Public Health & Policy > Health Policy
Fighting Obesity Long Term Will Save Money
— The government might be better served using a longer-term budget window when projecting costs for obesity prevention efforts, a modeling analysis found.
by Chris Kaiser, Cardiology Editor, MedPage Today April 27, 2013
A longer-term budget window for projecting costs in obesity prevention efforts might save the government more money, a modeling analysis found.
The 10-year window used by the Congressional Budget Office (CBO) to estimate costs of proposed federal legislation is often too short for assessing the long-run financial impact of policies involving chronic diseases such as obesity, according to economist Alex Brill, CEO of Matrix Global Advisors and former chief economist and policy director to the House Ways and Means Committee.
"The 10-year window effectively distorts policymakers' perspective on preventive health policies by focusing on the initial cost of the interventions and failing to capture the full scope of the policies' impact in the long term," he stated.
A 75-year budget window, however, would show a huge savings within Medicare and Medicaid as a result of avoiding obesity-related diseases and comorbidities that are common in an aging population, Brill noted in the analysis written for the nonprofit Campaign to End Obesity and published on its website.
Two-thirds of U.S. adults and nearly one-third of children and adolescents are overweight or obese. The estimated total cost of providing healthcare due to obesity -- including nonmedical costs -- is $450 billion annually, according to the paper.
"Properly modeled, effective obesity prevention measures will demonstrate their cost-containment effects outside the 10-year window," wrote Brill.
To demonstrate the potential long-term budget impact from obesity prevention among different groups, the analysis looked at four representative programs or policies, finding the highest potential savings among women.
For instance, obesity screening by physicians, which is recommended by the U.S. Preventive Services Task Force, could yield as much as $44 billion in savings if it prevents 1 million girls, assumed to earn average wages throughout their lives, from becoming obese.
Also, the State Children's Health Insurance Program (SCHIP) obesity demonstration program, which combats childhood obesity in economically distressed communities, could produce as much as $41 billion in savings by preventing obesity in 1 million girls who are and will remain Medicaid beneficiaries.
In addition, the Diabetes Prevention Program (DPP), which sets weight-loss goals for participants through physical activity and healthy eating habits, may yield savings of as much as $18.4 billion if it helps 1 million middle-age women avoid obesity.
Finally, weight-loss drugs under Medicare Part D could yield savings up to $11.4 billion if they prevent obesity in 1 million female seniors.
A 10-year budget window, however, would capture only the cost of the intervention and virtually none of these savings, Brill said.
The analysis pointed out that the CBO's cost estimates are not "designed to account for increase in quality of life and thus omit societal benefits that obesity prevention offers outside the budget."
Brill believes it is important for policymakers to acknowledge societal benefits that impact the projection of cost for healthcare policy. After all, "why should primary prevention be put on the defensive over its successful reduction of premature mortality?" he wrote, citing economist Charles Roehrig.
There is a precedent for the CBO to employ a 75-year budgetary window, particularly in "long-term analyses of Social Security's solvency and the health and economic impacts of tobacco taxes, [which] is the best approach," Brill noted.
"This alternative model would allow policymakers to more easily identify and distinguish between effective and ineffective policies and spending," he added.
Limitations of the analysis include the simplification of potentially important factors; the exclusion of factors such as race and geographic location; the assumption that all individuals practicing preventive health measures reach retirement age; and potentially conservative assumptions about Medicare and Medicaid enrollees.
From the American Heart Association:
Population-Based Prevention of Obesity
Support for this report was provided by a grant from the Robert Wood Johnson Foundation.
Brill is an employee of Matrix Global Advisors.
Campaign to End Obesity
Source Reference: Brill A "The long-run returns of obesity prevention policy" Campaign to End Obesity 2013.