August 10th, 2009
03:15 PM ET

Obesity, smoking add immense burdens to health care costs

By David S. Martin
CNN Senior Medical Producer

An orthopedic surgeon told me the story recently about a 300-plus pound man whose feet gradually failed under his immense weight - until he walked on the inside of his ankles.

He required complicated surgery on each foot and ankle – 3 ½ hours in the OR, a night in the hospital and months of rehab each time. The bill ran into the tens of thousands of dollars for a problem largely attributable to his weight.

“Bones aren’t any bigger than they were thousands of years ago,” the surgeon told me. Unfortunately, we are. And bones and tendons don’t grow to accommodate body weight.

The debate about health care is largely about dollar figures. How much will it cost? How will it affect the deficit? How much will it raise our taxes?

There are a couple of figures that don’t often make the debate, and they may pose an even greater challenge. I’m talking about the obesity rate and the percentage of Americans who continue to smoke.

A government-sponsored study recently estimated that medical spending for obesity reached $147 billion in 2008, almost doubling in the past decade. It’s not surprising. About 32 percent of American adults are obese, a condition linked to diabetes, heart disease, even cancer. As the story above illustrates, obesity can also do a number on your bones and joints.

If you want an idea of how big $147 billion is, it’s roughly 6 percent of all health care spending in the United States.

How about smoking? Almost 21 percent of American adults are addicted to cigarettes, according to the Centers for Disease Control and Prevention. That’s more than 45 million people. The estimated health care costs pegged to smoking: $96 billion.

It’s virtually impossible to live in the United States and not be aware of the health risks associated with smoking, yet the addictive habit continues – with tragic consequences for smokers and an immense burden on the health care system.

The Congressional Budget Office caused an uproar when it projected that Obama-backed changes in the health care would add $239 billion to the deficit over 10 years.

That’s nothing compared with the cost of obesity and cigarettes. Over 10 years, those costs top $2.4 trillion.

And that leads to the obvious question: How would you get Americans to lose weight and quit smoking?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Filed under: Health & Politics • Smoking • Weight loss

soundoff (48 Responses)
  1. Why do I care

    Best way to drive home the point is by having people pay the price themsemve if they fail to control their habits. ABC analysis is proven that consequences are the most effective way to educate and influence people. Besides, it is also unfair for other people to pay for the irrsponsible behaviour of some.

    Whether it is health care of plane fares, let these individual pay squarely for what they bring. The only public spending in this area should be directed on research to understand cause for such serious outbreak of the obesity problems, largely within USA. Something has changed in this decade. Is it chemical exposure or genetic tempering of crop?

    August 10, 2009 at 17:23 | Report abuse | Reply
  2. Margaret M. Dardis

    Proposals to deny late-life care to people with medically unsatisfactory life-styles make no sense, unless we adjust for I.Q., education, and mental health- or lack thereof. Only when a government health option includes mental health- as well as feet, teeth, eyes, ears- will it be logical to deny care to the illiterate, the emotionally disturbed, the uneducated, etc. And, of course, when the leaders of our land cease to put profits ahead of life-style. Case in point: Girls coerced into wearing stiletto heels, a form of dead-style that results in women's suffering 95% of the cases of bunions among older Americans. Should they be penalized for what Wal-Mart, Liz Claiborne, et al., made money on? Which is worse for our health: marijuana or ho-heels? (If anyone has done a translation of Veblen into contemporary U.S. language, let the literate read it- inconspicuous consumption might help with that lifestyle issue.)

    August 10, 2009 at 18:39 | Report abuse | Reply
  3. Patrick Gallagher

    How come AC360 (or CNN for that matter) has not done a complete and comprehensive poll or interview with the citizens of other countries that have "one payer system" or Universal Health Care. There are all these warnings and misinformation about what the citizens of Canada, Great Britain, France and the other top countries really think of their own health care systems. If we are so afraid of what we might get, why don't we find out what the average citizens of one of these countries really thinks of their own system? We poll everything else, why can't we poll their populations?

    From what I have read and heard we are not even getting close to "required state run health care" like these countries practice, but just to play devil's advocate... if this is what the opposition is warning us about, should we not have an unbiased report on what they think of their own systems?

    Paging Dr. Gupta: Ask the Doctors, Nurses and Patients what we should be afraid of???

    PG; Key Biscayne, Fl.

    August 10, 2009 at 23:02 | Report abuse | Reply
  4. Kraig Rasool

    Smoking is so the bad the habit for those who indulge and those who have to breathe the air around them....I have never smoked in my life and to even get a whiff of it makes me choke. There should be some
    sort of legislation that put cigarettes in the same category as hard core drugs, yet the companies that run the cigarette trade has buried themselves so deeply in cash that they are blind and dont care how
    many people die and suffer. I have relatives that are reeling from cancer, and some who have passed away from cancer (and one who even though had went thru chemotherapy continued to smoke until her death). Having said this it is extremely horrible to watch cigarette makers continue to be aloud to push this drug...The weight issue is
    also very sad, restaraunts continue to push large portions to people and commercials advertise food all day through the media all the while killing people. They know that food is adictive and you always hear the same answer..... "You have eat!!" Its a nightmare that keeps
    you in it grips and people in power need to put a stop to it..

    August 11, 2009 at 11:41 | Report abuse | Reply
  5. Mark McCuistion

    Good point Patrick. I think Michael Moore did just this in his films Sicko and Bowling for Columbine. I think the answers were pretty pro-Obama (surprise).

    August 11, 2009 at 14:54 | Report abuse | Reply
  6. George M

    Is thier anyone in the government that is looking into the cost to the american tax payers to provide medical care for illegal immigrants?

    August 11, 2009 at 17:58 | Report abuse | Reply
  7. Toni

    Obesity and smoking result in the majority of preventable illnesses – very few people in this country want to take personal responsibility for anything, their finances, their children, their parents – let alone their physicial and mental health. I have a always had a genetic predisposition for obesity – I was a 30lb one year old little girl (very short-still am) and it only got worse in adolescence. I am almost 50 years old – I eat fruits, vegetables,legumes, I basically flavor my food with meat or fish mainly a mediterranean diet – keep my calories under 1700(that includes a glass of red wine almost every day) at all times and exercise 7-9 hrs a week – to include cardio, resistance training and yoga/pilates. I take no medication, have not been ill with anything for years – not even a cold and I would rather eat a big bagel with cream cheese and sit on my butt every morning and watch TV instead of getting up at 4 am to work out. I travel a lot for work and take my exercise clothes with me everytime – no excuses. My health insurance company is raking it in on me – with the exception of a bad fall that required medical treatment I have not used any health care dollars since I gave birth to my last child 14 years ago-except for well check ups. Take care of yourself and you won't have to worry so much about what healthcare reform they pass. I am a nurse – there is so much waste in healthcare – let's start by making pharmaceutical company "inservice" lunches illegal – they must drop $500 at least feeding an physician's office full of staff – none of whom have a BMI less than 40. Don't think you are not paying for that when you fill your high blood pressure prescription!

    August 11, 2009 at 21:14 | Report abuse | Reply
    • Randy

      Well said and I totally agree with you on all accounts! I constantly hear people complain about the government: being too big, telling them what they can and can't do, and yet always wanting the government to protect them and give them more. People don't want to take charge and control their own life destiny by improving their lifestyle choices, like you have obviously done! My neice is over weight, constantly sick and complains about her health. She works in a doctor's office and there is a drug rep that takes the whole office out to eat every day. My neice is in her 40's, a single parent and has two teenage daughters. She complains constantly about everything and yet takes none of the blame for her situation.

      November 11, 2012 at 09:54 | Report abuse |
  8. efra

    I can’t believe that I missed out on town meeting, that’s how busy my life is. As you can see majority of white folks attended these meeting because they have time and money. They are making decisions on minorities and I feel that’s not right. I am for this plan and i am willing to contribute my little money that I make because I know how it is with out a health plan, especially for students.

    August 11, 2009 at 22:38 | Report abuse | Reply
  9. Don Ferrell

    I am glad to see finally someone has brought to the publics attention how we are being shafted daily by the medical community. When there is a recall from a medical company such as "Medtronics", they charge medicare and your insurance company... If your car was recalled, the manufacture would pay for all cost, not in the medical community. I have 1st hand experience with this.


    August 12, 2009 at 06:29 | Report abuse | Reply
  10. Maria K. Gaebler

    Recently my husband suffered a heart attack at work. We were very lucky. He was rushed to a hospital and had a stent implanted. Within 3 hours of getting the phone call, I was able to see my husband resting comfortably in his hospital room. Our cost for this remarkable care was absolutely nothing. We have great insurance and had already met our deductible for the year. It would be easy for me to say there is nothing wrong with the health care system. But here are some real stories about real people I know. (I've changed the names.)
    Sue has breast cancer. She's waiting to see if her insurance will cover genetic testing. Sue has several sisters and nieces. One day she might have granddaughters. Who pays for the genetic test that might save lives and cut costs in the future?
    Billy has an extremely rare disease. His mother stays home to care for him. His father has his own business. Any treatment Billy gets is experimental. The family will have to wait weeks, maybe months, to get a wheelchair for Billy. This hard working family is on the brink of financial ruin. Even if Billy gets Medicaid what about the rest of the family's health care?
    Jane, her mother, Mary and her daughter Sally had a good arrangement. Jane worked and Mary cared for Sally. Mary now has end stage cancer. Jane has quit her job to become Mary;s primary caregiver. Mary gets excellent hospice care (not a death panel) Who will provide health care for Jane? She has to take Sally to the emergency room if she runs a fever? That's hugely costly for all of us.
    The statement from our insurance company it showed the hospital costs at over $130,000. The insurance company was contracted to pay $64,000. What happened to the other $66,000? If someone without insurance had the same treatment would they have to come up with the entire $130,000?
    It' would be easy for me to sit in my comfortable house with my recovering husband and say don't mess with health care. But I can't.
    When 9/11 happened the entire country rallied to help victims, survivors and families. No one asked if a victim lived up to some arbitrary moral standard. No one asked if one family was more deserving than another. Americans rally is a crisis. Well, we are in a health care crisis now. We need to align our resources and care for people who can't afford health care as it is.
    Good health is the underpinning of Life, Liberty and the Pursuit of Happiness. Access to health care is, as I see it, a Constitutional Right.

    August 12, 2009 at 09:38 | Report abuse | Reply
  11. Kevin Cleary

    I agree with the first writer (Why do I care). The most effective means of breaking a habit or routine are direct incentives and disincentives.

    The United States has been trending in a disturbing manner that goes way beyond (but certainly includes) this smoking and obesity issue, and more to entitlements in general. Most people will stand up and say that it is their right to quality, affordable healthcare, but with no qualifiers as to what their responsibilities may be. Another example is blaming schools for children failing to learn, when it may in fact be that today's kids are not nearly as diligent as they were a generation ago, largely due to the parent's failings.

    Legislators take the path of least resistance and simply play into the hands of their constituents' entitlement mentality. If this trend continues, there will be no one to support those "entitled" because we all will be such.

    To the matter at hand: obese people and those who smoke should pay more for healthcare in premiums and/or out of pockets. I am a non-smoker who diets and exercises daily, and I don't want to pay for someone who doesn't.


    Atlanta, GA

    August 12, 2009 at 10:12 | Report abuse | Reply
  12. Lu

    I would like to know why alochol and drugs are always overlooked when it comes to the cost of health care? How many people develop
    liver damage due to alcohol? How many peple are injured by drunk drivers and have to be treated? Alcohol and drugs, in my opinion contribute alot to the medical expenses of the health care system. They ask you if you smoke on insurance applications, bu they don't ask about alcohol consumption? Why is that?

    August 12, 2009 at 20:48 | Report abuse | Reply
  13. pat lewis

    Tonight on Larry King Live re Health care comment:: the cost of health care would be so much less if people took care of themselves. It bothers me that we are being asked to pay for Pres. Obama's plan which takes care of everyone whether they take care of themselves or not.(obesity, smoking etc.) Particularly in this economic time when some have no jobs or other problems have this personal burden and then now we are being asked to add someone elses burden to ours is so difficult.. I know you are a Doctor and not a politician but maybe you can discuss with the politicians some criteria for those we need to support other than our own. I end with a little humor..We have spent millions to extend our lives and live to a grand old age. and now we (rumor) are spending even more money to get a plan through to shorten them.....Thank you for listening ..obviously a senior citizen

    August 12, 2009 at 22:30 | Report abuse | Reply

    As a family practitioner I spend most of my day either preventing or treating the 'metabolic syndrome' of diabetes, hypertension and hypercholesterolemia which are all caused by obesity.
    The way to get the average American to change his/her behavior is to use the carrot not the stick:
    I propose a $2000 tax credit for 20lb weight loss, which is kept off for 6 months.
    This loss would be verified by the patient's physician who would sign a form confirming the weight loss.
    Hopefully the patients would continue with their new lifstyle which would result in lower healthcare costs and therefore benefits for all.

    August 13, 2009 at 00:57 | Report abuse | Reply
  15. Carl

    Big Agribusiness uses taxpayer subsidised corn, soy and wheat to produce cheap, unhealthy, genetically modified, calorie dense, nutrient deficient, chemically laden processed foods.

    This affordable food is, heavily marketed to, and eaten by most Americans, but especially the poor. Obesity, diabetes, heart disease, cancer and numerous (un)heath problems result.

    Big Pharma heavily markets dangerous, usuriously priced chemicals (“Ask your doctor about......”) to mask the symptoms of these diseases, not heal the underlying causes. Never a suggestion about promoting healthy lifestyles .

    Big Agri and Big Pharma’s lobbyists pay lawmakers to keep the system firmly in place.

    Until this circle is dismantled we will continue to spiral toward a health and financial crisis. I am not optomistic.

    August 13, 2009 at 09:51 | Report abuse | Reply
  16. Tom

    Toni has hit the nail on the head.

    She obviously had every opportunity to play the "I'm genetically predisposed to being overweight so woe is me" and make the choice to live an overweight lifestyle. In the face of the challenge, she chose to live a healthy lifestyle. I'm not surprised as a 50 year old she has no chronic conditions, and utilizes little health services.

    Unfortunately, most Americans do not choose to live this lifestyle and, in spite of the well documented benefits of living healthy, choose to live unhealthy. Its easier to take a pill than work out every day. It is also easier to spend a few days in the hospital than years of committment to dietary and exercising discipline.

    Unfortunately. the Toni's of the world get the extreme short end of the stick in the health debate because their health care is more like real insurance where it is unlikely that she will incur a major cost. However she has to pay a higher premium because other people don't take care of themselves.

    We continue to overlook this issue, and no matter what plan we have, public, private, coops, an insurance exchange, etc, our total healthcare spend will continue to fester out of control until we address this obesity problem.

    August 13, 2009 at 12:19 | Report abuse | Reply
  17. CA Dover, NH

    Please listen to the comments posted by the doctors here; they have an accurate understanding of the complexities involved with obesity and addictions. The philosophy of "put the ___ down and step back" as the so called obvious solution is anything but. There is so much more going into these issues that will not be solved by punishment. I've spent decades struggling with obesity, partly due to my own behavior and partly due to medical issues NOT within my control. I know I was not able to make truely lasting changes until I was able to get an insurance policy committed to wellness and not just treating sickness. It meant the difference between taking necessary steps to empower myself (medical screenings, educational information, support), and just relying on fixing the problems after they occurred. I would much rather have the right medical screening, and the correct treatment option, instead of being denied preventative care.

    Unfortunately, this is all too common with our present medical system, even for those who have insurance, including myself. Our current system of medical care holds the standard of waiting until something is wrong before there is intervention. I'd much rather have an insurance company that offers me a discount if I go to the fitness center to strengthen my legs and preventative cortisone shots, rather that my last insurance company who told me they'd pay for my knee replacement, but not for the tools to help me keep it in shape. Consider this the next time you say you don't want health care reform.

    August 13, 2009 at 19:28 | Report abuse | Reply
  18. coastallife

    Liver damage is the 12th cause of death in the US, but liver damage is caused by everything from statins, red yeast rice, Tylenol, taking too many/high concentrations of vitamins, being too fat, and yes alcohol consumption (over time and of course some races more likely than others). Texting and driving is more dangerous than drunk driving (as studies showing up now are proving). Obesity costs now, not years from now like liver damage might. It is costing more than smoking, but since insurance companies are allowed to ask, don't expect them to take it off the application.

    August 13, 2009 at 21:24 | Report abuse | Reply
  19. Ms Shirley

    I am a Smoker. Have been one since age 19. I am now 70 years old.
    I have heard and read anti-smoking comments for about 15 years now, to the point of ad-nauseum. Carbon Monoxide from cigarettes is reputedly the culprit that is causing any or all of the many diseases I do not have, nor have I ever had, attributed to smoking, including emphasema, heart disease, throat disease, high blood pressure, kidney, colon nor breast diseases nor any type of cancer. I don't even have arthritis, a disease common to people my age. This has been verified by annual physicals every two years for the last 40, during which I blow into a tube like device to measure my breathing. I am able to blow the little ball to the top everytime. My Doctor is continually amazed and will usually have me to do the test again and again each time, then asking me "are you sure you smoke?"

    I have, however, noticed the lack of any mention of the chemicals including carbon monoxide, spewed into the air, on a daily basis, by
    Automobiles, busses, airplanes, manufacturing and the many industrys propelled by fossil fuels and other toxic matter. According to the AQMD, air quality management dept. of my county, 2500 tons of pollution is dispelled into this county daily. Not monthlly or weekly, daily.

    I have yet to see the help that Smog devices required on automobiles
    has done in my city when the dense yellow air, called smog, continually lies over the city 90% of the time.

    It seems that since discontinuing these industrys would affect many
    humans way of life we should just concentrate on banning the most insignificant of these polluters, cigarettes, as doing so will take the attention away from the real pollution creaters.

    On the subject of Obesity. I took it upon myself to quit smoking 38 years ago. I did not realize nor had I even been told, that weight gain sometimes accompanies smoke cessation. In eight months time, I went from a weight of 143, a positive weight for a 5'10 female, to 256 lbs. From a size 12 dress size to a snug, no tight matronly 24.
    Reaquanting myself with cigarettes, returned my body to its previous dress size and weight.

    One last observation, of the 19 people that I know that have been diagnosed with cancer, 14 have been breast cancer, 2 with colon cancer, 2 with lung cancer and one just said cancer, not what kind.

    August 14, 2009 at 18:42 | Report abuse | Reply
  20. Kevin Cleary

    This is my first blog (see my earlier post on this thread), and I am very pleasantly surprised at the intelligent commentary. It is obvious that people actually "get it."

    What I ask is that you actually voice your opinion to people you know. Our society is going in a bad direction with too much political correctness. No one bats an eye when you say that everyone deserves affordable healthcare, but as soon as you say obese people should pay more for healthcare (or lose weight), you run the risk of being labeled as prejudiced against overweight people.

    People must have the right to chose – be it eating too much, drinking, smoking, drugs or whatever, but they should expect to bear the consequences of their choices. No one can argue that that is a prejudiced opinion.

    August 15, 2009 at 07:42 | Report abuse | Reply
  21. joe

    I find it hard to believe Mr. Obama will tackle this issue as a smoker himself – but maybe Health Insurance should be like Auto Insurance – your rates go up if you have an accident, and why not make Health Insurance premiums be based on your lifestyle, if you smoke – you pay more (especially for any health issues from smoking) – it is clear smoking causes cancer and other health issues, so if you are smoking, you are knowledgeable of the fact you will need substantial care going forward, why shouldn't that population pay more. Why should the Tobacco companies not have to fund a smokers health care program? I don't think Mr. Obama's socialized medicine is fair and I think there are many other options if he would allow more time and not be a bully when it comes to his ideas.

    August 16, 2009 at 11:37 | Report abuse | Reply
    • Jimmy


      Health insurance is, on average, 65% more expensive for smokers.

      July 16, 2012 at 01:26 | Report abuse |
  22. We Should ALL Care

    There are fast food restaurants of every corner in these United States. These days both parents generally HAVE to work to run the household. A lot of times people aren't getting home until late and eating dinner late like after 9pm at night. If you don't eat late then you stop on the way home to grab ready meals for dinner which unfortunetly are packed with high fat and high calories. Why not make the fast food restaurants make healthier meals that are lower in fat and lower in calories. Even regular sit down restaurants serve way too much food. Cut the portions and cut the cost!! Why not??? Candy in every checkout counter...why??? The food chains that are out there making money hand over fist are causing a lot of the obesity issues in America. The prices are reasonable that the lower class and middle class can afford however, the nutrional value is not there. And guess what....people are addicted to the food. We took physical education out of the schools...what are we teaching our kids...we have vending machines in the schools ...what are we teaching our kids??? Come on... yes individuals are responsible for their actions but this is on a much larger scale and the government has to step in and take action...make a plan that would regulate the restauarnts into serving calorie and fat controlled meals and still price them affordably. People have addictive personalities....and food ..as we all know... can be and is an addiction to most. That is apparent in the numbers of Obese people in our country.

    August 20, 2009 at 18:09 | Report abuse | Reply
  23. food stamp recipient

    This is what i would do. I'd start with the people most likely to abuse both food and cigarettes–the poor. Start by changing food stamp benefits...by that I mean do NOT allow them to be used to buy anything that is not healthy, or regulate them by allowing only 1 large bag of chips a month, etc. With food stamp benefits computerized, this should be easier. I'd think anyway. Tell people who are getting Social Security Disability that their benefits would be halved if their blood tests positive for smoking...incredibly, most SSI recipients I know WANT smoking to be effectively enforced. because they want to quit!!

    As for people not on food stamps or SSI...well, I'd tell manufactuers of junk food to put in vitamins or minerals or they couldn't sell the item at all. I'd have the government subsidize makers of healthy food so it would be much cheaper. (This might not be possible.) Cigarettes? By prescription only. Period. if you can't afford a doctor, you shouldn't be doing money-wasting, dangerous activities like smoking anyway.

    August 25, 2009 at 01:35 | Report abuse | Reply
  24. Lu

    I agree with Mr Cleary's comment. People should have the right to chose. Some of the comments above are getting to close to the "Big Brother" theory. I still don't understand why everyone turns a blind eye to alcohol consumption. I think it is because society sees it as more acceptable, regardless of what its consequences are and the alcohol companies are too big to fight. Tell that to the eight people who died in the drunk driving crash recently.

    August 26, 2009 at 11:27 | Report abuse | Reply
  25. Mike

    What adds more to the cost of healthcare; obesity and smoking or illegal immigrants?

    August 29, 2009 at 19:00 | Report abuse | Reply
  26. Michael Combs

    I found a useful blog that gives great information on stats about quitting smoking along with all the info of reducing your risk of cancer.

    November 19, 2009 at 11:18 | Report abuse | Reply
  27. Kashif

    you put great information, shortly i can say that a good binging, please write more you can, yes definitly you can, here you are quit right "It’s virtually impossible to live in the United States and not be aware of the health risks associated with smoking, yet the addictive habit continues – with tragic consequences for smokers and an immense burden on the health care system"

    June 24, 2010 at 13:44 | Report abuse | Reply
  28. ChristinoSM

    Obesity is a bodily condition characterized by excessive storage of fat in adipose tissue. It is usually present in people who consume more calories containing food and lead a sedentary life. Treatment of Obesity can be done by consuming calorie-controlled or low-fat diet should only be attempted with expert support and advice. You should also have a follow-up appointment with your GP to check your progress. The most effective types of exercises are aerobic activities. Lose weight in order to improve your general quality of life, both physically and psychologically.

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  31. Jimmy

    David Martin needs to do a better job of researching this issue. The fact is the longer you live the more you add to healthcare costs. Smokers and the obese live an average of ten years less than healthy citizens. While reducing the number of smokers and obese will lower the cost of treating disease related to these bad habits, it will actually increase the overall cost of healthcare. Factor in the 18 billion dollars that smokers pay in cigarette taxes each year and you will find that they actually pay more than their share of the bill.

    July 15, 2012 at 19:52 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.