Two Doctors Discuss One Big Problem

Dr. Steve Aldana, a professor of Lifestyle Medicine at Brigham Young University, sat down with Dr. David Hunnicutt, president of the Wellness Council of America (WELLCOA), for a discussion on the costs of unhealthy behaviors in the United States. Aldana has published more than 60 research articles and has written five books on the connections between healthy living and disease prevention. He is a regular consultant to the Centers for Disease Control and Prevention, the National Institutes of Health, and the California Department of Health Services.

What follows are excerpts from the interview, which originally ran in the WELLCOA publication, Absolute Advantage:

Hunnicutt: How much does it cost if an employee is physically inactive?

Aldana: Basically, it’s estimated that sedentary living—the fact that we’re not moving around very much—costs us as a nation $150 billion. This is in 1987 dollars. That’s just due to healthcare costs associated with diseases that we get from not moving around. So that takes care of the first area.

When it comes to the second area, this is where the numbers get serious. In fact, 15% of all of the health-care costs we pay in the United States is due to sedentary lifestyles. Now, if employers want to calculate what physical inactivity is costing their company, I would suggest that they take a look at their total health-care expenditures for a year and take 15% of that. In reality, that’s going to be pretty close to the actual expenditures.

About 78-80% of the entire U.S. population does not get enough physical activity to get the benefits.

Looking at it another way, there’s about 20-25% that are actually moving around enough to lower their risks and to lower their prevalence of disease. The rest are not. So it’s the vast majority; and it has changed a little for the better over the last few years—not very much—a couple of percentage points.

Hunnicutt: What do we know about the cost of [overweight-ness] and/or obesity?

Aldana: When it comes to calculating costs, overweight and obesity are pretty much the same thing—they’re just varying degrees of the same thing.

By the way, about 67% of the population is either obese or overweight, and that number has some consequences associated with it. In a nutshell, about 12% of total health-care costs are obesity-related.

But there’s more than that, and it’s really interesting. If you take, for example, someone who’s obese and someone who’s not, and they both have the same health condition or the same disease, it costs $1,200 more to treat the obese person than it does the person who maintains a healthy weight—even though it may not be an obesity-related condition. This increase in treatment costs occurs because it’s more difficult to treat obese patients.

It’s tougher to get IV lines in them; it’s tougher to do surgery on them; they have more complications. As a result, it costs $1,200 more on average to treat an obese person than it does to treat a non-obese person for the same condition.

Hunnicutt: So between physical inactivity and obesity, it could cost an employer as much as 27% of their total health-care claims?

Aldana: It’s worse. The piece we’re missing here is the diet piece. The diet piece plus sedentary living are both contributing to the obesity epidemic. That’s when the numbers start to get really, really concerning. Indeed, when you factor this variable in, you’re now looking at 35-40% of total healthcare costs. If you add in tobacco use, you’re now sitting at 65-70% of total health-care expenditures within your organization.

Hunnicutt: What do we know about the efficacy of interventions like physical activity?

Aldana: A good intervention is going to get those people who are not already exercising to either start thinking about and/or participating in some form of regular physical activity. It’s not going to be a huge impact because it’s very difficult to make that kind of dent in this problem. But, if we can increase physical activity among the general population, I think you’re going to see that a few small percentage points will make a huge difference.