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EDITORIALS: THE SATURDAY PAGE : HEALTH AND SAFETY

Survival of the fattest?

Unhealthy habits can mean lower medical care costs -- mostly because you're likely to die sooner.

February 09, 2008

Go ahead and laugh -- all the way to the gym. We guffawed before we winced at the Dutch study published this week that found that slim and fit people actually cost the healthcare system more than obese people and smokers. That's because puffers and the pudgy tend to die young, while health nuts live longer and so rack up higher total medical bills.

Sadly, this is not a Jay Leno gag but a peer-reviewed study, by a bunch of distinguished Dutch institutions, published in the Public Library of Science Medicine journal. And no, it wasn't intended to make millions of people abandon their New Year's resolutions, although it may have the unintended consequence of driving health policy wonks to drink. The researchers were trying to examine whether, given that obesity is epidemic and causes premature illness and death, programs aimed at targeting obesity are a wise public health investment (strictly from the point of view of reducing costs).

The study used actual data on life expectancy and the cost of treating illness in the Netherlands to compare costs incurred by obese people who never smoked (but had a body mass index of more than 30), lifetime smokers who had a healthy body weight (a body mass index of 18.5 to 25) and a "healthy living" group of never-smokers of normal weight. The researchers found that from ages 20 to 56, obese people incurred the highest costs for medical care. After age 56, smokers generated the biggest bills. But because life expectancy for obese people was five years less than average, and smokers died seven years prematurely, the healthy living group had the highest total lifetime medical costs.

Naturally, caveats abound. First, as the researchers were quick to note, healthy, longer lives are valuable in and of themselves, regardless of their medical cost. Second, the study didn't measure the economic contributions of the group that had healthy habits, lived longer and presumably paid plenty of taxes in their ripe old age. And third, the study didn't examine the role of exercise, or lack thereof, which appears to be critical.

Before concluding that virtue goes unrewarded, it's worth checking out another study, this one done on British twins, which suggests that exercise slows the aging process on a molecular level. Judging by the condition of the tips of their DNA strands -- vital to proper cell replenishment -- those who exercised at least three hours a week had DNA that appeared nine years younger than that of their couch-potato twins. So while these healthy livers may run up huge medical bills in their last years of life, they can gloat all the way to the doctor.

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