title: The effect of obesity and cardiometabolic risk factors on expenditures and productivity in the United States.
abstract: OBJECTIVE
  To examine the effect of obesity and cardiometabolic risk factors on medical expenditures and missed work days.
  
  
  METHODS
  The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US population, was used to estimate the marginal effect of obesity (BMI > or = 30) on annual per-person medical expenditures and missed work days for patients with diabetes, dyslipidemia, or hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, and smoking status. Maximum Likelihood Heckman Selection with Smearing retransformation was used to assess medical expenditures, and Negative Binomial regression was used for missed work days.
  
  
  RESULTS
  Normal weight individuals with diabetes, dyslipidemia, or hypertension had significantly greater medical expenditures than those without the respective condition ($6,006 (5,124-6,887), $4,760 (4,102-5,417), $3,911 (3,345-4,476)) and obesity significantly exacerbated this effect ($7,986 (7,397-8,574), $7,636 (7,072-8,200), $6,197 (5,745-6,649); $2007; all P < 0.05). In addition, diabetes, dyslipidemia, and hypertension resulted in greater missed work days (3.1 (0.94-6.21), 3.2 (0.42-7.91), 1.4 (0.0-3.52)) (all P < 0.05 except hypertension), which resulted in greater lost productivity ($433, $451, $199) and obesity significantly exacerbated the deleterious effect on work days (8.7 (4.44-15.2), 5.5 (2.18-10.5), 4.5 (2.92-6.34)) and lost productivity ($1,217, $763, $622) (all P < 0.05). In addition, medical expenditures increased for increasing weight category and increasing number of risk factors.
  
  
  CONCLUSIONS
  Obesity significantly exacerbates the deleterious effect of diabetes, dyslipidemia, and hypertension on medical expenditures and productivity loss in the United States. Obesity is preventable and public health efforts need to be undertaken to prevent its alarming increase in order to reduce the incidence and effect of cardiometabolic risk factors.
authors.affiliation: Department of Clinical Pharmacy, University of Colorado at Denver, Colorado, USA. patrick.sullivan@uchsc.edu
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Sullivan
authors.forename: Vahram
authors.initials: V
authors.lastname: Ghushchyan
authors.forename: Rami H
authors.initials: RH
authors.lastname: Ben-Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics* / Q000453:epidemiology; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000191:economics* / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D018582:Sick Leave / Q000191:economics; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult