The US spends twice as much per capita each year on health care as Britain but sees higher rates of nearly every chronic disease, even among children, according to a study. Despite the cash outflow, Americans over 50 are in worse health than Britons and have shorter life expectancies. The trend also does not appear to be related to the fact that people in the US tend to be fatter than the British.

“Our findings suggest that body weight is not the driving force behind the observed health differentials between the US and England and that, if weight plays a role, it is a complicated one,” said the study in the American Journal of Epidemiology.

In fact, previous studies have not found any clear evidence for the difference when looking at health insurance, behaviors, obesity, socioeconomic status or race and ethnicity, leaving researchers puzzled as to why such variations could exist among otherwise similar populations.

A possibility for further investigation could be how residents of the two countries use health care resources differently.

“Despite the greater use of health care technology in the US, Americans receive less preventive health care than their English counterparts. They have fewer physician consultations per year,” it said.