...Obesity has been the hot topic recently, which is why this paper received heavy media coverage...

As much as we would like to believe the opposite, social science often follows media trends. Obesity has been the hot topic recently, which is why this paper received heavy media coverage. General press coverage tends to encourage more research in an area and, unsurprisingly, more citations.

The main innovation is a very social science contribution: Let's compare obesity with other problems. Very different from health sciences or medicine where there is a single focus on a specific condition. That is valuable, but sometimes we might want to ask the bigger question: How do things compare?

This paper compares the effects of obesity, overweight, smoking, and problem drinking on health care utilization and health status based on national survey data.  All are known to be risk factors for poor health and increased health care costs, but have not been compared on the same scale. Obesity has roughly the same association with chronic health conditions as aging 20 years, far exceeding the associations of smoking or problem drinking. Health care costs mirror the health effects. Obesity is associated with a 36% increase in inpatient and outpatient expenditures and a 77% increase in medications, compared with a 21% increase in inpatient and outpatient expenditures and a 28% increase in medications for current smokers and smaller effects for problem drinking. Nevertheless, the latter have achieved more consistent attention in recent decades in clinical practice and public health policy.  

We conducted a national study on changes in health (HealthCare for Communities), funded by the Robert Wood Johnson Foundation. The focus has been on alcohol, drug, and mental health problems, so the smoking/drinking issue was obvious, but I wanted to look at additional risk factors. The obesity effect was unexpected, but others have since replicated it.

Roland Sturm, Ph.D.
Senior Economist
RAND Corporation
Santa Monica, CA, USA