From Our 2007 Archives
Obesity Driving Rising U.S. Health CostsBy Steven Reinberg
TUESDAY, Oct. 2 (HealthDay News) -- Obesity is a big factor driving soaring rates of chronic disease in the United States, with many more Americans chronically ill than their European counterparts, a new study finds.
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It's an expensive problem, too: According to researchers, chronic illnesses such as diabetes and heart disease account for some $100 to $150 billion in health-care spending in the United States each year.
"The United States spends twice as much as European countries on health care," noted lead researcher Kenneth Thorpe, chairman of the department of health policy and management at Emory University's Rollins School of Public Health in Atlanta. "Seventy-five percent of what we spend in this country is associated with patients that have one or more chronic conditions and most of the growth is due to obesity."
"We have got to find more effective means to reduce, and at the worst, stabilize this persistent rise in obesity among adults and kids in this country," he said.
In addition, experts must find better and less expensive ways of managing chronic health-care problems, Thorpe said.
"That's where all the money is being spent," he said. "We are not going to control costs until we get the level and growth in chronic disease prevalence down."
The report appears in the Oct. 2 online edition of Health Affairs.
In the study, Thorpe's team compared 2004 data on the prevalence and treatment of diseases among adults aged 50 and older in the United States and Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden and Switzerland.
They report that about 17 percent of European adults are obese, compared with around a third of American adults. In addition, 53 percent of adult Americans are either former or current smokers, compared with 43 percent of those in Europe. American adults were also more likely than Europeans to have heart disease, cancer, diabetes and chronic lung disease -- all associated with obesity and/or smoking.
"The United States spends more on health care than any country in Europe," Thorpe said. In the United States, in 2004 the per capita spending on health care was $6,102 -- about twice as much as in the Netherlands and Germany, and almost twice that of France.
If the prevalence of obesity could be reduced (and along with it, chronic disease), Thorpe's team estimates that health spending could be cut by $100 billion to $150 billion per year, trimming up to 18.7 percent off the nation's total health-care budget.
There are several reasons for the costs of chronic disease in the United States, Thorpe's group notes. In addition to high rates of obesity and smoking, these include more aggressive cancer screening in the United States than in Europe, and more intensive drug treatment for chronic disease than in Europe, further driving up costs.
Thorpe believes the only way to get health-care costs under control is to find ways to reduce obesity. "There is a lack of an effective primary-care system in this country," he said. "We have to manage patients with chronic conditions more effectively, and we have got to find a way to prevent this rise in obesity."
One expert agreed with the scope of the problem, but said solutions remain elusive.
"There are two reasons why the U.S. might spend more of our total economy on health care than any other country -- treatment here costs more, and more of us need treatment," said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine.
That Americans are fatter than Europeans comes as no surprise, Katz said, but that more Americans smoke is surprising. "This finding does make me question the reliability of the data to some degree. But even if we know for sure that Americans have more chronic disease risk factors than populations abroad, it doesn't necessarily tell us how to fix the problem," he said.
Obesity rates in Europe are rising fast, so "we are exporting our bad example and higher health-care costs may well follow [there]," Katz said. "Without a doubt, the high costs of health care are best reduced by the propagation of health. Defining how best to get there from here is as yet a challenge inadequately met."
Another health-care cost expert agreed.
"I'm not sure obesity is a medical condition that lends itself to medical treatment," said Greg Scandlen, the founder of Consumers for Health Care Choices, a health-care lobbying group. "Certainly, it does suggest the need for more exercise and better diets, but that is a grandmother's advice. Do we need highly trained and expensive professionals telling people what grandmothers have told them for free for generations?"
"I'm just not sure this information is of much use to the health-care system, though it may be for the education system," Scandlen said. His suggestions? "Bring back P.E. classes, [use the] transportation system, use more bicycles and fewer cars, and urban design, get rid of escalators so people will walk up stairs," he said.
SOURCES: Kenneth Thorpe, Ph.D., chairman, department of health policy and management, Emory University Rollins School of Public Health, Atlanta; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Greg Scandlen, founder, Consumers for Health Care Choices, Hagerstown, Md.; Oct. 2, 2007, Health Affairs online
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