The increasing prevalence of obesity and the health-related costs of obesity
are of concern to healthcare providers, professionals and communities at
large. Two out of every three adults in America are considered overweight
or obese, compared to less than one in every four persons four decades ago.
The economic burden of overweight and obesity is rising in the United
States. The costs associated with overweight and obesity account for $117
billion, over 9 percent of total U.S. medical costs, with $61 billion in direct
costs, and $56 billion in indirect costs.
This economic burden is greater among residents of the South and rural areas.
Dietary quality and quantity, low levels of physical activity, the physical environment,
and certain policies adopted by public and private institutions work in
concert to create an environment where most people find it difficult to maintain
a healthy body weight. Overweight and obesity have been linked to unhealthy
diets and physical inactivity. Kentucky ranks 39th in meeting the healthy
dietary consumption, and second highest in physical inactivity in the nation.
The objective of this study was to estimate the county-level economic burden
of obesity in the rural South. Specifically, 59 counties in Kentucky were
selected. County selection was based on the availability of data via a Medicaid-financed program known as Kentucky Homeplace. Homeplace data served as
the basis for the economic burden of obesity estimates at the county level.
A second objective was to develop a methodology that could be applied to
limited data sets to estimate the economic burden of obesity at the county or
community level. To date, the literature on the economic burden of obesity has
focused on estimating National and State-level expenditures. However, this
same information may be useful to local decision makers as they too face
resource allocation decisions related to preventing or reducing obesity at the
community level. This research is the first known effort to estimate the
economic burden of obesity at the county level.
In estimating the economic burden of obesity at the county level, it is
important to focus on the out-of-pocket expenditure category. As medical
costs are shifted to these patients, Medicare, Medicaid, and private insurance
obesity-related expenditures are shifted to taxpayers and to insurance
companies mostly located outside of rural communities. The burden of out-of-pocket expenditures thus falls on the households located in the study
counties. The results indicate that the economic burden of obesity is significantly
higher for obese individuals compared to normal weight individuals.
This finding is of particular interest to Medicare and uninsured individuals.
These findings may not be generalizable to the population, as the sample
has an over-representation of older, female population compared to the
population at large. However, this limitation does not affect the general
process used to estimate the county-level economic burden of obesity; it
does point to the need to check sample statistics.
This study found the out-of-pocket economic burden of obesity for the 59
Kentucky counties was nearly $38 million. This burden is distributed in
differing degrees within counties based on their sociodemographic characteristics
and levels of obesity, and is not solely a function of population size.
This economic burden on individuals could present an opportunity for a
county willing to invest in obesity prevention or reduction measures.