Are Cost-Saving Arguments For Treating Obesity Another Form of Discrimination?
Yes, health care costs consume an increasing proportion of taxes (in countries with public healthcare systems) or personal income. Yes, there is also considerable waste in healthcare systems and not every dollar spent is necessary or provides any meaningful benefit. Indeed, even where health benefits are achieved, these may perhaps be had at a lower cost than in our current systems. Thus, there is no argument against reducing waste and improving cost-effectiveness of treatments (or for that matter, prevention). However, arguing in favour of cost-effectiveness should not be confused with arguments for cost-savings, as is often put forward in discussions about obesity treatment. Indeed, authors often bend over backwards to demonstrate the potential cost-savings that may come from treating obesity. Case in point is a study by Oleg Borisenko and colleagues, who in a paper published in Obesity Surgery, suggest that (based on the Scandinavian Bariatric Surgery Registry), surgical treatment of severe obesity led to savings of €8408 per patient, which translates into lifetime savings savings of €66 million for the cohort, operated in 2012. Be that as it may, I feel that savings cannot be the sole argument in favour of providing treatments for a disease. Given the tremendous impact that obesity has on the health and lives of people living with obesity, I would argue for treatments even if they increase healthcare costs. Let us remind ourselves that we do not argue about whether or not treating people with heart attacks, osteoarthritis, kidney failure or cancer saves money for the health care system – it rarely does, and is besides the point. The reason we spend money treating these conditions is because the people presenting with these conditions deserve treatment – period! Thus, I would argue that the primary reason that health care systems should be spending money on treating obesity is because people with obesity deserve treatment – not because it saves money for the system. Thus, even if there was a net cost to treating obesity, people with obesity deserve treatment as much as people with diabetes, heart disease or chronic kidney disease. If this means a greater cost to the health care system, so be it – raise taxes or increase payers contributions – don’t try to save money by simply refusing to pay for obesity treatment (or rationing it by making it difficult for patients to access). Using cost-savings as the prime argument for treating obesity… Read More »
Why Treating Severe Obesity Has The Highest Potential For Health Cost Savings
As the latest HQCA report on obesity in Alberta released this week, the substantial population burden of overweight and obesity (now affecting 6 in 10 Albertans) is a significant driver of health care costs in the province. In the US, this increased health care cost for adult obesity is estimated at around $3,508 per individual with a BMI greater than 30 for a total of well over US$ 300 billion per year. However, as highlighted in a recent article by John Cawley and colleagues in PharmacoEconomics, health care costs are not equally distributed across all people living with increased body weight – rather, obesity related health care costs rise exponentially with increasing BMI levels (i.e. at the extremes of BMI). Thus, the greatest health care savings for individual patients can be expected in those living with severe obesity. To illustrate this, the researchers used data from the US Medical Expenditure Panel Survey from 2000-2010 (n=41,435), to calculate the potential annual savings in health care costs (in US $ in the US health care system), for various reductions in body weight in individuals with BMI levels ranging from 30 kg/m2 to 45 kg/m2. Thus, for e.g. the annual cost savings with a 5% reduction in body weight for someone with a BMI of 30 kg/m2 amounted to a mere $69 per year. This figure, however, increased exponentially for people with higher BMIs, increasing to $528, $2,137, and $10,030 in an individual with a BMI of 35, 40, and 45 kg/m2, respectively (these figures were somewhat higher, when the individual also has diabetes). Thus, while treating obesity to achieve a 5% reduction in body weight in someone with a BMI of 30 kg/m2 may never be “cost-effective”, the same amount of weight loss in someone with more extreme obesity, would likely pay for itself or even lead to significant savings. Because the impact of obesity on mental and physical health, life-expectancy and quality of life is also greatest at higher levels of BMI, one could also make a strong ethical argument for singling out these individuals for priority treatment in the health care system. Obviously, as readers should be aware, BMI is at best a crude measure for health – a more precise assessment would have used more sophisticated staging systems like the Edmonton Obesity Staging System to calculate individual risk and benefits. However, we should remember that at a population level BMI does… Read More »
Plan Your Personalized Program For The Canadian Obesity Summit Now
If you are planning to attend the 4th Canadian Obesity Summit in Toronto next week (and anyone else, who is interested), you can now download the program app on your mobile, tablet, laptop, desktop, eReader, or anywhere else – the app works on all major platforms and operating systems, even works offline. You can access and download the app here. (To watch a brief video on how to install this app on your device click here) You can then create an individual profile (including photo) and a personalised day-by-day schedule. Obviously, you can also search by speakers, topics, categories, and other criteria. Hoping to see you at the Summit next week – have a great weekend! @DrSharma Gurgaon, Haryana
Patchy Progress on Obesity Prevention – Time To Expand The Food and Activity Paradigm?
In last week’s 2015 Lancet series on obesity, the majority of papers focus on policy interventions to address obesity. It suggests that a reframing of the obesity discussion, that avoids dichotomies (like nature vs. nurture debates) may provide a path forward – both in prevention and management. The policy framework presented by Christina Roberto and colleagues in The Lancet, is based on the NOURISHING framework, proposed by the World Cancer Research Fund International to categorise and describe these actions. Together, the actions in this framework address the food environment (e.g. food availability, taxation, restrictions on advertising, etc.), food systems (e.g. incentives and subsidies for production of healthier foods) and individual behaviour change (e.g through education and counselling). This “food-centric” view of obesity is complemented by recognising that physical activity, much of which is dictated by the built environment and captivity of the population in largely sedentary jobs, also has a role to play. On a positive note, the Christina and colleagues suggest that there may be reasons for careful optimism – apparently 89% of governments now report having units dedicated to the reduction of non-communicable diseases (including obesity), although the size and capacity of many of these units is unknown. On the other hand, despite an increasing number of such efforts over the past decades, no country has yet reversed its epidemice (albeit there is a flattening of obesity growth rates in the lower BMI ranges in some developed countries – with continuing rise in more severe obesity). Despite the potential role of government policies in reducing non-communicable diseases (including obesity) by “nudging” populations towards healthier diets and more physical activity, the authors also note that, “…the reality is that many policy efforts have little support from voters and intended programme participants, and although the passage of policies is crucial, there is also a need to mobilise policy action from the bottom up.” Indeed, there is growing list of examples, where government policies to promote healthy eating have had to be reversed due to lack of acceptance by the public or were simply circumvented by industry and consumers. Nevertheless, there is no doubt that policies in some form or fashion may well be required to improve population health – just how intrusive, costly and effective such measures will prove to be remains to be seen. All of this may change little for people who already have the problem. As the article explains,… Read More »
McKinsey on Obesity: Doing Something Beats Doing Nothing
Last week the McKinsey Global Institute, with much media fanfare, released a 120 page discussion paper titled, “Overcoming obesity: An initial economic analysis“, which estimates that the economic cost of the global obesity epidemic is upwards of $2 trillion, a number similar to the economic cost of tobacco consumption or armed conflicts. The report identifies 74 interventions in 18 areas (ranging from policy and population health to health care) deemed to be cost effective, which, if implemented, could lead to annual savings of $1.2 billion in the UK National Health Services alone. However, when it comes to the actual impact of these 74 strategies, the report is far more sobering in that it notes that many of these interventions are far from proven: “The evidence base on the clinical and behavioral interventions to reduce obesity is far from complete, and ongoing investment in research is imperative. However, in many cases this is proving a barrier to action. It need not be so. We should experiment with solutions and try them out rather than waiting for perfect proof of what works, especially in the many areas where interventions are low risk. We have enough knowledge to be taking more action than we currently are.” In other words, let’s not wait to find out what works – let’s just do something – anything (and keep our fingers crossed). Thus, the report urges us to “(1) deploy as many interventions as possible at scale and delivered effectively by the full range of sectors in society; (2) understand how to align incentives and build cooperation; and (3) do not focus unduly on prioritizing interventions because this can hamper constructive action.” I can see why politicians would welcome these recommendations, as they are essentially a carte blanche to either doing nothing (we don’t have the evidence) or doing whatever they want (anything is better than nothing). The fact that, “Based on existing evidence, any single intervention is likely to have only a small overall impact on its own. A systemic, sustained portfolio of initiatives, delivered at scale, is needed to address the health burden.” means that when any measure fails, it is not because it was the wrong measure but because there was either not enough of it or it was not complemented by additional measures. Again, a free pass for politicians, who can pass whatever measures they want (based on their political ideologies or populistic pressure from their… Read More »
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