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Are Cost-Saving Arguments For Treating Obesity Another Form of Discrimination?



sharma-obesity-australian-moneyYes, 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 reeks of discrimination.

This is why I refuse to participate in debates about how treating obesity can save health care systems millions of dollars – while this may well be the case, it is not the argument that I am willing to make to justify providing effective medical or surgical care to people living with this condition.

@DrSharma
Edmonton, AB

2 Comments

  1. “Using cost-savings as the prime argument for treating obesity reeks of discrimination.”

    You should do another article “Not providing obesity treatments reeks of discrimination.”

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  2. This is a great post. The argument behind reduced healthcare costs as an aim of treating obesity always makes me feel queasy. There are also some studies that show that although health care costs should theoretically decrease if obesity prevalence is reduced, overall costs to society increase as people live for longer. When the cost-saving argument is turned on its head, that costs are lower when obesity is NOT treated, one can see what a terrible argument it is. We should aim to treat obesity to improve quality of life, not to attempt to save healthcare costs.

    van Baal PH, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, Boshuizen HC, Engelfriet PM, Brouwer WB. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med. 2008 Feb;5(2):e29. doi: 10.1371/journal.pmed.0050029.

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