The hidden (and the not-so-hidden) costs of obesity

Most people know that the chronic illnesses linked to obesity—such as diabetes and heart disease—are expensive to treat, but there are a number of less obvious costs of obesity as well—and they’re the type of costs everyone pays. For example, the additional jet fuel needed to fly heavier Americans, compared to fuel needed at the average weight of Americans in 1960, is $5 billion annually.

In fact, the total costs related to obesity and being overweight in this country totaled $270 billion in 2009. Although genetics and other factors beyond people’s control undoubtedly play a role, much of this expenditure is preventable.

In 2014, no state had a prevalence of obesity less than 20 percent, and only five had a prevalence of less than 25 percent. Three states (Arkansas, Mississippi and West Virginia) had more than 35 percent of their population obese that same year. Nationwide, more than one third of adults are obese and about another third are considered overweight. Since 1960, the number of obese Americans has tripled.

“In the past 20 years, we’ve seen a pretty dramatic rise in obesity,” said Jay E. Maddock, Ph.D., dean of the Texas A&M Health Science Center School of Public Health, whose research focuses on social ecological approaches to increasing physical activity. “and it’s costing us so much, it’s very much a fundamental problem of modern society.”

Traditionally, the public health focus has been on preventing obesity in children, because kids are overweight have a much higher probability of becoming overweight or obese adults. This may be partly due to what their mothers ate while pregnant: studies have shown that to a certain extent, the obesity risk may be determined even before birth.

Still, it doesn’t help when schools use food for reward—like a pizza or ice cream party for a class that does something well—and physical activity as a punishment. “Kids should be moving throughout the day,” Maddock said. “Don’t take away recess as a punishment, but at the same time, don’t make the troublemaker run laps, or kids will start to associate exercise as something bad.”

These sorts of policies might be partly why approximately 17 percent of children and adolescents (2–19 years old) are obese, and about 27 percent of American young adults (17–24 years old, the prime recruiting age) are too overweight to be able to serve in the United States Armed Forces. “We have fewer kids who are even eligible to serve coming out of high school, and that’s a national readiness and national defense issue,” Maddock said.

There are also economic costs of lost opportunity. A study by researchers at the Brookings Institution found that 15-year-old boys in the 90th percentile or above of body mass index (BMI) are 3.3 percent more likely to drop out of school in the following year than their counterparts in the second and third BMI quartiles; 16-year-old girls in the 90th percentile or above are 12 percentage points less likely to complete the next-higher grade in school.

However, that’s not to say that there’s nothing that can be done to lower kids’ weight into the healthy range. Texas A&M researchers are working to reduce childhood obesity along the United States-Mexico border. There are also a number of small steps parents can take to help their children maintain a healthy weight, and standing desks may improve calorie expenditure.

“This is so important, and many of the changes are fairly inexpensive and simple, and the cost savings can be tremendous,” Maddock said. “We need policies and environments that make the healthy choice the default choice.”

Both public and private health insurance incur the high health care costs of treating obesity-linked diseases, which means that everyone pays the cost in terms of higher taxes or premiums. On average, an obese worker accrues $5,530 more per year in medical costs than one at a healthy weight. For comparison, smokers’ medical costs were only $1,274 per year higher than nonsmokers’.

“Obese workers are absent more often, tend to get injured more often, and are possibly not as productive while they are there,” Maddock said. Just one “very obese” male worker costs his company $1,026 per year in absentee costs alone.

According to the Texas Comptroller of Public Accounts, in 2009, the costs attributable to obesity—including health care costs, absenteeism, disability, and lost productivity—in Texas alone cost business $9.5 billion, and if current trends continue, that number could be $32.5 billion in 2030, when more than 44 percent of adults are expected to be obese.

Texas A&M is working on several different strategies to combat this problem. One of the main ways is through getting people to walk and stand more as part of their daily routines. “The percentage of the population that gets the recommended amount of exercise has stayed about the same,” Maddock said. “But the amount of time that we move throughout the day, on average, has decreased.”

Standing desks can help, as can leaving the car in the garage and walking for transportation. Due to zoning laws in much of the country that separate residential areas from commercial, people are forced to drive to get to work or to the store. That’s slowly changing, and researchers at the School of Public Health are working with the College of Architecture on a grant to study the Mueller district in Austin, a planned mixed-use community. “It has been shown that if areas are more walkable, people do walk more,” Maddock said. “It’s all about how we design and build our communities.”

“There’s no one thing you can do to cure obesity,” Maddock added, “but there’s a lot of things that if you do all of them together, you can really make a shift in population health.”