obesity the economics of an epidemic. outline basic facts health effects economic costs (direct and...
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Obesity
The Economics of an Epidemic
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Outline
• Basic Facts• Health Effects• Economic Costs (Direct and Indirect)• Model Problem– Economic vs Non-Economic Reasons
• Gov’t Intervention?
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Measuring Obesity
• Body Mass Index (BMI)
– Underweight = <18.5 – Normal weight = 18.5-24.9 – Overweight = 25-29.9 – Obesity = BMI of 30 or greater
2/mkgBMI
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• http://www.cdc.gov/obesity/data/adult.html
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Percent Adults Overweight/Obese 2011
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Problems with being Overweight
• Hypertension• Dyslipidemia (for example, high total cholesterol or high
levels of triglycerides)• Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Osteoarthritis • Sleep apnea and respiratory problems• Some cancers (endometrial, breast, and colon)
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Number of deaths for leading causes of death
• Heart disease: 652,091• Cancer: 559,312• Stroke (cerebrovascular diseases): 143,579• Chronic lower respiratory diseases: 130,933• Accidents (unintentional injuries): 117,809• Diabetes: 75,119• Alzheimer's disease: 71,599• Influenza/Pneumonia: 63,001• Nephritis, nephrotic syndrome, and nephrosis (kidney disease):
43,901• Septicemia (blood poisoning): 34,136
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Number of Deaths from Obesity
• Allison et al. 1999 – 280,000-325,000
• Mokdad et al. 2004 – 400,000
• Flegal et al. 2005– 112,000
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Paradoxical Effect of Overweight
• Historical evolutionary advantages to efficiently storing fat. It is a buffer against disease and famine
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Economic Costs
• Around 10% of medical spending in US• More than cigarette smoking 147 billion in
2008• Americans spend 33 Billion on weight
reduction products
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Economic Costs
• Direct– are costs where money is actually exchanged
• Indirect– are most often costs that measure productivity
loss and represent the value of time
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Direct
• Average increase in annual medical expenditures is $732 per person
• A total of 5.3% to 5.7% of total annual medical expenditures in the
• United States when combining per person costs and prevalence
• Government finances roughly half the costs attributable to obesity
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Direct
• Perhaps only 4.3% of lifetime costs (in the United States) when accounting for increased annual costs and premature mortalitySource: (2005). Annu Rev Public Health, 26, 239-57.
• 147 Billion per year Finkelstein et. al. 2009 (similar to smoking)
• 33 billion in weight loss aids. Rashad and Grossman 2004
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Direct• “Across all payers, obese people had medical
spending that was $1,429 greater than spending for normal-weight people in 2006.”– Finkelstein 2009
• The costs attributable to obesity are almost entirely a result of costs generated from treating the diseases that obesity promotes.
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Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing
Health Expenditure
• Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.
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Indirect
• How can we calculate indirect?– What are examples?
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Indirect
• Absenteeism• Presenteeism• Disability• Premature mortality• Workers’ compensation• Indirect costs ranged from $448.29 million ($204
per obese person) in Switzerland to $65.67 billion ($1627 per obese person) in the United States (33).
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Basic model of Weight Gain
• Calories In=Calories Out
• Women: BMR = 655 + ( 4.35 x weight in pounds ) + ( 4.7 x height in inches ) - ( 4.7 x age in years )
• Men: BMR = 66 + ( 6.23 x weight in pounds ) + ( 12.7 x height in inches ) - ( 6.8 x age in year )
• Dynamic Equations (150 calories = 10 pounds in 233 days)
• 3,500 calories = one pound
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Calorie Expenditures
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Calorie Consumption
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Food Technology
• Price of food has fallen
• Time cost of food prep has fallen more
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Fattening of America
• Since 1983 prices of “healthy foods”• Fresh fruits: 190% increase• Fresh vegetables: 144% increase• Fish: 100% increase• Dairy: 82% increase
• And not so healthy foods…• Fats and oils: 70% increase• Sugars and sweets: 66% increase• Carbonated beverages: 32% increase
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Non-Economic Reasons
• Women Working• Medications• Changes to Cigarette Prices• Climate Control• Pollution• Sleeping Less
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Behavioral Aspects of Eating
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Obesity and Food Out
• Supersize Me.
• Anderson, M. L., & Matsa, D. A. Are Restaurants Really Supersizing America?
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Obesity and Income
• White women pay a 9% wage penalty for being obese.
• Maternal employment and childhood obesity– Working mothers lead to obese children.
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Economic Costs of Obesity and Health Insurance
• The problems with not pricing insurance for weight risk.
• This leads to non-optimal weights.
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Government intervention and regulation in food
• South LA• Transfats
• Ag subsidies.• Import quotas on sugar.
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Food Pantries and Poverty
• A Cruel sort of Altruism
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Do food stamps cause obesity? Evidence from immigrant experience.
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Misc Artifacts of food intake
• Improved nutrition has lead to early onset of menstruation among women.
• Taller population
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Health care bill requires calories on menus at chain restaurants
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Research
• No effect
• Why?
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Social Norms
• 66% of the moms were overweight or obese, and 39% of kids were too heavy. Both numbers are close to the national trend.
• Most obese women (82%) underestimated their weight when looking at the silhouettes; 42.5% of overweight women did the same. About 13% of normal-weight women thought of themselves as thinner than they were.
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Social Norms
• Most overweight or obese children (86%) underestimated their weight, compared with 15% of normal-weight kids.
• 47.5% of moms with overweight or obese children thought their kids were at a healthy weight.
• 41% of the children thought their moms should lose weight.
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Is poor fitness contagious?
• http://www.bakadesuyo.com/is-poor-fitness-contagious
• More Peer Effects
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Solving the Problem
• How?