How Overall, Out-of-Pocket Costs of Obesity Escalated in 10 Years

March 27, 2023 - Obesity was linked to higher healthcare spending and higher out-of-pocket costs for individuals in employer-sponsored health plans, according to a Peterson-Kaiser Family Foundation (KFF) Health System Tracker study.

The researchers leveraged Merative MarketScan Commercial Database data. The timeframe that they studied started in 2011 and continued through 2021. Individuals in the study were in large, private, employer-sponsored health plans.

“We find that, on average, privately insured people with an obesity diagnosis have higher total and out-of-pocket spending than people without an obesity diagnosis. We also look at the cost of common surgical and pharmacological treatments for obesity,” the researchers explained.

People who had been diagnosed with obesity in the study’s timeframe saw average annual health spending levels that far exceeded their counterparts without obesity. The average annual cost of care was consistently more than twice as high for individuals with obesity compared to those without the diagnosis.

Healthcare costs rose over time, affecting healthcare spending for both those diagnosed with obesity and those not diagnosed with obesity.

In 2011, the average annual healthcare spending for enrollees without an obesity diagnosis was $3,530, while for enrollees with obesity, the annual healthcare spending was $9,556. Over the next decade, annual healthcare spending for those without obesity grew to $4,699 and spending for those with obesity rose to $12,588. The data represents 33 percent and 32 percent increases, respectively.

Out-of-pocket healthcare spending was also higher for individuals with an obesity diagnosis during this timeframe, growing as high as $1,492 in out-of-pocket healthcare spending in 2019 while individuals with no obesity diagnosis paid $712. Over the course of the study’s timeframe, people with obesity saw a 37 percent increase in out-of-pocket healthcare spending.

The overall cost of inpatient bariatric surgery—one of a variety of treatments for obesity—grew in a decade from $24,916 overall for surgery to $32,868. However, not all inpatient bariatric surgeries are priced the same. A quarter of the surgeries cost over $37,510.

As the procedure’s price rose, out-of-pocket healthcare spending for inpatient bariatric surgery rose with it. In 2011, enrollees covered $1,144 of the price of an inpatient bariatric surgery. Nine years later, patients paid 24 percent more for the procedure ($1,427).

As with the overall price of the surgery, enrollees’ cost-sharing tended to vary. A quarter of enrollees paid over $2,268 for their inpatient bariatric surgeries in 2021, while other enrollees paid nothing.

The researchers also touched on the cost of Semaglutide, a drug approved by the Food and Drug Administration for weight loss. Generally, they found that the drug’s price increased 20 percent between 2018 and 2021, and enrollees on average paid $66 in out-of-pocket healthcare spending for a month’s supply in 2021. However, the researchers could not account for drug rebates.

Obesity is often a primary target of employers’ wellness programming since it is one of the most expensive diseases in the US and is frequently connected to expensive comorbidities. Employers’ strategies for reducing obesity among employees may include incorporating obesity management and prevention into their diversity, equity, and inclusion strategies to promote equity and reducing barriers to care.