CONTINUING OBESITY EPIDEMIC COULD
INCREASE DISABILITY RATES BY 2020

One In Five Health Care Dollars Spent By 50-69-Year-Olds In 2020
Could Treat Consequences of Obesity, If Trends Continue

Bethesda, MD—Although disability rates among elderly Americans have declined in recent decades, a new study warns that those improvements could disappear by 2020, thanks to rising obesity levels among 50-69-year-olds. RAND researchers writing in the March/April issue of the bimonthly journal Health Affairs predict that if weight gain continues unchecked, disability rates among older adults will rise at a level of 1 percent a year. Consequently, one of every five health care dollars spent by this group would be to treat the health consequences of obesity by 2020.

“Improvements in medical care, public health, and other health behaviors have dramatically reduced disability among older Americans in the past. But the continuing increase in unhealthy weight has the potential to undo many of these gains,” says lead author Roland Sturm, a senior economist at the Santa Monica-based RAND. “If obesity continues to rise at its current rate, disability rates among 50-69-year-olds could increase by 1 percent per year more than if there were no further weight gain,” he says.

Sturm and his colleagues based their analysis on two data sets. The relationship between obesity and costs or health limitations was based on the Health and Retirement Study, a national panel survey of 9,825 respondents born during 1931-1941. Trends on weight are estimated from the 1985-2002 Behavioral Risk Factor Surveillance Survey. By extrapolating trends in different weight groups to 2020 and combining them with the estimated health effects, the authors estimated the effects of continuing weight increases at the population level.

Severe Obesity The Most Serious Problem

Researchers define obesity as a body mass index (a ratio of weight to height) of more than 30, or at least 30 pounds overweight for a woman. Sturm and colleagues found the strongest health and costs consequences among even heavier weight groups, which they say are increasing the fastest. The proportion of Americans with BMI of at least 40 based on self-reported height and weight — roughly 100 pounds or more overweight for an average adult man — has quadrupled between 1986 and 2000 from 1 in 200 to 1 in 50, while the proportion of Americans with moderate obesity has only doubled, according to the report.

Among moderately obese Americans (BMI between 30 and 35) between ages 50 and 69, about 11 percent report some limitation in activities of daily living such as walking across a room or getting dressed, according to the study. That number nearly doubles with a BMI of over 35, the report adds. Similarly, about 27 percent of moderately obese Americans in the age group studied report that their health limits work, compared to nearly 46 percent of Americans with a BMI over 35, the report says.

Corresponding differences also show up in health care costs. While moderate obesity is associated with 20-30 percent higher health care costs than normal weight, a BMI over 35 is associated with a 60 to nearly 70 percent increase, and a BMI of at least 40 more than doubles health care expenditures, according to the RAND analysis.

If obesity trends were to continue through 2020 and health behavior and medical technology stay constant, Sturm and colleagues predict that:

The proportion of 50-69-year-olds with disabilities (limitations in activities of daily living) would increase by 18 percent for men and 22 percent for women between 2000 and 2020.

The fraction of health care expenditures associated with treating the consequences of obesity would increase from 14 percent in 2000 to 21 percent in 2020 for men, and from 13 percent to 20 percent for women.

“Even though disability rates among the oldest Americans have continued to decline, there is no reason to be complacent about obesity,” says Sturm. “Severe obesity rates among Americans over 70 have increased by only half the increase among Americans 50-69. But today’s 60-year-old will be 70 someday, and our results anticipate the obesity consequences among the elderly by a decade,” he adds.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the March/April 2004 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs at 301-656-7401, ext. 230, or via e-mail, press@healthaffairs.org. Selected articles from the March/April issue are available free on the journal’s Web site, www.healthaffairs.org.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research.

©2004 Project HOPE–The People-to-People Health Foundation, Inc.