Economic Burden of Obesity: A Systematic Literature Review

Maximilian Tremmel, Ulf-G Gerdtham, Peter M Nilsson, Sanjib Saha, Maximilian Tremmel, Ulf-G Gerdtham, Peter M Nilsson, Sanjib Saha

Abstract

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

Keywords: burden of obesity; cost of illness; obesity; obesity-related disease.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart depicting the process of the study selection for the systematic review.

References

    1. Hubert H.B., Feinleib M., McNamara P.M., Castelli W.P. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67:968–977. doi: 10.1161/01.CIR.67.5.968.
    1. World Health Organization . Obesity: Preventing and Managing the Global Epidemic. World Health Organization; Geneva, Switzerland: 2000.
    1. Smith S.C. Multiple risk factors for cardiovascular disease and diabetes mellitus. Am. J. Med. 2007;120:S3–S11. doi: 10.1016/j.amjmed.2007.01.002.
    1. World Health Organization Obesity. [(accessed on 4 October 2016)]; Available online:
    1. Centers for Disease Control and Prevention Overweight & Obesity. [(accessed on 4 October 2016)]; Available online: .
    1. Dobbs R., Sawers C., Thompson F., Manyika J., Woetzel J.R., Child P., McKenna S., Spatharou A. Overcoming Obesity: An Initial Economic Analysis. McKinsey Global Institute; Jakarta, Indonesia: 2014.
    1. Birmingham C.L., Muller J.L., Palepu A., Spinelli J.J., Anis A.H. The cost of obesity in Canada. Can. Med. Assoc. J. 1999;160:483–488.
    1. Levy E., Levy P., Le Pen C., Basdevant A. The economic cost of obesity: The French situation. Int. J. Obes. Relat. Metab. Disord. 1995;19:788–792.
    1. Andreyeva T., Sturm R., Ringel J.S. Moderate and severe obesity have large differences in health care costs. Obes. Res. 2004;12:1936–1943. doi: 10.1038/oby.2004.243.
    1. Dee A., Kearns K., O’Neill C., Sharp L., Staines A., O’Dwyer V., Fitzgerald S., Perry I.J. The direct and indirect costs of both overweight and obesity: A systematic review. BMC Res. Notes. 2014;7 doi: 10.1186/1756-0500-7-242.
    1. Finkelstein E.A., Trogdon J.G., Cohen J.W., Dietz W. Annual medical spending attributable to obesity: Payer-and service-specific estimates. Health Aff. 2009;28:w822–w831. doi: 10.1377/hlthaff.28.5.w822.
    1. Specchia M.L., Veneziano M.A., Cadeddu C., Ferriero A.M., Mancuso A., Ianuale C., Parente P., Capri S., Ricciardi W. Economic impact of adult obesity on health systems: A systematic review. Eur. J. Public Health. 2015;25:255–262. doi: 10.1093/eurpub/cku170.
    1. Hodgson T.A. Costs of illness in cost-effectiveness analysis. PharmacoEconomics. 1994;6:536–552. doi: 10.2165/00019053-199406060-00007.
    1. Rice D.P. Cost of illness studies: What is good about them? Inj. Prev. 2000;6:177–179. doi: 10.1136/ip.6.3.177.
    1. Jo C. Cost-of-illness studies: Concepts, scopes, and methods. Clin. Mol. Hepatol. 2014;20:327–337. doi: 10.3350/cmh.2014.20.4.327.
    1. McCormick B., Stone I. Economic costs of obesity and the case for government intervention. Obes. Rev. 2007;8:161–164. doi: 10.1111/j.1467-789X.2007.00337.x.
    1. Bierl M., Marsh T., Webber L., Brown M., McPherson K., Rtveladze K. Apples and oranges: A comparison of costing methods for obesity. Obes. Rev. 2013;14:693–706. doi: 10.1111/obr.12044.
    1. Hammond R.A., Levine R. The economic impact of obesity in the United States. Diabetes Metab. Syndr. Obes. 2010;3:285–295. doi: 10.2147/DMSO.S7384.
    1. Hughes D., McGuire A. A review of the economic analysis of obesity. Br. Med. Bull. 1997;53:253–263. doi: 10.1093/oxfordjournals.bmb.a011612.
    1. Kortt M.A., Langley P.C., Cox E.R. A review of cost-of-illness studies on obesity. Clin. Ther. 1998;20:772–779. doi: 10.1016/S0149-2918(98)80140-9.
    1. Lehnert T., Sonntag D., Konnopka A., Riedel-Heller S., Konig H.H. Economic costs of overweight and obesity. Best Prac. Res. Clin. Endocrinol. Metab. 2013;27:105–115. doi: 10.1016/j.beem.2013.01.002.
    1. Muller-Riemenschneider F., Reinhold T., Berghofer A., Willich S.N. Health-economic burden of obesity in Europe. Eur. J. Epidemiol. 2008;23:499–509. doi: 10.1007/s10654-008-9239-1.
    1. Thompson D., Wolf A.M. The medical-care cost burden of obesity. Obes. Rev. 2001;2:189–197. doi: 10.1046/j.1467-789x.2001.00037.x.
    1. Tran B.X., Nair A.V., Kuhle S., Ohinmaa A., Veugelers P.J. Cost analyses of obesity in Canada: Scope, quality, and implications. Cost Eff. Res. Alloc. 2013;11 doi: 10.1186/1478-7547-11-3.
    1. Trogdon J.G., Finkelstein E.A., Hylands T., Dellea P.S., Kamal-Bahl S.J. Indirect costs of obesity: A review of the current literature. Obes. Rev. 2008;9:489–500. doi: 10.1111/j.1467-789X.2008.00472.x.
    1. Tsai A.G., Williamson D.F., Glick H.A. Direct medical cost of overweight and obesity in the USA: A quantitative systematic review. Obes. Rev. 2011;12:50–61. doi: 10.1111/j.1467-789X.2009.00708.x.
    1. Von Lengerke T., Krauth C. Economic costs of adult obesity: A review of recent European studies with a focus on subgroup-specific costs. Maturitas. 2011;69:220–229. doi: 10.1016/j.maturitas.2011.04.005.
    1. Withrow D., Alter D.A. The economic burden of obesity worldwide: A systematic review of the direct costs of obesity. Obes. Rev. 2011;12:131–141. doi: 10.1111/j.1467-789X.2009.00712.x.
    1. Rtveladze K., Marsh T., Barquera S., Sanchez Romero L.M., Levy D., Melendez G., Webber L., Kilpi F., McPherson K., Brown M. Obesity prevalence in Mexico: Impact on health and economic burden. Public Health Nutr. 2014;17:233–239. doi: 10.1017/S1368980013000086.
    1. Rtveladze K., Marsh T., Webber L., Kilpi F., Levy D., Conde W., McPherson K., Brown M. Health and economic burden of obesity in Brazil. PLoS ONE. 2013;8:e68785. doi: 10.1371/journal.pone.0068785.
    1. Su W., Huang J., Chen F., Iacobucci W., Mocarski M., Dall T.M., Perreault L. Modeling the clinical and economic implications of obesity using microsimulation. J. Med. Econ. 2015;18:886–897. doi: 10.3111/13696998.2015.1058805.
    1. Larg A., Moss J.R. Cost-of-illness studies. PharmacoEconomics. 2011;29:653–671. doi: 10.2165/11588380-000000000-00000.
    1. Weinstein M., Siegel J., Gold M., Kamlet M., Russell L. Cost-Effectiveness in Health and Medicine. Oxford University Press; Oxford, UK: 1996.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann. Intern. Med. 2009;151:264–269. doi: 10.7326/0003-4819-151-4-200908180-00135.
    1. Alter D.A., Wijeysundera H.C., Franklin B., Austin P.C., Chong A., Oh P.I., Tu J.V., Stukel T.A. Obesity, lifestyle risk-factors, and health service outcomes among healthy middle-aged adults in Canada. BMC Health Serv. Res. 2012;12 doi: 10.1186/1472-6963-12-238.
    1. An R. Health care expenses in relation to obesity and smoking among US adults by gender, race/ethnicity, and age group: 1998–2011. Public Health. 2015;129:29–36. doi: 10.1016/j.puhe.2014.11.003.
    1. Andreyeva T., Luedicke J., Wang Y.C. State-level estimates of obesity-attributable costs of absenteeism. J. Occup. Environ. Med. 2014;56:1120–1127. doi: 10.1097/JOM.0000000000000298.
    1. Bahia L., Coutinho E.S., Barufaldi L.A., Abreu Gde A., Malhao T.A., De Souza C.P., Araujo D.V. The costs of overweight and obesity-related diseases in the Brazilian public health system: Cross-sectional study. BMC Public Health. 2012;12 doi: 10.1186/1471-2458-12-440.
    1. Cawley J., Meyerhoefer C. The medical care costs of obesity: An instrumental variables approach. J. Health Econ. 2012;31:219–230. doi: 10.1016/j.jhealeco.2011.10.003.
    1. De Oliveira M.L., Santos L.M., Da Silva E.N. Direct healthcare cost of obesity in brazil: An application of the cost-of-illness method from the perspective of the public health system in 2011. PLoS ONE. 2015;10:e0121160. doi: 10.1371/journal.pone.0121160.
    1. Doherty E., Dee A., O’Neill C. Estimating the amount of overweight and obesity related health-care use in the Republic of Ireland using SLAN data. Econ. Soc. Rev. 2012;43:227–250.
    1. Effertz T., Engel S., Verheyen F., Linder R. The costs and consequences of obesity in Germany: A new approach from a prevalence and life-cycle perspective. Eur. J. Health Econ. 2016;17:1141–1158. doi: 10.1007/s10198-015-0751-4.
    1. Konig H.H., Lehnert T., Brenner H., Schottker B., Quinzler R., Haefeli W.E., Matschinger H., Heider D. Health service use and costs associated with excess weight in older adults in Germany. Age Ageing. 2015;44:616–623. doi: 10.1093/ageing/afu120.
    1. Konnopka A., Bodemann M., Konig H.H. Health burden and costs of obesity and overweight in Germany. Eur. J. Health Econ. 2011;12:345–352. doi: 10.1007/s10198-010-0242-6.
    1. Krueger H., Krueger J., Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can. J. Public Health. 2015;106:e171–e177. doi: 10.17269/cjph.106.4994.
    1. Lehnert T., Streltchenia P., Konnopka A., Riedel-Heller S.G., Konig H.H. Health burden and costs of obesity and overweight in Germany: An update. Eur. J. Health Econ. 2015;16:957–967. doi: 10.1007/s10198-014-0645-x.
    1. Lehnert T., Stuhldreher N., Streltchenia P., Riedel-Heller S.G., Konig H.H. Sick leave days and costs associated with overweight and obesity in Germany. J. Occup. Environ. Med. 2014;56:20–27. doi: 10.1097/JOM.0000000000000065.
    1. Mora T., Gil J., Sicras-Mainar A. The influence of obesity and overweight on medical costs: A panel data perspective. Eur. J. Health Econ. 2015;16:161–173. doi: 10.1007/s10198-014-0562-z.
    1. Neovius K., Rehnberg C., Rasmussen F., Neovius M. Lifetime productivity losses associated with obesity status in early adulthood: A population-based study of Swedish men. Appl. Health Econ. Health Policy. 2012;10:309–317. doi: 10.1007/BF03261865.
    1. Pitayatienanan P., Butchon R., Yothasamut J., Aekplakorn W., Teerawattananon Y., Suksomboon N., Thavorncharoensap M. Economic costs of obesity in Thailand: A retrospective cost-of-illness study. BMC Health Serv. Res. 2014;14 doi: 10.1186/1472-6963-14-146.
    1. Wang Y.C., Pamplin J., Long M.W., Ward Z.J., Gortmaker S.L., Andreyeva T. Severe obesity in adults cost state medicaid programs nearly $8 billion in 2013. Health Aff. 2015;34:1923–1931. doi: 10.1377/hlthaff.2015.0633.
    1. Yang Z., Zhang N. The burden of overweight and obesity on long-term care and Medicaid financing. Med. Care. 2014;52:658–663. doi: 10.1097/MLR.0000000000000154.
    1. Kang J.H., Jeong B.G., Cho Y.G., Song H.R., Kim K.A. Socioeconomic costs of overweight and obesity in Korean adults. J. Korean Med. Sci. 2011;26:1533–1540. doi: 10.3346/jkms.2011.26.12.1533.
    1. Lette M., Bemelmans W.J., Breda J., Slobbe L.C., Dias J., Boshuizen H.C. Health care costs attributable to overweight calculated in a standardized way for three European countries. Eur. J. Health Econ. 2016;17:61–69. doi: 10.1007/s10198-014-0655-8.
    1. Bloom B.S., Bruno D.J., Maman D.Y., Jayadevappa R. Usefulness of US cost-of-illness studies in healthcare decision making. PharmacoEconomics. 2001;19:207–213. doi: 10.2165/00019053-200119020-00007.
    1. Liu J.L.Y., Maniadakis N., Gray A., Rayner M. The economic burden of coronary heart disease in the UK. Heart. 2002;88:597–603. doi: 10.1136/heart.88.6.597.
    1. Segel J.E. Cost-of-Illness Studies—A Primer. [(accessed on 6 September 2016)]; Available online: .
    1. Saha S., Gerdtham U.G. Cost of illness studies on reproductive, maternal, newborn, and child health: A systematic literature review. Health Econ. Rev. 2013;3 doi: 10.1186/2191-1991-3-24.
    1. Organization for Economic Co-Operation and Development (OECD) Glossary of Statistical Terms—Developed, Developing Countries. [(accessed on 27 November 2016)]; Available online: .
    1. Butland B., Jebb S., Kopelman P., McPherson K., Thomas S., Mardell J., Parry V. Tackling Obesities: Future Choices-Project Report. [(accessed on 27 November 2016)]; Available online: .
    1. Ezzati M., Lopez A. Comparative Quantification of Health Risks. [(accessed on 27 November 2016)]; Available online: .
    1. Mogyorosy Z., Smith P. The Main Methodological Issues in Costing Health Care Services: A Literature Review. [(accessed on 27 November 2016)]; Available online: .
    1. Rutter C.M., Zaslavsky A., Feuer E. Dynamic microsimulation models for health outcomes: A review. Med. Decis. Making. 2011;31:10–18. doi: 10.1177/0272989X10369005.
    1. Santos L.M., De Oliveira I.V., Peters L.R., Conde W.L. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system. Obes. Surg. 2010;20:943–948. doi: 10.1007/s11695-008-9570-3.
    1. World Health Organization Choosing Intervention That Are Cost Effective. [(accessed on 14 November 2012)]; Available online: .
    1. Vigo D., Thornicroft G., Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3:171–178. doi: 10.1016/S2215-0366(15)00505-2.
    1. World Health Organization Depression—Fact Sheet. [(accessed on 4 October 2016)]; Available online:
    1. Mannan M., Mamun A., Doi S., Clavarino A. Is there a bi-directional relationship between depression and obesity among adult men and women? Systematic review and bias-adjusted meta analysis. Asian J. Psychiatr. 2016;21:51–66. doi: 10.1016/j.ajp.2015.12.008.
    1. Krauth C., Stahmeyer J.T., Petersen J.J., Freytag A., Gerlach F.M., Gensichen J. Resource utilisation and costs of depressive patients in Germany: Results from the primary care monitoring for depressive patients trial. Depress. Res. Treat. 2014;2014 doi: 10.1155/2014/730891.
    1. Vainio H., Kaaks R., Bianchini F. Weight control and physical activity in cancer prevention: International evaluation of the evidence. Eur. J. Cancer Prev. 2002;11:S94–S100.
    1. Marmot M., Atinmo T., Byers T., Chen J., Hirohata T., Jackson A., James W., Kolonel L., Kumanyika S., Leitzmann C. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. [(accessed on 6 September 2016)]; Available online: .
    1. Kitahara C.M., Platz E.A., Freeman L.E., Hsing A.W., Linet M.S., Park Y., Schairer C., Schatzkin A., Shikany J.M., Berrington De Gonzalez A. Obesity and thyroid cancer risk among US men and women: A pooled analysis of five prospective studies. Cancer Epidemiol. Biomarkers Prev. 2011;20:464–472. doi: 10.1158/1055-9965.EPI-10-1220.
    1. Lichtman M.A. Obesity and the risk for a hematological malignancy: Leukemia, lymphoma, or myeloma. Oncologist. 2010;15:1083–1101. doi: 10.1634/theoncologist.2010-0206.
    1. Yabroff K.R., Lund J., Kepka D., Mariotto A. Economic burden of cancer in the US: Estimates, projections, and future research. Cancer Epidemiol. Biomarkers Prev. 2011;20:2006–2014. doi: 10.1158/1055-9965.EPI-11-0650.
    1. Fabbrini E., Sullivan S., Klein S. Obesity and nonalcoholic fatty liver disease: Biochemical, metabolic and clinical implications. Hepatology. 2010;51:679–689. doi: 10.1002/hep.23280.
    1. Marchesini G., Moscatiello S., Di Domizio S., Forlani G. Obesity-associated liver disease. J. Clin. Endocrinol. Metab. 2008;93:S74–S80. doi: 10.1210/jc.2008-1399.
    1. Younossi Z.M., Henry L. Economic and quality-of-life implications of non-alcoholic fatty liver disease. PharmacoEconomics. 2015;33:1245–1253. doi: 10.1007/s40273-015-0316-5.
    1. Li J., Song J., Zaytseva Y.Y., Liu Y., Rychahou P., Jiang K., Starr M.E., Kim J.T., Harris J.W., Yiannikouris F.B., et al. An obligatory role for neurotensin in high-fat-diet-induced obesity. Nature. 2016;533:411–415. doi: 10.1038/nature17662.
    1. Dinsa G.D., Goryakin Y., Fumagalli E., Suhrcke M. Obesity and socioeconomic status in developing countries: A systematic review. Obes. Rev. 2012;13:1067–1079. doi: 10.1111/j.1467-789X.2012.01017.x.
    1. Shrestha N., Pedisic Z., Neil-Sztramko S., Kukkonen-Harjula K.T., Hermans V. The Impact of obesity in the workplace: A review of contributing factors, consequences and potential solutions. Curr. Obes. Rep. 2016;5:344–360. doi: 10.1007/s13679-016-0227-6.
    1. Murphy C.C., Claire Yang Y., Shaheen N.J., Hofstetter W.L., Sandler R.S. An age-period-cohort analysis of obesity and incident esophageal adenocarcinoma among white males. Dis. Esophagus. 2016 doi: 10.1111/dote.12526.

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