This study illustrates the importance for policymakers of long-termbudget impact analyses of preventive health policies, specifically those aimed at obesity prevention. The study recommends that the Congressional Budget Office (CBO), the agency responsible for estimating costs of proposed federal legislation, develop the capacity to estimate the costs of these policies over a 75-year horizon.
Obesity rates have doubled among adults in the last twenty years and tripled among children in a single generation. Evidence suggests that by 2040 roughly half the adult population may be obese. Obesity increases the risk of type 2 diabetes, high blood pressure, heart disease, certain types of cancer, stroke, and many other diseases and conditions. These associated conditions carry high financial costs and can be devastating to quality of life. Health care spending due to obesity is estimated to be as high as $210 billion annually, or 21 percent of total national health care spending. When also accounting for the nonmedical costs of obesity, the overall annual cost is estimated to be $450 billion.
The Institute of Medicine and other scientific bodies have identified evidence-based strategies for addressing the childhood obesity epidemic. One impediment to pursuing obesity prevention policies at the federal level lies in how their budgetary impacts are assessed. CBO generally uses a ten-year budget window, but effective preventive health measures can have long-run budgetary impacts that differ greatly from their ten-year projections. In fact, very little of the federal savings they induce may be captured in the first decade, especially if an intervention is geared toward children or young adults and yields meaningful impacts on health care costs for individuals receiving Medicare decades in the future.
In addition to distorting policymakers' understanding of the net cost of preventive health policies, a narrow budget window also fails to distinguish between effective and ineffective interventions. Because a ten-year window misses most or all of the savings from an effective obesity prevention policy, a tenyear cost estimate for such a policy would not differ from a ten-year estimate for an ineffective one.
This study constructs an illustrative model of the long-term budget impact of obesity prevention policies, accounting for the Medicaid, Medicare, Social Security, and tax effects of preventing obesity. The model demonstrates the complexities involved in reaching a long-term cost estimate. Using four obesity prevention policies and programs as examples, the model generates lifetime (i.e., 75-year) percapita savings estimates for different types of people. In so doing, it makes it possible to compare the discrepancy between 75-year and ten-year cost estimates of a policy to prevent obesity.