly-sized
effects," declared author Roland Sturm, a RAND economist.
Sturm used data from Healthcare for Communities,
a national household telephone survey of about 10,000
respondents taken in 1997-98. The results are based
on the subset of adults between 18 and 65 years of age.
He also used the body mass index (BMI), a ratio of height
to weight, to define overweight and obesity. (For example,
someone who is 5 ft. 4 in. tall and weighs 174 lbs.
or more is considered obese, as is a person who is 5
ft. 10 in. tall and weighs 209 lbs. or more.) According
to those criteria, one in five Americans is obese, while
an additional one in three is overweight. Obesity has
increased by 60 percent between 1991 and 2000, while
smoking rates have been cut roughly in half since 1964.
Sturm cautions that the full long-run
consequences of increased obesity rates are not yet
fully visible, because of the time lag between the onset
of obesity and the development of chronic health problems.
"The largest declines in smoking rates
happened between 1960 and 1980, whereas the largest
increase in obesity has occurred since 1980," Sturm
notes. He adds that there are important outcomes outside
the scope of his analysis that could provide a different
ranking. Smoking may still account for more premature
deaths and alcohol abuse is likely to account for more
externalities (e.g. drunk driving accidents).
Sturm used similar survey data in a study
he co-authored last year that found more Americans are
overweight or obese than, collectively, are daily smokers,
problem drinkers, and below the federal poverty line.
Both studies were funded by the Robert
Wood Johnson Foundation. RAND is a nonprofit organization
that helps improve policy and decisionmaking through
research and analysis. ##
RAND News Release
Public Information Office, 310-451-6913
Not for release until 12:01 a.m. Tuesday, March 12,
Sturm R. The Effects of Obesity,
Smoking, and Problem Drinking on Chronic Medical Problems
and Health Care Costs. Health Affairs. 2002;21(2):245-253.
Sturm R, Wells KB. Does Obesity
Contribute As Much to Morbidity As Poverty or Smoking?
Public Health. 2001;115:229-295.
Link to Research Brief: http://www.rand.org/publications/RB/RB4549/