Elsevier

Maturitas

Volume 69, Issue 3, July 2011, Pages 220-229
Maturitas

Review
Economic costs of adult obesity: A review of recent European studies with a focus on subgroup-specific costs

https://doi.org/10.1016/j.maturitas.2011.04.005Get rights and content

Abstract

This review aims to provide an update on economic costs of obesity in Europe with a focus on costs in subgroups defined by relevant third variables such as sex, age, socio-economic status, and morbidity factors. A structured search using MeSH-vocabulary and Title/Abstract-searches was conducted in PubMed for 2007 to 2010. All cost categories except intangible costs were considered. N = 19 primary cost of illness studies on adults from Europe which had included at least one cost category as an outcome were identified. Nine studies reported costs in specific subgroups. Two studies (both from Germany) took a societal perspective, with total (direct and indirect) costs of obesity accounting for 0.47–0.61% of gross domestic product. Excess per-capita direct costs ranged from €117 to €1873, depending on cost categories and comparison group (normal weight, non-obese). One study estimated lower lifetime health care costs given obesity. Regarding subgroups, higher costs of obesity were generally found in men, groups with higher socio-economic status (regarding costs of severe obesity), and groups with co-existing abdominal obesity, diabetes (especially type 1), elevated HbA1c (among patients with type 2 diabetes), and physical co-morbidities given BMI  27 (compared to a “BMI  30 only”-group). In conclusion, while substantial obesity costs were found in most studies, subgroup analyses and lifetime perspectives call for a differentiated approach to the costs of obesity. Findings such as the higher health care costs in severely obese groups with higher socio-economic status (despite fewer co-morbidities), and lower lifetime long-term care costs in obese groups (due to reduced life expectancy), may generate hypotheses both on under- vs. overuse of services, and target groups for interventions.

Introduction

That economic factors have stimulated war in all ages is a commonplace of history. Thus, it may come as no surprise that “war”, as a metaphor, has permeated the field of obesity as well [1], [2]. After all, if costs of illness attributable to obesity – as a condition basically both preventable and remediable – could be minimized, monetary resources within national health care systems and economies could be re-allocated towards other ends.

Against this background, the economic costs of obesity have raised considerable interest in recent years. The most recent review for Europe which encompassed both direct and indirect costs estimated obesity-related costs to range from 0.09% to 0.61% of total annual gross domestic income in Western European countries [3]. These authors have also stressed the need to intensify preventive strategies in order to limit obesity-attributable growth of health care expenditures across Europe in the future. To this end, in our view it is even more important to identify subgroups across which the costs of obesity vary than to update national estimates of these costs.

For instance, one might expect that obese adults from lower socioeconomic status (SES) groups incur higher per-capita costs than more educated and affluent obese groups due to more, and more severe, co-morbidities in the former. However, it has been shown e.g. for Germany that high-SES groups consult medical specialists such as internists more often (in contrast to general practitioners), and also a broader variety of specialists [4]. That is, in order to identify which SES-groups incur higher costs, an analysis of the costs of obesity in specific subgroups – i.e., in this case, defined by SES – is needed. By and large, such subgroup-specific cost assessments may identify obese groups with conspicuously low (or high) costs. Consecutively, this may generate hypotheses e.g. on under- vs. overuse of services, and target groups for interventions. In sum, the present review aims to provide an update on the economic costs of obesity in European countries with a focus on costs in subgroups defined by relevant third variables.

Section snippets

Literature search and study selection

The literature search was conducted in PubMed (http://www.pubmed.gov) for the print publication period of January 01st, 2007, to December 31st, 2010. The search terms used are shown in Table 1. The terms to identify obesity and costs of obesity as study topics combined MeSH-vocabulary and Title/Abstract-searches of these and related expressions. The search considered all cost categories except intangible costs (e.g. reduced quality of life), and resulted in the identification of 153

Results

As shown in Table 2, costs of obesity were reported for eight European countries: Denmark [15], [21], [23], [26], France [25], Germany [5], [6], [7], [8], [14], [22], Ireland [17], the Netherlands [12], Portugal [18], Spain [19], and the United Kingdom (UK) [9], [11], [16], [24]. Almost 80% of the studies were conducted in Germany (6 studies), Denmark (4), and the UK (4).

Fifteen studies used body mass index (BMI) as the only indicator of obesity, one study only used waist circumference (WC,

Key findings

Among the 19 studies included, all but one of the 14 studies contrasting obesity with non-obese comparison groups found higher costs given obesity, regardless of whether total costs or specific costs components were analysed. The exception used a lifetime perspective in a hypothetical cohort and found the obese group to incur lower lifetime health care costs primarily due to lower long-term care costs in life-years lost. In the only two studies taking on a societal perspective including

Conclusions

Like others before, this review has quite consistently found evidence for substantial and significant economic costs of obesity. At the same time, however, a closer look at these results calls for a more differentiated approach to the costs of obesity than the metaphor of “war” initially cited may mislead one to take. On the one hand, “obese” not necessarily equals “obese” when it comes to costs, as is indicated by the higher excess costs found for obese men (vs. obese women), and obese upper

Contributors

Thomas von Lengerke and Christian Krauth participated in the preparation, conduct and writing of the review article, and have seen and approved the final version.

Competing interests

The authors have no conflicts of interest.

Funding

No funding.

Provenance and peer review

Commissioned and externally peer reviewed.

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