Obesity

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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
• Govt Intervention?

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Measuring Obesity

• Body Mass Index (BMI)
• Underweight lt18.5
• Normal weight 18.5-24.9
• Overweight 25-29.9
• Obesity BMI of 30 or greater

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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 InCalories 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-contagio
  us
• More Peer Effects

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Solving the Problem

• How?