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With the obesity epidemic in the U.S. now encompassing some 130 millionadults, young to middle-aged Americans who are overweight ultimately may endup paying dearly. Not only are these individuals markedly more susceptible todeveloping type 2 diabetes (as well as other obesity-related diseases), butthey also account for increased Medicarecosts.
That's the finding of a recent study conducted by physicians andresearchers at Northwestern University inChicago.1 The studyexamined the relationship of body mass index (BMI) in young adulthood andmiddle age to subsequent health care expenditures at age 65 and older.
The study incorporated Medicare data from 1984 to 2002, which it linked tobaseline data from the Chicago Heart Association (CHA) Detection Project inIndustry collected from 1967 to1973.2,3CHA studied 9,978 men (average age 46 years) and 7,623 women (average age 48.4years) with an overall average age of 33 to 64 years. Participants were 1)free of coronary heart disease, diabetes, and major electrocardiographicabnormalities; 2) not underweight (BMI <18.5); and 3) eligible to receiveMedicare (age >65 years) for at least 2 years during 1984–2002.
Participants were classified by their baseline BMI as non-overweight (BMI18.5–24.9), overweight (BMI 25.0–29.9), obese (BMI30.0–34.9), and severely obese (BMI > –35.0).
BASELINE DATA
Between November 1967 and January 1973, the CHA study screened almost40,000 men and women aged 18 and older of varied ethnic and socioeconomicbackgrounds (mainly non-Hispanic white and about 10% African American)employed at 84 Chicago-area organizations; of these, 17,601 were eligible toparticipate. Baseline measurements included height, weight, a single casualsupine blood pressure, and level of serum total cholesterol. Participants alsoprovided demographic data, smoking history, and information on medicaldiagnoses and treatments, including those for hypertension and diabetes.Electrocardiograms (resting) were classified as having major, minor only, orno abnormalities.
"We were surprised to see the large difference in average annualcumulative Medicare charges between those with optimal BMI in young adulthoodand middle age and those who were overweight or obese," says Martha L.Daviglus, MD, PhD, associate professor, Department of Preventive Medicine, atNorthwestern's Feinberg School of Medicine. "So, although we clearlyunderstand the relationship of BMI and other risk factors to subsequentmortality, these health care cost data served to underline the fact that noteveryone with an unfavorable risk-factor profile experiences an earlydeath." Instead, the study demonstrated that most people who wereoverweight or obese at early ages went on to experience greater morbidity anddisability when older, resulting in the higher Medicare costs.
So what does this mean for clinicians? "For the younger, overweightor obese patient who is otherwise healthy, it is imperative that aggressivecounseling and interventions be considered, with the goal of preventing morbidconsequences long-term," says Daviglus. Because the database did notinclude information on diet and exercise, "We would like to see futureresearch focus on the role of these lifestyle factors in subsequent healthcare costs," she adds. 
References
2. Stamler J, Dyer AR, Shekelle RB, et al.: Relationship of baselinemajor risk factors to coronary and all-cause mortality, and to longevity.Cardiology 82:191–222, 1993.[Medline]
3. Stamler J, Rhomberg P, Schoenberger JA, et al.: Multivariateanalysis of the relationship of seven variables to blood pressure: findings ofthe Chicago Heart Association Detection Project in Industry, 1967–1972.J Chronic Dis 28:527–548, 1975.[Medline]
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