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Journal of General Internal Medicine

, Volume 26, Issue 11, pp 1284–1290 | Cite as

Obesity, Depression, and Health Services Costs Among Middle-Aged Women

  • Gregory E. SimonEmail author
  • David Arterburn
  • Paul Rohde
  • Evette J. Ludman
  • Jennifer A. Linde
  • Belinda H. Operskalski
  • Robert W. Jeffery
Original Research

Abstract

Background

Both obesity and depression have been associated with significant increases in health care costs. Previous research has not examined whether cost increases associated with obesity could be explained by confounding effects of depression.

Objective

Examine whether the association between obesity and health care costs is explained by co-occurring depression.

Design

Cross-sectional study including telephone survey and linkage to health plan records.

Participants

4462 women aged 40 to 65 enrolled in prepaid health plan in the Pacific Northwest.

Main Measures

The telephone survey included self-report of height and weight and measurement of depression by the Patient Health Questionnaire (PHQ9). Survey data were linked to health plan cost accounting records.

Key Results

Compared to women with BMI less than 25, proportional increases in health care costs were 65% (95% CI 41% to 93%) for women with BMI 30 to 35 and 157% (95% CI 91% to 246%) for women with BMI of 35 or more. Adjustment for co-occurring symptoms of depression reduced these proportional differences to 40% (95% CI 18% to 66%) and 87% (95% CI 42% to 147%), respectively. Cost increases associated with obesity were spread across all major categories of health services (primary care visits, outpatient prescriptions, inpatient medical services, and specialty mental health care).

Conclusions

Among middle-aged women, both obesity and depression are independently associated with substantially higher health care costs. These cost increases are spread across the full range of outpatient and inpatient health services. Given the high prevalence of obesity, cost increases of this magnitude have major policy and public health importance

KEY WORDS

depression obesity cost epidemiology 

Notes

Contributors

All listed authors made substantive contributions to the design and conduct of this study; all made substantive contributions to the drafting and/or editing of this manuscript.

Other Contributors

There are no other individuals who made substantial contributions but do not meet criteria for authorship.

Funding

Funded by NIMH grant R01 MH068127

Prior Presentation

N/A

Conflict of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Gregory E. Simon
    • 1
    • 4
    Email author
  • David Arterburn
    • 1
  • Paul Rohde
    • 2
  • Evette J. Ludman
    • 1
  • Jennifer A. Linde
    • 3
  • Belinda H. Operskalski
    • 1
  • Robert W. Jeffery
    • 3
  1. 1.Group Health Research InstituteSeattleUSA
  2. 2.Oregon Research InstituteEugeneUSA
  3. 3.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Center for Health StudiesSeattleUSA

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