Thursday, July 9, 2009

More on Chubby People

Matt Yglesias deals with part of the "news" about obesity: obese people don't necessarily suffer from shortened lives because of their obesity. Actually, the Washington Post (apparently his main source) doesn't get even this quite right: no one lives longer than the obese; most of the obese are well above the life expectancy of the non-obese, and only the most severely obese are "down" to the mortality of the non-obese. The Post says "better treatments are keeping them alive nearly as long" as the non-obese. As far as anyone can tell, it is obesity itself that is keeping them alive--either as long as the non-obese, or longer, not "nearly" as long.

As Yglesias and his sources struggle with the thought that the obese have long lives, they naturally start to think: ah, but they must be miserable lives due to their obesity--it would be a health benefit them to lose weight.

..but they’re much sicker for longer, requiring such costly interventions as knee replacements and diabetes care and dialysis. Medicare spends anywhere from $1,400 to $6,000 more annually on health care for an obese senior than for the non-obese, Levi said.

Sandy Swarc summarizes the most reliable research: higher body mass index (BMI) generally correlates not only with longer life, but with better health. There are only two health risks that even correlate with high BMI:

The only statistically significant inverse correlations to the men’s BMIs were with diabetes and hypertension — but they didn’t affect the men’s mortality rates, perhaps because, as we’ve seen, heavier people with both conditions have lower health complications compared to slender people with those conditions. Other popular myths weren’t supported in this study, which also won’t surprise regular readers who’ve followed the research. The men who gained weight as they aged and those who lost weight to achieve a normal weight had identical rates of developing diabetes, and the same cholesterol levels and blood pressures, as they aged.

Men who stay thin into old age may be more likely to avoid diabetes and high blood pressure--perhaps the only health advantages for this body type. Men who lose weight develop these conditions at the same rate as those who stay chubby--and to repeat, on mortality and all other known health indicatos, the obese are the best off of all.

This is important because it contributes to thinking about health policy. Yglesias says:

This is basically good news, since the sort of measures that could create more opportunities for healthy diet and exercise habits are themselves relatively cheap compared to the delivery of health care services. But it’s long been a bit unclear as to whether or not cost-effective measures along those lines would actually pay for themselves in terms of reduced medical costs down the road. Insofar as that does seem to be the case, it further strengthens the argument that we can afford to build a healthier society. I don’t actually think it makes a ton of sense to argue that we should promote wellness in order to save money. Rather, we should promote wellness in order to produce healthier, longer-lived, happier people. But if such measures are cost-negative, that strengthens the case for taking the necessary steps.

Even though he favours single-payer health care, he doesn't want to take the Swiftian step of saying we should do whatever saves the most money--that might lead to some ghoulish suggestions. But he is impressed that getting people to lose weight might save money in addition to the benefits for the individual. The best research, however, suggests that the health benefits of losing weight are difficult to detect. People who have lost weight are likely to die sooner--which will save money. If weight-loss programs are only one part of general "wellness" and "prevention" programs, including testing for diseases among a mainly health population, this is likely to get extremely expensive. It is simply wishful thinking to say that if people ate more fruits and vegetables, there would be savings to the health care system. If people actually live longer, they are likely to be more expensive overall. Even if they don't, there are huge expenses involved. For some reason defenders of Obama's plan are determined to show that they can save money.

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