1. October 6, 2005 Dennis Haeckl The Health And Cost Consequences Of Obesity Among The Future Elderly D. Lakdawalla, D. Goldman, B. Shang Health Affairs September 26, 2005 http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.r30/DC1. Additional sources: http://www.healthaffairs.org, http://www.who.org

2. October 6, 2005Dennis Haeckl Facts and Definitions ► BMI: body mass index measures a person's weight in relation to his/her square of the height; BMI=kg/m^2 ► Overweight: BMI 25.0 and higher ► Obesity: BMI 30.0 and higher ► Worldwide: more than 1 billion adults are overweight, at least 300 million of them are clinic obese ► USA: according to National Health and Nutrition Examination Survey (NHANES) the age-adjusted prevalence of overweight and obesity increased to 65% and 31% in 1999/2000 (from 56% and 23% during 1988-1994) ► The WHO attributes obesity epidemic proportions because of its prevalence and the fact that it is a major contributor to many disabilities and chronic diseases, such as diabetes, cardiovascular disease and hypertension

3. October 6, 2005Dennis Haeckl Future Elderly Model (FEM) ► Dana Goldman and his colleagues at RAND used a detailed microsimulation model to examine different scenarios for the future of the elderly and the Medicare program ► They built a model of the aged population, the Future Elderly Model (FEM) ► Concept: the model takes the current health status of the elderly and estimates what medical services people will use; then, it simulates the change of the health status over the course of the year ► The FEM consists of three components: a model of health care costs; a model of health status transitions and a model to predict characteristics of future ► The simulation started in 1998 and followed a single representative cohort of 70-year olds – tracking their costs, health, and disability – until everyone in the cohort has died

4. October 6, 2005Dennis Haeckl Back To Obesity – Study Results Obese people suffer from diabetes for 41% of their life years – normal weight people just 17%. The gradient in hypertension is also quite large. All of these differences are statistically significant at 5% level (letters a to e) and refer to the remaining lifetimes of people age seventy and older.

5. October 6, 2005Dennis Haeckl Costs Of Obesity The obese spend about $17,500 annually, of which about $11,500 is Medicare's responsibility. Thus, total expenditures are more than $39,000 higher than for the normal weight groups. Moreover, an obese 70-year-old can expect to face 2.8 additional years of ADL disability (ADL = activities of daily living). The U.S. Centers for Disease Control and Prevention has suggested that a year of life spent with an ADL limitation is about half as valuable as a year of healthy life. Therefore, the cost of 2.8 additional disabled life years is similar to losing 1.4 years of life. Since a year of life to an elderly person is easily worth more than $28,000, the cost of disability must be larger than $39,000. The total burden on Medicare for the obese is more than 20% higher than for the overweight group.

6. October 6, 2005Dennis Haeckl Outlook And Discussed Solutions ► The above mentioned results suggest that future Medicare spending will continue to rise if current trends of excess weight remain unchanged ► The determinants of obesity are complex and multifactorial, with genetic, biological, behavioral, sociological, and environmental contributors ► Given the cumulative impact of prolonged exposure to adverse weight levels, and the high costs and ineffectiveness of existing programs to treat obesity, perhaps the only solution is primary prevention of weight gain from young ages ► Some researchers criticize the disparity between many interventions that have been implemented to reduce smoking rates and the paucity of interventions aimed at reducing obesity rates ► Health warnings in fast-food restaurants? ► How about taxation?