Rising Disability in the
Young Tied to Obesity

Disability is no longer limited to the old.

Thanks largely to the obesity epidemic, disability rates among the under-60 crowd have risen sharply over the past 20 years, says a RAND Corp. report published in the January issue of Health Affairs.

Disability rates among the elderly, by contrast, have fallen slightly.

"It's about time someone finally is taking the numbers and trying to prove scientifically something that I see every day," says Dr. Christine Ren, director of the Surgical Weight Loss Program at New York University Medical Center. "Obesity affects everything in your body so it causes deterioration, whether it's metabolic deterioration such as diabetes, vascular deterioration such as stroke and heart attack, or mechanical deterioration."

The study found mental illness and musculoskeletal problems were the leading causes of disability in this younger segment.

The study authors analyzed information collected from 1984 to 2000 by the National Health Interview Survey (NHIS). In 1984, NHIS began asking questions related to disability, such as whether respondents needed help with personal care or other routine needs.

During this time period, the number of people aged 30 to 49 who had trouble caring for themselves or performing other routine tasks shot up by more than 50 percent. Meanwhile, for people aged 60 to 69, disability declined by more than 10 percent.

The upward spike was especially pronounced for disability due to musculoskeletal problems (primarily back problems) and diabetes.

This trend could lead to a nursing home population that is 10 percent to 25 percent larger than it would otherwise have been, the study authors project.

While obesity may account for about one-third of the overall trend, says study author Dana Goldman, other factors also appear to play a role. Medical technology, for instance, saves lives but might not prevent disability. More people may be reporting disability nowadays and insurance policies can have a big effect on people reporting being disabled, Goldman adds.

This is ominous news from the point of view of health-care costs. The authors forecast that Medicare expenditures could be 10 percent to 15 percent higher than without this increase in the number of disabled.

"Disability is a major driver of health-care costs. Medicare has a disability program itself, so when there's an increase in disability, they are going to get a lot more people on their rolls -- and it is going to cost more," Goldman says. "What it suggests is that Medicare could be facing a larger health-care crisis and insolvency earlier than anyone expected."

This perspective paves the way for federal government involvement in the problem. "It says maybe there's a role for the federal government to be interested in investing in people's health prior to their ending up on the Medicare program," Goldman says. "Of course, the government should be interested in people's health, but it might even have a financial incentive."

Initiatives such as the U.S. Food and Drug Administration's effort to have restaurants provide nutritional information on food could have beneficial health consequences, Goldman says. "One of the roles of the government would be to educate people on the consequences, and that doesn't necessarily cost a lot of money."

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