The articles contained in this supplement point to the substantial public health and financing implications of increasing cardiometabolic risk in the US population. In short, these articles establish in a variety of settings and populations that obesity can lead to metabolic changes that, in turn, can lead to the development of dyslipidemia, diabetes, and cardiovascular disease (or the combination of these). The cluster of these cardiometabolic risk factors leads to complications that increase the expense of treatment and overall economic burden to the health-care system and workforce. The opening commentary by Michael Fine rightly points out that the medical care system in the United States is ill-equipped to deal with and finance the expected number of patients with multiple cardiometabolic risk factors that will fill the medical offices, pharmacies, and health-care institutions in the coming years.

The first empirical article by Hollenbeak and colleagues uses national data from National Health and Nutrition Examination Survey (NHANES) to predict the prevalence of six cardiometabolic risk clusters in an adult population. Not surprisingly, they find that the cluster of metabolic risk factors that define the metabolic syndrome occur in 36% to 40% of the US population older than 18 years. The article by Caro et al. extends this analysis and uses a Markov model to predict the development and cost of diabetes and cardiovascular disease among the same NHANES population. These investigators show that increasing cardiometabolic risk in a population is associated with increasing disease and cardiovascular events and that the economic consequence of these complications is substantial.

The third article by Richard Scranton and colleagues uses NHANES data and a simple demographic model to predict the prevalence of cardiometabolic risk factors in two large cohort studies—the Atherosclerosis Risk in Communities and the Framingham Offspring Study. They find results that are similar to those of Hollenbeak and conclude that prevalence of cardiometabolic risk estimation in health plan populations can be achieved using simple demographic models calibrated on national data. The article by Finkelstein et al. uses data from the Medical Expenditure Panel Survey (2001–03) to investigate the agerelated impact of obesity on diabetes and dyslipidemia prevalence and cost. Using these longitudinal data, these investigators show the expected relationship between increasing age in obese patients and the increased prevalence of diabetes and dyslipidemia.

With increasing implementation of electronic health records, researchers and health policy decision-makers will be able to combine clinical data with medical claims files to create more robust analyses of disease and economic burden. Brixner and coauthors use a large medical records database to identify patients with clinical indicators of cardiometabolic risk. Consistent with other articles in this supplement, Brixner et al. find close to 37% of patients in the medical records database have cardiometabolic risk factors that would support the diagnosis of metabolic syndrome.

The remaining articles by Fitch et al. and Sullivan et al. highlight the impact that cardiometabolic disease has on working age populations and the employers who finance much of the US health-care system. Both articles show that, left unchecked, the onslaught of obesity and cardiometabolic disease will substantially increase the cost of health care for employers and will negatively impact work force participation.

When taken together, the collection of articles in this supplement is a poignant and timely reminder of the coming epidemic of obesity and cardiometabolic disease and their attendant impact on public health and the financing of health care in the United States. As many of the authors of this collection point out, there are steps that can and should be taken now to reduce the risk of obesity and other cardiometabolic risk factors in the population. In particular, Dr Fine provides some advice for payers at the end of his commentary: “A blanket exclusion of weight reduction services and medications may no longer be in the best interest of managed care organizations or their members.” I would add that it may not be in the best interest of employers or of society at large. All organizations with an interest in the provision of health care should give this recommendation careful consideration.