Human Resources News & Insights

Smoking or obesity: Which costs health plans more?

When it comes to wellness programs, the two biggest goals have always been: a) Get employees to lose weight, and b) get them to stop smoking. But a recent study gives employers a better idea of what their No. 1 wellness focus should be.

Researchers at the Mayo Clinic in Rochester, MN, set out to find which was associated with high healthcare costs — smoking or obesity.

The study, which was published in the March Journal of Occupational and Environmental Medicine, the official publication of the American College of Occupational and Environmental Medicine, analyzed the costs of smoking and obesity among 25,022 Mayo Clinic employees and 5,507 retirees between 2001 and 2007.

Healthcare costs were defined as the sum of the expenses incurred by the patient and health plan combined. They were calculated using medical and pharmacy claims data.

Result? Obesity was found to be the costliest by far.

The cost breakdown for smokers v. non-smokers:

  • Compared to non-smokers, the average cost of healthcare for employees who smoked was $1,274 higher, and
  • The cost of care for retirees who smoked was $1,401 higher than for those who didn’t smoke.

The cost breakdown for those with a normal body mass index v. obese individuals:

  • Compared to those with a normal BMI, obese workers generated $1,850 more in healthcare costs
  • Workers classified as morbidly obese I generated $3,086 more
  • Workers classified as morbidly obese II generated $5,530 more
  • Retirees classified as morbidly obese I generated $2,907 more in healthcare costs than non-obese retirees, and
  • Retirees classified as morbidly obese II generated $5,467 more.

The numbers are clear. Obesity can cost more — a lot more — than smoking. And healthcare costs go up exponentially the heavier plan participants are.

The researchers also pointed out that their findings were consistent with numerous previous studies.

Source:The effects of Incremental Costs of Smoking and Obesity on Health Care Costs Among Adults: A 7-Year Longitudinal Study,” Journal of Occupational and Environmental Medicine, March 2012.

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  • The sad thing is that depression costs a company even more than either. Focusing solely on physical health without addressing underlying causes of poor lifestyle choices will fail every time.

    Successful wellness programs will touch on all aspects of health: physical, emotional and financial.

  • Offended

    Why is OK for overweight people to be treated so badly by the world. Some people have health issues that cause them to be overweight. Case in point I have a family member who has under active thyroid which causes this problem for her, she is not lazy and works just as hard as anyone else in the family. She has tried medication after medication, nothing makes the issue any better. Never ASSume that someone is overweight because they choose not to eat well and that they are lazy. This is the only thing that is still a legal discrimination in this county. And I am sorry but it is no wonder this country is full of kids with eating disorders. Doctors are too quick to slap a label on a kid as Obese or Fat. Neither word sounds any nicer.

  • MMAN

    @Offened…have you been out lately? Go to a classroom nowadays and see how many “chubby” kids there are (very few of them that seem to be lean and fit like most kids I knew when I was growing up in the 80s). I say that to say this, this is a stark contrast from what you saw years ago when maybe two or three kids in the classroom were overweight and this was probably due to health issues (same thing for adults). So you really can’t blame it “all”, and I say “all” on health issues or there would have been just as many overweight people (as a percentage of the population) 30 years ago as there are today. So something has indeed changed…could it be our eating habits, could it be the lack of physical activity? If so, this is definitely reflective of changes in behaviors (choices). While there is no excuse for treating people badly for it as I do not feel that employers should be able to legally discriminate against obese people by not hiring them because of that fact (as another article deals with), or make jokes about them etc. I do on the other hand feel that their health insurance premiums are free game just as they are for tobacco users (notice I said tobacco users not smokers). This is not treating them badly. But I do agree with you on one thing, doctors and society as a whole are way too quick to label people as obese or fat.

  • Joe

    So the takeaway from this article is it’s OK to smoke up?

  • Offended –

    First let me say, I am sorry to hear about your family member. Obviously, chronic conditions and medications can cause weight gain. Americans with Disability Act protects otherwise qualified applicants and employees from being the subject of discrimination.

    Every client I discuss this area with is made aware of ADA issues and other laws. For instance, ensuring the plan complies with Title VII (EEOC) concerns by not discriminating based on race, religion, sex or other protected classes.

    A solid wellness program will include protections for all workers in the design. There are options for helping everyone on the level they seek.

    Unfortunately, too frequently the issue of obesity is not the result of chronic conditions or medications. Quite the opposite most chronic conditions and medications are the result of obesity.

    Employers are asked to supplement the cost of health care for employees (and dependents.) Therefore, it is important for them to give people access to tools and opportunities to lead healthier lives. Providing support for employees who seek healthier lives pays not only in medical savings but in productivity too.

    Your point about the pressure on people is interesting. Good emotional health is vital to making good lifestyle choices. It is why my wellness designs encourage addressing emotional health.

    Best wishes to your family member.

  • MMAN

    @Joe…why would you ask this? I’m confused. No one said its O.K. to smoke up?#@!

  • Joe

    @MMAN The tone of the article is quite clear. Lets take a look:

    “A recent study gives employers a better idea of what their No. 1 wellness focus should be.” Translation: You should be focusing on fatties, not smokers.

    “Result? Obesity was found to be the costliest by far.” Translation: Smokers don’t cost that much, so put all your efforts into fighting fat people.

    “The numbers are clear. Obesity can cost more — a lot more — than smoking. And healthcare costs go up exponentially the heavier plan participants are.” Translation: You’re being financially irresponsible by employing fat people. Smoking doesn’t even compare. Don’t waste time and money thinking about smokers.

    Honestly, this piece is so skewed with its implications about the study, and it’s urging that companies focus less on smoking and more on obesity I would be shocked if the author was not in fact a smoker tired of being bugged about it. It reads heavily of deflection.

    The fact is that both are dangerous and both need equal attention. Why elevate one over the other? And hey, what about fat people who smoke? Why weren’t they included?

  • MMAN

    @Joe…I read these articles on the assumption that they are correct…not saying that they are but assuming that they are. With that said, I comment on the purported findings of the article. The article says that obese people are far more costly than smokers…now I am not a smoker or obese thankfully but the numbers are what they are. It just sounds like you do not want to hear the music. If obese people’s healthcare costs are in fact this much higher than smokers, then it is what it is. If smoker’s healthcare costs are higher than obese people’s then we could say the same thing only vice versa. I just don’t get where you are coming from saying that they article is actually saying…”don’t wast time and money thinking about smokers”. I don’t read this at all. It was just a comparison and a study for pete’s sake. I mean if the study said just the opposite, would you have then said “I would be shocked if the author was not in fact obese (inserted where “a smoker” was) tired of being bugged about it. It reads heavily of deflection.” So I guess anyone who writes an article throws their own personal spin on it eh?

  • Lucy

    There are a lot of ASSumptions when people look at other people who are not as perfect as they perceive themselves. First of all, I am not a smoker and second, I am overweight. I am a mother of a very active elementary age child, scout leader and active PTA member. I am not lazy in any way, nor do I eat like a pig. But, the important part I want to get out into this conversation is that I am also not on ANY medication. I do not have ANY health issues, I do not have high blood pressure. I do not have high cholesterol, I do not have diabetes. I drink lots of water, live in a 3 story house and do lots of yard work. I have plenty of friends and relatives who are not overweight, but take a TON of medicine, drink so much diet soda or alcohol that it’s like a food group. Fact is if you looked at us, you would ASSume that I am the health problem, taking expensive medicine and lots of doctors appointments. You would be ASSuming wrong. It’s the others who are at the doctor A LOT and taking A LOT of medicine and have health issues. So – I can’t believe I am the only person who isn’t a drain on insurance. I think this line is just rude – do we make people who are sick feel bad for their health expenses? Let’s make us all healthier by educating everyone about better lifestyle choices and food choices.

  • Joe


    The simple reason is that overweight people are the last subgroup that it’s still OK to discriminate against. It’s fine to say all fat people are lazy, weak-willed, unmotivated, stupid, ignorant, or even ugly. If you made the same claim about someone based on their ethnicity people would be up in arms about it. But if you change ethnicity to fat, there is no limit. You can make horrible jokes, call people hurtful names, and of course, employment discrimination against the overweight is not only tollerated and common, it is encouraged by articles such as this one. The fact is, there are a lot of bullies out there, and they love it when their target is not protected in any way. They would be just as happy saying people of this race are all thieves is or members of that ethnic group are all lazy but they can’t get away with it.

  • Common Sense

    @Your translations are kind of a stretch. The study is simply identifying which of the two is a greater financial concern. The article indicates that since obesity is a far greater problem than smoking, more resources should go into fixing the obesity problem.

    I must have missed the line that suggested it is “o.k. to smoke up”, I even read between the lines and couldn’t find that message.

    You say “Honestly, this piece is so skewed with its implications about the study, and it’s urging that companies focus less on smoking and more on obesity…The fact is that both are dangerous and both need equal attention. Why elevate one over the other?”

    Why would you suggest that we give equal attention to two problems of different size and scope?

    Cancer and Hutchinson-Gilford Progeria are both dangerous diseases. Hutchinson-Gilford Progeria however only effects 1 in 8 million children. By your logic these diseases need equal attention because they are both dangerous. Should we divert half of all cancer research into Progeria research?

    This article is not nearly as skewed as your commentary.

    “I would be shocked if” you were not in fact obese and “tired of being bugged about it”.

  • MMAN

    @Everyone on this thread…so let me get this straight, an article like this should not be published, even if it is true, so no one will feel bad about themselves? Who is calling anyone names? The only thing I’ve seen is the word obese used to describe overweight people. Those who were/are offended at this article are the one’s who are throwing the word “fat” around. Sorry folks, the word obese is the politically correct term used to describe this unhealthy condition, just like anorexia is used to describe the opposite end of the spectrum. I mean what should all of you propose we call it? Just not mention it, pretend the issue doesn’t exist? How can we as a society truly deal with the issue without publishing studies such as this and facing the issues? No doubt there is no room for name calling, rudeness, or hurtful behavior but by using respectful terminology (maybe we haven’t come up with this yet) I think we can deal with this issue like it should be dealt with.

    To compare obesity with ethnicity as one has done, is just plain erroneous. While I realize that obesity in some- possibly many- circumstances is out of one’s control as it does have a lot to do with genetics and other health conditions, unfortunately it is also in many cases caused by behavioral choices as well (as is evidenced by the increase in the number of obese people). Ethinicity on the otherhand, can never be determined by the behavioral choices of the individual. It is truly a trait that we are born with in “all” circumstances.

    But please let me also say that I never believe it is O.K. to discriminate against obese people by denying an obese person a position that they are qualified for based on the fact that they are obese. However, I do agree in charging them the higher premiums on insurance just as we do tobacco users.

  • Joe

    Great to hear from all the smokers who are happy to see that someone else is getting the heat for a change.

  • Common Sense

    Just so there is no confusion, my original remarks were addressed to Joe, not the author.

    @Joe Was your last comment sarcasm, because other than you I don’t see all these smokers that you speak of.

    @MMAN FYI, anorexia is not considered the opposite of obese. I believe anorexia is considered a mental disease/disorder. Obesity is a phyical disorder. The opposite of Obese would be emaciated, malnourished or underweight. (these conditions may be caused by anorexia or some other reason).

  • MMAN

    @Common sense True, but the bottom line is both are unhealthy conditions but I must add in many circumstances obesity, while it is a physical disorder, it is often fueled by a mental disorder (call it overeating or whatever) just as the deathly thin look in anorexics are a result of their mental disorder. Have you no knowledge of this? Watch the health channels on television where people eat because they are addicted to food and can not control themselves just like the anorexic. Sorry, you are not totally correct on this one, you have just pointed out a minor nuance…at least for this conversation anyway.

  • Common Sense

    @mman You ask snarkily “Have you no knowledge of this?” Yes, I was aware that obesity is sometimes caused by a mental disorder (Not exactly a news flash. I am quite certain that everybody else on this board has been aware of this since middle school). And thanks for the suggestion, but I didn’t need to watch television to understand the problem. The fact that I did not bring it up does not mean I was “not totally correct.” (I was). I simply thought it was so obvious that it did not bear mentioning, but thanks anyway for trying to clarify.

  • MMAN

    @Common Sense…they why did you bring up such a small nuance to correct me then? Sure I agree that it is common knowledge regarding obesity and it may not be the exact polar opposite of anorexia (but anyone with any “common sense” should have been able to tell that remark wasn’t for the purpose to say that they are) but for you to bring out the technicality like you did is not substantial for this conversation. I guess instead of using the word anorexia I should have used the phrase “anorexic looking” or even the words you have suggested to suit people like you who try to pick apart anything anyone says on here rather than grasping the major concept of what people are actually saying…even when it is evident. To clarify, your pointing those things out to me really takes nothing away from what I had said in the post even though you would like to believe otherwise.

  • Common Sense

    I am sorry MMAN, based on what you wrote it just seemed you were unaware of the distinction. I thought you would have liked to have known. Unlike your response to me, I originally addressed it very matter-of-factly without any snarkiness.
    I appreciate it when others alert me to my mistakes so that I can avoid making them again in the future.