Use of healthcare services and expenditure in the US in 2025: The effect of obesity and morbid obesity

Abstract

Objective: This paper explores the contribution of body-mass index (BMI) categories in shaping past trends of use of healthcare services and associated expenditure in the US and projects results to 2025.

Methods: The study uses Medical Expenditure Panel Survey (MEPS) data for 2000-2012, reweighted on National Health and Nutrition Survey (NHANES) data for 1972-2012 and US Census Bureau data, to carry out projections for up to 2025. A combination of logistic regressions and generalized linear models was used to model use and associated expenditure for the following healthcare services: inpatient care (with/without surgery), office-based care, outpatient-care, drug prescription and home health care. Quantile regressions were used to analyse and project BMI levels.

Results: 20.5 million individuals will be severely obese in 2025. Normal-weight and overweight individuals have stable trends in use for many healthcare services. Conversely, use of healthcare services in patients in class II and class III obesity will increase substantially. Total healthcare expenditure increases more quickly in the obese population than in normal-weight individuals.

Conclusions: Class III obesity (BMI≥40 kg/m2) significantly affects demand and expenditure for all healthcare services. Careful healthcare service planning and implementing effective policy actions to counteract such trends is crucial to meet future demand.

Fig 1. Change in use of healthcare services (%) by category of service and BMI; US population 2000–2025.

Note: continuous lines represent historical trends; dotted lines represent projections; BMI (Body Mass Index) categories are defined according to WHO thresholds (WHO 2016) for adults and Cole et al. 2000 for children and teenagers; 2000 is base year equal to 100; additional results in the S1 Fig.

Fig 2. Change in healthcare expenditure (%) by category of service and BMI; US population 2000–2025.

Note: continuous lines represent historical trends; dotted lines represent projections; BMI (Body Mass Index) categories are defined according to WHO thresholds (WHO 2016) for adults and Cole et al. 2000 for children and teenagers; 2000 is base year equal to 100; additional results in the S2 Fig.