The Real Cost of Obesity May Not be in Health Care

When you follow the current public discussion on the consequences of obesity, the focus is most often on the potential costs for health care. This is not surprising, given that obesity is directly linked to a wide range of chronic diseases including hypertension, type 2 diabetes, sleep apnea, osteoarthritis and many forms of cancer.

But health risk are not the only cost of obesity. Even a cursory glance at the patients presenting in our clinic immediately makes it evident that a disproportionate number are on short or long-term disability, not working to their full potential or simply unemployed. If you take into consideration that the average age of patients in our clinic is in the lower 40s, it immediately becomes evident that there are economic losses to society here that go well beyond the simple costs of health care.

Numerous studies have in fact documented that obesity may have important economic consequences for individuals – and thus society.

This was once again demonstrated in the largest study on this issue to date. Nina Karnehed and colleagues from the Karolinska Institute in Stockholm examined social mobility in over 750,000 men born between 1951 and 1965. Subjects were studied at age 10 and again at age 30.

Men who were obese at age 18 were almost 30% less likely to be upwardly mobile (achieve a higher socioeconomic status than their fathers) and 30% more likely to be downwardly mobile (achieve a lower socioeconomic status than their fathers) compared to normal weight men. This finding was independent of childhood socioeconomic index (SEI), IQ or education, suggesting that societal factors (e.g. bias and discrimination) may be responsible.

This difference is substantial. Downward social mobility means less income and lower SEI with all its consequences. These costs to society may be far greater than any costs to health care.

I am no economist, but I don’t find it difficult to imagine that when a substantial proportion of the population (currently 25% of all adults) are at risk of not realizing their full economic potential this could mean a huge loss for the overall economy.

Thus, apparently obesity not only affects mental or physical health but also socioeconomic health – an important consequence of the obesity epidemic that I have not heard much about in the media or elsewhere.

Perhaps the increased health care costs of obesity are the least of our worries.

Edmonton, Alberta