Monday, February 4, 2008

Big Fat Public Health Care Costs (Revised)

Ok, some people took umbrage with my math in my original post comparing the cost of obesity vs. the cost of the war on obesity. My math was pretty generalized, but then, so are the estimates thrown about by the media on what a fat person costs the taxpayers. My conclusion was that the U.K. is actually spending 35 Million GBP more on failed attempts to make people not fat than they claimed fat people actually cost the public health care system. E-mailers didn't like that.

So I dug deeper. I found more hard numbers, citations, data from the UK's National Audit Office, etc. What I realized part way through is that I'm arguing against fallacious methodology in the first place. The UK's estimate of what "obesity" costs the NHS each year is based on the cost of treating fat people for diseases they assume are caused by fat. The specific studies they use to determine this aren't listed, but considering no independent study (as in, not funded by pharmaceutical companies or weight loss clinics) has proven that fat causes a single disease (remember: correlation is not causation), and that more recent studies are showing that even correlation disappears in most cases when physical fitness is taken into account, I cannot accept their numbers estimating the "cost of obesity" to be valid in the first place.

So here's the revised breakdown, showing that instead of 35 Million GBP, the UK is actually wasting 324 Million GBP, or US $639,772,672.47 trying to make people no longer fat.

(update 2/5/08: Ironically, the day after I posted this, a supporting article came out on Junkfood Science. It analyzed a new study that shows fat people actually have fewer health care costs than thin people over a lifetime. Who'da thunkit?)

Big Fat Public Health Care Costs

It's a good year to be fat, especially if you're a shareholder of Roche or GlaxoSmithKline. According to a January, 2008 report 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 unfortunate (and sometimes lethal) side effects. The majority of media coverage is touting this fact as a positive move, due to what they claim is the high cost of obesity to the public health service.

Claims of “the cost of obesity” vary wildly, from 1 Billion GPB to 40 Billion GBP per year. Few of these claims cite scientific sources; fewer still actually detail the methodology of arriving at that number. One of the few that does is the official Audit Office of the British Government. They say that obesity costs their country 500 million GBP per year. They come to that figure by researching various studies that show a correlation between adiposity and particular diseases. They then calculate the cost of treating the people in the “obese” category of the BMI scale for those diseases, adding in workdays lost through sickness and early death.

This sounds scientific until one considers the fact that thin people get those diseases too. It’s only in fat individuals that the disorder is blamed on the adipose tissue, rather than the likelier suspects of genetics, environment, stress and/or level of fitness. In other words, the estimated cost of obesity is based entirely on the false assumption that correlation equals causation, and that the disease being treated would not exist if obesity were eliminated. (2001 NAO report by the Comptroller and Auditor General).

If, as many studies independent of the pharmaceutical industry are now showing, fatness has little or no bearing on health when fitness is taken into account, this estimate of 500 million GBP disappears entirely. But let’s look at some numbers that do not disappear quite so easily.
According to the NHS (National Health Service), they spend $47.5 Million GBP on prescription weight loss medication, primarily Orlistat and Sibutramine.

According to the British Obesity Surgery Patient Association, an average of 10,000 weight loss surgeries are performed in the UK each year. An average cost for WLS (without complications) is 10,000 GBP. Complications arise in an average of 16% of cases, more than doubling the cost of the treatment. So, on average, the UK can expect to spend approximately 116 Million GBP per year on WLS procedures, not counting lost workdays and the cost of the much-shortened lifespan of WLS patients.

34 Million GBP has been allocated annually to local primary care trusts for obesity prevention programs.

124 Million GPB has been allocated per year over three years for the new 5-point plan for obesity prevention, including programs targeting the gaming industry

2.5 Million GBP has been allocated for the NHS to offer free dance and boxing classes to obese individuals.

So far we’re up to 324 Million GBP, or 64% of the original 500 million GBP expenses blamed on obesity. As no hard numbers were available, I did not account for the cost of TV ads, NHS doctor consultations and monitoring of diets, supplements for programs such as Weight Watchers, government grants for studies, the time and expense of schools to weigh and measure students or police their lunch boxes for snacks, or the billable hours of elected and appointed officials to study, brainstorm, argue, and fight for anti-obesity policies.

In other words, the “cost of obesity” could be better labeled as the “cost of the war on obesity”. The British government is spending 324 Million GBP, or US $639,772,672.47) on failed attempts to make their citizens not fat. So who is really costing whom?

Imagine what all that time and money could do to benefit every citizen if it were spent on HAES instead of hate?


RioIriri said...

How dare you use logic and math to make sense!

Awesome work you did researching this. Thank you.


HT said...

Terrific article, thank you so much!

Lucifer_666 said...

Brilliant piece and I have to congratulate you on a great blog aswell...I have over this past while become increasingly concerned on how society, media, Government and the health crowds are using this issue for their own ends and really are creating further biasness and hate towards the overweight when in fact we should be encouraging exceptance of difference. I can't count on my hands the amount of arguments I have had with people about this very subject and I was aware this while that the ways in which they reach these vast 'fat cost' numbers are extremely dubious....

I have only really started to read your blog now but so far everything you say makes sense and its about time more came out and said it!!

So keep up the good work