Weighing the Costs of Obesity for Women Over 50

The needs of women over 50 who are overweight and obese are becoming a burden on the medical fraternity. Slight of frame and shrinking in weight and height. That’s the stereotype of the “little old man” or the “little old lady.” The classic model is the elder who is frail, losing body, bone and muscle mass. But not everyone loses weight at the end of life, and obesity is impacting the costs of medical services!

The rise in the overall obesity rate over the past three decades includes a hefty share of older adults. According to a 2017 report by the National Center for Health Statistics, almost 40% of Americans 60 and older are obese, identified as having a body mass index (BMI) of 30 or more. Data from the Centers for Disease Control classifies 15% of Americans as morbidly obese, meaning their BMI exceeds 40.

Care facilities are witnessing a significant hike in obese residents. Research published in 2018 noted that the number of aged residents who were classified as obese rose from 22% to 28% in the decade between 2005 and 2015.

In rehabilitative, short-term or long-term care facilities, overweight and obese people require more services, staff, and additional staff training, all at a higher cost. In a home setting, obese relatives present significant challenges for family caregivers. Providing care for a mother who weighs 90 pounds is different from one who weighs 300 pounds.

People classified as obese require care at an earlier age due mainly to mobility issues. They have younger children and fully employed siblings or spouses who can’t provide care. They’re more likely to report they had caregiving needs but no caregiver.

It’s well-documented that nursing home directors refuse admission of obese patients. We can guess it’s because they’re too resource-intensive. People who are obese require many more services and nursing homes see the patient as unprofitable due to the higher costs incurred for care. The present funding design for long-term care in the United States is poorly responsive to the special services necessary for the care of elderly people with obesity.

Caring for patients with more needs should generate higher reimbursement from medical insurance. At present obesity is not a characteristic approved to increase billing, however, it is a very real contributor to the cost of services. Policymakers and insurance companies need to consider updating the payment system to account for the increase in care costs required by these patients, whether it is in-home health, long term care or other systems. How will this added cost impact the cost of insurance for the younger members?

The problem

 A RAND Corp. analysis of nearly 10,000 Medicare beneficiaries found that starting at age 70, an obese person will cost Medicare 35% more than a beneficiary of median weight. Obese older adults are more expensive to care for than their lighter counterparts. Obesity leads to a series of complex medical issues with an elevated risk of chronic diagnoses including diabetes, hypertension and cardiovascular disease. Obesity has been linked to sleep disturbances, joint problems, and mobility challenges. 

People who are overweight can be frail in spite of their size. Their loss of mobility may have caused them to not stand on their own in years and they can’t move their bodies. Caring for people with obesity can require specialized equipment like motorized lifts and an adapted environment including more spacious rooms with wider doorways, retrofitted bathrooms with floor-mounted commodes, larger beds, wider wheelchairs and even longer blood pressure cuffs.

Can these patients lose weight?

Bariatric surgery can be effective for some older people. Shedding pounds through dieting is often not successful. Losing weight requires exercise to burn calories. Exercising creates muscle strength and shape, dieting alone can be dangerous, placing them at risk for fractures.

For most of the older women and men that are obese, it has been a lifelong condition and struggle. Their metabolism has changed and they can’t get the weight off. There’s a science behind why people can’t lose weight that goes way beyond that they ate too much. Obesity is a disease and losing weight at an advanced age is not that easy!

Obesity beyond death

The expenses and limitations of obesity extend to the end of life—and beyond. Some crematoriums do not accept oversized bodies. Families choosing traditional funerals can choose from oversized products produced by casket and coffin manufacturers; some funeral homes rely on motorized hoists and reinforced hearses to accommodate heavier bodies, with costs passed on to families.

Obese people may not be able to donate their bodies to science after their deaths. Most medical school programs have size and weight limits based on BMI. The act of handling the cadaver in the lab becomes a problem if the person is too big. The excess weight gets in the way, making it challenging to look at the anatomy and get to certain structures.

Our healthcare system works much more efficiently for someone who weighs 160 than for someone who weighs 300. Will that change? With the percentage of people being obese increases, it is a real concern for families and society to consider.