Wednesday, February 06, 2008

Obesity won't sink Health Care. Huzzah?

Good grief!

Apparently obesity saves health care dollars.

Yesterday the net was abuzz with the news that treating and preventing obesity won't actually save money in the long run because it costs the system more if you live a long life.

Today I imagine it'll be splashed across the newspapers.

The story comes from a paper published in the online Public Library of Science journal that using a mathematical model "proved" that obesity saved health care dollars by killing off its victims before they could incur the health care costs associated with a long life.

You know, working in obesity medicine, I've grown to expect bias, but this story shocked me.

Since when do we measure the benefit of chronic disease treatment in terms of dollars saved?

The papers and stories are basically all telling people not to worry about the costs of obesity because treatment won't in fact cost health care systems more money.

If we're worried about health care dollars, maybe we should stop treating cancer, heart disease, strokes, lupus, appendicitis, and inflammatory bowel disease. Maybe we should stop blood transfusions, dialysis and cardioversions. Let's throw out antibiotics, anti-depressants and anti-rejection drugs. And while we're at it, let's shut down the ambulances, emergency rooms and delivery suites. Because you know what, if we do all of those things, those selfish sick people won't live as long and therefore they won't cost the system so much damn money.

It's only because the disease we're talking about is obesity, that anyone dare suggest that perhaps it's not such a concern because in the end, it won't cripple the health care system because people will die too young for them to truly sink it.

What about the incredible morbidity associated with obesity? The terrible impact on a person's quality of life, both medically and unfortunately in many cases socially? Are those not reasons in and of themselves to pursue every avenue of treatment? How did money enter this equation?

I'm not going to discuss the study in detail because frankly it simply doesn't matter. It doesn't matter because the fact is, I'm a doctor and I'm going to keep treating obesity because it's a chronic medical condition and treating it helps people live healthier longer lives and that's what doctors and the health care system are supposed to do, without question, without hesitation, worrying about the patient and not the bottom line.

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  1. "Since when do we measure the benefit of chronic disease treatment in terms of dollars saved?"

    Since US employers and HMOs started using obesity as an excuse to deny people health insurance.

    It's not an issue here in Canada, but down south, the "cost" of obesity to health care providers has long been an excuse for everything from enforced diets to outright firings. In a country where the overweight and obese have been told for years what a drain they are on the system, and have suffered both public ridicule and workplace bias because of their size, this news makes a huge difference in how these folks are treated.

    No, it's by no means an excuse to remain unhealthy and eat poorly. But it throws a whole system of prejudice on its head. HMOs no longer have an excuse to deny health insurance to the obese.

  2. Actually Sheryl, I imagine that this study will actually make it more difficult for obese folks to get health care coverage.

    Fact is, insurance companies will look at the study and the conclusion to infer (and the one that has been inferred in most news reports), that treating obesity does not save money in the long run and therefore why bother treating it?

    Don't believe me?

    Read the AP story and see how they've spun it,

    "The results counter the common perception that preventing obesity will save health systems worldwide millions of dollars"

    Substitute the word HMO for health systems and then consider whether or not this will help or hinder efforts for the obese to receive coverage for treatment.

  3. I want to argue the point, but knowing the sleazeball tactics of most HMOs, you're probably right. It's really too bad - this should be good news that fat advocates can use as ammunition to fight discrimination, instead it will likely get turned around and used to deny healthcare to even more people.

  4. Anonymous4:51 pm

    Quoting From the Globe and Mail:
    The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.

    I'm very sceptical of this study, or at least the reporting and public reaction towards it, because it goes against all conventional wisdom about the real costs of being obese (I'm not a doctor). What about the cost of diabetes, heart disease, knee and joint replacements? The social costs? Or the cost in pain and suffering of all those, including the obese, who must wait longer for health care services, or do without services (opportunity cost) in order for the health care systom to deal with diseases strongly associated with obesity?

    I also read a letter to the editor (I can't find it now -- it was either in the vancouver sun, the times colonist, or the globe and mail) written by a doctor which criticised the fact that the story did not mention a previous longitudinal study that came to different conclusions. Perhaps some other reader has a better memory than me and can provide a citation.

  5. The previous longitudinal study did indeed draw different conclusions. If you'd like to read it, it's available for free online here.

    Also problematic for drawing broad North American conclusions is the fact that according to the Dutch article, direct health care costs attributable to overweight and obesity in the Netherlands only amounted to 2%. In the United States and Canada that percentage is much higher with a recent guesstimate in the States pegging it at over 9%. Therefore treatment might in fact lead to a much larger cost savings in North America.

    You're also right in questioning the wisdom of omitting indirect costs such as lost productivity, long term disability, days of work lost etc., which certainly are increased in the obese population.

  6. Anonymous2:32 am

    Hey! I'm a first year medical student and I work in the hospital so I see the doctors sometimes can't help as well as they could because of the attitude of government "They are sick, they can't work, who needs them anyway?" As long as some of their relatives dies from cancer. I love what I'm studying but sometimes it really disappoints me that there is so much money and politics involved, and some day I will have to deal with all this crap... ahhhh.

  7. I think there are several issues here which I have watched and which I think we need to separate out about the cost of obesity.

    To be honest, I question how the cost of obesity is actually calculated.

    Most large people I know here is the US only go to a doctor when it is a real emergency because they are fearful of the abuse they will receive from medical personnel ranging from why don't you have gastric bypass to the silent but obvious digust.

    I would really like to see the raw data on these studies.

    Also, studies like this legitimize abuse of large people (even those not overweight). I have recently had people walk over to my table when in a restaurant and tell me I shouldn't be eating whatever I'm eating.

    Further, this also allows idiots to make statements like being obese is voluntary and for some of us - it is simply not. I have never been "normal" size in my entire life. I have either been too tall for a woman (5'9" or 5'10"), too large, too loud, etc. I think this reinforces stupid cultural stereotypes.

    Let's work from good science not stupid science.