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So, obesity is a serious problem. And it does drive up health care costs in the US. But, and we know this seems counterintuitive, weight loss doesn't necessarily bring down health care costs. Aaron Carroll tells you why.

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I wanna talk about one paper this week, which came out recently. People talk about obesity and how much it costs all the time, but are the numbers real? How much can we really save by combating obesity? This is Healthcare Triage News.

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The study's entitled "Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status." As the paper notes, the prevalence of obesity has more than doubled in the United States in the past three decades. And of course, obesity can lead to diabetes, cardiovascular disease, and other serious problems.

This study was an attempt to use Medical Expenditure Panel Survey, or MEPS data, to see how much losing weight might save people in healthcare costs, both with and without diabetes. The top line results showed that, on average, obesity raised healthcare costs by just over $3,500 per person. That means that obesity costs the United States more than $315 billion a year.

And it's important to dig down. The costs are not equally spread over obese individuals. People with class 1 obesity, or those whose BMI is greater than 30 but less than 35, pretty much have no elevated healthcare costs. When we say lots of people in the United States are obese or overweight, many of them still have BMIs less than 35.

What is a BMI of 35? Well, for a male who's somewhere between 5'9" and 5'10" like me, that would be about 240 pounds. That's definitely obese. I could weigh like 60 more pounds than I do now and still not incur any significant increased healthcare costs.

The paper further reports that a person who has a starting BMI of 40, and can lose 5% of their weight, might expect to see reductions in healthcare costs of $2,137. But only about 6% of adults have a BMI that high. That's about 275 pounds for someone of my height.

The savings also depend on whether you have diabetes. For instance, the savings that might be achieved by a 5% weight loss for a person with a BMI of 40 is $2,123 if they have type 2 diabetes, but only $643 if they don't.

Please hear me. There are lots of great reasons for people to not be obese. A lot of those are about quality of life, or how you feel, or what you can do, or even how healthy you are in general. I'm not saying that obesity isn't a problem in this respect.

My point is this: focusing on money and talking about the costs of obesity in the aggregate makes it sound like if everybody in the United States would just lose a little weight, we'd save massive money. But it's not that simple. The vast majority of the costs of obesity are located in a relatively small group of people, those who are extremely obese and have diabetes.

If our goal is to reduce the cost the United States for obesity [sic], we should likely focus on that small group of people, who are also likely the hardest to reach and influence. Trying to get lots of people who have a BMI of 30 to 35 to lose some weight might make them feel better, but it won't influence healthcare spending in the United States much at all.

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