Extra: The Fab 4 (not the ones from Liverpool)

To reduce medical costs, I submit that, one should decrease both the need for services and the cost of services. To help ourselves preserve health, we should all know our personal values for the following 4 items (obviously, this list is not exhaustive):

BMI

Body Mass Index (BMI) is a useful metric that allows an “apples to apples” comparison of adults of different height and weight. It is useful in epidemiology as 1 measure to predict health and is calculated by dividing a person’s weight in kilograms by height in meters squared. As per CDC guidelines, if one is <18.5 kg/m², one is “underweight”. This is unhealthy. BMI of 18.5-24.9 is considered “healthy”. 25.0-25.9 is “overweight”. BMI >30.0 is obese. A simple definition of “morbid obesity” (possibly now switching to the term class III obesity) is a BMI >40.0.

It is accepted that too low or high a BMI is unhealthy but there has been limited research done into related costs. However, Zachary Ward et al. wrote an article in PLOS ONE published 3/24/21 regarding elevated BMI and related costs. To paraphrase, for each 1 unit of BMI above 30, there was an additional cost of $253/person-year. The article estimates that the excess cost was $172.74 billion in the US annually. The article reported costs in $US 2019. By virtue of medical inflation and greater rates of obesity, I extrapolate to $200,000,000,000 in the US annually as of 2024.

According to this article, lowest expenditures for women was a BMI of 20.5 and men 23.5.

Fasting glucose (or HgA1c)

The 2 tests here are used to screen, predict, and/or monitor one’s glycemic (sugar) status, often in the context of diabetes mellitus. A fasting glucose is the instantaneous glucose/sugar level in fasting blood. HgA1c (hemoglobin A1C) is the average blood sugar level over a 4-month period (so not instantaneous). Both are used to evaluate glycemic status. According to the ADA’s (American Diabetic Association) Annual Cost of Diabetes report (2023), the US spent $412.9 billion related to diabetes. $306.6 billion are in direct medical costs and $106.3 billion are in indirect costs.

Cholesterol (total, at least, but more ideally the profile)

Total cholesterol (and the related HDL, LDL, and triglycerides) greatly affects our health. Excess cholesterol leads to atherosclerosis which is a disease characterized by damaged or blocked arteries. Indeed, atherosclerosis causes more death than all cancers combined. Blockages of arteries to the brain causes cerebral infarcts (“strokes”). Blockages of the heart’s arteries to itself cause myocardial infarctions (“heart attacks”). Other blockages lead to aneurysmal ruptures. Amazingly, this does not exhaust all the disease atherosclerosis causes. The cost of treatment stratified by degree of cholesterol elevation is difficult to obtain but I would estimate it costs hundreds of billions of dollars, much like poorly treated diabetes mellitus (please see the last paragraph of this article).

Blood Pressure

According to CDC publication from the office of Policy, Performance, and Evaluation (internally reviewed, Oct. 2022), 108,000,000 adult Americans have hypertension (significantly elevated bp) costing the nation “$131-198 billion/yr” <editor’s note: it is unclear to me why the range is so great>. Hypertension contributes to 500,000 deaths/yr. in the US. For me, the most dramatic statistic in this article is only 1 in 4 patients have hypertension controlled.

The above noted numbers are extraordinary. They represent still another singular opportunity for improvement both to promote health and to reduce costs.

We should all know our bp values and map them onto this table:

Please note that there is overlap in related costs between the 4 items above. If one has morbid obesity and diabetes mellitus, the former tends to worsen the latter. Thus, one cannot linearly add the cost of obesity with diabetes mellitus. They overlap (as will, to an extent, morbid obesity worsen cholesterol and hypertension). However, if we know the above 4 values and work as a team with our physician and/or other clinicians to optimize these values, we will improve our health and save hundreds of billions of dollars per year. As usual, the benefits align.