The Heavy Costs of Being Heavy: A Financial Juggernaut

How much would you spend dieting? How much would you spend if you remained overweight/obese? How much would you spend on bariatric surgery? 

MONEEEYYYY$$$ (Yes, I’m singing the Pink Floyd song)

The world is changing, physical activity is at an all time low. Cheap non-nutritional food is commonplace. Obesity has reached pandemic proportions. But in the end what are the financial costs? 

Lets start with examining the costs of being obese, obesity in and of itself holds quite a few problems, but the diseases that are caused by or associated with obesity are very important: diabetes, cardiovascular disease, hypertension, renal failure, etc. Because of the high levels of mortality (especially if you consider myocardial infarction) and sequelae that accompany them.

Diabetic patients in USA for example spend from $54.66 to $117.48 a month on supplies only (fingerstick supplies for example). Their medication costs range from $32.82 to $71.84 a month. This would give us a total cost per month for the average diabetic ranging from $87.48 to $189.32 !!! That’s $1049.76-$2271.84 a year just for being diabetic.

This doesn’t end here. Most diabetics develop hypertension (high blood pressure) and hyperlipidemia (high lipids/fat content in blood) which also tallies up costs, adding $657.24 to yearly medication costs (maybe even more). Hypertension and hyperlipidemia are both very important risk factors for cardiovascular disease which causes myocardial infarction! (Myocardial infarction costs are covered further down).

A study done by Wolf & Colditz in 1994 estimated that the direct costs of obesity for USA was $45,800 million (which would be $67,000 million if we adjust for inflation). This gives us a view of the bigger picture, it costs a LOT to be obese.

You may think that these costs do not even merit concern, much less a blog post. But this is where physiology comes in! The damage that these diseases produce aren’t centered around having high blood pressure (or glucose/lipids) per se, the real damage is what those excess levels of blood/lipids/sugars do to your body in the long run.

Ahoy mateys! Thar be blood vessel damage ahead!

We will give a brief explanation on the damages produced by high blood pressure (hypertension), high blood glucose (diabetes mellitus) and high blood lipids (hyperlipidemia). In fact we could make a whole post about it [hmmm] but for the sake of brevity here’s a common path they all share: all three cause some degree or form of blood vessel damage.

Constant uncontrolled high blood pressure takes a toll on the tiniest of blood vessels that in the long run cause inflammation that later leads to wall stiffness (sclerosis), plus it facilitates the deposit of lipids (fat) within their walls (this is called an atheromatous plaque).

Constant uncontrolled high blood lipids cause damage as stated in the aforementioned paragraph: if there are more circulating lipids in the blood, they are more likely to be deposited in vessel walls.

Constant uncontrolled high blood glucose is a bit trickier, as it is more of a chemical reaction that occurs in here, rather than the physical stress of high blood pressure or the increased viscosity and inflammatory processes of lipids. A simple explanation would be that glucose reacts with most molecules and chemically modifies them. This is called glycation. Glycation changes the structure of the walls of miniature blood vessels and acts in concert with high blood pressure to increase the stiffness (or sclerosing) of vessel walls everywhere. This in turn raises high blood pressure, affects kidneys and the retina (eyesight).

Fun fact: Glucose also glycates hemoglobin, the major molecule used to deliver oxygen to tissues. This is measured as HbA1c,  a high value means that blood glucose has been elevated for the last several months and has had time to glycate hemoglobin into a lot of HbA1c.

What does blood vessel damage cause in the long run?

Remaining obese for a long period of time causes chronic blood vessel damage, which in turn causes a whole plethora of diseases, which includes one of the most common causes of death in the world: myocardial infarction. Other diseases caused by blood vessel damage: renal failure, blindness, stroke, just to name a few.

And this my friends is where costs really tally up, you have to add the cost of having a myocardial infarction, knee surgery for weight bearing problems, kidney transplant for renal failure, retinal surgery for blindness, expensive medications for stroke, expensive chemotherapy or surgery for cancer, etc. to the aforementioned costs of being overweight / obese.

Why?

Because these diseases have been proven time and time again to be very strongly associated (many are even caused by) with obesity. If you are obese you have a three-fold increase in the risk of developing diabetes mellitus, hyperlipidemia & sleep apnea compared to the average population. And a two-fold risk increase of developing cardiovascular diseases, hypertension, osteoarthritis (knees) and gout.

This stresses the great importance that should be placed on reducing weight, not only from a medical point of view but also by assessing the economical burden placed on the patient and upon governments and institutions.

Ok Doc, I’m obese, how much $ will that set me back if I don’t do something about it?

Price of an average heart attack: $760,000.
Price of an average kidney transplant: $262,900.
Price of an average stroke: $15,000.
Price of an average knee surgery price: $11,900.
Losing weight and avoiding these costs and living a healthy, full life?

Priceless.

For everything else, there’s losing weight.

I see, let me “weigh” my options then, how much will it cost me to lose weight with medications/diets?

While there are many myths that state that eating healthy is more expensive than junk-food. Sadly, for the most part these are myths are true. Current manufacturing technologies and readily-available resources give companies the means to create addictive, high-sugar, high-carb and high-calorie foods that are sold at a remarkably low price to the average consumer.

Fun fact: according to a study done by Drenowski in 2003. It costs manufacturers ¢4 to produce 1 lb of refined sugar. Talk about cheap!

If you want to lose weight via eating healthier: 

According to another study by Drenowski (2004), the average US person needs to spend $1,000 more a year on top of what is already spent on food.

Note this only means eating healthier, but in order to lose weight you might need to add a bit more a year to this value. Why? because you need to decrease the amount of calories you eat to lose weight, thus needing to consume healthier but low calorie foods to satiate hunger and keep that waistline in check. This could be misleading and pave the way for uninformed judgement-calls such as saying “since orange juice is healthy I’m going to drink 4 liters of it!” Obviously weight is gained with excess calories, the body can’t tell the difference if those calories came from eat either a cheeseburger or orange juice. Healthier doesn’t necessarily mean low calorie/high nutrient. But its a good place to  start.

There is no current or reliable data on how much a low calorie/high nutrient diet costs, but one can speculate that it would add to what a healthier diet already averages out.

Another important factor to consider is the fact that exercise is a great aide in lowering BMI (body mass index). This could add even more expenses to yearly costs of weight-loss in the form of: gym memberships, personal trainers, clothing, etc. Its a great investment nonetheless  but the additional cost is sadly what makes some people stay far away from the notion of exercising.

Adding these up:

• Healthier low calorie foods are more expensive than unhealthy high calorie foods.
• Exercising adds some expense to this cost.
• Even if weight is successfully lost, maintaining it is difficult as eating habits return to baseline behavior.
• Very high risk of rebound weight-gain.

So whats a more effective way of treating surgery ? I want an alternative help me out!

Yes there is medical treatment for obesity and it consists of following a guideline setup by one of many weight-loss clinics. They usually ask you to cover the cost of food and charge you by a predetermined amount per weight lost (some offer a price of $1/lb lost).

And while this weight loss method has proven more effective than conventional means of losing weight, it has been heavily criticized because of lack of variety when it comes to prescription drugs available and because of the side effects related to some medications.

This treatment is typically set up in the following manner:

• You attend an appointment at the weight-loss clinic with a physician.
• They run a series of tests (blood draws, electrocardiogram or maybe even costlier exams).
• Once you are approved by both physician and psychiatric/psychological counselor you start receiving the prescription medications.
• The clinic gives you a weight loss plan to follow which includes covering the cost of specialized food and supplements that they sell you at their desired prices.

Annual average costs are $1600-$2000 for medical treatment alone in the US. Supplement/food prices vary greatly from one clinic to another.

A major setback for this method is that some (not all) medications to treat obesity have some side effects that have caused some drugs to be pulled from the markets in the past.

Medical therapy also carries the same risk of rebound weight gain as the conventional method of diet/exercise since medical treatment is not recommended in some instances for use in extended periods of time; also adhesion to any dietary regimen greatly varies between people.

So what would be the most effective way of losing weight that carries the least risk of gaining it back again?

This is where bariatric surgery comes in. Mind you, as with all surgeries there are some risks involved. Yet with current surgical techniques, skilled surgeons and medical advances, those risks have considerably diminished.

There are many different types of weight-loss surgeries and we have covered them extensively. So lets just center on what the main surgeries have in common: they allow eating smaller amounts of food + absorbing less calories.

The Clash of the Obesity Treatment Titans: Bariatric surgery VS Medical therapy

Schauer, et al. (2012) have produced a marveously executed study that compares three treatments for obesity: medical treatment, gastric bypass and gastric sleeve.

They have found that both bariatric procedures can produce equal (and in some cases greater) weight loss if compared to medical treatment alone.

Additionally, both bariatric procedures demonstrated better percentage resolution/improvement of obesity-related diseases such as diabetes and hyperlipidemia. This improvement has been shown to be twice or thrice the amount observed with medical treatment.

Benefits of bariatric surgery VS medical treatment:

• Effects like these remain for life.
• Eating behavior is forcibly changed due to some restrictive properties of surgery.
• Better eating habits mean a better average weight for years to come.
• Higher incidence of resolution or improvement of diabetes, hyperlipidemia, hypertension.
• Relatively low total cost (average is from $5500 – $10,000)

This cost can seem much to the naked eye but you should account for some important facts:

No other therapy has a better and proven resolution/improvement percentage of diabetes in obese patients, so you could potentially lower or in some cases discontinue diabetic meds, thus cutting expenses (remember that tose were an average of $2000/year ?).

No other therapy has a better and proven resolution/improvement percentage of hypertension/hyperlipidemia in obese patients, you could also lower or cease medications (hypertension/hyperlipidemia annual average costs were ~$600/year).

Also consider that you do not spend money on “special food”, that weight loss by bariatric surgery has been proven to be long-lasting and that you will potentially save yourself the costs of being obese and developing (and paying) for a heart attack, stroke or kidney transplant!!!

The only post-op recommendations after a bariatric surgery involve follow-ups, which are simple and fast. Blood draws that are relatively low in cost since they are done looking for simple nutrient deficiencies, and vitamin supplements.

Ok that was an intense review, but lets conclude this topic

With all of these facts you now have the necessary information to choose which method you think is right for you. But as always I encourage each and every one of you to do your own research, just try to use respectable data when doing so: peer reviewed medical journals  (specifically meta-analysis) are considered the gold standard in medical data, there are other kinds of studies that are of less statistical significance yet are great sources of information: retrospective studies, surveys, etc.

Disclaimer: the intention of this post is to present facts with current available data, no intention of placing more or less importance on any other forms of treatment is prevalent. Most data was obtained from US sources and as such they reflect the findings that each author encountered during his/her analysis. You are fully encouraged to ultimately consult any and all queries with the physician of your choice before any form of treatment is initiated. Data that was used is included at the bottom of this post.

Have a great week!!!!

-LIMARP Staff

References

1. Drewnowski A. Food choices and diet costs: An economic analysis. 2005 [cited 2013 Jan 8]; Available from: http://depts.washington.edu/uwcphn/news/summits/poverty_obesity/drewnowski_pov.pdf
2. . Drewnowski A, Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004 Jan 1;79(1):6–16.
3. Eisenstein EL, Shaw LK, Nelson CL, Anstrom KJ, Hakim Z, Mark DB. Obesity and Long-Term Clinical and Economic Outcomes in Coronary Artery Disease Patients. Obesity Research. 2002;10(2):83–91.
4. Greenway FL, Ryan DH, Bray GA, Rood JC, Tucker EW, Smith SR. Pharmaceutical Cost Savings of Treating Obesity with Weight Loss Medications. Obesity Research. 1999;7(6):523–31.
5. Hawkes C, Blouin C, Henson S, Drager N, Dubé L. Trade, Food, Diet and Health: Perspectives and Policy Options. John Wiley & Sons; 2009.
6. Lipsky LM. Are energy-dense foods really cheaper? Reexamining the relation between food price and energy density. Am J Clin Nutr. 2009 Nov 1;90(5):1397–401.
7. Lock K, Smith RD, Dangour AD, Keogh-Brown M, Pigatto G, Hawkes C, et al. Health, agricultural, and economic effects of adoption of healthy diet recommendations. The Lancet. 2010;376(9753):1699–709.
8. McDermott AJ, Stephens MB. Cost of eating: whole foods versus convenience foods in a low-income model. Family Medicine. 2010;42(4):280.
9. Powell LM. Fast food costs and adolescent body mass index: Evidence from panel data. Journal of Health Economics. 2009;28(5):963.
10. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. New England Journal of Medicine. 2012;366(17):1567–76.
11. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obesity Reviews. 2011;12(2):131–41.
12. Wolf AM. What Is the Economic Case for Treating Obesity? Obesity Research. 1998;6(S1):2S–7S.
13. Wolf AM, Colditz GA. Current Estimates of the Economic Cost of Obesity in the United States. Obesity Research. 1998;6(2):97–106.