What Obesity Really Costs – Brian Klepper

lingering doubts that America’s cavalier attitude toward lousy food and
obesity is draining the nation’s health and economic vitality should
have been laid to rest a couple weeks ago. Two important studies were released
that quantified just how much our inability to resist fast food is
costing us.

In Health Affairs, the premier journal of
health care market dynamics, economics and policy, Professor Ken Thorpe
and colleagues from Emory reported on a study comparing incidences of chronic disease in the US and in 10 European countries.
They found strong evidence that Americans have much higher levels of
lifestyle-related chronic disease than do Europeans – in other words,
we’re sicker – that American medicine tends to identify and treat
disease more aggressively than does European medicine, and that our
more excessive lifestyles and aggressive treatment patterns undoubtedly
contribute significantly to our much higher per capita health care
spending, which can be twice what Europeans pay.

The second study, from the Milken Institute, is called An UnHealthy America: The Economic Burden of Chronic Disease,
and it provides a calculation of the direct and indirect costs of seven
of the most common and costly chronic diseases. The findings are
staggering. America currently spends more than a trillion dollars –
more than $200 billion for direct care and more than $900 million in
lost productivity – on avoidable conditions. Unless we do something
differently, that number is expected to rise to $6 trillion by the
middle of the century, crippling the nation’s health status and


Dr. Thorpe and his colleagues present compelling evidence that, at
least in part, Americans pay so much more for our health care than
Europeans because we take such poor care of ourselves. And once we get
disease, we may not manage the care processes as well as Europeans do.

those points aside, in a sense there  is little new in these studies.
Instead, they confirm what we already all know, and in a damning way.
As a people, we appear to be nearly unconscious of the impacts of our
habits on our health or prosperity.

America’s addiction to
fast, prepared and junk foods is, of course, continually stoked by the
propaganda machines of  the processed food industry, which spend huge
sums on both marketing and lobbying. 

America’s health care
crisis has two enormous wings. On one side, a fee-for-service
reimbursement system and a lack of transparency cultivate an
opportunistic culture that generates excessive care and cost throughout
the health care supply chain, the care delivery system and the
financing sector. On the other, a food industry preys on our children
without regard for the consequences to them or the welfare of the

Neither of these problems can be resolved until the
nation’s most powerful individuals – the business leaders who run firms
outside of health care and the food industries – unite to demand
greater adherence to behaviors that work for, rather than against
America’s future.


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20 replies »

  1. My opinion on fast food is that is should have a higher tax applied on it. Fast food can be good if you eat it from time to time but you should never eat it too often because eating such processed foods leads to obesity. Obese people are not healthy! Obese people have much higher risks of developing different medical conditions and are a long term minus for tax payers money. Also, I would apply a higher tax on sweet drinks (like cocacola, sprite…), because all these drinks influnce on someone’s health as well. Drinking too much of fuzzy drinks will also make you fat.

    But general people are unable to see this, they don’t know that if population gets fatter that means more money for health care. This is sad.
    What to do? Well, people should pay more attention to their health, maybe read some books or articles on healthy food and healthy lifestyle. Nowadays, omega 3 fat is so popular. If people would try to do something on their omega 3 vs omega 6 ratio everyone would be more healthy. Also, when we talk about omega 3 daily intake, this article on how much omega 3 per day might be interesting.
    Bottom line – if people would pay more attention to their healh this world would be a better place. Sure this means a downfall of all fast food companies and some pharmacy companies as well, but at the end of the day this would be a plus.
    Regards, T

  2. While I agree that obesity causes chronic deseases, I wouldn’t use the study that simply compares the incidence of deseases between the US and Europe as a proof. I may be missing something here, but how can one deduce that all difference in the number of chronic deseases between the US and Europe is due to obesity? There are lots of other differences between the US and Europe. Here are a couple:
    1. There is more screening in the US. Screening increases incidence because of a) overdiagnosis and b)by advancing diagnosis: the incidence of cancer increases with age, so you get more people diagnosed at younger age; hence a higher total number diagnosed. I am not saying it is good or bad, just that it is a well-known fact to anybody with basic understanding of epidemiology that more screening=higher incidence.
    2. European work/life balance is different. They have more vacation, they work less hours. So one can argue they have less stress, hence less heart desease.
    A study that shows how much money obesity costs should account for these differences. I don’t see this in your post, am I missing something here?

  3. Not to seem callous or cavalier. While there is no question that obesity and the chronic diseases that accompany obesity are a significant burden for the health care system as a whole. The secondary effects of obesity are becoming evident on the staff of medical institutions as well. I am an orthopedist. I am priviledged to treat a number of the staff members at my institution. On any given day I will see a number of knee, shoulder and back injuries from moving patients on the bariatrics ward. On a weekly basis I will replace the knees or shoulders of a bariatric patient. The toll the surgery takes on my own body is becoming troublesome. This is not a joke… I wonder if the workplace environment folks have looked into this. Like second hand smoke.

  4. The problem is down in the trenches the emphasis is on weight loss rather than a healthy lifestyle.

  5. I believe at the end of the day healthcare is more of a personal issue. One must make the right decisions and choose to live a healthy life by eating right and exercising regularly. With that said, big business has not set a good environment for this to take place. There is to much money being made on both sides of healthcare, for this to ever come to a halt. Big pharma makes billions by supplying our “magic pill”/instant gratification society with their prescription drugs, and the fast food and junk food industry keeps them needing that magic pill.

  6. There are countless ways for employers to not only encourage active healthy living, but to benefit from that investment. Incentives are only the beginning. They are a useful tool to break the inertia. Studies have shown that after 10 weeks, the original incentive doesn’t mean that much. The progress that people have made on their health becomes their incentive and that’s one that will last a lifetime. Smart employers are realizing that they need to take the reins and put investment into place to drive this behavior. Healthy people cost less and they are more productive. Brian’s citations tell us what we already know, but his call for action by industry might be misguided. The call should be more for industry to lead by example first.

  7. I’m with Peter – restore VIGOROUS gym in the schools K-12 and make them pass fitness tests like we had to in the 50’s-60’s. It’s gotta start early. I LOVE the ‘No Child’s Big Behind’ moniker – priceless, Peter!

  8. I’m relatively new to the UK after 13 years living in the US. There’s a food retailer here, Sainsburys, that has this ingenious wheel diagram that’s stamped on all its foods. It makes it very, very easy to see key nutritional facts about what you’re buying.
    I think it should be copied/licensed everywhere.
    Even my four year old now says: “We can’t buy this! It has too many red bits.”
    See this link for more:

  9. Barry, I’m wondering if the high taxes lead to reduced expectations as to what’s really important in life. Maybe a little more sharing will create more moderate goals. And don’t just blame the middle class on high expectations, those multi-bathroom Mac-mansions aren’t about need, but about show. Just try to keep afloat on one income today. The cost structure has been raised because of two income spending.

  10. I’m a little skeptical of the indirect cost figure, but I certainly agree that obesity and its associated healthcare costs are significant problems.
    When we look at our society vs those of Canada and Western Europe specifically, I’m struck by what I would call a significant difference in expectations as to what constitutes a decent and acceptable middle class lifestyle. Lifestyle expectations in the U.S. have skyrocketed in the last 30-40 years. Everyone seems to want a home with multiple baths, a large family room, good size yard, at least two cars, summer camp for the kids, at least one good family vacation per year, etc. Middle class life 30 or 40 years ago would be considered woefully inadequate today. The problem is that the cost of fulfilling these inflated expectations requires more than one income for most families. In Europe, people appear content to live in a much smaller house, drive a smaller car, and work fewer hours.
    While I’m not suggesting that we move toward the European model of high taxes and extensive social services, I am suggesting that if American lifestyle expectations were not so high, it might be possible for millions more Americans to live on one income and allow one spouse to stay home full time (if that were their preference). A stay at home spouse might then be in a position to help to provide a simpler, less stressful and probably healthier lifestyle for the entire family. The time saving virtues of fast and processed foods would not be in such great demand, and there would probably be considerably less obesity. Perhaps we’ve met the enemy and it’s us!

  11. “A food industry preys on our children without regard for the consequences to them or the welfare of the nation.”
    If you’re expecting a food company to take responsisbility for the health of the nation before their profits then…. It’s sad but true, most conglomerates are only out for profits.

  12. Remove tax incentives to grow corn (the base stock to most of our unhealthy food) and transfer those incentives to fresh fruits and vegetables; organic of course. There Eric, that’s a tax neutral approach. Then tax fast food – maybe hard to define but we all know it when we see it. Dito on Brian’s stop advertising junk food to children. I’ve said this many times before but it’s hard for the food industry to stop training kids to eat their crap. Restore gym to schools and name it the, “No Child’s Big Behind” program.
    Too bad there’s so much money now in making us unhealthy and fat so this is just good clean talk with little action to follow by our political cowards.

  13. The UAW has been thrust into a unique position as both health payor, and worker representative. As such, they have the power to add worker thrift, and exercise and whole food nutrition to the medical charts of their workers, for the first time tracking the causes of chronic disease! Present health plans, tracking only symptoms (HBP, sugar, and cholesterol) are effective only against trauma and infections, about 20% of health costs.

  14. I could only say that health is a personal matter and the government could only do so much to tone down our inkling on greasy, fast foods or encourage Americans to exercise regularly; at the end of the day it’s a personal decision to stick to more nutritious meals, workout and lose the flab. I think that a far more extensive info drive on health, fitness and nutrition would do the trick, apart from encouraging more Americans to consume more natural foods and supplements such as Omega 3 and fiber rich flax seed instead of the usual processed foods we love to binge on.

  15. There is one thing you can take from a breast cancer dietary intervention study play book that was published in the December 2006 JNCI. “Low fat diets reduce breast cancer deaths.” Women cut their recurrence rate by 60% if they stayed with a diet in which fewer than 20% of calories were from fat. Nothing but nothing has ever achieved results like that before. Not chemo. Not radiation. The fact is, you can cut your chance of having cancer come back 60% if you cut the fat in your diet by 30%. Talk about a behavior that works for, rather than against.

  16. They could provide financial support for building parks, sidewalks, pools and gyms, while taxing convenience stores and fast-food joints. Even better, we could work to encourage walking-friendly communities where it is possible and safe to park the car (or walk from your nearby home) in the town center and do all your day’s errands on foot.

  17. Hi Eric. They won’t. If they decide that its in their economic interests – say, because a fat workforce is an expensive, less-than-optimally productive workforce – they’ll encourage the passage of laws that block advertising to kids (we already do this with alcohol and tobacco), and that possibly regulate what’s in certain foods. They’ll promote greater transparency and consumer information about food content, and support consumer decision-support tools for people who want to be healthy. They’ll also support incentives for people to meet health targets. There are lots of ways to skin this cat without directly mandating that people eat a certain way.

  18. Brian-
    1. how will ‘the nation’s most powerful individuals’ make people eat and act healthy?