ReviewEconomic costs of adult obesity: A review of recent European studies with a focus on subgroup-specific costs
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.
References (37)
- et al.
Impact of waist circumference difference on health-care cost among overweight and obese subjects: the PROCEED cohort
Value Health
(2010) Out-of-pocket health care expenditures due to excess of body weight in Portugal
Econ Hum Biol
(2008)- et al.
Cost of arterial hypertension according to levels of morbidity in primary care setting
Med Clin (Barc)
(2009) - et al.
Cost of obesity in France
Presse Med
(2007) A war on obesity, not the obese
Science
(2003)New York City's war on fat
N Engl J Med
(2009)- et al.
Health-economic burden of obesity in Europe
Eur J Epidemiol
(2008) - et al.
Predictors for ambulatory medical care utilization in Germany
Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz
(2005) - et al.
Excess health care costs of obesity in adults with diabetes mellitus: a claims data analysis
Exp Clin Endocrinol Diabetes
(2010) - et al.
Excess direct medical costs of severe obesity by socioeconomic status in German adults
Psychosoc Med
(2010)