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  Direct Costs In 1995, direct obesity-related health care costs in the United States exceeded $50 billion. This sum accounted for 5.7% of the entire national expenditure for health care.
Adapted from Wolf and Colditz 70 and Quesenberry, et al. 49 Direct medical costs comprise the expenses incurred for diagnostic and treatment services related to management of obesity. Added short-term and long-term direct costs include costs for:
Indirect Costs Morbidity and mortality result in not only direct costs but also indirect costs to the individual, to employers and to society. These include costs for lost workdays, restricted-activity days and days in bed. Wolf and Colditz evaluated the impact in 1994 of obesity-related comorbidities using data from the 1994 National Health Interview Survey (NHIS). They calculate the cost of lost productivity attributable to obesity (BMI of 30 or greater) as $3.9 billion, reflecting 39.2 million days of lost work. Also attributable to obesity were 239 million restricted-activity days, 89.5 million bed days and 62.6 million physician visits.70 And such costs are constantly rising. Compared with data in the 1988 NHIS, by 1994 the number of workdays lost had climbed by 50%,70 bed days by 28% and restricted-activity days by 36%. Physician visits had nearly doubled (88%). 70 Costs: The Predictive Power of BMI A powerful example of the way in which direct health care costs escalate with increasing obesity recently emerged in a unique study49 performed at Kaiser Permanente, Northern California Region, a health maintenance organization with more than 2.4 million members. A 1-year retrospective analysis was done of actual cost and service utilization data from the records of 17,118 eligible respondents to a 1993 random sample mail survey. Compared with members having BMIs in the 20 to 24.9 range, it was found that mean annual outlays for those in the BMI 30 to 34.9 group were 25% greater, and for those in the BMI 35 or greater group such outlays were 44% greater. Significant associations were observed between BMI and total costs, inpatient costs and days, as well as outpatient costs, visits, and pharmacy and laboratory services. 49 Kaiser Permanente, Northern California Region: Annual Patient Costs Rise with Increasing BMI 
Adapted from Quesenberry, et al. 49 Excess outlays due to obesity amounted to $220 million - or approximately 6% of the total cost of health care for all plan members. This major cost increment could largely be explained by obesity comorbidities, particularly coronary artery disease, hypertension and diabetes. Indirect costs as well as direct costs multiply with increasing BMI. Analyzing data from the 1988 National Health Interview Survey (NHIS), Wolf and Colditz71 estimated the impact of obesity in 1993 dollars. With elevations of BMI, direct medical costs and physician visits increased, as did indirect costs such as workdays lost, restricted-activity days and bed days. 71 | ||||||||
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