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This chapter provides an overview of the economic costs of obesity in the United States with a particular focus on the costs of obesity related to women’s health care. The chapter begins by briefly introducing the relationship of obesity with health problems that often result in increased costs. Costs, both direct and indirect, are defined, and overall costs associated with obesity are reviewed. The chapter then largely addresses the costs of obesity related to women’s health care, particularly obstetrical and gynecological services.


Costs of obesity and its comorbidities are both direct and indirect. Direct costs include the medical care interventions to treat morbidity associated with obesity. Indirect costs include costs that are secondary to obesity, increases in premature mortality, reduction in productivity, and increases in insurance costs.

Direct Costs

Direct costs include direct patient care services, such as outpatient and inpatient health services, laboratory and radiological tests, and drug therapy. Obese individuals incur, on average, annual medical care expenditures of $732 higher than individuals of normal weight.1 A systematic review of the direct costs of obesity found that obese individuals have medical costs approximately 30% higher than their normal-weight peers.2 Annual spending due to obesity has been estimated at 9.1% of annual medical spending in the United States.3 A more recent study, which employed Medical Expenditure Panel Survey (MEPS) data, estimated that medical care associated with obesity is 20.6% of U.S. health care expenditures.4 It is estimated that Medicare and Medicaid are responsible for approximately 42% of this spending.3

Indirect Costs

Indirect costs, which are more difficult to measure than direct costs, can be defined as resources forgone as a result of a health condition and fall into various categories. Indirect costs include higher disability insurance premiums, decreased labor market productivity, and premature mortality. Published research findings offer a wide range of estimates for the total indirect costs of obesity; direct comparison of results across studies is difficult due to a set of methodological issues, including the date of measurement, representativeness of the sample, and scope of measurement.5

Indirect costs include the value of lost work; days missed from work are a cost to both employees (in lost wages) and employers (in work not completed). Obese employees miss more days from work due to short-term absences, long-term disability, and premature death than nonobese employees.6 The cost of absenteeism for obese and morbidly obese was estimated at $4.2 billion each year.7 These individuals may also work at less than full capacity (also known as presenteeism). The costs of absenteeism and presenteeism resulting from obesity among full-time employees based on 2006 MEPS data were estimated at $73.1 billion annually, with roughly two-thirds of those costs associated with approximately one-third of employees with a body mass index (BMI) over ...

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