Overweight in adolescents: Implications for health expenditures

We consider a compelling research question raised by the growing prevalence of overweight among adolescents: do overweight adolescents incur greater health care expenditures than adolescents of normal weight? To address this question, we use data from the Medical Expenditure Panel Survey (MEPS) and estimate a two-part, generalized linear model (GLM) of health spending. Considering separate models by gender, we find that overweight females incur $790 more in annual expenditures than those of normal weight but we find no expenditure differences by bodyweight for males. We find that mental health spending is associated with part of the disparity in expenditures for adolescent females but establishing causality between mental health problems and weight-related health expenditure differences is challenging.     

Unusual synchronization of Red Sea fish energy expenditures

The highly gregarious goat fish Parupeneus forskalii found in the Red Sea at Eilat, Israel exhibit highly synchronous swimming and feeding activity. Five fish were studied under controlled conditions and highly resolved time‐series of their energy expenditures were measured. All fish demonstrated strong phase synchronization in that their activity levels, although erratic in time and intensity, were collectively coordinated and peaked simultaneously together. The synchronization of these wildly varying, and possibly chaotic signals of energy expenditures, were quantified using phase analysis. We suggest that, ecologically, this collective synchronization is a strategy that increases food‐catch.     

Components and control of cellular energy expenditures in endothermy

Attempts to predict and to measure the energy cost of ionic homeostasis in tissue cells are briefly reviewed and attention is drawn to the importance of ion-flux--as well as ion-gradient--maintenance for the preservation of cell structure and function. The energetic consequences of acute and chronic adjustments of two primary-active transport processes, Na-K transport across plasma(sarco) lemma and Ca transport across the endo(sarco)plasmic-reticular membrane, are illustrated. The question of the contribution of protein turnover to the energy expenditure of cell maintenance is raised, but not answered. After looking back on the now well-established concepts of the "intrinsic" cellular control of energy expenditure and the so-called "extrinsic" cellular control by intracellular calcium ion activities, it is suggested that the organ may also control cell metabolism under non-ischemic conditions, through heterogeneous distribution of arterial blood and erythrocytes to cells.     

State- and payer-specific estimates of annual medical expenditures attributable to obesity

The goal of this study is to expand prior analyses by presenting current state-level estimates of the costs of obesity in total and separately for Medicare and Medicaid. Quantifying current Medicare and Medicaid expenditures attributable to obesity is important because high public sector costs of obesity have been a primary motivation for publicly funded obesity prevention efforts at the state level. We also present estimates of the obesity-attributable fraction (OAF) of total, Medicare, and Medicaid expenditures and the percentage of total obesity costs within each state that is funded by the public sector. We used the 2006 Medical Expenditure Panel Survey, nationally representative data that include information on obesity and medical expenditures, to generate an equation that predicts annual medical expenditures as a function of obesity status. We used the 2006 Behavioral Risk Factor Surveillance System, state representative data, and the equation generated from the national model to predict state (and payer within state) expenditures and the fraction of expenditures attributable to obesity for each state. Across states, annual medical expenditures would be between 6.7 and 10.7% lower in the absence of obesity. Between 22% (Virginia) and 55% (Rhode Island) of the state-level costs of obesity are financed by the public sector via Medicare and Medicaid. The high costs of obesity at the state level emphasize the need to prevent and control obesity as a way to manage state medical costs.     

Energy reserves and metabolic expenditures of monarch butterflies overwintering in southern California

Abstract. 1. Energetic expenditure and predicted requirements for overwintering metabolism were determined for monarch butterflies ( Danaus plexippus L.) in southern California.
2. Fat content of butterflies declined steadily from a maximum of 71% lean dry weight in late November to a minimum of 36% lean dry weight in late January. The energy expenditure measured by fat depletion over a 61 day period from 24 November to 25 January was 26.05 joules per day.
3. Butterflies were generally the same temperature as the air at any time they were inactive, whether they were part of a large cluster or roosting solitarily.
4. Oxygen consumption of butterflies increased in a curvilinear fashion with increasing air temperature. Thus, the predicted metabolic requirements for an inactive butterfly during their quiescent period from late November to late January was 30.32 joules per day.
5. In contrast to the steady depletion of fat reserves during their quiescent period in December and January, low and stable fat levels of butterflies in late February coincide with high levels of flight activity, mating and emigration of females from the colony.
6. Progressive tightening of the energy balance due to increasing nocturnal temperatures from northern to southern California coastal areas may limit the southern distribution and duration of overwintering aggregations.     

Effect of the California tobacco control program on personal health care expenditures

Background

Large state tobacco control programs have been shown to reduce smoking and would be expected to affect health care costs. We investigate the effect of California''s large-scale tobacco control program on aggregate personal health care expenditures in the state.

Methods and Findings

Cointegrating regressions were used to predict (1) the difference in per capita cigarette consumption between California and 38 control states as a function of the difference in cumulative expenditures of the California and control state tobacco control programs, and (2) the relationship between the difference in cigarette consumption and the difference in per capita personal health expenditures between the control states and California between 1980 and 2004. Between 1989 (when it started) and 2004, the California program was associated with $86 billion (2004 US dollars) (95% confidence interval [CI] $28 billion to $151 billion) lower health care expenditures than would have been expected without the program. This reduction grew over time, reaching 7.3% (95% CI 2.7%–12.1%) of total health care expenditures in 2004.

Conclusions

A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care expenditures.     

Out-of-pocket health care expenditures due to excess of body weight in Portugal

The prevalence for excessive weight has also been increasing dramatically in Portugal over the last decades. The consequences for families as well as for the publicly funded Portuguese health care system are a matter of policy interest. This paper uses an econometric model to compute the fraction of the national out-of-pocket health care expenditures attributable to overweight and obesity among Portuguese adults. Given that public health care system pays for a substantial share of the national health care expenditures, the estimated the out-of-pocket expenditures is only a share of the total expenditures. Per-capita expenditures and the burden that obesity and overweight impose on families are also estimated. Two waves of the Portuguese National Health Survey (NHS), namely; 1995/1996 and 1998/1999 are considered. The results suggest that out-of-pocket expenditures due to excess weight have increased sharply during these 3 years. The two-part model estimates suggest that the obese and overweight are more likely to incur out-of-pocket health care expenditures but, in the restricted sample of those that incur expenditures, there is weak or no evidence that the obese or overweight spend, on average, more than those of normal weight. Overall, it is estimated that in 1995/1996, more than 1.8% out-of-pocket health care expenditures were attributable to obesity and 2% to overweight (although not statistically significant). The estimated percentages are over 2.9% for obesity and 4% for overweight in 1998/1999. Combined, the estimated attributable percentage of national out-of-pocket expenditures due to excess weight was 3.8% in 1995/1996 and 6.9% in 1998/1999. Per-capita expenditures due to obesity or overweight are small, on average, in absolute terms, but they can be a significant cost for low income families. With respect to public policy concerns, the results suggest that measures which only slightly increase the out-of-pocket health care expenditures of being obese (overweight) are likely to be inefficient.