Politicians and others usually list the funding of prevention and chronic disease management programs as a key method of achieving cost containment. Smoking and obesity are most frequently mentioned as risk factors to target. In the long run, however, removing these risk factors would probably increase medical costs—even assuming that preventive interventions cost nothing.
Using a simulation model, researchers found that never-smokers of normal weight actually incurred higher lifetime medical costs than obese nonsmokers. Smokers of normal weight had the lowest costs. Life years gained through prevention are not lived in full health. Reduction of risky behavior resulted in substituting expensive, chronic diseases of aging for cheap, lethal ones.
Healthy living is still a good thing, researchers conclude, considering that “the aim of health care is not to save money but to save people from preventable suffering and death” (van Ball PHM, et al., PLoS Medicine 2008;5(2):e29).
The Japanese Ministry of Health, however, believes that a new law to reduce waistlines will rein in ballooning medical costs. Companies and local governments are now required to measure the waistlines of all persons between the ages of 40 and 74 as part of their annual checkups. If the target of a 10% reduction in the number of overweight people in 4 years, and 25% in 7 years, is not met, the national government will impose penalties on the companies or local governments.
Japanese are not noted for being overweight. But a flower-shop owner who got measured during an aggressive special check-up campaign was dismayed to learn that his waist measured 33.6 inches, 0.1 inch over the limit. The average for white American men is 39 inches.
“Strikeout,” said the defeated flower-shop owner .
Critics say that more than half of all Japanese men will be considered overweight. They think the campaign will encourage overmedication and ultimately increase medical costs (NY Times 6/13/08).
Childhood obesity is a major funding area for the Robert Wood Johnson Foundation (RWJF). Based on a World Bank study, RWJF claims obesity costs 12% of the U.S. healthcare budget. Tens of millions of dollars worth of studies on obesity have found, among other things, that poor minorities are more likely to be fat than wealthy whites, and that there are three times as many supermarkets in wealthy neighborhoods as in poor ones, and four times as many in white neighborhoods as in black ones. Proposed interventions to reduce both fat and disparities are not spelled out.
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