The Health Economics of
Obesity and Weight Loss
ANNE M. WOLF
Obesity1 in the United States is a major public health problem with substantial economic consequences. Despite the known health risks, managed care organizations, health insurance plans, employers, and the government (i.e., Medicaid) do not consistently provide services to treat this growing epidemic (see Chapter 20). It is imperative that leaders who study and treat obesity be well versed in the economic consequences of obesity and weight loss, so that they can approach and educate health care decision makers regarding health care coverage of this chronic disease.
Economic costs represent the overall economic burden caused by disease, whether on the nation or on a payer of health care (i.e., managed care organization, employer). They are categorized classically into two components: direct medical costs, and indirect morbidity and mortality costs. Direct medical costs are the cost of preventive, diagnostic, and treatment services related to the disease (e.g., hospital care, physician services, medications). Indirect costs are the value of lost output due to cessation or reduction of productivity caused by morbidity and mortality. Morbidity costs are wages lost by people who are unable to work because of illness and disability. Mortality costs are the value of future earnings lost by people who die prematurely. This chapter focuses on direct and indirect morbidity costs; indirect mortality costs of obesity are incomplete estimates but will be available from large, long-term clinical trials, such as the Study of Health Outcomes of Weight Loss (SHOW) trial.
1Throughout this chapter, overweight is defined as a body mass index (BMI) ≥ 25 kg/m2, moderate overweight
as a BMI ≥ 27.8 kg/m2 (men) and 27.3 kg/m2 (women), and obesity as a BMI ≥ 30 kg/m2.