Obesity: Getting Bigger

© 2004 Milliman All Rights Reserved

M I L L I M A N

Research
Report
Obesity: A Big Problem Getting Bigger
Kate Fitch, RN, MEd, CCM
Bruce Pyenson, FSA, MAAA
Steven Abbs
Margaret Liang
Peer Review by Tom Ruehle, FSA, MAAA; Kathy Zaharias, RN, MBA

MILLIMAN RESEARCH REPORT

March 2004

Obesity: A Big Problem Getting Bigger
PAGE

I.

EXECUTIVE SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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II.

DEFINITION OF OBESITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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III.

INCREASING PREVALENCE OF OBESITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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IV.

HEALTH RISKS ASSOCIATED WITH OBESITY . . . . . . . . . . . . . .
In contrast, the corresponding prevalence rates for adults with a BMI < 25 are 18.2% for men and 16.5% for women.

High total cholesterol (defined as ≥ 240 mg/dL)

Data from NHANES III and several large longitudinal studies report a higher body weight associated with increased cholesterol levels.
Diabetes

For each additional unit of BMI > 22, the relative risk of diabetes rises by roughly 25%. Studies also show that 46% of diabetics have a BMI ≥
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Post-surgical services—After surgery, patients will need follow-up care, counseling, nutritional products, prescriptions, and monitoring.

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Complications—Bariatric surgery has risk, and some patients will suffer complications. Extra services may include longer lengths of stay, extra physician visits, or rehabilitation. Our database investigation suggests that some patients will suffer complications that could cause much higher costs. For example, we observed that some bariatric surgery patients received ventilator care or extensive surgery not obviously related to the bariatric procedures. In addition, some patients received revisions or reversals of bariatric surgery.

Step 2: Estimate the utilization for each service.
When a plan first offers bariatric surgery as a covered benefit, it may see a surge in utilization as the “pentup” demand is released.
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A useful starting point is to estimate the maximum number of people who would potentially qualify for bariatric surgery based on the plan criteria. The plan is not likely to have data on individuals’ BMI measures, so population data from sources such as NHANES may be used for this