Piling on the costs to healthcare

Helen Palmer Jan 4, 2007

KAI RYSSDAL: I hope you’re ready for the lines by the Stairmasters at the gym this week. New Year’s resolutions to shed those extra pounds have many of us hard at work. Because being overweight can hurt your ego, y’know. But it has another, more tangible cost, as Helen Palmer explains from the Marketplace Health Desk at WGBH.

HELEN PALMER: And the cost is:

ANNE ELIXHAUSER: The total health care costs of obesity were about $117 billion in 2000.

That’s Anne Elixhauser. She’s a research scientist at the Government’s Agency for Health Care Research and Quality — AHRQ. Elixhauser reckons the costs are even higher now.

ELIXHAUSER: We’re looking at at least $200 billion in health care expenditures that are attributable to obesity annually.

That cost includes obese patients treated for conditions their weight helps cause — heart disease, depression, arthritis, back problems, diabetes. Medical costs across the obesity spectrum are spiraling. The AHRQ found that hospital visits for obese patients more than doubled in the last decade.

The most dramatic intervention is stomach shrinking surgery — up a hundred fold in the last dozen years.

Surgeon Rebecca Shore of Massachusetts Emerson Hospital told a group of potential patients that it really does get the weight off.

REBECCA SHORE: With the bypass it’s between 70 and 100 percent of your excess body weight, and with the band it’s probably between 45 and 70 percent of your excess body weight.

But at a cost. It’s around $35,000 for a full bypass and 15 to $20,000 for the less-dramatic gastric band. Medicare and many insurance companies cover the operation when doctors say it’s medically necessary. And so they should, says Janey Pratt. She’s a surgeon at Massachusetts General Hospital. Obesity is a medical condition, not a failure of willpower. Besides, Pratt says a Canadian study showed that the surgery’s also cost-effective.

JANEY PRATT: After 3.5 years, you recoup your costs, and then the people who didn’t have surgery are spending a lot more in terms of health care costs for re-admissions to the hospital for conditions related to their obesity.

Pratt says the operation’s literally a life saver: many patients die prematurely because they’re obese.

Brandi Mancuso says she could well have been one of them.

BRANDI MANCUSO: When I was heavy, I honestly didn’t care about myself at all. I just figured, if I woke up in the morning then God meant me to wake up. There was no goals, there was no hope, there was no desire to be different.

Mancuso’s lost 200 pounds in the 14 months since she had a gastric bypass. She says she likes herself now — and her new 139-pound body.

But the costs of being obese still weigh her down. A Massachusetts state program paid for her stomach-shrinking surgery, and her medical bills when she weighed 340 pounds. Now, she says, she has to pay them back — more than $100,000 in all.

But you don’t have to be morbidly obese to run up hefty medical bills. Diabetes, one of the most common complications of excess weight, is also one of the costliest.

Ronald Kahn heads Boston’s Joslin Diabetes Center.

RONALD KAHN: Diabetes accounts for at least 130 or more billion dollars in the United States between the direct cost of medical care and the indirect cost.

Now, at the personal level, the costs to treat diabetes aren’t overwhelming. 56-year-old Harry Levy.

HARRY LEVY: A hundred test strips out-of-pocket is $30. So you’re looking at $2 a day just for disposables, not counting medication.

The meds add another $20 or so to his monthly bill. But Levy says the real costs lie in the health complications diabetes can trigger.

LEVY: The longterm prognosis is horrible — loss of limbs and loss of vision and — it’s beyond even thinking about.

Levy, who runs a magic business, didn’t want that outcome. So he took up a diet and exercise program: the carrot and the treadmill.

LEVY: OK, so there’s the price I’m paying right now: I have to spend an hour of my day exercising and I have to be careful and thoughtful about what I eat.

But, almost magically, 51 pounds melted away in 12 weeks. He’s now the poster child for controlling obesity and its spiraling medical costs the old-fashioned way. Surgeon Janey Pratt says for most of us that’s the way to go.

PRATT: Life in moderation, and a little bit of exercise, a lot of healthy food and, you know, your weight will be what it is and throw out the scale. Throw out the scale. You don’t need it.

In Boston, I’m Helen Palmer for Marketplace.

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