We know obesity increases your risk of having high blood pressure, getting
A study published Monday in the journal Health Affairs found that medical care associated with severe obesity cost state-run health programs $8 billion in 2013. California's program for the poor, known as Medi-Cal, took the biggest hit, spending $1.3 billion that year on severe obesity-related care.
Though the obesity epidemic in America has garnered a lot of attention, there hasn't been enough focus on severe obesity, which has much bigger health risks and associated costs, said Michael Long, study author and assistant professor of prevention and community health at the Milken Institute School of Public Health at George Washington University.
"Within the field there's wide awareness of the much higher clinical severity [of severe obesity] but I don't think policy makers have a clear understanding," Long said in an interview. Though it's vital to continue trying to prevent obesity, he said, we should also be focusing on people who are already obese and "improving their lives, not on just labeling them as a healthcare problem."
Obesity and severe obesity were defined as having a body-mass index -- a measure of weight and height -- between 30 and 35, and 35 and over, respectively. To be considered obese or severely obese, a 5-foot-6 person would need to weigh more than 185 pounds or more than 216 pounds, respectively.
Using these measures, the researchers estimated that 29% of Californians are obese and 11% are severely obese. Though that means California has the nation's third-lowest obesity rate, it doesn't shield the state from high healthcare costs.
Because of its large overall population, California is still home to the greatest number of severely obese people: 3.2 million. And according to the study, that created healthcare costs of $9.1 billion in 2013 in California, with $1.3 billion covered by Medi-Cal and the remainder picked up by other health plans including Medicare.
"The idea that this is a problem in states with very high prevalence is mistaken," Long said.
Every state spends money treating patients who are obese, Long said. His research found that nationally, covering a patient who is moderately obese means a $941 annual increase in healthcare spending, while a severely obese patient means a $1,980 increase, compared with a person of normal weight.
That's why all states should treat obesity as a medical condition, Long said. The American Medical Assn. didn't officially recognize obesity as a disease until 2013, and health plans haven't historically covered therapies to treat it like one.
Anthony Cava, spokesman for California's Department of Health Care Services, which runs Medi-Cal, said he couldn't comment specifically on the study's findings, but that "obesity is clearly a significant driver of health problems and healthcare costs."
He said the department "seeks to improve care and quality of life for Medi-Cal members, while lowering healthcare costs," so it is using multiple strategies to address the obesity epidemic. The department recently evaluated how Medi-Cal managed care plans are encouraging healthful eating and physical activity and running obesity prevention and management programs, he said, and its Child Health and Disability Prevention Program has begun teaching healthful eating and exercise habits to low-income kids and families in several counties.
According to recent national guidelines, 64.5% of Americans are candidates for weight-loss treatment. More than 50% of Americans could be considered for drug therapy and lifestyle therapy; 15% could be considered for bariatric surgery -- a procedure that reduces the size of a person's stomach.
But in 2013, only 26 state-run health programs provided nutrition counseling, 10 provided drug therapy, and 45 provided bariatric surgery, Long said. Medi-Cal covers bariatric surgery and some behavioral therapy.
Long said there's evidence that counseling programs are effective, and more states should offer those treatments. Combating obesity is also a way to contain healthcare costs, which is especially important after states added thousands of people to their health programs under the Affordable Care Act.
"We shouldn't just wait and count up the cases of diabetes," Long said. "We should do something. We should take action to help people have healthier lives."
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