Obesity costs greater than Iraq costs

Personal research in to comparing the costs of obesity to the costs of the Iraq war has revealed this sobering statistic: Obesity costs U.S. taxpayers more than the war in Iraq.

Here are the facts:

Obesity: $117 Billion per year, $9.75 Billion per month, $13,348,545 per hour.
" Overweight and obesity as major public health problems (are) costing U.S. society as much as $117 billion a year."1

Iraq: $108 Billion per year, $9 Billion per month, $12,321,734 per hour.
" Specific appropriations, which averaged about $93 billion a year from 2003 through 2005, have risen to $120 billion in 2006 and $170 billion in 2007... The Defense Department is currently obligating an average of almost $11 billion a month for expenses related to its operations in Iraq and Afghanistan and for other activities related to the war on terrorism. Most of that sum (more than $9 billion per month) is related to operations in Iraq."

Sources:
1) Fred Kuchler and Nicole Ballenger, " Societal Costs of Obesity: How Can We Assess When Federal Interventions Will Pay?", USDA Economic Research Service, FoodReview, Winter 2002, http://www.ers.usda.gov/publications/FoodReview/DEC2002/frvol25i3e.pdf

2) Congressional Budget Office Testimony, Statement of Robert A. Sunshine, Assistant Director for Budget Analysis, "Estimated Costs of U.S. Operations in Iraq and Afghanistan and of Other Activities Related to the War on Terrorism", before the Committee on the Budget U.S. House of Representatives, July 31, 2007, http://www.cbo.gov/ftpdoc.cfm?index=8497&type=0

Obesity Factoid

Good quote:

“Obesity is associated with a 36% increase in inpatient and outpatient spending and a 77% increase in medications, compared with a 21% increase in inpatient and outpatient spending and a 28% increase in medications for current smokers.”
Source: Strum, R., 2002, "The effects of obesity, smoking, and drinking on medical problems and costs", Health Affairs, 21(2), 245-253

School Lunch and Obesity cost comparison

I have been vexed (hexed?) in my attempts to verify some of the secondary research numbers in my Taxing Burden of Obesity post, so I am trying to piece together my own research. Thanks for the comments from Ken who has helped me revisit the numbers. I need some more research to complete the comparison in that post. I need more work on nutrition costs beyond obesity numbers (e.g. heart disease).

For now, here are some facts from a 2005 USDA Food and Nutritions Service presentation entitled "School Meal Program Performance: What Do We Know?"(1):

• 94,622 schools (grades K-12) participated in the National School Lunch Program (NSLP).
• Over 90% of all public schools participate.
  
• Almost 49 million students participate in NSLP.
• 8.9 million participated in National School Breakfast Program (NSBP).
  
• School cafeterias served 4.8 billion lunches.
• Over 29 million lunches per day.
• Over 9 million breakfasts per day.
• The NSLP also provided 154 million afterschool snacks.
• About half of all lunches and 3/4 of all breakfasts are served free.
  
• The cost to USDA of providing lunches and snacks was $7.6 billion(2).
• The cost for the NSBP was $1.9 billion(3).

If we take the numbers out a little further we can form a crude estimate of how much the NSLP costs per year: $155.10 per student who participated. For breakfasts, the cost per participant is $213.48. So, annual costs per child who actually eats school breakfast, lunch and/or snack is $368.58.

For comparison, according to the 2001 Surgeon General's " Call to Action to Prevent and Decrease Overweight and Obesity": "

• Approximately 300,000 U.S. deaths a year currently are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking). (4)
• The total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the year 2000."(4)
  
• 32.9% of our population is considered obese(5).
  
• 32.9% = 860,182,371 Americans considered obese in 2000.
  
• The 2000 U.S. population was 283 million (when cost determined)(6)

So this suggests we are spending $136 per person per year on obesity. This number does not directly include related health issues like heart disease and diabetes. More work to connect these costs will be the work of another post.

Sources
(1) Alberta C. Frost, "School Meal Program Performance: What Do We Know?", presentation, USDA, Dec. 15, 2005
(2) Newman & Ralston, "Profiles of Participants in the National School Lunch Program: Data From Two National Surveys", USDA ERS Economic Information Bulletin, Number 17, August 2006
; or USDA ERS website, " Child Nutrition Programs: National School Lunch Program", viewed March 29, 2007.
(3) USDA Food and Nutrition Services, School Breakfast Program Fact Sheet, viewed March 29, 2007.
(4) Office of the Surgeon General, US Health and Human Services, " The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity", 2001, viewed March 29, 2007.
(5) Dept. of Health and Human Services Center for Disease Control and Prevention website " Overweight and Obesity: Home", viewed march 29, 2007
(6) US Census, http://www.census.gov/prod/2004pubs/04statab/pop.pdf

Fruit and Veggie Consumption Findings

FoodNavigator-USA's recent article, "Americans not eating enough veggies - study", discusses the findings of recent studies in to fruit and vegetable consumption.

One particular study, from Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research, aggregated research from previous National Health and Nutrition Examination Surveys and covered 1988-2002. This Johns Hopkins/Welch study concludes that "Despite campaigns and slogans, Americans have not increased their consumption, with 28 percent and 32 percent meeting USDA guidelines for fruits and vegetables, respectively, and less than 11 percent meeting the current USDA guidelines for both fruits and vegetables."(1)

Other factoids from this study(2):

• Approximately 62% did not consume any whole fruit servings
  
• 75% did not consume any fruit juice servings; about half of the participants reported no whole fruit and no fruit juice servings.
• Approximately 25% of participants reported eating no daily vegetable servings.
  
• About half of participants reported consuming at least one serving of garden vegetables.
• About 28% met vegetable guidelines when fried potatoes were excluded as a vegetable.
  
• Roughly 12% consumed at least one serving of legumes.
  
• Roughly 14% reported no daily vegetable and no daily fruit servings.
• After adjusting for age, gender, and ethnicity, mean energy and fiber intakes were higher for those consuming more fruits and vegetables.
• Non-Hispanic blacks were less likely to meet fruit and vegetable guidelines than non-Hispanic whites (7% vs 11%).
• "With two thirds of the US adult population overweight or obese, the implications of a diet low in fruits and vegetables are extensive…New strategies, in addition to the 5-A-Day Campaign, are necessary to help Americans make desirable behavioral changes to consume a healthy diet that includes a variety of fruits and vegetables."(3)
  

Sources:
(1) FoodNavigator-USA, "Americans not eating enough veggies - study", March 19, 2007,
(2) Casagrande, Wang, Anderson, Gary, "Have Americans Increased Their Fruit and Vegetable Intake? The Trends Between 1988 and 2002", American Journal of Preventive Medicine, Volume 32, Issue 4 , April 2007, Pages 257-263
(3) Ibid.

Change in Added Sugar Consumption

Here are some graphs I made from the servings.xls spreadsheet at the USDA Economic Research Service website that show the growth of per capita (per person) consumption of added sugars between 1970 and 2004.

Notes:
(1) Total added sugars includes all corn derived sweeteners plus edible syrups and honey, which showed up on the graph near zero so I did not include them.
(2) All corn sweeteners include High Fructose Corn Syrup, Glucose, Dextrose, and Corn Sweeteners.


Source for both: USDA/Economic Research Service 2006 data, http://www.ers.usda.gov/Data/FoodConsumption/

The Growth of Obesity Across the Country

We have been hearing that obesity is an epidemic across the nation. But what does an epidemic really look like?

The Center for Disease Control's web page Overweight and Obesity: Obesity Trends: U.S. Obesity Trends 1985–2005 includes a powerful powerpoint presentation (or pdf) that illustrates the growth of Body Mass Index (BMI) across time.

For a quick snapshot, here are a couple of images that show what an epidemic looks like. Notice how in the year 2000 they added a new higher category, and in 2005 they added two more.


Source: "Overweight and Obesity: Obesity Trends: U.S. Obesity Trends 1985–2005", U.S. Dept of Health and uman Services, Center for Disease Control, http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm; viewed March 10, 2007

Changes in Food Prices, 1985-2000

Nice graphic and quote from the Institute for Agriculture and Trade Policy:

" Within the United States, the real cost of fresh fruits and vegetables has risen nearly 40 percent in the past 20 years. The real costs of soda pop, sweets and fats and oils, on the other hand, have gone down."


Source: Schoonover and Muller, " Food Without Thought: How U.S. Farm Policy Contributes to Obesity," Institute for Agriculture and Trade Policy, 2006, http://www.iatp.org/iatp/publications.cfm?accountID=258&refID=80627

Health Costs on the Federal Budget

Most of us have probably heard that obesity is a problem and raising the cost of healthcare in the U.S. Here is a chart from the USDA's Economic Research Service (2003) showing the growth of health costs as a percentage of the federal budget.

Source: USDA Economic Research Service, " FoodReview: Weighing In on Obesity," Vol. 25, No. 3

Media and Obesity

The Kaiser Family Foundation released a report in 2004, The Role of Media in Childhood Obesity, that brings together research from a variety of disciplines for the first time in a document that looks exclusively at the role of media in contributing to and potentially helping to reduce rates of childhood obesity.

From the press release:
The typical child sees about 40,000 ads a year on TV, and that the majority of ads targeted to kids are for candy, cereal, soda and fast food... Exposure to food advertising affects children’s food choices and requests for products in the supermarket.

The report also highlights ways media can play a positive role in helping to reduce childhood obesity, through programs that encourage children to be active and help teach good nutrition, through public education campaigns aimed at children and parents, and by using popular media characters to promote healthier food options to children.

Source: Kaiser Family Foundation, The Role of Media in Childhood Obesity, Feb. 2004

The taxing burden of obesity

Ann Cooper wrote a paper for the Food and Society Policy Fellows with this quote (and source):

"It costs approximately $6,000 to feed a child lunch during the entire tenure of their K-12 education, and it costs our health care system and our taxes approximately $175,000 per adult, for illnesses related to poor childhood nutrition."

Sources: “National School Lunch Program,” USDA: Child Nutrition Webpage: FNS Online, February 2002; “Nutrition and the Health of Young People: Fact Sheet,” USDA:CDC, June 1997.

More obesity facts

Quotes (and original sources) from the Center for Science in the Public Interest's Improve School Foods program:

• " According to the USDA, healthier diets could prevent at least $71 billion per year in medical costs, lost productivity, and lost lives."
• Source: Frazao E. "High Costs of Poor Eating Patterns in the United States." In America's Eating Habits: Changes and Consequences. Edited by Elizabeth Frazao. Washington, D.C.: Economic Research Service, U.S. Department of Agriculture, 1999. Agriculture Information Bulletin No. 750, pp. 5-32.
• " U.S. health-care costs due to obesity are $94 billion a year, half of which ($47 billion) is paid through Medicare and Medicaid."
• Source: Finkelstein EA, Fiebelkorn IC, Wang G. “State-level Estimates of Annual Medical Expenditures Attributable to Obesity.” Obesity Research 2004; 12:18-24.
• " From 1979 to 1999, annual hospital costs for treating obesity-related diseases in children rose three-fold (from $35 million to $127 million)."
• Source: Wang G, Dietz W. "Economic Burden of Obesity in Youths Aged 6 to 17 Years: 1979-1999." Pediatrics 2002, vol. 109, pp. e81.

The Cost of Obesity

A recent National Academy of Sciences report, "Preventing Childhood Obesity: Health in the Balance", described how the best way to fight the increasing obesity youth epidemic is to reform a number of separate yet interrelated social sectors. From the report’s Sept. 30, 2004 press release:

"We must act now and we must do this as a nation," said Jeffrey Koplan, vice president for academic health affairs, Emory University, Atlanta, and former director of the Centers for Disease Control and Prevention. Koplan chaired the committee of 19 experts in child health, nutrition, fitness, and public health who developed the report in response to a request from Congress for an obesity prevention plan based on sound science and the most promising approaches.

"Obesity may be a personal issue, but at the same time, families, communities, and corporations all are adversely affected by obesity and all bear responsibility for changing social norms to better promote healthier lifestyles," Koplan added. "We recognize that several of our recommendations challenge entrenched aspects of American life and business, but if we are not willing to make some fundamental shifts in our attitudes and actions, obesity's toll on our nation's health and well-being will only worsen.

“ Among specific steps recommended by the report is a call for schools to implement nutritional standards for all foods and beverages served on school grounds, including those from vending machines.”

The Insitute of Medicine's Prevention of Obesity in Children and Youth program website continues to show the costs that society carries for such issues by showing that “Obesity-associated annual hospital costs for children and youth more than tripled over two decades, rising from $35 million in 1979-1981 to $127 million in 1997-1999. After adjusting for inflation and converting to 2004 dollars, the national healthcare expenditures related to obesity and overweight in adults alone range from $98 billion to $129 billion annually.”

Obesity and diabetes discussion are dominating most health discussions these days, including a cover story by Time and expanded coverage around a TIME/ABC News Summit on Obesity. The executive summary mentions items the attendess disagreed on as well as these items of agreement: “The challenge is to shift from an economy and eating habits that are quantity-driven to ones that are quality-driven… Our economy and longstanding government policies are based on providing plentiful, cheap — and often low-quality food. That needs to change.”


At the summit, U.S. Surgeon General Richard Carmona said

" As we look to the future and where childhood obesity will be in 20 years... it is every bit as threatening to us as is the terrorist threat we face today. It is the threat from within."

Together these facts and concerns show the realities of how some of our current ag, nutrition, and education policies are affecting our children’s health, and our public health system financially. The calls for needing social norm-busting approaches is clear, and a new approach that impacts what we feed our children has been mentioned from those within our federal government. Since changing what people feed their children at home is extremely difficult and brings in to play invasion of privacy arguments, we can collectively utilize our public funds to address these issues.