More than 5 million Californians between the ages of 12 and 64 who are enrolled in health-management organizations are overweight or obese–factors that increase the risk of diabetes, heart disease and several types of cancer.
“HMOs should address this problem both to help their membership lead healthier, more productive lives, and to control growing health-care costs,” reported the study by UCLA’s Center for Health Policy Research, which said obesity and overweight add some $7.7 billion to the annual cost of medial care.
The findings were posted on the Web site of the Office of the Patient Advocate, an independent state government office charged with educating consumers about their rights and responsibilities as HMO enrollees. The OPA, established seven years ago, publishes an Internet-based report card on the quality of HMO services and advises the Department of Managed Health Care regarding consumer issues. The OPA also has launched an anti-obesity effort to educate the public. The figures represent data collected through 2003.
On the average, the combined level of overweight or obese in California’s HMOs was 52 percent, or 5.2 million of the total 9.98 million HMO enrollees.
“Members of Aetna (59 percent), Kaiser (54 percent) and Health Net (53 percent) reported higher combined prevalence of overweight and obesity relative to the statewide rate; Cigna (52 percent) was comparable to the state average; while members of Blue Cross (51 percent), Blue Shield (49 percent) and PacifiCare (49 percent) had combined overweight and obesity rates lower than the statewide average,” according to the study. In a separate category, described as “other HMOs,” the average was 52 percent. In another listing described as “unknown HMOs,” the average was 46 percent. The latter category referred to people who were enrolled in HMOs but did not know the name of their plan.
There are differences between overweight and obesity. According to the National Institutes of Health, obesity is defined as having a body mass index of 30 or higher, based on height and weight. Overweight is less, between 25 and 25.9. A normal weight range is 18.5 to 24.9, and underweight is defined as 18.5 or less. The BMI number is relatively simple to calculate: It is obtained by dividing the weight in pounds by the height in inches by the height in inches (again) and multiplying by 703. Thus, to calculate the BMI for a person weighing 210 pounds who is 6-feet tall, one would divide 210 by 72, then divide again by 72, then multiply by 703, for a BMI of 28.5.
The populations of overweight and obese HMO patients, when divided according to category and viewed separately, show that there are more overweight HMO patients than there are obese patients. For example, Blue Cross reported that 34 percent of its patients were overweight, compared with 17 percent who were identified as obese. In the “unknown HMO” category, the disparity was even greater: 34 percent reported as overweight, while 12 percent were listed as obese.
Kaiser, the state’s largest HMO with nearly 4 million members, reported 33.6 percent as overweight and 20.2 percent as obese.
The study also examined the relationship between ethnicity and obesity. Those reporting Latino race/ethnicity had the highest combined prevalence of overweight and obesity, 62 percent, and they ranged from 59.4 percent in Blue Shield to 78.9 percent in Aetna. Latinos were followed by whites at 54.2 percent. Other race/ethnicity breakdowns: American Indians/Alaska Natives, 51.5 percent; African Americans, 45.5 percent; and Asian-Pacific Islanders, 35.3 percent.
The study also noted that overweight and obesity increase progressively with age. The average combined level of overweight and obesity increased from 24.9 percent for the age group 12 to 17, to 64.6 percent for the age group 50 to 64. A similar trend was observed for the average percentage of obese enrollees: an increase of 11.5 percent from the age group of 12 to 17 to 24.8 percent among the age group of 50 to 64.
Researchers said a goal of the study was to emphasize that enrollees “should be able to improve their lifestyle, health and eating habits when given the information and encouragement to do so. However, health plans can take steps to help the process. Physician incentives to discuss weight management may be more effective than the physician guidelines currently in place.
“The purpose of our analysis,” researchers added, “is to provide additional motivation for HMOs in California to take action and battle the epidemic of overweight and obesity. Because data on overweight and obesity rates are not reported as part of other quality and satisfaction surveys, our results provide important information on the health status of HMO members not available from any other source.”