Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Heart Institute Edson Saad/Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Int J Obes (Lond). 2019 Nov;43(11):2225-2232. doi: 10.1038/s41366-018-0257-0. Epub 2018 Nov 20.
BACKGROUND/OBJECTIVE: Obesity is a chronic disease, a risk factor for other chronic conditions and for early mortality, and is associated with higher health care utilization. Annual spending among obese individuals is at least 30% higher vs. that for normal-weight peers. In contrast, higher cardiorespiratory fitness (CRF) is related to many health benefits. We sought to examine the association between CRF and health care costs across the spectrum of body mass index (BMI).
Data from 3,924 men (58.1 ± 11.1 years, 29.2 ± 5.3 kg.m) who completed a maximal exercise test for clinical reasons and to estimate CRF were recorded prospectively at the time of testing. Cost data (USD) from each subject during a 6-year period after the exercise test were merged with the exercise database and compared according to BMI and estimated CRF (CRFe). Subjects were categorized as normal-weight (BMI < 25.0 kg.m), overweight (BMI 25.0-29.9 kg.m), and obese (BMI ≥ 30.0 kg.m). We also formed four CRFe categories based on age-stratified quartiles of metabolic equivalents (METs) achieved: least-fit (5.1 ± 1.5 METs; n = 1,044), moderately-fit (7.6 ± 1.5 METs; n = 938), fit (9.4 ± 1.5 METs; n = 988), and highly-fit (12.4 ± 2.2 METs; n = 954).
Average annual costs per person adjusted for age and presence of cardiovascular disease were $37,018, $40,572, and $45,683 for normal-weight, overweight, and obese subjects, respectively (p < 0.01). For each 1-MET incremental increase in CRFe, annual cost savings per person were $3,272, $4,252, and $6,103 for normal-weight, overweight, and obese subjects, respectively. Stratified by CRFe categories, annual costs for normal-weight, overweight, and obese subjects in the highest CRFe quartile were $28,028, $31,669, and $32,807 lower, respectively, compared to subjects in the lowest CRFe quartile (p < 0.01).
Higher CRFe is associated with lower health care costs. Cost savings were particularly evident in obese subjects, suggesting that the economic burden of obesity may be reduced through interventions that target improvements in CRF.
背景/目的：肥胖是一种慢性病，是其他慢性疾病和早逝的风险因素，并且与更高的医疗保健利用率有关。肥胖个体的年支出至少比正常体重的同龄人高 30%。相比之下，更高的心肺适能（CRF）与许多健康益处相关。我们试图研究 CRF 与整个身体质量指数（BMI）范围内的医疗保健成本之间的关联。
前瞻性地记录了 3924 名男性（58.1±11.1 岁，29.2±5.3kg.m）在进行最大运动测试时的数据，这些男性出于临床原因进行了最大运动测试以估计 CRF。在运动测试后的 6 年内，将每位受试者的成本数据（美元）与运动数据库合并，并根据 BMI 和估计的 CRF（CRFe）进行比较。受试者根据 BMI 被分为正常体重（BMI<25.0kg.m）、超重（BMI 25.0-29.9kg.m）和肥胖（BMI≥30.0kg.m）。我们还根据达到的代谢当量（METs）年龄分层四分位数将 CRFe 分为四个类别：最差（5.1±1.5METs；n=1044）、中等（7.6±1.5METs；n=938）、良好（9.4±1.5METs；n=988）和优秀（12.4±2.2METs；n=954）。
调整年龄和心血管疾病存在后，人均年费用分别为正常体重、超重和肥胖受试者 37018 美元、40572 美元和 45683 美元（p<0.01）。对于 CRFe 每增加 1 个 MET，正常体重、超重和肥胖受试者的人均年度成本节省分别为 3272 美元、4252 美元和 6103 美元。按 CRFe 类别分层，CRFe 最高四分位数的正常体重、超重和肥胖受试者的年费用分别比 CRFe 最低四分位数的受试者低 28028 美元、31669 美元和 32807 美元（p<0.01）。
更高的 CRF 与更低的医疗保健成本相关。肥胖受试者的成本节约尤其明显，这表明通过针对改善 CRF 的干预措施，可能会降低肥胖的经济负担。
