Rising Rates of Obesity in the US

Highest-cost cases (people) of obesity account for 20% of the US healthcare system among three-quarters of the total obesity costs as per a series of five studies presented at this year’s European Congress of Obesity (ECO 2022), in Maastricht, Netherlands.

The prevalence of type 2 diabetes has also doubled approximately across an 8-year study period, regardless of class of obesity.

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‘Three-quarters of the total obesity costs to the healthcare system among people living with obesity in the US are accounted for by the 20% highest-cost cases with the prevalence of type 2 diabetes becoming doubled], regardless of class of obesity.’

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The studies were conducted by Dr. Marc Evans, University Hospital, Llandough, Penarth, Cardiff, UK, and Dr. Jonathan Pearson-Stuttard at the data and analytics company Lane Clark & Peacock LLP, London, UK, and colleagues.

Obesity is known to be approximately double healthcare costs in the US compared to those with a healthy weight.

The five studies covered 8 years and included 28,583 people living with obesity in the US. The authors conclude that: “Healthcare costs and rates of hospitalisation are greater for individuals in higher compared with lower obesity classes. Our results highlight the relationship between body mass index (BMI) and increasing use of healthcare resources and suggest that obesity progression may contribute significantly to the economic burden of the disease.”

Obesity Rates and Health Care

Adults (18 years and over) were identified in the IQVIA Ambulatory Electronic Medical Records database and linked to the IQVIA PharMetrics Plus administrative claims database, both commonly used databases for large-scale research purposes.

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Individuals with a BMI measurement of 30–70 kg/m² during a baseline period (1 January 2007–31 March 2012), and with continuous enrollment in the database for at least 1 year before their baseline year and 8 years follow-up (up to 2020) were included in the analysis; those who were pregnant or had cancer at the start of the study were excluded. The index date was the date the person had their BMI measured.

Three cohorts were formed based on obesity class (class I: BMI 30–<35 kg/m²; class II: BMI 35–<40 kg/m²; class III: BMI 40–<70 kg/m²). Obesity-related complications (ORCs) and total per-person direct healthcare costs (inpatient, outpatient, and pharmacy costs; measured in 2019 US dollars) were evaluated in the baseline year and year 8.

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High-cost cases were defined as the 20% of cases with the highest total costs in year 8; the remaining cases were designated in the low-cost category.

Classes of Obesity and their Burden

For the group with class I obesity, the 20% of individuals who had the highest healthcare costs accounted for 79% of all healthcare costs in this group; for those with class II obesity this figure was 77% and for the group with class III obesity 74%.

The authors say: “We found that at least three quarters of the total direct healthcare costs in people with obesity in US clinical practice came from 20% of individuals. People in the high-cost category of obesity had substantially more obesity related-complications than people in the low-cost category, suggesting a clear association between obesity-related complications and economic burden.”

A second analysis of the same study population estimated how many ORCs (obstructive sleep apnoea, heart failure, urinary incontinence, osteoarthritis of the knee, type 2 diabetes, prediabetes, asthma, psoriasis, gastro-oesophageal reflux disease, hypertension, dyslipidemia, musculoskeletal pain, atherosclerotic cardiovascular disease, and chronic kidney disease/kidney failure) were present in people living with obesity at the start of the study.

The authors found that among 28,583 individuals with obesity, 12,686 (44%) had no ORCs, 7,242 (25%) had one ORC, 4,180 (15%) had two ORCs, and 4,475 (16%) had three or more ORCs.

The more ORCs an individual had, the higher their healthcare costs at the start of the study; and average costs increased for all groups across the 8 years of the study, indicating a worsening of ORCs or development of additional ones in all categories.

In each year, costs increased with the number of ORCs; mean annual per-person costs were highest for individuals with three or more ORCs (year 0, USD 14,290; year 8, USD 20,078) and lowest for those with no ORCs at index (year 0, USD 1,626; year 8, USD 7,015). For patients with one ORC or two ORCs, costs were USD 4,649 and USD 7,089 at year 0, and USD 9,296 and USD 11,738 at year 8, respectively.

Source-Eurekalert