The price of obesity
It’s familiar news by now that America’s obesity epidemic is both dangerous and costly. Obesity significantly increases the risk of many diseases, including heart disease and diabetes, and is associated with at least 112,000 deaths a year. The economic impact is equally startling: Obese patients add an estimated $75 billion a year to the nation’s medical bill.
What has been less discussed and studied is the personal financial toll that obesity has on the 60 million Americans who are seriously overweight. In recent years researchers have been exploring that issue, and their findings raise a provocative question: Could obesity be as dangerous to individuals’ wealth as to their health? The preliminary evidence suggests that the answer is yes.
It likely will be years before these costs can be pinpointed. No studies, for example, have looked at whether obese people spend more on food. But some economists estimate that obese people could be spending tens of thousands of extra dollars a year because of their weight.
Recent studies have found that obese people spend more on out-of-pocket medical costs than thinner people. They also have lower incomes, are less likely to hold managerial jobs and are more likely to miss work. They are less likely to be married and more likely to get divorced. When they marry, their spouses generally earn less than non-obese people. They inherit less wealth from their parents, who are more likely to be overweight themselves.
Beyond these research findings, experts say that obese people spend more on diets and on items such as larger-size clothes or extra-sturdy furniture. A few airlines have begun requiring severely obese passengers to buy two tickets.
Another finding: Obesity’s financial burdens aren’t distributed evenly between the sexes. While both men and women who are severely obese make less money at work than people of normal weight, women suffer a bigger wage penalty. This summer, researchers at New York University found that an increase of 10% in a woman’s body mass decreased her income by 6%. The study also found that overweight women are less likely to be college graduates and more likely to work in less-skilled industries.
“There’s no single smoking gun to explain it,” said economist Roland Sturm of Rand Corp. in Santa Monica. “But it’s clear that for obese people, especially the morbidly obese, their weight can affect how well they do financially.”
Experts say it’s difficult to sort out the relationship between obesity and wealth. Obese people are poorer than the non-obese, but no one can say exactly why. Does being poor cause people to become obese, or does being obese keep people poor? What does seem clear is that the economic situation faced by seriously overweight people can make it harder for them to make the exercise, diet and lifestyle changes that promote weight loss. More healthful foods, such as fresh fruits and vegetables, generally cost more than less nutritious alternatives like fast-food cheeseburgers. And the costs of weight loss programs, personal trainers and gym memberships can be prohibitive.
The number of Americans who are considered obese has doubled in the last 25 years, according to the Centers for Disease Control, and now accounts for more than 30% of the population. The number of morbidly obese people (generally defined as 100 pounds or more overweight) has grown to 9 million.
Last year Jay Zagorsky, an economist at Ohio State University, released a study that followed 2,000 teens for two decades, tracking their weight and wealth. By the time the teens reached middle age (39 years old), there was a sharp disparity in their finances. Normal-weight people had accumulated nearly twice as much wealth as those who were obese (about a third of the original group).
The differences can be explained, in part, because obese people earn less money on the job and inherit less money from their parents, Zagorsky said. “It may be a small difference each year,” he said, “but it adds up over time into something much bigger.”
Sara Flammang, a 44-year-old Tustin woman, understands well how costs can mount. At 5 foot 3 inches and 324 pounds, Flammang has rarely dated since her teen years, has never married and supports herself with a supervisory job at a financial services company. She believes she was passed over for promotions with previous employers because of her weight. Having never graduated from college, she enrolled at a local college but dropped out because she was embarrassed when she couldn’t fit into the desks.
And there are other costs. Flammang shops for expensive plus-size clothes on the Internet because she can’t wear what’s sold in most stores. Two years ago she spent several thousand dollars more than she wanted to on a couch that was sturdy enough to support her large frame. Flammang has been diagnosed with high blood pressure, asthma and sleep apnea; she also suffers from chronic back and knee problems. She estimates that she pays about $3,000 a year out of pocket for medical costs. That includes $150 a month, not covered by insurance, in medication for asthma and acid reflux disease exacerbated by her weight, and twice-weekly visits to her chiropractor, at $15 each. The sleep apnea, which is relatively common among the severely overweight, causes her fatigue throughout the day.
Like many obese people, Flammang spends a lot on diets. Over the years, she’s tried Weight Watchers, NutriSystem and Jenny Craig, among others, and she has spent money on nutritionists and gym memberships. Last year she considered gastric bypass surgery but decided against it after her health insurer required that she pay $250 for a psychiatric exam, $300 for a physical exam and $200 for a nutrition class before it would authorize the costly procedure.
Zagorsky, the Ohio State researcher, has found that people who significantly decrease their body weight may see a corresponding rise in their personal wealth. Their salary likely increases once they lose the weight, he says.
Flammang hopes it isn’t too late for her. This spring she began a two-month program at the Lindora Medical Clinic in Costa Mesa, which is costing about $1,000. She has lost 37 pounds so far. Last month she accepted a promotion at work and now manages four employees.
“I honestly don’t think I would have taken the promotion before,” she says. “I would have worried I wasn’t up for it or would be too tired. But I am feeling better than I have in a long, long time.”
