The burden of overweight and obesity on long-term care and Medicaid financing

Med Care. 2014 Jul;52(7):658-63. doi: 10.1097/MLR.0000000000000154.


Background: The obesity rate among the elderly long-term care (LTC) residents in the United States is increasing rapidly. However, there is a paucity of research investigating the burden of obesity on LTC and Medicaid financing. The purpose of this study is to fill the knowledge gap by estimating the burden of overweight and obesity on LTC and Medicaid financing.

Methods: Using nationally representative Cost and Use Files of Medicare Current Beneficiary Survey from 1997 to 2005, we used 2-part model and cohort-based simulation to evaluate the effect of overweight and obesity on LTC days and Medicaid expenditures across the lifespan among the current elderly population. Combining the per capita estimates with 2010 census, we project future aggregate burden of obesity on LTC demand and Medicaid cost among baby boomers.

Results: Obesity and related chronic diseases lead to higher probability to enter LTC facility in a younger age, more LTC days before death, and higher lifetime LTC cost reimbursed by Medicaid. However, such effect is only statistically significant among women, not significant among men. At the population level, we project that overweight and obesity will induce 1.3 billion or more LTC patient days and $68 billion or more Medicaid costs (in 2012 value) among baby boomers.

Conclusions: Overweight and obesity among the elderly will bring tremendous burden to LTC providers and Medicaid. Policy makers should keep the burden of obesity on LTC in mind when planning LTC and Medicaid policy reform.

MeSH terms

  • Age Factors
  • Aged
  • Body Mass Index
  • Female
  • Health Status
  • Homes for the Aged / economics*
  • Humans
  • Life Expectancy
  • Male
  • Medicaid / economics*
  • Nursing Homes / economics*
  • Obesity / economics
  • Overweight / economics*
  • Sex Factors
  • Socioeconomic Factors
  • United States / epidemiology