Abstract
Introduction: Obesity is a growing public health challenge in the US and carries a heavy economic toll. Previous work has detailed the overall health expenditures in this population, but we lack a current understanding on how these expenditures translate into financial hardship. We aimed to assess the financial hardship from medical bills, as well as other cost-related healthcare shortcomings experienced by those with obesity. Methods: We used the National Health Interview Survey (2013-18), a US nationally representative sample, to assess financial hardship from medical bills - difficulty paying or unable to pay at all (and consequences, including high financial distress, foregone/delayed care due to cost, and cost-related medication nonadherence) in non-elderly adults (18-65 years [i.e., those without universal coverage]) across different BMI strata. BMI was categorized as normal (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obesity classes 1 (30-34.9 kg/m 2 ), 2 (35-39.9 kg/m 2 ), and 3 (≥ 40 kg/m 2 ). Results: Among 139,521 surveyed individuals, 12,129 (weighted 8.5%) had class 3 obesity, representing 16 million non-elderly adults annually. A total of 38.0% of non-elderly adults with class 3 obesity reported having financial hardship from medical bills, compared with 24.7% among those with normal weight. Compared with adults with normal weight, those with class 3 obesity had higher odds of financial hardship from medical bills (OR 1.53, 95% CI 1.44-1.64), and among those with any financial hardship, higher odds of its consequences, including high financial distress (OR 1.13, 95% CI 1.01-1.25) and cost-related medication nonadherence (OR 1.16, 95% CI 1.02, 1.32). Conclusion: Non-elderly adults with class 3 obesity had 50% higher odds of financial hardship from medical bills, compared with those with normal weight, along with higher odds for its consequences, like financial distress and cost-related medication nonadherence.
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