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Tuesday, January 25, 2011

More pile on the band wagon of demonizing the obese

DrRich has written this essay on the topic of demonizing the obese. Now the legendary and feared (feared at least by employees whose boss hires them to "help cut costs") McKensey group has joined the chorus singing the horrors of the obesity epidemic.They have determined the real cost of obesity which is supposed to be in the U.S.450 billion per year which is three times the direct medical costs.So what are the other costs?

They include in the overall cost of obesity the increased cost of food and of purchasing extra sized clothing. somehow they consider purchases of food and clothing to be some mythical "cost to society". I wonder if someone at McKensey actually sat in on economics 101 and learned that one person's cost is another's stream of income. Buying food, regardless of one's BMI, is not a cost to society but just a market transaction just as it is when the thin person buys a car. However, economics can be such a subtle and counter intuitive discipline.Apparently giving folks money to buy new cars was thought to stimulate the economy (remember cash for clunkers) but some "incremental" money spent by the obese on extra food and big shirts is a cost to society.

McKensey speaks obesity as a pandemic, the whole world is getting more obese and they contend that the problem is so vast and important than "governments must lead the fight against obesity" Well at least they didn't call it a war.

The McKensey group has been knee deep in health care policy matters for some time. Dr. Robert Kocher has been in and out of the group serving in between with President Obama's Council of Economic Advisers. He was a co-author of this fluff piece promoting Obamacare that appeared in the Annals of Internal Medicine and will be long remembered for this incredible quote; "It (Obama care) guarantees access to health care to all Americans."

While it has become dogma that the obese increase health care costs because of their increased incidence of such things as heart disease and arthritis and that by mitigating obesity there will be cost savings ,one should be aware of a attractive counterargument .Simply put that argument is that the obese will die at a younger age and therefore it is at least logically possible that they will consume less health care service overall. This is exactly what this article from Dutch authors concluded based on a series of simulation mathematical model scenarios. Here is a quote:

As with all mathematical models such as this, the accuracy of these findings depend on how well the model reflects real life and the data fed into it. In this case, the model does not take into account varying degrees of obesity, which are likely to affect lifetime health-care costs, nor indirect costs of obesity such as reduced productivity. Nevertheless, these findings suggest that although effective obesity prevention reduces the costs of obesity-related diseases, this reduction is offset by the increased costs of diseases unrelated to obesity that occur during the extra years of life gained by slimming down.

Over ten years ago I did some consulting to a large intentional petrochemical company. One day a group came by hawking their employee wellness packet .After their presentation, a Human Resources manager asked will not their pension expenses go up if we keep future retirees healthy longer. A refreshingly honest presenter said yes- that was probably so and added that the best thing for a pension plan would be for employees to be healthy productive workers, then retire and die the next day without a prolonged expensive illness .Of course we would never want to do that.

So if cost to "society" is behind the movement to fix the obesity problem maybe we should at least keep the topic on the drawing board even if anti-obesity advocates aren't ready to consider going back to the drawing board.

A public health initiative that improves people's health is a goal many would support but the claim that prevention necessarily saves money is one that is based more on faith than sound empirical evidence.

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