Middle Age Obesity and Medicare Cost at Older Ages

James Lubitz, National Center for Health Statistics (NCHS), CDC
Liming Cai, National Center for Health Statistics (NCHS), CDC
Elsie R. Pamuk, National Center for Health Statistics (NCHS), CDC
Katherine Flegal, National Center for Health Statistics (NCHS), CDC

We examined the relationship between body mass index (BMI) at middle age and cumulative Medicare expenditures from age 65 until death, using the National Health and Nutrition Examination Survey I Epidemiological Followup Study, linked to 1991 to 2000 Medicare claims. The relationship between BMI at age 45 and Medicare expenditures was modeled using a generalized linear mixed model. We estimated two models, one using BMI measured at NHANES I baseline only, and the other using BMI measured both at baseline and 1982. Persons of normal weight in middle age had the lowest spending, followed by overweight persons, with obese persons having the highest spending. Because overweight and normal weight persons had similar life expectancies after age 65, the higher spending for the overweight indicates that excess weight affects morbidity, but not mortality in this group. However, middle-age obesity led both to shorter life and higher Medicare expenses in this cohort.