Abstract
Background
Both obesity and depression have been associated with significant increases in health care costs. Previous research has not examined whether cost increases associated with obesity could be explained by confounding effects of depression.
Objective
Examine whether the association between obesity and health care costs is explained by co-occurring depression.
Design
Cross-sectional study including telephone survey and linkage to health plan records.
Participants
4462 women aged 40 to 65 enrolled in prepaid health plan in the Pacific Northwest.
Main Measures
The telephone survey included self-report of height and weight and measurement of depression by the Patient Health Questionnaire (PHQ9). Survey data were linked to health plan cost accounting records.
Key Results
Compared to women with BMI less than 25, proportional increases in health care costs were 65% (95% CI 41% to 93%) for women with BMI 30 to 35 and 157% (95% CI 91% to 246%) for women with BMI of 35 or more. Adjustment for co-occurring symptoms of depression reduced these proportional differences to 40% (95% CI 18% to 66%) and 87% (95% CI 42% to 147%), respectively. Cost increases associated with obesity were spread across all major categories of health services (primary care visits, outpatient prescriptions, inpatient medical services, and specialty mental health care).
Conclusions
Among middle-aged women, both obesity and depression are independently associated with substantially higher health care costs. These cost increases are spread across the full range of outpatient and inpatient health services. Given the high prevalence of obesity, cost increases of this magnitude have major policy and public health importance
Similar content being viewed by others
References
Bertakis KD, Azari R. Obesity and the use of health care services. Obes Res. 2005;13(2):372–9.
Quesenberry CP, Jr., Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med. 1998;158(5):466–72.
Andreyeva T, Sturm R, Ringel JS. Moderate and severe obesity have large differences in health care costs. Obes Res. 2004;12(12):1936–43.
Daviglus ML, Liu K, Yan LL, et al. Relation of body mass index in young adulthood and middle age to Medicare expenditures in older age. JAMA. 2004;292(22):2743–9.
Cai L, Lubitz J, Flegal KM, Pamuk ER. The predicted effects of chronic obesity in middle age on Medicare costs and mortality. Med Care. 2010;48(6):510–7.
Onyike C, Crum R, Lee H, Lyketsos C, Eaton W. Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2003;158:1139–47.
Heo M, Pietrobelli A, Fontaine K, Sirey J, Faity M. Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes. 2005;(epub Nov 15).
Ma J, Xiao L. Obesity and depression in US women: results from the 2005–2006 National Health and Nutritional Examination Survey. Obesity (Silver Spring). 2010;18(2):347–53.
Zhao G, Ford ES, Dhingra S, Li C, Strine TW, Mokdad AH. Depression and anxiety among US adults: associations with body mass index. Int J Obes (Lond). 2009;33(2):257–66.
Simon G, Ludman E, Linde J, et al. Association between obesity and depression in middle-aged women. Gen Hosp Psychiatry. 2008;30:32–9.
Simon G, VonKorff M, Saunders K, et al. Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry. 2006;63:824–30.
Simon GE, Ludman EJ, Linde JA, et al. Association between obesity and depression in middle-aged women. Gen Hosp Psychiatry. 2008;30(1):32–9.
Simon G, Ormel J, VonKorff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiat. 1995;152:352–7.
Simon G, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry. 1995;52:850–6.
Unützer J, Patrick D, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients age 65 and over: a four-year prospective study. JAMA. 1997;277:1618–23.
Taplin S, Thompson R, Schintzer F, Anderman C, Immanuel V. Revisions in the risk-based Breast Cancer Screening Program at Group Health Cooperative. Cancer. 1990;66:812–8.
Cochran W. Sampling techniques. New York: Wiley; 1977.
Huang F, Chung H, Kroenke K, Delucchi K, Spitzer R. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21:547–52.
Kroenke K, Spitzer R, Williams J. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Lowe B, Kroenke K, Herzog W, Grafe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004;81:61–6.
Spitzer R, Kroenke K, Williams J. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–44.
Linde JA, Simon GE, Ludman EJ, et al. A Randomized Controlled Trial of Behavioral Weight Loss Treatment versus Combined Weight Loss/Depression Treatment among Women with Comorbid Obesity and Depression. Ann Behav Med. (in press).
Weinberg C. Toward a clear definition of confounding. Am J Epidemiol. 1993;137:1–8.
Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2003;54(3):216–26.
Rohde P, Ichikawa L, Simon GE, et al. Associations of child sexual and physical abuse with obesity and depression in middle-aged women. Child Abuse Negl. 2008;32(9):878–87.
Simon G, Chisholm D, Treglia M, Bushnell D. Course of depression, health services costs, and work productivity in an international primary care study. Gen Hosp Psychiatry. 2002;24:328–35.
Simon G, Revicki D, Heiligenstein J, et al. Recovery from depression, work productivity, and health care costs among primary care patients. Gen Hosp Psychiatry. 2000;22:153–62.
McEwen LN, Coelho RB, Baumann LM, Bilik D, Nota-Kirby B, Herman WH. The cost, quality of life impact, and cost-utility of bariatric surgery in a managed care population. Obes Surg. 2010;20(7):919–28.
Sampalis JS, Liberman M, Auger S, Christou NV. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14(7):939–47.
Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14(9):589–96.
Makary MA, Clarke JM, Shore AD, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg. 2010;145(8):726–31.
Rivenes AC, Harvey SB, Mykletun A. The relationship between abdominal fat, obesity, and common mental disorders: results from the HUNT study. J Psychosom Res. 2009;66(4):269–75.
Marijnissen RM, Bus BA, Holewijn S, et al. Depressive symptom clusters are differentially associated with general and visceral obesity. J Am Geriatr Soc. 2011;59(1):67–72.
Katon W, Unutzer J, Fan M, et al. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes Care. 2006. 2006;29:265–70.
Katon WJ, Russo JE, Von Korff M, Lin EH, Ludman E, Ciechanowski PS. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care. 2008;31(6):1155–9.
Simon GE, Katon WJ, Lin EH, et al. Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry. 2007;64(1):65–72.
Unutzer J, Katon WJ, Fan MY, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008;14(2):95–100.
Contributors
All listed authors made substantive contributions to the design and conduct of this study; all made substantive contributions to the drafting and/or editing of this manuscript.
Other Contributors
There are no other individuals who made substantial contributions but do not meet criteria for authorship.
Funding
Funded by NIMH grant R01 MH068127
Prior Presentation
N/A
Conflict of Interest
None disclosed.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Simon, G.E., Arterburn, D., Rohde, P. et al. Obesity, Depression, and Health Services Costs Among Middle-Aged Women. J GEN INTERN MED 26, 1284–1290 (2011). https://doi.org/10.1007/s11606-011-1774-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-011-1774-x