Category: Obesity Updates

Weight Loss Therapy a Bargain for Medicare

Emory Professor, Kenneth Thorpe, examines the costs of treating obesity-related conditions and found medications that help Medicare enrollees lose weight could save money for Medicare in the long term.

Permanent weight loss of 10 to 15% will yield $9,445 to $15,987 in gross per capita savings throughout their lifetime, and $8,070 to $13,474 over ten years. Similarly, initial weight loss of 10 to 15% followed by 90% weight regain will result in gross per capita savings of $7,556 to $11,109 over their lifetime, and $6,456 to $8,911 over ten years. Targeting weight loss medications to adults with obesity (BMI ≥ 30) produces greater savings to the Medicare program.

Three Oreo Cookies a Day

That’s all it takes to make us fat. From Timothy Taylor at the Conversable Economist:

The rise in American rates of obesity can be traced back to what seems like a fairly small rise in daily calories consumed, I learned this lesson from an article on the causes of obesity about 10 years back in my own Journal of Economic Perspectives. In “Why Have Americans Become More Obese?” David M. Cutler, Edward L. Glaeser and Jesse M. Shapiro wrote that the “10- to 12-pound increase in median weight we observe in the past two decades requires a net caloric imbalance of about 100 to 150 calories per day. These calorie numbers are strikingly small. One hundred and fifty calories per day is three Oreo cookies or one can of Pepsi. It is about a mile and a half of walking.”

More Myths about Obesity

There were some myths that I already knew were false. But the presumptions pretty much blew me away. Early childhood weight and habits predicting later outcomes? No evidence. Eating more fruits and vegetables? No effect on their own. Snacking associated with weight gain? Nope. Built environment related to obesity? Try again.

Granted some things about obesity are correct. Exercise is good for you no matter what, and it can help in long term weight loss. Programs that involve families are more likely to help children. Bariatric surgery can be a real life saver for some people.

Austin Frakt summaryNEJM study.

Myths About Losing Weight

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Source: Gina Kolata in The New York Times

Being Overweight = Longer Life + Higher Medical Bills

Re: last week’s finding that overweight people may live longer. Here’s the rest of the story:

“The study looked at quantity of life, not quality of life, and that’s a very important distinction,” noted Dana Goldman, director of the University of Southern California’s Leonard D. Schaeffer Center for Health Policy and Economics.

A higher body mass index — a standard measure for determining whether people are overweight or obese — is associated with a number of chronic illnesses, including diabetes, heart disease and hypertension. These chronic illnesses are expensive to treat. If, as it now turns out, overweight people are living longer in addition to racking up more chronic illnesses, that means Medicare is on the hook for paying for more expensive people for more years.

Catherine Rampell. Critique of the study here. A defense of fat here.

Less Smoking vs. More Obesity: Is It a Wash?

We find that both changes in smoking and in obesity are expected to have large effects on mortality. For males, the reductions in smoking have larger effects than the rise in obesity throughout the projection period. By 2040, male life expectancy at age 40 is expected to have gained 0.92 years from the combined effects. Among women, however, the two sets of effects largely offset one another throughout the projection period, with a small gain of 0.26 years expected by 2040.

Source: NBER paper.

Inactivity is Not the Source of Modern Obesity

My colleagues and I recently measured daily energy expenditure among the Hadza people of Tanzania, one of the few remaining populations of traditional hunter-gatherers.

We found that despite all this physical activity, the number of calories that the Hadza burned per day was indistinguishable from that of typical adults in Europe and the United States. We ran a number of statistical tests, accounting for body mass, lean body mass, age, sex and fat mass, and still found no difference in daily energy expenditure between the Hadza and their Western counterparts.

See more of Herman Pontzer’s findings in the NYT.

Things You May Not Know About Government and Obesity

Mayor Bloomberg wants to ban large sodas. The Institute of Medicine wants to tax unhealthy folks. As John Goodman showed in a previous post, it’s hard to justify any of this. Here are some additional considerations.

Population obesity seems to have plateaued. The National Health and Nutrition Examination Survey (NHANES) shows no trend in US child and adolescent BMI since 1999. US men and women have had constant obesity rates and mean BMI since 2003. NHANES BMI measurements date suggest that the growth in U.S. overweight occurred between 1976-80 and 1988-94.

In 1997, the government made 35.4 million adults overweight overnight. It redefined overweight as a BMI greater than or equal to 25 regardless of age. Before that, overweight was BMI ≥ 27 for those 35 or older. Kathleen Flegal of the National Center for Health Statistics estimates that the change increased the fraction of overweight adults from roughly a third of the population to over half of it.

O would some power the giftie gie us…

A team of researchers led by a group from the University of Illinois at Urbana-Champaign recently asked 3,622 young men and women in Mexico to estimate their body size based on categories ranging from very underweight to obese. People in the normal weight range selected the correct category about 80 percent of the time, but 58 percent of overweight students incorrectly described themselves as normal weight. Among the obese, 75 percent placed themselves in the overweight category, and only 10 percent accurately described their body size.

Source: Tara Parker-Pope in the NYT.

The Wages of Obesity

They’re lower, unless you are male, or black.

In 2008, obese women made an average of $5,826 (15 percent) less than normal-weight females, the George Washington University researchers said….

White women who were obese had lower wages in both 2004 and 2008 than normal-weight white women, while wages were lower for obese white men only in 2004….

In 2004, Hispanic women who were obese earned $6,618 less than normal-weight Hispanic women. In 2008, the gap among women narrowed slightly but doubled for men. Hispanic men who were obese earned $8,394 less than normal weight Hispanic men.

In both 2004 and 2008, black men who were obese earned more than normal-weight black men, while wages were similar for obese and normal-weight black women.

HealthDay News story here.  Pointer from Jan Gurley.