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McPHERSON: Does Preventing Obesity Lead to Reduced Health-Care Costs 

Most people want to live a longer life, and they do not consider the consequences to society. But a major goal of life is to maximise one's total quality-adjusted life years (QALYs). Unfortunately, this new study provides little insight into the total QALYs associated with obesity and smoking. Certainly those who are obese and those who smoke will live fewer years on average, but will these people be compensated by enriched quality of their fewer years? Available evidence suggests strongly that quality of life, quite apart from increased illness rates, is considerably compromised by obesity [6].

We know already that health expenditure is high amongst the elderly, especially so amongst those who die of old age [7]. Van Baal and colleagues' study confirms the high medical costs of living to old age, but the results should not be interpreted as justifying the “cost savings” to society of dying younger. And, as the authors point out, it would be wrong to interpret the findings as meaning that public-health prevention (e.g., to prevent obesity) has no benefits. As the authors say, whilst prevention may not be “a cure for increasing expenditures—instead it may well be a cost-effective cure for much morbidity and mortality and, importantly, contribute to the health of nations” [1].

The balance of QALYs gained or lost, although not addressed in the van Baal study, could have been addressed—at least approximately. The subsequent analyses ought to tell us what this balance looks like for successful projects to contain the growth of obesity in populations. We need to know this balance both for lifetime gains and losses in quality of life and for comparisons of aggregated quality of life between more-obese societies and less-obese ones. Unlike the health expenditure comparison considered by van Baal and colleagues, the signs are that the overall balance will be entirely positive for obesity prevention—for individuals and populations.

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