“We frequently hear that obesity represents a high cost for each individuals and society since it increases the danger of health problems. All in all, nonetheless, the prices related to being obese are much higher,” says Christina Hansen Edwards, a researcher on the Norwegian University of Science and Technology (NTNU).

Because the Nineteen Eighties, Norwegians have develop into increasingly heavier. Over the past 40 years, the share of individuals with obesity, i.e., a body mass index (BMI) of over 30, has increased significantly. It’s currently estimated that nearly one in 4 Norwegians is obese, which is comparable to obesity rates throughout Europe.

Healthcare costs related to obese and obesity at a person versus a population level – a HUNT study. Image Credit: Recent Africa / Shutterstock

Nevertheless, the variety of people who find themselves ‘only’ obese has also increased. From 1980 to 2000, the common BMI of the population increased by one point every decade.

“We’re seeing a shift in the whole population towards a better BMI. Individuals with a BMI within the ‘normal range’ have also gained weight,” says Edwards.

The researchers have now examined the connection between BMI and costs within the specialist health service.

“Although the person costs are highest for people who find themselves obese, the full costs for society are highest in relation to people who find themselves obese, since there are a lot of more people who find themselves obese than obese,” says Gudrun Maria Waaler Bjørnelv, a researcher at NTNU’s Department of Public Health and Nursing.

Population-level measures needed

In other words, although the danger of disease is higher in case your BMI is over 30, the general risk of disease in the whole population will likely be greater with a BMI of over 25. It is because the overwhelming majority of individuals find themselves inside this range on the size.

Edwards thinks it will be significant for politicians to concentrate on this when managing health and societal resources.

“Individuals with obesity need good treatment from the health services. Nevertheless, with a view to ease the burden of disease and the prices of obese and obesity in the whole population, individualized treatment ought to be combined with effective measures on the population level,” says Edwards.

The study relies on figures from the HUNT Study – a longitudinal population health study in Norway. It shows that 75 percent of men and 61 percent of ladies were obese or obese.

Of those, 3.7 percent of men and 6.6 percent of ladies had a BMI of over 35, while 22.4 percent of men had a waist measurement of greater than 102 cm, and 23.4 percent of ladies had a waist measurement of over 88 cm.

“At the person level, we saw that a rise in BMI resulted in the best increase in expenses for the specialist health services amongst those that previously had the best BMI. If one compares a person with a BMI of 37 to a person with a BMI of 38, on average, the latter will end in NOK 2110 (roughly US $210) more in average costs for the specialist health services per yr. The same difference in men with a BMI of 27 and 28 respectively will only end in a rise of NOK 293 (roughly US$ 29),” Edwards said.

Shouldn’t feel ashamed

Similar comparisons amongst women show differences between NOK 1306 (US $130) and NOK 277 (US $28)—nonetheless, the image changes when the researchers take a look at the population’s figures as a complete.

“On the societal level, against this, we see that the most important increase in costs for the specialist health services was attributable to changes in BMI in those who were ‘only’ obese, i.e. they’d a BMI of between 25 and 30, in addition to in those with mild obesity, i.e. a BMI of between 30 and 35. This was true for each ladies and men,” says Bjørnelv.

She emphasizes that the purpose of the comparison shouldn’t be primarily to save lots of the health service money but that the specialist health service costs reflect the burden of disease in individuals and society.

“Individuals with obesity mustn’t feel ashamed that they cost society money,” Bjørnelv said.

“Obesity is usually portrayed as expensive for society,” he said, referring to the Norwegian Broadcasting Corporation’s series ‘A fat life’.

On this TV series, host Ronny Brede Aase uses himself and his own body to make clear questions on obesity, lifestyle, and health. Within the series, Aase says that he’s “an expenditure,” which Bjørnelv says shouldn’t be necessarily correct.

“Individuals with obesity mustn’t feel ashamed that they cost society money. Although they’re at higher risk of disease, the best specialist health service costs result from those that are obese,” he said. “We don’t desire people who find themselves obese to feel ashamed due to that, but we should be reflective in how we make clear the difficulty and the way we take care of this as a society.”

Recent research has shown that individuals with a high BMI have an increased likelihood of being stigmatized and discriminated against, also within the healthcare system.

“This may cause individuals with a high BMI to avoid the usage of health services, in order that they receive poorer health services and the connection between doctor and patient is broken. This can be a field where there’s a transparent need for more research, for instance on how stigma affects the prices of health services in the long run,” Bjørnelv said.

Consensus on risk

The researchers are also keen to emphasise that BMI as a unit of measurement is primarily vital when taking a look at obese and obesity in groups and never in each individual.

“BMI alone shouldn’t be an appropriate measuring unit at a person level, but at a population level it may give a superb picture of obesity and obese,” Edwards said.

She clarifies that the ends in the study are average costs for various BMI values and that there are variations around this average. A single person with a given BMI will, subsequently, be unable to make use of these results to say anything about their very own costs.

It’s also not a provided that being obese results in health problems.

“That is where the variation is available in. An individual with a BMI of 33 doesn’t necessarily have higher costs for health services than an individual with a BMI of 23. But when we take a look at the common of all individuals with a BMI of 33 and 23, then individuals with a BMI of 33 have higher costs for health services than those with BMI of 23,” she said.

Due to this fact, direct measures to the whole population can be more appropriate.

BMI is thus primarily a useful unit of measurement on the population level and fewer useful for people.

“In our study, we investigated the connection between BMI and healthcare costs,” she said.

Although many alternative aspects can influence this relationship, there’s broad agreement amongst researchers that a rise in BMI increases the danger of numerous diseases, Edwards said.

Due to this fact, the researchers concluded that it will be appropriate to implement measures targeting the whole population.

“The challenge then is checking out which measures work,” says Edwards.

So, what should health policymakers do? Bjørnelv and Edwards imagine that studies should be conducted on the effectiveness of national public health measures.

“The measures that were introduced as a part of the Smoking Act were unpopular after they were introduced, but eventually this turned around completely. Similar measures, resembling promoting bans, taxation, and access restrictions on unhealthy food, might have been tested to beat the obesity pandemic. This requires brave politicians who dare to take controversial decisions,” Edwards said.