I’ll take a pack of cigarettes, a large soda and a package of pork rinds

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The following is a guest post by Harold DeMonaco, one of our expert editors on HealthNewsReview.org and Director of the Innovation Support Center at the Massachusetts General Hospital.


While researching a totally different topic, I ran across a recent article published in the Journal of Occupational and Environmental Medicine. Researchers from the Mayo Clinic evaluated healthcare costs for employees and retirees of the Clinic who had continuous benefit coverage from 2001 through 2007. The Mayo Clinic funded the research project. Specifically, they looked at the incremental costs associated with obesity and with smoking. No surprises here, both increased healthcare costs. I found some of the data interesting.

The researchers collected data from a number of administrative sources including patient registration and information provided by employee patients during routine office visits.

Smoking status is routinely collected as part of office visits. The evaluation included over 25,000 current employees and about 5,500 retirees. The baseline characteristics of these healthcare workers are interesting in and of themselves.


Smoking status 












Of those who responded, roughly one out of every eight employees smokes. Current and retiree employee healthcare costs were $1,274 (or 16%) and $1,401 (or about 12%) respectively more than their counterparts who do not smoke. There are probably other factors involved such as income and education, but the numbers speak for themselves. Smoking does add significantly to healthcare costs.

The researchers also looked at body mass index and healthcare costs. 57% of the current employees are overweight to morbidly obese as compared to 66% of retirees.


Body Mass Index 



Morbidly Obese 1

Morbidly Obese 2

Employee Costs 





Retiree Costs 






Like all studies, this one has several limitations. But the basic information is telling. According to Kaiser Family Foundation Minnesota is just about on average with the rest of the US in terms of overweight and obesity rates (63%). I’ll go out on a limb and suggest that the results are likely repeatable elsewhere. Healthcare workers don’t seem to be very good examples of a healthy lifestyle. It does not appear that we are taking our own advice.

Total healthcare costs exceeded $2.6 Trillion in 2010 or about 18% of our gross domestic product. We can expect those numbers to dramatically increase as the population ages, tobacco continues to be subsidized (to the tune of $194 Million in 2010) and our waistbands continue to expand. With the ongoing debate over Obamacare, I would have thought, as a non-journalist, that more in the mainstream media would have picked up on this story rather than chin implants.

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Marilyn Mann

April 24, 2012 at 12:16 pm

Wow, just wow. I certainly would not deny that obesity add to health care costs. However, I feel that the title of your post and the statement about healthcare workers not being examples of a healthy lifestyle perpetuate the unfortunate tendency of most people (including health care providers) to assume that obesity is due simply to lack of willpower on the part of individual people. Weight bias seems to be the last socially acceptable form of bias. As obesity specialist Arya Sharma put it in a recent interview:

“Nobody likes fat people, and everybody thinks it’s their fault. Most people don’t understand the science and the biology behind obesity. They think this is really a matter of personal responsibility, and if you would eat better and get your butt off that couch, then you would be fine. As long as the public and government and everybody believes that to be true, you are not going to have the same kind of level playing field that you’ll have for hypertension or depression or any of those other conditions.”


Yoni Freedhoff

April 24, 2012 at 1:15 pm

I agree with Marilyn. The truism of “eat less, exercise more” is probably at the heart of the article above, yet that truism ignores the fact that people haven’t changed, the world in which they live has and that would apply to health care workers as well.

Expecting to solve environmental problems on the backs of individuals choice is akin to expecting to deal with a flooding river by focusing on swimming lessons. Instead we ought to be worrying more about stemming the flood.

    Harold DeMonaco

    April 24, 2012 at 4:27 pm

    Thank you both for your comments. I certainly do not endorse any form of bias, weight or otherwise. The reality is that a person’s weight is by and large dependent on a rather simple equation. If you take in more calories than you burn, you will gain weight. I recognize that this simple equation is not as simple as it seems. Environmental, social, economic and cultural norms all play a significant role. I am not an expert in obesity or much of anything else but I do know where to find information. Both the Centers for Disease Control and Prevention (see: http://www.cdc.gov/obesity/causes/index.html ) and the National Institutes of Health (see: http://win.niddk.nih.gov/publications/choosing.htm) support the notion that obesity is related to an unhealthy lifestyle. Here’s what the CDC says:

    The Caloric Balance Equation

    Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity.
    Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status.
    Behavior and environment play a large role causing people to be overweight and obese. These are the greatest areas for prevention and treatment actions.

    Promoting that healthy lifestyle should be the job of healthcare workers. That job is made a bit more difficult if over half of us are overweight or obese.

      Yoni Freedhoff

      April 24, 2012 at 6:01 pm

      While I’m all for “walking our talk”, I’m not sure it’s essential. What is true is that health care professionals aren’t actually taught anything about nutrition or healthy living beyond “eat less and exercise more”, so if you think the tools are there, I’m sorry to tell you you’re mistaken.

Harold DeMonaco

April 25, 2012 at 5:54 am

Here’s a point we can agree on. Nutritional education is sorely lacking in just about every healthcare discipline and current practitioners are woefully ill-prepared to deal with the obesity epidemic in the US. I don’t think that takes healthcare professionals off the hook however.

Marilyn Mann

April 27, 2012 at 12:46 pm

The Rudd Center at Yale has these guidelines for the portrayal of overweight or obese people in the media.


Adele Hite

April 30, 2012 at 10:08 pm

The CDC’s assessment of obesity is overly-simplified, as you noted. However, it is also self-contradictory. If obesity is caused by “eating too many calories,” in the context of any given genetic or metabolic context (and I might add in the context of any given life stage, hormonal state, disease state, or pharmaceutical use), what does that even mean? Ditto “not enough” physical activity. Calories in, calories out does not begin to address the complex mechanisms that drive eating behavior and energy storage/metabolism in the first place (why are some foods more satiating? how do we “count” the calories in nutrients that are used for structure and enzymes and not for fuel?). Our first concern should not be “how much” people are eating, but what they are eating and–for that matter–when. Many would argue that Americans in general, and obese Americans in particular, are well-nourished or “over-nourished.” However, our nutrient-poor food supply may create a situation where innate drives for real nutrition cause people eat *until* they are nourished–accumulating unneeded food energy along the way–not the other way around. I have a better definition of obesity: Obesity is a symptom of a mismatch between metabolic needs and food intake.