This study conducted by the Mayo Clinic in Minnesota and published in the January 2016 Medicine Journal looked at emergency department utilization by obese patients (those with a high BMI) and concluded that this group are substantially higher utilizers of emergency department services compared to their peers particularly in younger adult age groups.  This is a disturbing trend as about one third of the population is obese and this is trending upwards and projected to be 50% of the population by 2030.  Obese patients tend to be sicker and their lifespan is nearly a decade less.  It also postulates that these patients may tend to avoid medical care because of the stigmata and perhaps the emergency department is a place where intervention might be worthwhile.

bmi bodies

The obesity epidemic remains an urgent public health crisis with significant impact on morbidity, mortality, and healthcare costs.1 More than one-third of all Americans are obese (body mass index [BMI] ≥30 kg/m2) and the prevalence of obesity in the United States (US) is on track to rise to 50% by 2030.2,3 The adverse health consequences of obesity include cardiovascular disease, hypertension, dyslipidemia, diabetes mellitus, sleep apnea, and psychiatric comorbidities including depression.4 Obesity contributes to at least 162,000 deaths each year across all ages and can shorten life expectancy by nearly a decade in young and middle-aged adults.4–6 In addition, medical costs in the US related to obesity are $210 billion per year7 and projected to increase by an additional $48 to $66 billion by 2030.3Underlying the disparities in medical costs between obese and nonobese individuals are different patterns of healthcare utilization. Focus on healthcare utilization and costs in the elderly is expected given that younger adults tend to use health services comparatively less than older adults.8 However, similar to the concentrated healthcare costs and utilization observed among older adults, 5% of 18- to 44-year olds account for more than 50% of all healthcare expenditures in their age group.9 In addition, adults typically gain most of their weight in their early decades.10 Adults experiencing higher weight gain in young adulthood are likely to have sustained, higher weight later in life.11 Obesity and obesity-related conditions are likely contributors to increased healthcare utilization as cross-sectional studies in the US have demonstrated that higher BMI is associated with higher rates of outpatient clinic visits, emergency department (ED) visits, and hospitalizations.12–14 However, analyses based on cross-sectional measures of BMI fail to capture the potential influence of weight change over time.15 BMI increase over the life course, particularly in early to middle adulthood, may uniquely contribute to increased healthcare utilization.


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2. Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 2014; 311:806–814.

3. Wang YC, McPherson K, Marsh T, et al. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet 2011; 378:815–825.

4. Office of the Surgeon General (US). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Office of Disease Prevention and Health Promotion (US), Centers for Disease Control and Prevention (US), National Institutes of Health, U.S. Department of Health and Human Services. Rockville, MD: Office of the Surgeon General (US); 2001; Section 2: Posing Questions and Developing Strategies. Available from: Accessed November 30, 2014.

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6. Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298:2028–2037.

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8. National Center for Health StatisticsNational Center for Health Statistics, Health, United States, 2013: With Special Feature on Prescription Drugs. Hyattsville, Maryland:2014.

9. Cohen S, Uberoi N. Differentials in the Concentration in the Level of Health Expenditures across Population Subgroups in the U.S., 2010. Statistical Brief #421. Rockville, MD: Agency for Healthcare Research and Quality; 2013.

10. Sheehan TJ, DuBrava S, DeChello LM, et al. Rates of weight change for black and white Americans over a twenty year period. Int J Obes Relat Metab Disord 2003; 27:498–504.

11. Malhotra R, Ostbye T, Riley CM, et al. Young adult weight trajectories through midlife by body mass category. Obesity 2013; 21:1923–1934.

12. Quesenberry CP Jr, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med 1998; 158:466–472.

13. Raebel MA, Malone DC, Conner DA, et al. Health services use and health care costs of obese and nonobese individuals. Arch Intern Med 2004; 164:2135–2140.

14. Bertakis KD, Azari R. Obesity and the use of health care services. Obes Res 2005; 13:372–379.

15. Zajacova A, Ailshire J. Body mass trajectories and mortality among older adults: a joint growth mixture-discrete-time survival analysis. Gerontologist 2014; 54:221–231.

Source: Body Mass Index Trajectories and Healthcare Utilization in Y… : Medicine