Severe obesity: expensive to society, frustrating to treat, but important to confront.

Obesity is a major contributor to chronic and costly diseases and disabilities. More than 30% of American adults are obese, and the percentage has been rising for 20 years. A recent estimate placed the direct economic costs of obesity at more than $39.3 billion, or 5.5% of all medical expenditures in the mid-1980s. These numbers underestimate prevalence and cost because the studies designed to monitor our nation's health problems have ignored the most obese segment of the population-individuals weighing more than 350 pounds. The methods used to treat obesity are controversial, some of them lacking appropriate evaluation. Physicians have been reluctant to treat obese people because of the intensity and duration of an effective treatment program. Finally, many treatments fail in the long term and therefore are not considered cost effective. Multiple treatment options are currently available, and this review presents data to aid physicians in selection of the best therapy to help their patients. As cost advantages of comprehensive care of obese patients become more obvious under capitated financing systems, further investigation should focus on mechanisms of choosing more individualized care plans to defined subsegments of the obese population to make care more cost effective.