Q+A: The economic case for obesity treatment

medical costsCan putting a price tag on childhood obesity propel treatment and prevention efforts into comprehensive action? Perhaps, says David Ludwig, MD, PhD, of Boston Children’s Hospital.

Although the U.S. Task Force on Childhood Obesity set a goal of dropping obesity prevalence among youth to 5 percent by 2030, efforts have failed to make a significant dent. Recent data indicate only slight dips in obesity prevalence among 6- to 19-year-olds in some states. And other data show that the prevalence of extreme obesity in children continues to rise.

With nearly 20 percent of U.S. children tipping the scales as obese, policymakers need not only to act but also to justify the investment in childhood obesity treatment and prevention programs.

Duke University researchers offered a helping hand in a review article in the April 7 online Pediatrics, estimating the incremental lifetime direct medical cost of childhood obesity. Their economic model showed a $19,000 incremental lifetime medical cost of an obese child relative to a normal-weight youth.

Ludwig, who directs the New Balance Foundation Obesity Prevention Center Boston Children’s Hospital, provides insights into the next steps.

Vector: How does this model add to our understanding of childhood obesity?

Ludwig: Our failure to systematically address childhood obesity is the ultimate penny-wise and pound-foolish approach.

Obesity can affect virtually every organ system in a child’s body in the short term, and increase long-term risk for many chronic diseases. Today, more children are carrying more weight from an increasingly early age, with potentially devastating medical and economic consequences. Obesity directly increases health care costs in adults through the need to treat patients with obesity-related conditions such as diabetes, heart disease and orthopedic problems. Other indirect costs include lost work days, which reduces overall economic productivity.

This review shows that the economic toll begins very early.

Vector: The clinical case seems clear. Are there economic constraints to preventing and treating childhood obesity?

Ludwig: Absolutely. Many insurance plans either don’t compensate for obesity treatment or do so inadequately by offering a maximum of only three visits. Obesity is a chronic disease; other chronic diseases, such as asthma and cancer, are not managed or reimbursed in this limited way.

As a chronic condition, obesity requires long-term treatment. The problem with the conventional insurance structure is that the companies that pay for childhood obesity treatment don’t realize the economic benefits of the treatment. They only incur costs. The benefits—reduced prevalence (and costs) of obesity-related conditions in adulthood—accrue in the future, when that child will likely be with a different insurance provider.

Vector: Is there an alternative structure that would better reflect the true costs of treatment and prevention?

Ludwig: Our current reimbursement structure works for acute care, albeit at a high cost, but fails in the area of chronic care and prevention.

A single-payer reimbursement structure is much more sensible for treatment and prevention of chronic diseases, because with a single-payer system, the payer doesn’t care when the savings are realized. It just matters that the system eventually sees the savings from treatment and prevention. This system can take the broadest view of what’s best for public health.

Vector: What next steps are required to reach the U.S. Task Force goal?

junk food
The public can vote two ways, Ludwig says: with the ballot and with the fork.
Ludwig: Despite high levels of attention to childhood obesity, we lack a truly comprehensive approach to the problem. Although Michelle Obama and other leaders emphasize healthy nutrition and physical activity, this message is undermined by junk food marketing campaigns aimed at children. In addition, opportunities for recreation have been curtailed.

During World War II, we developed a comprehensive strategy that allowed every component of society to work together to achieve a great goal, the defeat of fascism. We won with a sustained, concerted effort that united people even at the cost of individual sacrifice.

Unfortunately, the food industry has, as a whole, not been inclined toward sacrifice of its special interest in the best interest of society. To make matters worse, ongoing negotiations in Washington D.C. have not considered how to expand the Supplemental Nutrition Assistance Program (food stamps) to impoverished families, but instead focus on how much to cut back. The public health community and consumer interest groups do not have as loud a voice as special interests regarding obesity-related policy, and continuing erosions of campaign finance regulations threaten to make this situation worse.

But it’s important to remember that the public ultimately gets to vote two ways: with the ballot, for representatives who will put public health in front of private profit; and with the fork, thereby giving food companies an incentive to market more healthful foods.