A reduction in BMI among adults is associated with lower health care spending, study suggests

Adults with employer-sponsored insurance see estimated cost savings of 7% with a 5% BMI reduction and 30% with a 25% BMI reduction

In a recent study published in JAMA Network Open, researchers estimated the amount adults with overweight or obesity spend on healthcare if they have Medicare or insurance sponsored by their employers and the effect of body mass index (BMI) on spending.

They found evidence of substantial savings associated with weight loss for people with both forms of insurance, particularly for those who had other health conditions.

Background

Obesity among adults in the United States rose from 31% to 42% between 2000 and 2020. To meet recommended BMI levels, approximately 73% of adult individuals must lose weight. Excess weight is associated with a higher risk of chronic diseases such as pulmonary disease, osteoarthritis, cancer, heart disease, hypertension, and type 2 diabetes.

Obesity-related diseases contribute significantly to rising healthcare spending, with obesity linked to over $260 million in healthcare costs in 2016 and expected to rise to $385 billion by 2024. Most costs are paid by insurance through employment, with Medicaid and Medicare covering approximately 25%.

In the workforce, obesity among employees is known to lead to health costs and higher rates of accidents in the workplace. Workers who are obese have double the number of workers’ compensation claims, triple the number of workers’ compensation days, medical claims costs that are seven times higher, and indemnity claim costs that are 11 times higher.

People who have a BMI over 35 increase their risk of having type 2 diabetes in their lifetime by 70% or more, while a five-point increase in BMI increases the probability of heart failure by approximately 30%. Excess weight also increases the risk of hypertension by between 65% and 78%.

Interventions such as lifestyle programs are cost-effective and can reduce weight by 5-7%, while bariatric surgeries, though effective, are expensive and associated with risks and revisional procedures. Medicare covers the latter for individuals who have a BMI over 35 and comorbidity and those with a BMI over 40.

An emerging treatment is the use of glucagon-like peptide-1 (GLP-1) medications, which can reduce weight by up to 12%; approximately 25% of users lose over 20%.

About the study

In this study, researchers evaluated reductions in healthcare spending reductions due to weight loss, including Medicare spending. They included data from cross-sectional surveys conducted between 2001 and 2016 and in 2018 and 2020, focusing on adults who had insurance through their employment or Medicare. The dataset was nationally representative and included self-reported information on healthcare use, insurance, and medical conditions.

Researchers focused on adults between the ages of 24 and 64 who had a BMI of 25 or more, including those with children between 11 and 45 in their household and excluding people with expenditures over $506,000, missing data, adults with a BMI over 80, and pregnant women. The medical conditions analyzed include arthritis, heart disease, asthma, mental health disorders, hypertension, hyperlipidemia, and diabetes.

Using this information, researchers calculated healthcare spending after adjusting for household composition, region, education, race, gender, and age and focusing on how spending changed with BMI levels reduced by 25%, 20%, 15%, 10%, and 5%.

Findings

The study analyzed healthcare spending for 13,435 adults with insurance through employment and 3,774 Medicare beneficiaries, all with a BMI of 25 or higher. The results showed a clear association between BMI and increased healthcare costs in both groups.

For employer-sponsored insurance, each 1% increase in BMI over 30 was linked to an additional $326 in annual spending. For Medicare, the increase was $633. Racial disparities were observed, with Hispanic and non-Hispanic Black adults spending less than non-Hispanic White adults.

Weight loss was associated with significant reductions in healthcare spending. A 5% weight loss resulted in savings of $670 (8%) for employer-sponsored insurance and $1,262 for Medicare. A more substantial 25% weight loss led to savings of $2,849 (34%) for employer-sponsored insurance and $5,442 (31%) for Medicare.

These savings were more pronounced for individuals with higher baseline BMIs, particularly those with chronic conditions. For example, a 15% weight loss among employer-sponsored insurance participants with arthritis resulted in savings of $4,950, while among Medicare participants with hypertension, savings were $3,709.

Overall, the study found that reducing BMI, especially in individuals with higher baseline BMI and chronic conditions, could lead to substantial healthcare savings in both employer-sponsored insurance and Medicare populations.

Conclusions

Significant annual savings are projected from weight loss for both Medicare and employer-based insurance, especially for those with higher baseline BMI levels. However, the study does not account for potential savings from preventing conditions linked to excess weight. Improving access to weight loss treatments and medications could help reduce obesity-related healthcare costs.