Phase 3 · Comorbidity-burden projection · prototype

Where the obesity-attributable comorbidity bill is heading

As the obese share grows (CHOICES slope), the diabetes / hypertension / cardiovascular burden it carries grows with it. This projects that cost forward — and is explicit about what it is and isn't.

Read this first — what this is. A calibrated extrapolation: it scales the current obesity→comorbidity cost relationship (Phases 0–2) along a published obesity trajectory. It is not a dynamic incidence model — it doesn't simulate individuals developing disease over time (that's what the RAND and Tufts CVD-PREDICT microsimulations do, and what a claims-based model would do). Use it to size the direction and rough magnitude, not as a forecast of enrollees.

Inputs

Default = NJ from the projection engine (40% → 42.3%). Swap in your state's CHOICES blend for another state.

Cost basis
Horizon

Obesity-attributable comorbidity cost / year

Diabetes Hypertension Cardiovascular (CHD/stroke/HF)
—
2026 burden
—
2030 burden
—
increase
—
cumulative (base→end)
Methodology & honest limits

How it's built. Obese adults each year = covered lives × adult share × obese rate(year), where obese rate moves linearly from the 2026 base to the 2030 CHOICES level (and is extrapolated beyond, if selected). Each obese adult carries the Phase 0–2 obesity-attributable comorbidity cost (~$2,000 all-payer / ~$1,120 Medicaid-paid), split into diabetes / hypertension / cardiovascular. Multiplying the two and summing over years gives the trajectory.

  • Not a dynamic incidence model. It scales a cross-sectional relationship; it doesn't model the lag from new obesity to new disease. The rigorous dynamic versions are RAND's obesity microsim and Tufts CVD-PREDICT — cite those when a true forecast is needed.
  • The obesity slope is the published one (CHOICES, base data to 2016, to 2030) — gentle over a 4-year window, so the trajectory is driven more by enrollment and the cost per obese adult than by the slope. Beyond 2030 is extrapolation.
  • Pre-GLP-1. Neither CHOICES nor this baseline reflects the post-2023 GLP-1 uptake that may bend the obesity curve down — the optional bent line is illustrative, not estimated.
  • Associational, national, public-data. Same limits as Phases 0–2; the exact trajectory for a plan needs its longitudinal claims (the paid path).

Sources: NHANES 2021–23 + MEPS 2023 (cost per obese adult, Phases 0–2); CHOICES / Ward 2019 (obesity slope); RAND & Tufts CVD-PREDICT (dynamic-model references). Calibrated extrapolation — not a predictive model. Prototype.