Thursday, January 31, 2008

Big Fat public health care costs - a breakdown

It's a good year to be fat, especially if you're a shareholder of Roche or GlaxoSmithKline. Apparently the sale of prescription weight-loss drugs has undergone an eightfold increase since 1999. 1.06 million people in the U.K. are on some kind of prescription drug that promises to usher them into the exciting new world of fashionable thinness through heart palpitations or uncontrollable loose bowels. Why all this fuss?

Why, for the burden of obesity on public health care! The article claims that obesity will cost the U.K. 45.5 billion GBP a year by 2050. They arrive by this highly scientific number by a careful weighing of the cost of every disease obesity is supposed to cause, multiplied by the estimated likelihood that the person with that disease is fat. After all, correlation is always causation, so every fat person with heart disease has only their fat to blame. They run the data through a highly calibrated publicly-funded magic 8 ball to arrive at the 45.5 billion GBP figure. Oh, did I mention that they include the cost of the research to stigmatize fat people into the cost of obesity? Sort of like suing people and tacking on your own lawyer's fee for the trouble it took to do so.

So let's break this down.

A one-month supply of the popular weight-loss drug Xenical is 102.792 GBP at Let's use that as an estimate. After all it's just as scientific as their numbers.

A one year supply of Xenical is 1233.50 GBP. Multiply that by the 1.06 million people and you are spending 1,307,510,000 GBP per year on weight loss drugs in the UK. That's on the public dole.

Weight loss surgeries have increased dramatically as well. In 2005 there were 4400 surgeries performed in the UK. Since that's the most recent hard number I could find, I'll go with that. After all, we want to be scientific. An average cost for WLS (without complications) is 10,000 GBP. So, in 2005, the UK spent maybe 44,000,000 GBP on WLS procedures.

Now the 45 billion GBP projected for 2050 is a projection, of course. Right now the same study states that "obesity" costs the public health system a whopping 1 billion GBP per year.

So let's break this down. Let's be unscientific and set aside the fact that correlation is not causation and that the cost estimates are radically skewed in the first place as they have no evidence that any of the diseases used in the estimate are actually CAUSED by fat. Only that some fat people have those diseases. (as do some thin people...coincidence?) They also generally fail to take into account the studies that show that fat has protective aspects that reduce the occurrence of certain diseases, and therefore LOWER health care costs in those instances. So let's accept the magic 8 ball numbers and say for argument's sake that fat costs the British Health system 1 billion a year. Let's fudge in the other direction to really be generous with our estimates and not take into account the cost of government staff and resources to enact anti-fat policy, police lunchboxes, lobby for new food labeling guidelines throughout the EU, and other "hidden" costs of the war on obesity.

If fat costs the UK 1 billion GBP a year, and failed attempts to make people not fat costs the UK a highly conservative 1.35 billion GBP a year, doesn't that mean the attempt to solve the problem costs the taxpayers 35,000,000 GBP more than the cost of the original problem?

Doesn't that mean that the UK could very conservatively save itself 35 million GBP a year (approx. US$69,537,012.28 at the current exchange rate) by simply ending the war on fat?

I wonder, if they plowed that 35 million into promotion of HAES, fresh foods in schools, pedestrian-friendly cities, etc.....would they also eliminate the so called "cost of obesity"? A lot of studies are now showing that when lifestyle is taken into account, active and fit fat people (even the "morbidly obese) have the same relative lifespan and health as active and fit thin people.


I think not.


Breanna said...

You know. not exactly cost related. But my sister weight about the same as I do now. And she needs surgery. And they told her to come back when she was frickin 20lbs thinner. That just still burns my butt to think about.. ugh.....

Brigid Keely said...

Wow, that's a really interesting break down. Thanks for posting this.

JoGeek said...

Breana, you should post the story to the blog "first do no harm." It's a blog specifically for stories of weight discrimination in health care.

Also, Michigan's one of the few states where it is illegal to discriminate based on weight, so denying surgery to a fat person may actually now be against the law. If nothing else, I've learned that it's perfectly acceptable to fire your doctor if he refuses to treat you (or treats you improperly). People should definitely stand up for their body's rights and demand adequate care.

Cassandra said...

I've recently been very aggressive and pro-active about my healthcare, continuing to go through a 2 year long ordeal about PCOS and now my gallbladder. As I've reviewed the whole smattering of tests I've had done, I realized that half of the time the tests I was given were completely unnecessary. I've had blood drawn 8 times for no reason whatsoever in the past year. So if they were to say fatness causes PCOS, well golly I wonder why my fat is costing so much in healthcare, it couldn't possibly be because they're doing a bunch of pointless tests on me and doing everything but taking care of the real issue.

It's the nickle-and-diming that goes on that leads up to those huge health care costs - they want to find ways to cut down, but they would rather flat out refuse care to entire groups of people than revamp testing and procedures to be more efficient.

JoGeek said...

Cassandra: That's a really good point. The savings would be across the board instead of focused on a single group. I guess the trick is having doctors who actually know what's necessary and what isn't, so that they don't refuse a procedure to someone who really does need it.

Breanna said...

I'll talk to my sister about the Dr thing. I know since than she has gone from a size 20 to about a 12/14. Mostly because of her own bad habits and not taking care of herself. Long story. I'm sure you have some idea of.. Anyway. The Dr I used to have. Every time I would go into his office. he would tell me how I should try to lose some weight. I weigh 232lbs. Yeah that's way to much. But my weight has never really been a factor in any of the reasons I have gone to the Dr. So it used to make it so I would never really go to the Dr unless I was seriously sick. The new Dr I have. She has never mentioned anything to me about my weight. The only one who has was the Rheumatologist. And he didn't tell me I was obese or anything like that he just told me that since I hold some of my weight in the mid section that it would be very helpful to my knees and my hips if I could maybe take off 20lbs. And that the best way for me to do that would to just be more active. That he didn't think it was healthy to diet. it was best to eat better and work out more. I was not upset by what he said at all. And I actually believe and know he is right that I would have less issues with my knees and hips if I just worked out some more. Even if I didn't lose weight the working out would be good for me... Looks over at the elliptical and says.. Damn it I need to get them battery's we need.. lol