title: The Burden of Obesity on Diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012.
abstract: Diabetes is one of the most prevalent and costly chronic diseases in the United States.
  
  
  
  To analyze the risk of developing diabetes and the annual cost of diabetes for a US general population.
  
  
  
  Data from the Medical Expenditure Panel Survey, 2008 to 2012, were used to analyze 1) probabilities of developing diabetes and 2) annual total health care expenditures for diabetics. The age-, sex-, race-, and body mass index (BMI)-specific risks of developing diabetes were estimated by fitting an exponential survival function to age at first diabetes diagnosis. Annual health care expenditures were estimated using a generalized linear model with log-link and gamma variance function. Complex sampling designs in the Medical Expenditure Panel Survey were adjusted for. All dollar values are presented in 2012 US dollars.
  
  
  
  We observed a more than 6 times increase in diabetes risks for class III obese (BMI ≥ 40 kg/m2) individuals compared with normal-weight individuals. Using age 50 years as an example, we found a more than 3 times increase in annual health care expenditures for those with diabetes ($13,581) compared with those without diabetes ($3,954). Compared with normal-weight (18.5 ≤ BMI < 25 kg/m2) individuals, class II obese (35 ≤ BMI < 40 kg/m2) and class III obese (BMI ≥ 40 kg/m2) individuals incurred an annual marginal cost of $628 and $756, respectively. The annual health care expenditure differentials between those with and without diabetes of age 50 years were the highest for individuals with class II ($12,907) and class III ($9,703) obesity.
  
  
  
  This article highlights the importance of obesity on diabetes burden. Our results suggested that obesity, in particular, class II and class III (i.e., BMI ≥ 35 kg/m2) obesity, is associated with a substantial increase in the risk of developing diabetes and imposes a large economic burden.
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Man Yee Mallory
authors.initials: MY
authors.lastname: Leung
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Carlsson
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.affiliation: Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. Electronic address: changsh@wudosis.wustl.edu.
authors.forename: Su-Hsin
authors.initials: SH
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009765:Obesity / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States
keywords: diabetes; economic burden; health care expenditures; obesity