Wednesday, April 20, 2011

Obesity Costs Albertans $1.27 Billion (or more)

A recent report commissioned by Alberta Health Services estimates that in 2005, the total direct and indirect costs of illnesses attributable to obesity in Alberta were $1.27 billion.

This represents 28.0% of the total direct and indirect costs attributable to obesity for 22 specific health conditions and 5.6% of the total direct and indirect costs for all health conditions in Alberta.

Coronary heart disease ($307.1 million) had the highest direct and indirect costs attributable to overweight and obese BMI status; osteoarthritis ($167.7 million), type 2 diabetes ($161.5 million), hypertension ($125.5 million), and the 14 cancer sites ($117.5 million) had the highest obesity-attributable costs after coronary heart disease. Among the 14 cancer sites, colorectal cancer ($31.6 million), postmenopausal breast cancer ($14.5 million), and leukemia ($11.0 million) had the highest costs attributable to overweight and obesity in Alberta.

While the direct health care cost attributable to overweight and obesity was $630.1 million, or 49.5% of the total cost of overweight and obesity, the indirect cost was $643.8 million including $63.1 million in short-term disability costs, $209.6 million in long-term disability costs, and $371.1 million in premature mortality costs.

As the report notes, these costs are conservative as the analysis did not include the costs for:

  • Private out-of-pocket costs such as those paid for private caregivers, illness-related aids, and home modifications not reimbursed by governmental agencies;
  • Costs associated with reduced production during work hours (presenteeism) as a result of a health problem;
  • The value of time lost from work
  • The value of lost leisure time of family members or friends who care for the patient;
  • Intangible costs that involve pain and suffering borne by patients and their families.

The report also did not assess the cost of obesity in youth under age 15 or in the Aboriginal population living on reserves.

Although the report did not analyses how much of these costs could be reduced or avoided by providing effective obesity treatments, it is very likely (based on other estimates) that the savings could be substantial.

As I have said before, no health care system can afford not to tackle obesity.

AMS
Edmonton, Alberta

The Summary of The Cost of Obesity in Alberta Report is available here

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16 Responses to “Obesity Costs Albertans $1.27 Billion (or more)”

  1. Anonymous says:

    I hope widespread publicising of these results will help spur prevention efforts.

    I also hope these costs will help discredit the “Health at Any Size” advocates, who deny that obesity is a real health problem, and cry “fat bias” whenever prevention of overeating and obesity is brought up.

  2. Beth@WeightMaven says:

    Sorry Anon, I completely beg to differ. I’m not a major HAES evangelist, but the point is that the problem here *IS* health, not weight. Yes, obesity is associated with all of these diseases because — more often than not — the very things that make you fat make you sick.

    Have you ever looked at studies that show people making marked changes in their health markers even though they’ve only lost 5% or 10% of their weight? They’re still fat, but they have changed their health because what they did to lose weight was change their diet, typically removing the things in our diet that cause inflammation and other disease promoters.

    Yes, our health care costs are skyrocketing, but it’s not primarily due to obesity per se. It’s a much bigger social problem, primarily related to the food system. As Michael Pollan said on Oprah a little while ago (and which likely holds as true in Canada as in the US):

    “When you hear the phrase ‘health care crisis’ or ‘health care cost crisis,’ that is a euphemism for the catastrophe that is the American diet. 75% of our health care spending is on chronic diseases linked to diet. That’s really what’s bankrupting us, and that has to do with the way we’re eating — way too many calories, too much processed foods, tons of refined carbohydrates.”

    I vote for pointing the finger at the real problem, because the prospect of demonizing fat people (given the lack of any successful long-term strategy for losing weight) is not a pretty one IMO.

  3. DebraSY says:

    Could you give us a link? I am skeptical.

    To my knowledge, there are really no good studies that predict the costs of
    being fat.

    In many studies, they are usually taking into account the costs of “obesity-related diseases,” such as diabetes, osteoarthritis, heart disease, etc., though the studies do not isolate the obese participants/subjects from the nonobese. That would lead me to ask whether the rising cost of diabetes (and other modern diseases), is happening because we’re all, on average, fatter OR are we all more insulin resistant because of another obesogenic cause in our diet/environment, and did this third factor also make us fatter on average too?

    Moreover, no studies, to my knowledge, subtract for anything — such as the
    lowered costs because of fat people NOT taking advantage of medical services
    for fear of “the lecture.” Of course, since many fat people don’t take advantage
    of early health interventions, by the time they seek help, they are in a more
    serious and expensive medical conundrum. Which relates to a final point,
    nothing is subtracted from obesity-related expenses for premature death
    (leading to fewer years of expensive elder care), even though the scare
    mongers insist that fat people die younger (though evidence here is refutable, too).

    I gotta tell you, I don’t like the tenor of the “report,” if you are conveying it accurately. It will only lead to more fat discrimination/stigmatization and less examination of what may be the REAL factors that are making people unhealthy/sick and also raising our average weight.

  4. NewMe says:

    Contrary to anonymous, I feel that there is something rather fishy in the state of Denmark with respect to this study.

    I have alerted more analytical minds than mine to your post and this study and hope that they will post a comment here.

    And even if this study is substantively correct, not placing it in context and discussing what can be done to deal with this seemingly intractable “problem” leaves me feeling that the study could be used by professionals and non-professionals (in particular in the media) alike to create an atmosphere of fat blaming and shaming and add to the climate of fear mongering that currently surrounds the whole issue of weight management.

    I realize that you are simply presenting the results of a study, but I would like to hear your take on it and in particular, what kinds of concrete steps you believe are required in light of its findings. Without such commentary, we are left with hysterical fear and no roadmap towards health.

  5. Arya M. Sharma, MD says:

    “create an atmosphere of fat blaming and shaming and add to the climate of fear mongering that currently surrounds the whole issue of weight management.”

    This is certainly not the intent of the post and regular readers will recall my concerns about just that topic. I would rather see the data used to begin providing credible obesity management services (note the use of management – not weight loss!) to address some of the underlying problems leading to these costs.

    While there is no secret bullet to prevent or treat obesity – we can certainly do a much better job of helping people manage their health and weight than we are currently doing – the place to start doing this is to stop blaming people for their weight problems but to take a non-judgemental approach to determining the underlying drivers and helping patients address their individual causes and barriers – while this may not work for eveyone, there are 1000s of people who could benefit from this kind of treatment.

  6. NewMe says:

    Dr. Sharma,

    Your comments are appreciated. I knew you would respond along those lines and I believe it was your duty to do so. To my mind, presenting such studies without any commentary (as is the case with your post, not the comment above) invites the kind of fat shaming and blaming as well as unfocused fat hysteria and fear mongering that I know you yourself do not yourself subscribe to.

  7. NewMe says:

    Woops, that’s “do not subscribe to”. One “yourself” too many.

  8. DeeLeigh says:

    The report is here, and the methodology starts on page 14.

    People have already chimed in with some of the reasons why this type of study tends to be inaccurate and inflammatory. It boils down to this: “associated with” doesn’t mean “caused by.” The causation can be reversed (i.e. the condition contributes to a higher BMI), or both the condition and the BMI can be influenced by other factors. Upon reading the method section, it’s clear that this hasn’t been adequately controlled for. I’m surprised that you didn’t comment on this issue yourself, Dr. Sharma.

    Do thin people live forever and without illnesses? No, they don’t. I’m sure that Alberta has population-level data on the BMIs of individuals and could compare the real health care costs for people with various BMIs. That would also require some qualification. It would have to control for socioeconomic status, age, etc. However, I’ve never seen a study that made that sort of direct comparison. I wonder why. Maybe the numbers aren’t what they expect them to be?

  9. DebraSY says:

    Sorry. I see the link now at the bottom of your post. Will give it a look. Still skeptical about the tenor.

  10. Beth@WeightMaven says:

    BTW, one other point I should have made. I don’t know if this has been studied (don’t have any handy references), but I would bet money there’s a strong correlation between degree of obesity and number of attempts at weight loss.

    Losing weight for the sake of not being obese is not the greatest public health strategy. It’s very likely that many/most weight loss attempts sets up conditions (e.g., lowered lean body mass) that make weight-loss maintenance and longer-term health far more challenging than simply addressing healthy behaviors at any size (Ooops … I’m an HAES evangelist after all!!).

    So a message about obesity being the primary cause helps to set up the wrong solution IMO — and maybe even make the problem worse.

    I hope I’m around when Pollan’s message (our standard Western diet makes us sick) is widely accepted. Re this, I’m just skimming a report re a pig study reported in the latest Obesity (free; http://www.nature.com/oby/journal/v19/n4/full/oby2010292a.html). Here’s a highlight from their findings:

    “Our study showed that the establishment of a diet-induced obesity in minipigs was accompanied by a modification of the basal brain metabolism that is probably an acquired and specific feature of the disease. … These results demonstrated that some brain functional features described in obese humans can also be found in diet-induced obese minipigs, which suggests that the nutritional context is of prime importance in the modulation of the basal brain metabolism and the possible emergence of cerebral functional abnormalities.”

    Instead of getting people fixated on their weight or their BMI, I think we’re far better off getting them focused on what they can more easily control: the quality of their diet. Although maybe that’s hard too.

  11. DeeLeigh says:

    Oh, and if you were to compare the cost of healthcare for obese and non-obese people? You’d better not include the costs of obesity treatments or the health problem (such as gall stones) that they cause.

  12. NewMe says:

    Amen, ladies!

  13. Anonymous says:

    Dr Sharma,
    Re ” providing credible obesity management services” (good idea)

    When would this start? When someone was first overweight, (prevention of development of obesity)
    or when a person gained even more weight and became actually obese?

    If obesity is is uncurable, the sooner the problem is caught the better.
    for example – like wearing seatbelts or helmets – better to avoid head injuries than treat brain damage.

  14. Rachel says:

    I know obesity treatment and prevention needs attention from decision makers (and funding for good programs) but I really dislike these kinds of articles. They don’t help the cause at all in my opinion. They create more resentment and anger against the obese for “costing society money”.
    Dr. Sharma, Alberta Heath Services isn’t like you, government is still stuck in the old model of viewing obesity. I think they’ve added up some numbers based on biased values. And for what purpose? Its beating the same old drum of moral panic over obesity.
    There’s just so many things wrong with that headline. First, I’ve just finished reading about a study that looked at the negative health impacts of weight bias. Weight bias, not obesity can cause depression. Lets add up how much money weight bias is costing society? Second, okay, lets assume obesity is bad and costs the health system money. Then lets see how much money compared to traffic collisions (which are almost all caused by bad driving) I’ll bet its higher…How about smoking? assaults? bad diet? And third, lets try some reverse logic, if fat people cost 5.6% of health care expenses in 2005, then that must mean that skinny people used up the rest which would be 94.4% of the budget. Loves it!

  15. Rachel says:

    Oh, and Alberta Health Services probably counted in obese people who eat candy, smoke and drink alcohol while driving and cause traffic collisions too. Oh and hit their kids at the same time. Cause that’s all due to obesity right? Give me a break!

  16. Why I Will Continue to Read Arya Sharma’s Blog « Debra's Just Maintaining says:

    [...] posts of May 9th and 10th were unfortunate (as well as his uncritical post a couple of weeks ago on the Alberta study that portrays fat people as society’s financial pariahs, and his premature post demanding [...]

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