"These are what we call 'real and immediate costs.' These are not the costs associated with an operation or serious event like a heart attack that might happen at some time in the future. Rather, this is what the men, or their employers, spend month after month on their prescription drugs," said Thomas G. Allison, Ph.D., M.P.H., lead author of the study and a consultant in internal medicine and cardiovascular disease at the Mayo Clinic in Rochester, Minn.
The researchers studied male business executives, average age 47, who had been sent by their companies to have physical examinations at Mayo Clinic's Executive Physical program between January 2001 and May 2002. The men, who did not have heart disease and were first-time participants in the program, had a cardiovascular risk factor evaluation as part of their exams.
Allison and his colleagues tallied the cost of drugs prescribed to the men as a result of their examinations. The tally also included the cost of prescriptions for drugs they were already taking.
Allison said that while he and colleagues had embarked on a study looking at something related to obesity, they were somewhat surprised at the health problems associated with the condition.
"We did not expect to see such significant health problems so strongly associated with weight, including degenerative joint disease, depression, sleep apnea, high blood pressure, high blood cholesterol and more," Allison said. "We began to think, 'How could we quantify it?'"
One way to summarize the impact, the researchers concluded, was to figure out how much people in different weight categories spent each month at the pharmacy.
The researchers divided the subjects into weight categories: normal-weight men had a body mass index (BMI) of less than 25; overweight men had a BMI of 25 to 30; and obese men had a BMI higher than 30. Fifteen percent of the men studied were normal weight, 52 percent were overweight, and 32 percent were obese.
Pharmacy costs were subdivided into drugs prescribed to treat coronary heart disease (CHD) risk factors and those for other medical conditions related to weight.
For normal-weight men, prescriptions for CHD risk factors cost $9.89 per month, and those for other medical conditions cost $12.96 per month. For overweight men, CHD-related prescriptions cost $18.41 per month and other prescriptions $20.86. For obese men, CHD-related drugs cost $42.02 per month and other drugs were $38.29.
All major CHD risk factors except smoking increased as BMI class increased. The prevalence of low back pain/degenerative joint disease, erectile dysfunction, sleep apnea, gastroesophageal reflux, depression and gout increased as BMI increased.
"Previous studies looking at the cost of obesity might be underestimating the toll," Allison said. "The men in this study were in a health program that exceeds the type of physical examination that a normal healthcare plan would offer."
Allison also said that companies should take notice of these costs and, perhaps, invest in programs to reduce obesity in the workplace. Co-authors are Iftikhar J. Kullo, M.D; Chul Kim, M.D.; and Donald D. Hensrud, M.D.
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