The Cost of Inaction in Treating Obesity in the U.S.

OBJECTIVE To quantify the preventable disease burden and foregone economic benefits resulting from maintaining current limited access to obesity treatment among U.S. adults. RESEARCH DESIGN AND METHODS Using microsimulation modeling, we projected 10-year health and economic outcomes under three scenarios: current limited treatment access, expanded access to intensive lifestyle management or earlier-generation medications, and expanded access to glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists. The model simulated individual-level trajectories for 107.6 million adults with obesity across commercial insurance, Medicare, Medicaid, and uninsured populations, incorporating clinical outcomes, medical expenditures, productivity losses, quality-adjusted life-years, and mortality. RESULTS By forgoing treatment, an estimated 5.3 million preventable deaths, 5.0 million diabetes cases, 5.5 million heart failure cases, 2.8 million strokes, 1.3 million myocardial infarctions, and 1.5 million obesity-related cancers would occur over 10 years. The economic cost of inaction totals $10.5–$13.3 trillion in foregone benefits, including $1.8 trillion in avoidable medical expenditures, $3.0 trillion in lost productivity, and $5.6–$8.5 trillion in diminished quality of life. Over the 10-year period, expanded access to intensive lifestyle management or earlier-generation medications would prevent 3% of deaths and 17–23% of major complications, while expanded access to incretin-based therapies would prevent 9% of deaths and 22–31% of complications. CONCLUSIONS Maintaining current limited treatment access results in substantial preventable disease burden and significant foregone economic benefits. Conventional framing focuses on intervention costs while ignoring ongoing expenses of untreated disease. This reframes the cost question from whether we can afford treatment to whether we can afford the consequences of inadequate access and intervention.