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Economic costs of overweight and obesity

https://doi.org/10.1016/j.beem.2013.01.002Get rights and content

Obesity has substantially increased in recent decades and is now one of the major global health problems. The large obesity-related health burden negatively impacts many relevant health outcomes (e.g. quality of life, disability, mortality) and leads to increased healthcare utilization. This excess service use is the main driver behind high healthcare costs of obese individuals. Findings indicate that costs rise curvilinearly with increasing body mass index, especially among the obese. As more individuals of a country's population become obese, a larger share of total annual national healthcare expenditure is spent on obesity and obesity-related health problems. In addition to escalating healthcare costs, obesity goes along with indirect costs through decreases in workforce productivity. The empirical evidence has shown beyond doubt that obesity negatively impacts individuals, healthcare systems, employers, and the economy as a whole. This article provides a brief overview of selected economic consequences associated with excess-weight.

Introduction

Obesity is one of the major public health challenges of our time.1, ∗2, 3 Although the causes for the marked increases in obesity over the last 30 years are incompletely understood, ecological models plausibly sketch how technological, economic, and ultimately social changes have created an environment (“obesogenic environment”) conducive to weight gain.4 From an economic point of view, these environmental changes have altered the opportunity cost for behaviors related to energy intake (dietary behavior) and energy expenditure (physical activity),5 promoting a positive energy balance and subsequent weight gain in broad segments of the population.∗4, 5, 6 The most widely used measure in population based health research, is the body mass index (BMI = kg/m2).1, 3, 7 According to the World Health Organization (WHO), overweight is defined as 25 kg/m2 ≤ BMI < 30 kg/m2, and obesity as BMI ≥ 30 kg/m2.7 Obesity may further be subdivided into moderate (class I) obesity: 30 kg/m2 ≤ BMI < 35 kg/m2, severe (class II) obesity: 35 kg/m2 ≤ BMI < 40 kg/m2, and morbid (class III) obesity: BMI ≥ 40 kg/m2.

Globally, overweight and obesity have considerably increased since the early 1980s.3 In 2008, about one-third of the world's adult population (∼1.46 billion) was overweight, whereas the age-standardized prevalence of obesity was 9.8% in men and 13.8% in women; with wide variation between and within countries.3 Particularly affected are the USA, where 35.5% of men and 35.8% of women were classified as obese in 2010.3, ∗8 These increases pose large problems for healthcare systems worldwide, since obesity constitutes a serious risk factor for a plethora of health problems.9, 10 While some are simply a consequence of the physical burden of the excess adipose tissue itself (e.g. aches and pains, dyspnea, sleep disturbances), the majority of obesity-related medical conditions result from serious endocrine and metabolic changes (e.g. diabetes mellitus type 2, cardiovascular disease, increased cancer risk).10 As a result, obesity is inversely associated with a multitude of health-related outcomes.11, 12 Research has shown that obese persons enjoy a lower quality of life,13 possess more functional limitations,14 and have a reduced life expectancy.15 Because of the large number of diseases excess-weight may bring about, obese persons use considerably more healthcare services.16, 17 Against this background obesity must be expected to negatively impact economic outcomes as well.∗18, 19

Based upon available literature reviews, augmented with exemplary original research articles, the present study provides an overview of selected economic outcomes associated with overweight and obesity. Section two gives a brief introduction to basic concepts of cost of illness (COI) studies, in which concepts and terms, referred to throughout the remainder of this article, will be introduced. Sections three and four cover the economic impact of excess-weight in adults (in terms of direct and indirect costs), while section five is dedicated to economic consequences of overweight and obesity in children and adolescents. The article closes with a short summary and some recommendations for further research.

Section snippets

Basic concepts of cost of illness studies

From an economic point of view costs quantify the amount of consumed or lost resources in monetary terms. With respect to COI, direct and indirect costs can be distinguished.19 While the term direct cost refers to the resources consumed when providing healthcare services (e.g. labor for providing medical services), the term indirect cost refers to the loss in economic production caused by illness (e.g. due to sick leave). Fig. 1 provides an overview of categories of costs of obesity. Costs can

Direct cost of obesity

Published studies on the direct cost of overweight and obesity have been summarized in literature reviews.21, ∗29, 30, 31, 32, 33, ∗34 The available empirical evidence comes almost exclusively from high-income countries, particularly North America and Europe. Comparisons between studies are complicated by differences in study methodology, e.g. BMI-cutoff points, included cost/expenditure categories, populations, data sources.21, ∗29, 35 The following presentation is limited to findings from

Indirect cost of obesity

Higher medical expenditures are not the only costs associated with obesity. In addition, excess-weight can go along with indirect costs through decreases in workforce productivity (Box 1).∗41, 42 The extent to which obesity leads to changes in job performance depends on individual characteristics, especially the degree of excess-weight, on the one hand, and a multitude of work-related characteristics and requirements on the other, e.g. physical strain, stress level, sedentary nature of the job,

The economic impact of obesity in children and adolescents

The prevalence of overweight and obesity in children and adolescents has substantially increased in recent decades.∗55, 56, 57 Similar to adults, obese children and adolescents are also faced with increased risks to contract obesity-related diseases, many of which may already develop during childhood/adolescence.∗55, 58 Affected youth are in addition at greatly increased risk of becoming obese adults, with those who were obese during childhood being much more likely to suffer from

Summary

This article provides a brief overview of selected economic outcomes associated with obesity. Empirical findings have shown beyond doubt that a strong positive association exists between excess-weight and medical expenditures/costs. While this relationship seems less pronounced for children and adolescents,∗55, ∗59 empirical evidence convincingly indicates that costs increase in curvilinear fashion for adults with BMI ≥ 25 kg/m2.35 The high and increasing prevalence of overweight and obesity in

Conflict of interest statement

TL, DS, AK, SRH, and HHK have nothing to declare.

Practice points

  • -

    To detect obesity early, at best before the manifestation of related disorders, physicians should routinely screen patients for obesity by calculating the BMI. Patients with BMI ≥ 30 kg/m2 should be made aware of possible health consequences, and, depending on the country-specific guidelines (e.g.8) and availability of interventions, offered appropriate interventions, e.g. comprehensive behavioral intervention, or bariatric surgery

Acknowledgments

This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1001. The BMBF had no further role in the study design; in the collection, analyses and interpretation of data; in writing the report; and in the decision to submit the paper for publication. The publication of study results was not contingent on the sponsor's approval.

References (76)

  • A.C. Monheit et al.

    Overweight in adolescents: implications for health expenditures

    Economics and Human Biology

    (2009)
  • A. Breitfelder et al.

    Relative weight-related costs of healthcare use by children–results from the two German birth cohorts, GINI-plus and LISA-plus

    Economics and Human Biology

    (2011)
  • R. Sturm

    Increases in morbid obesity in the USA: 2000-2005

    Public Health

    (2007)
  • E.E. Frezza et al.

    The impact of morbid obesity on the state economy: an initial evaluation

    Surgery for Obesity and Related Disorders

    (2006)
  • V.S. Malik et al.

    Global obesity: trends, risk factors and policy implications

    Nature Reviews Endocrinology

    (2012)
  • E.A. Finkelstein et al.

    The economics of obesity

    American Journal of Clinical Nutrition

    (2010)
  • J.O. Hill et al.

    Energy balance and obesity

    Circulation

    (2012)
  • S.A. Jebb et al.

    Key methodologies in obesity research and practice

  • V.A. Moyer

    Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement

    Annals of Internal Medicine

    (2012)
  • M. Blüher

    Are there still healthy obese patients?

    Current Opinion in Endocrinology, Diabetes and Obesity

    (2012)
  • G.A. Bray

    Medical consequences of obesity

    The Journal of Clinical Endocrinology and Metabolism

    (2004)
  • M. Blüher

    The distinction of metabolically 'healthy' from 'unhealthy' obese individuals

    Current Opinion in Lipidology

    (2010)
  • R.L. Kolotkin et al.

    Quality of life and obesity

    Obesity Reviews

    (2001)
  • K.E. Backholer et al.

    Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis

    Obesity Reviews

    (2012)
  • K.M. Flegal et al.

    Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

    Journal of the American Medical Association (JAMA)

    (2013)
  • C.P. Quesenberry et al.

    Obesity, health services use, and healthcare costs among members of a health maintenance organization

    Archives of Internal Medicine

    (1998)
  • C.L. Keating et al.

    Healthcare utilization and costs in severely obese subjects before bariatric surgery

    Obesity

    (2012)
  • L. Roux et al.

    Economics and obesity: costing the problem or evaluating solutions?

    Obesity Research

    (2004)
  • A.M. Wolf

    Economic outcomes of the obese patient

    Obesity Research

    (2002)
  • B. Rockhill et al.

    Use and misuse of population attributable fractions

    American Journal of Public Health

    (1998)
  • D. Thompson et al.

    The medical-care cost burden of obesity

    Obesity Reviews

    (2001)
  • L. Roux

    Cost-effectiveness of anit-obesity interventions

  • A. Gray et al.

    Applied methods of cost-effectiveness analysis in healthcare

    (2011)
  • R. Padwal et al.

    Bariatric surgery: a systematic review of the clinical and economic evidence

    Journal of General Internal Medicine

    (2011)
  • T. Lehnert et al.

    The long-term cost-effectiveness of obesity prevention interventions: systematic literature review

    Obesity Reviews

    (2012)
  • U.K. Griffiths et al.

    Economic evaluations of adult weight management interventions: a systematic literature review focusing on methods used for determining health impacts

    Applied Health Economics and Health Policy

    (2012)
  • S. Klarenbach et al.

    Bariatric surgery for severe obesity: systematic review and economic evaluation

    (2010)
  • S. O'Meara et al.

    The clinical effectiveness and cost- effectiveness of sibutramine in the management of obesity: a technology assessment

    Health Technology Assessment

    (2002)
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