Linking Obesity and Health Care

Why We Should All Want to Reduce the Rate of Obesity in Our Country

Emilie Openchowski explains how the rising rate of obesity in America will increase the cost of health care for all of us and why we should care about reversing the overweight trend with new public policies.

There’s little doubt that obesity—having a body mass index count higher than 30, when a healthy number is between 18.5 and 24.9—and its negative health consequences are some of the greatest challenges our society faces today. A recent study published in the American Journal of Preventive Medicine this month predicts that 42 percent of Americans will be obese by 2030, and 11 percent of the population will be severely obese—or roughly 100 pounds overweight—by that year.

These rates mean an additional 32 million people would be characterized as obese—triple the number it was half a century ago—causing the health care costs of obesity to rise by a stunning $550 billion over the next two decades. If something isn’t done to counter this trend—regardless of whether Obamacare is ruled constitutional in the Supreme Court—health care costs will be more than unaffordable for the average American and maybe for our country as a whole.

Obesity in America

Currently, approximately one-third of the U.S. adult population and 17 percent of American adolescents are obese. These Americans are much more likely to develop obesity-related ailments requiring medical treatment—such as type 2 diabetes, heart disease, and kidney failure—than their healthy counterparts. One study published in January in the Journal of Health Economics found that annual medical spending for an obese person was $3,271, compared to the $512 for a nonobese person. This adds an estimated $190 billion per year in health care spending as a result of obesity, or 20.6 percent of total health care expenditures in America. Being severely obese can increase health care costs by approximately 50 percent.

Obesity-related health care costs are partly paid for by nonobese Americans through taxes to support Medicare and Medicaid and higher overall insurance premiums. In much the same way that nonsmokers end up paying in part for health care costs associated with smoking tobacco, or the insured pay for emergency care for the uninsured, everyone shoulders the burden for needed health services. This means we all can expect taxes and premiums to soar if the number of obese people grows as projected.

Aside from the financial cost of obesity, the societal and physical costs are also incredibly debilitating. The effects of obesity on worker productivity are high: Obese men take 5.9 more sick days per year and obese women take 9.4 more sick days per year than do their healthy counterparts. This absenteeism costs employers up to $6.4 billion per year and therefore has serious implications on our economy’s overall health.

Studies also show that obesity-related illness can affect worker productivity even when employees are at work. According to Eric Finkelstein, Duke University health economist and lead author of the American Journal of Preventive Medicine study, obese workers can lose up to one month of productive work per year just from being unable to keep up physically at work. At a rate of $3,792 per month per obese male worker and $3,037 per month per obese female worker, this “presenteeism” means a bottom-line loss for employers of $30 billion per year.

Obesity, poverty, and children

Not only is the present workforce getting wider—our future workforce is also increasingly overweight. Childhood obesity is an epidemic in this country, with approximately 3,600 new cases of type 2 diabetes cropping up yearly in children—once considered a portion of the population that rarely, if ever, suffered from that affliction. According to First Lady Michelle Obama’s Let’s Move! campaign, if we continue along this path, one-third of all children born after 2000 will develop diabetes in their lifetime.

Childhood obesity and overweight rates are especially high in families living below the poverty line. Whereas one in three children in the general population is considered overweight or obese, a staggering 44.8 percent—almost half—of children in poverty fall into these categories. Many researchers argue that this trend is in part due to the higher prices of healthier, perishable foods such as fruit and vegetables when compared to foods with long shelf lives, including chips and soda. In other words, “families get fatter as they buy cheaper and less healthy foods in order to try to fill up.”

Hunger and obesity are closely linked for many of these families living below the poverty line. Though they can take advantage of the Supplemental Nutrition Assistance Program designed to help them put food on the table, oftentimes the program benefits don’t cover more expensive foods such as fresh produce, so they are forced to choose the cheaper and less healthy food items. There are also plenty of people living in poverty who would perhaps rather eat more healthful foods but live in areas called food deserts—places that just don’t have access to foods such as fresh fruits and vegetables because full-service grocery stores don’t exist within a reasonable radius.

How community schools could help

One way the Center for American Progress believes we can help lift these families out of poverty and make healthier options more available to them is to pair antipoverty strategies with schools. These so-called community schools enable teachers, principals, and other staff to “concentrate on what’s happening in the classroom with the knowledge that students’ ‘outside’ needs are being addressed.”

It is well-documented that poor students are extremely affected in the classroom by issues related to poverty and that the malnutrition and other food issues that many poor students face cause a lack of concentration and motivation in school. But one problem families in poverty face when trying to take part in programs such as Medicaid, the Supplemental Nutrition Assistance Program, and Temporary Assistance for Needy Families, is accessibility—meaning many Americans don’t know about or can’t easily qualify for these programs, or if they do figure it out, they choose not to participate because of the stigma surrounding social welfare programs.

Schools are well-positioned to deal with these issues because they have the best access to poor students, are entrenched in communities and thus are familiar institutions, and have already-established relationships with poor students and their families. These schools are a great way to connect families with programs such as the Supplemental Nutrition Assistance Program, the Women, Infants, and Children nutrition assistance program, and other healthy food bank resources for families that need help.

Other schools also have experience providing services to needy families in off-peak times—federal programs in place make it possible for these schools to provide meals for poor children after school and over the summer, when many kids go hungry or are forced to choose cheap, unhealthy options because they can’t access or afford a well-balanced meal.

Centralizing these antipoverty programs under one roof—in schools—can combat the issues of accessibility and stigma, and will help relieve the pressure many families feel, which in turn will alleviate stress for poor students. At the same time it will help families make better, healthier lifestyle choices, all of which leads to healthier children and thus better students.


Community schools are a good start to working to combat obesity, hunger, and poverty in America, but the idea should be expanded further to reach the children who are not attending school and are unemployed, as well as the families without children. Already some programs exist—the Child and Adult Care Food program that provides meals at child-care centers and homeless shelters, for example—but these can be expanded further and enhanced. In order to ensure a better future for ourselves, our children, and our pocketbooks, concrete steps must be taken to promote obesity prevention, and to incentivize healthy decisions (and disincentivize unhealthy ones) for everyone.

Obesity-related disease, much like the cancer found in smokers, is for the most part preventable. Including prevention provisions in any health care laws is key, mainly because it promises to contain costs better than mere treatment of obesity-related ills. A 2008 study found that investing $10 per person in activities that work to improve health and prevent chronic diseases could save the country $16 billion annually.

The Affordable Care Act is a vital piece of legislation that not only addresses these prevention questions but also creates grant programs for schools to establish school-based health centers, which expand the premise of community schools to provide antipoverty programs along with academics to their students.

A third of our nation already suffers from preventable afflictions caused by obesity. As Duke University health professor Eric Finkelstein told The Washington Post, “The world has changed in ways that allow people to be that overweight.” It’s past time to reverse that trend, especially if we as a society don’t want to sink under the weight of obesity’s health care costs.

Emilie Openchowski is an Assistant Editor at the Center for American Progress who works closely with the health care and poverty teams at the Center.

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Emilie Openchowski

Assistant Managing Editor