The Economic Burden of Obesity by Glycemic Stage in the United States

Abstract

BackgroundElectronic medical records and insurance claims data from the Geisinger Health System were examined to assess the real-world healthcare costs of being overweight or obese at different glycemic stages, including normal glycemia, pre-diabetes (PreD), and type 2 diabetes (T2D).MethodsThe medical history of the sample subjects was segmented into different glycemic stages via diagnosis codes, glycosylated hemoglobin A1c or fasting plasma glucose laboratory results, and use of antidiabetic drugs. Healthcare resource utilization captured by the claims and associated costs (in 2013 values) were examined for each glycemic stage. The association between costs and body mass index (BMI) was estimated by regressions, and adjusted for sociodemographics. We predicted the adjusted incremental annual costs associated with high BMI, relative to normal BMI (18.5–24.9 kg/m2).ResultsWe identified 48,344 adults in normal glycemic stage, 3,085 in the PreD stage, and 9,526 in the T2D stage (mean age 46, 58, and 60 years, respectively; mean BMI 29, 32, and 33 kg/m2, respectively). The adjusted incremental annual costs associated with high BMI relative to normal BMI ranged from $336 for overweight (25–29.9 kg/m2) to $1,850 for class III obesity (≥40 kg/m2) during normal glycemic stage; were only significant for class III ($2,434) during the PreD stage; and ranged from $1,139 for overweight to $4,649 for class III during the T2D stage (all p < 0.05).ConclusionsPositive associations between healthcare costs and BMI levels were observed within each glycemic stage. Management of body weight is important in reducing the overall healthcare costs, especially for subjects with PreD or T2D.

The Association Between Body Mass Index and Health and Economic Outcomes in the United States

“…However, in contrast to Li et al, 42 our results also suggest modest differences in the T2D subgroup as well. We attribute this, in part, to a ''ceiling effect.''…”

“…Similar to Li et al, 42 incremental direct costs were much more modest in the euglycemia and pre-diabetes subgroups, with only obese class III and normal weight differing on direct costs for the pre-diabetes group (and no differences across BMI classes for the euglycemia group). However, in contrast to Li et al, 42 our results also suggest modest differences in the T2D subgroup as well.…”

Obesity and healthcare resource utilization: results from Clinical Practice Research Database (CPRD)

“…However, in contrast to the present study, greater total healthcare costs in individuals with obesity and T2D in the USA‐conducted study were equally driven by greater inpatient costs and prescriptions 6.…”

For a Step Change to Curb the Obesity Epidemic

“…Corica et al [3] review evidence on the impact of obesity and age on quality of life, highlighting the lesser-studied effect of obesity on the elderly. Cawley et al [1] and Li et al [4] use different approaches and data sources to estimate the medical care costs (and savings) associated with weight/body mass index (BMI)-and potential weight loss-for patients with and without diabetes. Allen et al [5] highlight the impact that obesity has had on Medicare expenditures for certain chronic conditions-such as diabetes, heart disease, hypertension, and hyperlipidemiaover nearly a quarter century .…”

“…Notably, obesity accounts for 42.3, 30.9, 22.4, and 9.8 % of the increase in the number of cases of diabetes, heart disease, hypertension, and hyperlipidemia, respectively, in the past quarter century [5]. Finally, obesity has a large impact on patient wellness, productivity [12][13][14], and quality of life [2,3], and is associated with significant costs to healthcare payers and society [1,4,5,15].…”