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Karalus MA, Sullivan TA, Wild CE, Cave TL, O'Sullivan NA, Hofman PL, Edwards EA, Mouat S, Wong W, Anderson YC. The cost of investigating weight-related comorbidities in children and adolescents in Aotearoa/New Zealand. J Paediatr Child Health 2021; 57:1942-1948. [PMID: 34196427 DOI: 10.1111/jpc.15618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022]
Abstract
AIM Expert recommendations for child/adolescent obesity include extensive investigation for weight-related comorbidities, based on body mass index (BMI) percentile cut-offs. This study aimed to estimate the cost of initial investigations for weight-related comorbidities in children/adolescents with obesity, according to international expert guidelines. METHODS The annual mean cost of investigations for weight-related comorbidities in children/adolescents was calculated from a health-funder perspective using 2019 cost data obtained from three New Zealand District Health Boards. Prevalence data for child/adolescent obesity (aged 2-14 years) were obtained from the New Zealand Health Survey (2017/2018), and prevalence of weight-related comorbidities requiring further investigation were obtained from a previous New Zealand study of a cohort of children with obesity. RESULTS The cost of initial laboratory screening for weight-related comorbidities per child was NZD 28.36. Based on national prevalence data from 2018/2019 for children with BMI greater than the 98th percentile (obesity cut-off), the total annual cost for initial laboratory screening for weight-related comorbidities in children/adolescents aged 2-14 years with obesity was estimated at NZD 2,665,840. The cost of further investigation in the presence of risk factors was estimated at NZD 2,972,934. CONCLUSIONS Investigating weight-related comorbidities in New Zealand according to international expert guidelines is resource-intensive. Ways to further determine who warrants investigation with an individualised approach are required.
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Affiliation(s)
- Miriam A Karalus
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Trudy A Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Cervantée E Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Niamh A O'Sullivan
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Elizabeth A Edwards
- Department of Respiratory Medicine, Starship Children's Health, Auckland, New Zealand
| | - Stephen Mouat
- Department of Gastroenterology and Hepatology, Starship Children's Health, Auckland, New Zealand
| | - William Wong
- Department of Nephrology, Starship Children's Health, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand.,Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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2
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Abstract
OBJECTIVE To estimate the economic burden of overweight in Bangladesh. DESIGN We used data from Household Income and Expenditure Survey, 2010. A prevalence-based approach was used to calculate the population attributable fraction (PAF) for diseases attributable to overweight. Cost of illness methodology was used to calculate annual out of pocket (OOP) expenditure for each disease using nationally representative survey data. The cost attributable to overweight for each disease was estimated by multiplying the PAF by annual OOP expenditure. The total cost of overweight was estimated by adding PAF-weighted costs of treating the diseases. SETTING Nationwide, covering the whole of Bangladesh. PARTICIPANTS Individuals whose BMI ≥ 25 kg/m2. RESULTS The total cost attributable to overweight in Bangladesh in 2010 was estimated at US$147·38 million. This represented about 0·13 % of Bangladesh's Gross Domestic Product and 3·69 % of total health care expenditure in 2010. The sensitivity analysis revealed that the total cost could be as high as US$334 million or as low as US$71 million. CONCLUSIONS A substantial amount of health care resource is devoted to the treatment of overweight-related diseases in Bangladesh. Effective national strategies for overweight prevention programme should be established and implemented.
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Chiavaroli V, Gibbins JD, Cutfield WS, Derraik JGB. Childhood obesity in New Zealand. World J Pediatr 2019; 15:322-331. [PMID: 31079339 DOI: 10.1007/s12519-019-00261-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Paediatric obesity has reached epidemic proportions globally, resulting in significant adverse effects on health and wellbeing. Early life events, including those that happen before, during, and after pregnancy can predispose children to later obesity. The purpose of this review is to examine the magnitude of obesity among New Zealand children and adolescents, and to determine their underlying risk factors and associated comorbidities. DATA SOURCES PubMed, Web of Science, and Google Scholar searches were performed using the key terms "obesity", "overweight", "children", "adolescents", and "New Zealand". RESULTS Obesity is a major public health concern in New Zealand, with more than 33% of children and adolescents aged 2-14 years being overweight or obese. Obesity disproportionately affects Māori (New Zealand's indigenous population) and Pacific children and adolescents, as well as those of lower socioeconomic status. New Zealand's obesity epidemic is associated with numerous health issues, including cardiometabolic, gastrointestinal, and psychological problems, which also disproportionately affect Māori and Pacific children and adolescents. Notably, a number of factors may be useful to identify those at increased risk (such as demographic and anthropometric characteristics) and inform possible interventions. CONCLUSIONS The prevalence of overweight and obese children and adolescents in New Zealand is markedly high, with a greater impact on particular ethnicities and those of lower socioeconomic status. Alleviating the current burden of pediatric obesity should be a key priority for New Zealand, for the benefit of both current and subsequent generations. Future strategies should focus on obesity prevention, particularly starting at a young age and targeting those at greatest risk.
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Affiliation(s)
| | - John D Gibbins
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand. .,A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand. .,Endocrinology Department, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. .,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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4
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Zhao J, Mackay L, Chang K, Mavoa S, Stewart T, Ikeda E, Donnellan N, Smith M. Visualising Combined Time Use Patterns of Children's Activities and Their Association with Weight Status and Neighbourhood Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050897. [PMID: 30871114 PMCID: PMC6427195 DOI: 10.3390/ijerph16050897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/23/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
Compositional data techniques are an emerging method in physical activity research. These techniques account for the complexities of, and interrelationships between, behaviours that occur throughout a day (e.g., physical activity, sitting, and sleep). The field of health geography research is also developing rapidly. Novel spatial techniques and data visualisation approaches are increasingly being recognised for their utility in understanding health from a socio-ecological perspective. Linking compositional data approaches with geospatial datasets can yield insights into the role of environments in promoting or hindering the health implications of the daily time-use composition of behaviours. The 7-day behaviour data used in this study were derived from accelerometer data for 882 Auckland school children and linked to weight status and neighbourhood deprivation. We developed novel geospatial visualisation techniques to explore activity composition over a day and generated new insights into links between environments and child health behaviours and outcomes. Visualisation strategies that integrate compositional activities, time of day, weight status, and neighbourhood deprivation information were devised. They include a ringmap overview, small-multiple ringmaps, and individual and aggregated time–activity diagrams. Simultaneous visualisation of geospatial and compositional behaviour data can be useful for triangulating data from diverse disciplines, making sense of complex issues, and for effective knowledge translation.
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Affiliation(s)
- Jinfeng Zhao
- School of Nursing, The University of Auckland, Auckland 1023, New Zealand.
| | - Lisa Mackay
- School of Sport and Recreation, Auckland University of Technology, Auckland 0627, New Zealand.
| | - Kevin Chang
- Department of Statistics, The University of Auckland, Auckland 1010, New Zealand.
| | - Suzanne Mavoa
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia.
| | - Tom Stewart
- School of Sport and Recreation, Auckland University of Technology, Auckland 0627, New Zealand.
| | - Erika Ikeda
- School of Sport and Recreation, Auckland University of Technology, Auckland 0627, New Zealand.
| | - Niamh Donnellan
- School of Nursing, The University of Auckland, Auckland 1023, New Zealand.
| | - Melody Smith
- School of Nursing, The University of Auckland, Auckland 1023, New Zealand.
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5
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Larsen AT, Højgaard B, Ibsen R, Kjellberg J. The Socio-economic Impact of Bariatric Surgery. Obes Surg 2017; 28:338-348. [DOI: 10.1007/s11695-017-2834-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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Kjellberg J, Tange Larsen A, Ibsen R, Højgaard B. The Socioeconomic Burden of Obesity. Obes Facts 2017; 10:493-502. [PMID: 29020681 PMCID: PMC5741162 DOI: 10.1159/000480404] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/17/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the socioeconomic impact of obesity by estimating the direct and indirect costs associated with obesity in Denmark, based on individual level data. METHODS Costs were assessed for different BMI groups, and the relative risks for change in direct and indirect costs per BMI point above 30 were estimated. A fourth analysis estimated the odds ratio for comorbidities per BMI point above 30. Individual data on income, social transfer payments, healthcare costs and diagnoses were retrieved from national registries. RESULTS One BMI point above 30 was associated with a 2% decrease in income, a 3% increase in social transfer payments, and a 4% increase in healthcare costs. In absolute numbers, income contributed to most of the total economic burden. One BMI point above 30 was also associated with increased comorbidity, which explains the increase in both direct and indirect costs. CONCLUSION Obesity is associated with increased comorbidity, giving rise to an increase in both direct and indirect costs. Especially income is affected, which emphasizes the importance of including both measures when evaluating the total socioeconomic burden of obesity. Our findings draw attention to the potential for saving public resources and preventing loss of income by preventing obesity.
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Affiliation(s)
- Jakob Kjellberg
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
- *Dr. Jakob Kjellberg, Danish Institute for Local and Regional Government Research, Købmagergade 22, Copenhagen, Denmark,
| | | | | | - Betina Højgaard
- Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
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7
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Atella V, Kopinska J, Medea G, Belotti F, Tosti V, Mortari AP, Cricelli C, Fontana L. Excess body weight increases the burden of age-associated chronic diseases and their associated health care expenditures. Aging (Albany NY) 2016; 7:882-92. [PMID: 26540605 PMCID: PMC4637212 DOI: 10.18632/aging.100833] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aging and excessive adiposity are both associated with an increased risk of developing multiple chronic diseases, which drive ever increasing health costs. The main aim of this study was to determine the net (non-estimated) health costs of excessive adiposity and associated age-related chronic diseases. We used a prevalence-based approach that combines accurate data from the Health Search CSD-LPD, an observational dataset with patient records collected by Italian general practitioners and up-to-date health care expenditures data from the SiSSI Project. In this very large study, 557,145 men and women older than 18 years were observed at different points in time between 2004 and 2010. The proportion of younger and older adults reporting no chronic disease decreased with increasing BMI. After adjustment for age, sex, geographic residence, and GPs heterogeneity, a strong J-shaped association was found between BMI and total health care costs, more pronounced in middle-aged and older adults. Relative to normal weight, in the 45-64 age group, the per-capita total cost was 10% higher in overweight individuals, and 27 to 68% greater in patients with obesity and very severe obesity, respectively. The association between BMI and diabetes, hypertension and cardiovascular disease largely explained these elevated costs.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy.,Center for Health Policy, Stanford University, Stanford, CA 94305, USA
| | - Joanna Kopinska
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Gerardo Medea
- Italian College of General Practitioners (SIMG), Florence, Italy
| | - Federico Belotti
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Valeria Tosti
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrea Piano Mortari
- Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners (SIMG), Florence, Italy
| | - Luigi Fontana
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.,Department of Clinical and Experimental Sciences, Brescia University, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
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8
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Burns M, Gavey N. ‘Healthy Weight’ at What Cost? ‘Bulimia’ and a Discourse of Weight Control. J Health Psychol 2016; 9:549-65. [PMID: 15231056 DOI: 10.1177/1359105304044039] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Public health messages emphasizing ‘healthy weight’ link good health to a narrow range of body weights and stress energy regulation to achieve this. We examined whether women who practise bulimia deploy notions of ‘healthy weight’ in their talk about body management activities. Analysis is based on interviews with 15 women who practise bulimia and on material collected from cultural locations containing ‘health promotion’ advice. Poststructuralist discourse analysis revealed that slenderness was constituted as healthy in both sites and that the careful regulation of energy intake and output was similarly reified as a healthy practice. We conclude that a discourse of ‘healthy weight’ cannot be unhinged from a cultural imperative of slenderness for women, and that paradoxically ‘health’ practices provide a rationality that supports the practices of binge eating and compensating.
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Affiliation(s)
- Maree Burns
- Department of Psychology, University of Auckland, New Zealand.
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9
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Hoque ME, Mannan M, Long KZ, Al Mamun A. Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review. Trop Med Int Health 2016; 21:458-69. [PMID: 26892222 DOI: 10.1111/tmi.12679] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the economic burden of underweight and overweight among adults in the Asia-Pacific region. METHOD Systematic review of articles published until March 2015. RESULTS Seventeen suitable articles were found, of which 13 assess the economic burden of overweight/obesity and estimate that it accounts for 1.5-9.9% of a country's total healthcare expenditure. Four articles on the economic burden of underweight estimate it at 2.5-3.8% of the country's total GDP. Using hospital data, and compared to normal weight individuals, four articles estimated extra healthcare costs for overweight individuals of 7-9.8% and more, and extra healthcare costs for obese individuals of 17-22.3% and higher. CONCLUSION Despite methodological diversity across the studies, there is a consensus that both underweight and overweight impose a substantial financial burden on healthcare systems in the Asia-Pacific region.
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Affiliation(s)
| | - Munim Mannan
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Kurt Z Long
- School of Public Health, University of Queensland, Brisbane, QLD, Australia.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Abdullah Al Mamun
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
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10
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Barber JA, Schumann KP, Foran-Tuller KA, Islam LZ, Barnes RD. Medication Use and Metabolic Syndrome Among Overweight/Obese Patients With and Without Binge-Eating Disorder in a Primary Care Sample. Prim Care Companion CNS Disord 2015; 17:15m01816. [PMID: 26835176 PMCID: PMC4732320 DOI: 10.4088/pcc.15m01816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/15/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine metabolic factors among overweight/obese individuals with binge-eating disorder (BED) and non-binge-eating overweight/obese (NBO) patients recruited from primary care and to examine and compare medication use by these groups. METHOD Participants were 102 adults recruited for a weight loss study within primary care centers who were assessed for BED (28 [38%] met DSM-5 BED criteria). Participants completed a medication log, had physiologic measurements taken, and were evaluated for the presence of metabolic syndrome using 2 methods. Data were collected between February 2012 and October 2012. RESULTS The BED group had a higher mean body mass index (BMI), a higher pulse, and a larger waist circumference than the NBO group. Of the sample, 65% reported current medication use (prescription and/or over-the-counter medications): 19.6% took 3 to 4 medications and 15.7% took ≥ 5 medications. Aside from vitamin and over-the-counter allergy pill use, there were no differences in medication use between BED and NBO patients. Full metabolic syndrome (≥ 3 criteria met) was present in 31.5% of the sample when using objective measurement alone, and 39.1% of the sample when defined by objective measurement and pharmacologic management. No significant differences were observed regardless of definition. CONCLUSIONS Despite higher BMI, pulse, and waist circumference, the current sample of BED patients in primary care did not present with poorer metabolic health than NBO patients.
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Affiliation(s)
- Jessica A. Barber
- Department of Psychology, VA Connecticut Healthcare System, West Haven
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kristina P. Schumann
- Department of Psychology, VA Connecticut Healthcare System, West Haven
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kelly A. Foran-Tuller
- Department of Psychology, VA Connecticut Healthcare System, West Haven
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Leila Z. Islam
- Department of Psychology, VA Connecticut Healthcare System, West Haven
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rachel D. Barnes
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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11
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Dee A, Kearns K, O'Neill C, Sharp L, Staines A, O'Dwyer V, Fitzgerald S, Perry IJ. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes 2014. [PMID: 24739239 DOI: 10.1186/1756-0500/7/242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. METHODS A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. RESULTS Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. CONCLUSION A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.
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Affiliation(s)
- Anne Dee
- Department of Public Health, Health Service Executive West, Mount Kennett House, Henry Street, Limerick, Ireland.
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12
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Dee A, Kearns K, O'Neill C, Sharp L, Staines A, O'Dwyer V, Fitzgerald S, Perry IJ. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes 2014; 7:242. [PMID: 24739239 PMCID: PMC4006977 DOI: 10.1186/1756-0500-7-242] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included. Methods A computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. Results Five published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs. Conclusion A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.
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Affiliation(s)
- Anne Dee
- Department of Public Health, Health Service Executive West, Mount Kennett House, Henry Street, Limerick, Ireland.
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13
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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; 14:146. [PMID: 24690106 PMCID: PMC4109797 DOI: 10.1186/1472-6963-14-146] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 03/24/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Over the last decade, the prevalence of obesity (BMI ≥ 25 kg/m2) in Thailand has been rising rapidly and consistently. Estimating the cost of obesity to society is an essential step in setting priorities for research and resource use and helping improve public awareness of the negative economic impacts of obesity. This prevalence-based, cost-of-illness study aims to estimate the economic costs of obesity in Thailand. METHODS The estimated costs in this study included health care cost, cost of productivity loss due to premature mortality, and cost of productivity loss due to hospital-related absenteeism. The Obesity-Attributable Fraction (OAF) was used to estimate the extent to which the co-morbidities were attributable to obesity. The health care cost of obesity was further estimated by multiplying the number of patients in each disease category attributable to obesity by the unit cost of treatment. The cost of productivity loss was calculated using the human capital approach. RESULTS The health care cost attributable to obesity was estimated at 5,584 million baht or 1.5% of national health expenditure. The cost of productivity loss attributable to obesity was estimated at 6,558 million baht - accounting for 54% of the total cost of obesity. The cost of hospital-related absenteeism was estimated at 694 million baht, while the cost of premature mortality was estimated at 5,864 million baht. The total cost of obesity was then estimated at 12,142 million baht (725.3 million US$PPP, 16.74 baht =1 US$PPP accounting for 0.13% of Thailand's Gross Domestic Product (GDP). CONCLUSIONS Obesity imposes a substantial economic burden on Thai society especially in term of health care costs. Large-scale comprehensive interventions focused on improving public awareness of the cost of and problems associated with obesity and promoting a healthy lifestyle should be regarded as a public health priority.
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Affiliation(s)
- Paiboon Pitayatienanan
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Jomkwan Yothasamut
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Wichai Aekplakorn
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Naeti Suksomboon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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14
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Poppitt SD, Silvestre MP, Liu A. Etiology of Obesity Over the Life Span: Ecologic and Genetic Highlights from New Zealand Cohorts. Curr Obes Rep 2014; 3:38-45. [PMID: 26626466 DOI: 10.1007/s13679-013-0079-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The origins of the New Zealand population are highly diverse. New Zealand Māori are the indigenous peoples with a population of approximately half a million (~12 %), with the remainder comprising predominantly European/Caucasian (~50 %), Pacific Island Polynesian (~28 %) and Asian (~10 %) peoples. With a prevalence of overweight and obesity of 65 % for adults >15 years of age, of which 28 % have a BMI > 30 kg/m(2), New Zealand has been ranked third highest in a global OECD obesity review, behind only the US and Mexico. Levels of childhood obesity are also significant, with 31 % of New Zealand's children either overweight or obese. Few gender differences exist, but there are significant differences between ethnicities (Asian > European Caucasian > Māori > Pacific) with disproportionate representation by those poorer and with less formal education. A high 62 % of Pacifika are obese and virtually the entire adult population has a BMI >25 kg/m(2). Public health measures to limit progressive increases in weight are unsuccessful, and clearly should be priority for government focused on disease prevention.
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Affiliation(s)
- S D Poppitt
- Human Nutrition Unit, University of Auckland, 18 Carrick Place, Mt Eden, Auckland, 1024, New Zealand.
- School of Biological Sciences, University of Auckland, Auckland, New Zealand.
- Department of Medicine, University of Auckland, Auckland, New Zealand.
- Riddet Institute, Palmerston North, New Zealand.
| | - M P Silvestre
- Human Nutrition Unit, University of Auckland, 18 Carrick Place, Mt Eden, Auckland, 1024, New Zealand
- School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - A Liu
- Human Nutrition Unit, University of Auckland, 18 Carrick Place, Mt Eden, Auckland, 1024, New Zealand
- Department of Medicine, University of Auckland, Auckland, New Zealand
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15
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Lal A, Moodie M, Ashton T, Siahpush M, Swinburn B. Health care and lost productivity costs of overweight and obesity in New Zealand. Aust N Z J Public Health 2013; 36:550-6. [PMID: 23216496 DOI: 10.1111/j.1753-6405.2012.00931.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006. METHODS A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA). RESULTS Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA. CONCLUSION The cost burden of overweight and obesity in NZ is considerable. IMPLICATIONS Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs.
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Affiliation(s)
- Anita Lal
- Deakin Health Economics, Population Health Strategic Research Centre, Deakin University, Victoria, Australia.
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16
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Roux L, Donaldson C. Economics and Obesity: Costing the Problem or Evaluating Solutions? ACTA ACUST UNITED AC 2012; 12:173-9. [PMID: 14981208 DOI: 10.1038/oby.2004.23] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There is no doubt that obesity is a major public health problem. However, what is the contribution of economics to solving it? In this report, we make the case that the role of economics is not in measuring the economic burden of obesity, through so-called cost-of-illness studies. Such studies merely confirm that obesity is a serious societal issue; adding a monetary figure to this does not add much. The economic foundations of such estimates can also be questioned, thus lessening their policy relevance. The real value of economics in the arena of obesity care is in evaluating, through formal economic evaluation, the use of our scarce health care resources in different strategies to prevent and treat obesity.
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Affiliation(s)
- Larissa Roux
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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17
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Wolfenstetter SB. Future direct and indirect costs of obesity and the influence of gaining weight: results from the MONICA/KORA cohort studies, 1995-2005. ECONOMICS AND HUMAN BIOLOGY 2012; 10:127-138. [PMID: 21983232 DOI: 10.1016/j.ehb.2011.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 08/09/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
Over the last two decades, the prevalence of obesity has risen worldwide. As obesity is a confirmed risk factor for a number of diseases, its increasing prevalence nurtures the supposition that obesity may present a growing and significant economic burden to society. The objective of this study is to analyse the correlation between body mass index (BMI) and future direct and indirect costs, as well as the correlation between changing BMI and future in(direct) costs. Health care utilisation and productivity losses were based on data from 2581 participants aged 25-65 years (1994/95) from two cross-sectional, population-representative health surveys (MONICA/KORA-survey-S3 1994/95 and follow-up KORA-survey-F3 2004/05) in Augsburg, Germany. The predicted average adjusted total direct costs per year and per user were estimated to be €1029-(healthy weight), €1093-(overweight) and €1040-(obesity). There are significantly greater future costs in the utilisation of general practitioners per user and per year at higher obesity levels (€72; €75; €96). The average total direct costs per person for those who stay in the same BMI class are €982, €1000 and €973. An overweight participant who becomes obese incurs significant costs of internists of €160 compared with those who remain overweight (€124). An overweight user incurs indirect costs of €2474, compared with €2136 for those who remain a healthy weight. There is a trend for higher predicted (in)direct costs when people are overweight or obese compared with healthy weight persons 10 years earlier. Potential cost savings could be attained if preventive programs effectively targeted these individuals.
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Affiliation(s)
- S B Wolfenstetter
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany.
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18
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Ewing BT, Thompson MA, Wachtel MS, Frezza EE. A cost-benefit analysis of bariatric surgery on the South Plains region of Texas. Obes Surg 2011; 21:644-9. [PMID: 20852965 DOI: 10.1007/s11695-010-0266-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The regional economic burdens of obesity have not been fully quantified. This study incorporated bariatric surgery demographics collected from a large university hospital with regional economic and employment data to evaluate the cost of obesity for the South Plains region of Texas. Data were collected from patients who underwent laparoscopic gastric bypass and laparoscopic banding between September 2003 and September 2005 at Texas Tech University Health Sciences Center. A regional economic model estimated the economic impact of lost productivity due to obesity. Comparisons of lost work days in the year before and after surgery were used to estimate the potential benefit of bariatric surgery to the South Plains economy. Total output impacts of obesity, over $364 million, were 3.3% of total personal income; total labor income impacts neared $60 million: the losses corresponded to $2,389 lost output and $390 lost labor income per household. Obesity cost the South Plains over 1,977 jobs and decreased indirect business tax revenues by over $13 million. The net benefit of bariatric surgery was estimated at $9.9 billion for a discount rate of 3%, $5.0 billion for a discount rate of 5%, and $1.3 billion for a discount rate of 10%. Potential benefits to the South Plains economy of performing bariatric surgery more than outweigh its costs.
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Affiliation(s)
- Bradley T Ewing
- Rawls College of Business, Texas Tech University, Lubbock, TX, USA
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19
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Oliver M, Schluter PJ, Rush E, Schofield GM, Paterson J. Physical activity, sedentariness, and body fatness in a sample of 6-year-old Pacific children. ACTA ACUST UNITED AC 2011; 6:e565-73. [DOI: 10.3109/17477166.2010.512389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
In the last decade, the prevalence of obesity has increased significantly in populations worldwide. A less dramatic, but equally important increase has been seen in our knowledge of its effects on health and the burden it places on healthcare systems. This systematic review aims to assess the current published literature on the direct costs associated with obesity. A computerized search of English language articles published between 1990 and June 2009 yielded 32 articles suitable for review. Based on these articles, obesity was estimated to account for between 0.7% and 2.8% of a country's total healthcare expenditures. Furthermore, obese individuals were found to have medical costs that were approximately 30% greater than their normal weight peers. Although variations in inclusion/exclusion criteria, reporting methods and included costs varied widely between the studies, a lack of examination of how and why the excess costs were being accrued appeared to be a commonality between most studies. Accordingly, future studies must better explore how costs accrue among obese populations, in order to best facilitate health and social policy interventions.
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Affiliation(s)
- D Withrow
- Department of Life Sciences, Queen's University, Toronto, ON, Canada
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22
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Chu NF, Wang SC, Chang HY, Wu DM. Medical services utilization and expenditure of obesity-related disorders in Taiwanese adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:829-836. [PMID: 20825625 DOI: 10.1111/j.1524-4733.2010.00776.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To evaluate medical service utilization and medical expenditure associated with obesity-related diseases among different weight status subjects in Taiwan. METHODS A cross-sectional survey based on the National Health Interview Survey performed in 2001. Subjects greater than 20 years old who lived in Taiwan, as corroborated by National Health Insurance (NHI), during 2001, were included. Overall, the data set included 15,461 subjects with age of 20-85 years old. After excluding those subjects with incomplete or missing data or who refused to link their data with the NHI data, 12,283 subjects were used for analyses. RESULTS In general, obesity-related disorders, such as hypertension, diabetes mellitus (DM), and cardiovascular diseases have increasing prevalence with greater body mass index (BMI; P<0.001). Obese subjects (BMI≧27kg/m(2) ) had the highest prevalence of hypertension (31.9%), after DM (26.9%). After adjusting for age, smoking, drinking and obesity-related disorders, it was found that medical utilization in outpatient increases from 1.33 to 4.04 visits/year (P<0.001) and in-hospital increases from 0.05 to 0.07 admissions/year (P>0.05) with higher BMI. Average outpatient expenditure (including physician fee, laboratory test and drug costs) per year is NT$1201, 1857, 3960, and 5118 (at an exchange rate of NT$32 to US$1) for underweight, normal, overweight, and obese subjects, respectively (P<0.001). CONCLUSIONS Medical utilization and outpatient medical expenditure was found to increase with higher BMI status. However, there was a J-shaped (in female) or even negative (in male) relationship between BMI and in-hospital medical expenditures. Further studies are needed to resolve this major public health problem, even in a developing country such as Taiwan.
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Affiliation(s)
- Nain-Feng Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.
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23
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Anis AH, Zhang W, Bansback N, Guh DP, Amarsi Z, Birmingham CL. Obesity and overweight in Canada: an updated cost-of-illness study. Obes Rev 2010; 11:31-40. [PMID: 19413707 DOI: 10.1111/j.1467-789x.2009.00579.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study is to update the estimates of the economic burden of illness because of overweight and obesity in Canada by incorporating the increase in prevalence of overweight and obesity, findings of new related comorbidities and rise in the national healthcare expenditure. The burden was estimated from a societal perspective using the prevalence-based cost-of-illness methodology. Results from a literature review of the risks of 18 related comorbidities were combined with prevalence of overweight and obesity in Canada to estimate the extent to which each comorbidity is attributable to overweight and obesity. The direct costs were extracted from the National Health Expenditure Database and allocated to each comorbidity using weights principally from the Economic Burden of Illness in Canada. The study showed that the total direct costs attributable to overweight and obesity in Canada were $6.0 billion in 2006, with 66% attributable to obesity. This corresponds to 4.1% of the total health expenditures in Canada in 2006. The inclusion of newly identified comorbidities increased the direct cost estimates of obesity by 25%, while the rise in national healthcare expenditure accounted for a 19% increase. Policies to reduce being overweight and obese could potentially save the Canadian healthcare system millions of dollars.
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Affiliation(s)
- A H Anis
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6.
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24
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Oliva J, González L, Labeaga JM, Alvarez Dardet C. [Public health, obesity and economics: the good, the bad and the ugly]. GACETA SANITARIA 2009; 22:507-10. [PMID: 19080924 DOI: 10.1016/s0213-9111(08)75346-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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The economic impact of morbid obesity. Surg Endosc 2009; 23:677-9. [DOI: 10.1007/s00464-008-0325-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 12/17/2008] [Indexed: 01/20/2023]
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26
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Smith MB, Signal L. Global influences on milk purchasing in New Zealand--implications for health and inequalities. Global Health 2009; 5:1. [PMID: 19152688 PMCID: PMC2672082 DOI: 10.1186/1744-8603-5-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 01/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Economic changes and policy reforms, consistent with economic globalization, in New Zealand in the mid-1980s, combined with the recent global demand for dairy products, particularly from countries undergoing a 'nutrition transition', have created an environment where a proportion of the New Zealand population is now experiencing financial difficulty purchasing milk. This situation has the potential to adversely affect health. DISCUSSION Similar to other developed nations, widening income disparities and health inequalities have resulted from economic globalization in New Zealand; with regard to nutrition, a proportion of the population now faces food poverty. Further, rates of overweight/obesity and chronic diseases have increased in recent decades, primarily affecting indigenous people and lower socio-economic groups. Economic globalization in New Zealand has changed the domestic milk supply with regard to the consumer and may shed light on the link between globalization, nutrition and health outcomes. This paper describes the economic changes in New Zealand, specifically in the dairy market and discusses how these changes have the potential to create inequalities and adverse health outcomes. The implications for the success of current policy addressing chronic health outcomes is discussed, alternative policy options such as subsidies, price controls or alteration of taxation of recommended foods relative to 'unhealthy' foods are presented and the need for further research is considered. SUMMARY Changes in economic ideology in New Zealand have altered the focus of policy development, from social to commercial. To achieve equity in health and improve access to social determinants of health, such as healthy nutrition, policy-makers must give consideration to health outcomes when developing and implementing economic policy, both national and global.
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Affiliation(s)
- Moira B Smith
- HePPRU: Health Promotion and Policy Research Unit & HIA Research Unit, Department of Public Health, University of Otago, Wellington, Mein St, Newtown, PO Box 7343, Wellington South, New Zealand
| | - Louise Signal
- HePPRU: Health Promotion and Policy Research Unit & HIA Research Unit, Department of Public Health, University of Otago, Wellington, Mein St, Newtown, PO Box 7343, Wellington South, New Zealand
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27
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Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care. J Health Serv Res Policy 2008; 13:158-66. [DOI: 10.1258/jhsrp.2008.007140] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention. Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18-75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline. Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up. Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.
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Abstract
Obesity has risen dramatically in the past few decades. However, the relative contribution of energy intake and energy expenditure to rising obesity is not known. Moreover, the extent to which social and economic factors tip the energy balance is not well understood. This exploratory study estimates the relative contribution of increased caloric intake and reduced physical activity to obesity in developed countries using two methods of energy accounting. Results show that rising obesity is primarily the result of consuming more calories. We estimate multivariate regression models and use simulation analysis to explore technological and sociodemographic determinants of this dietary excess. Results indicate that the increase in caloric intake is associated with technological innovations as well as changing sociodemographic factors. This review offers useful insights to future research concerned with the etiology of obesity and suggests that obesity-related policies should focus on encouraging lower caloric intake.
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Affiliation(s)
- Sara Bleich
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
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29
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Müller-Riemenschneider F, Reinhold T, Berghöfer A, Willich SN. Health-economic burden of obesity in Europe. Eur J Epidemiol 2008; 23:499-509. [PMID: 18509729 DOI: 10.1007/s10654-008-9239-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 03/13/2008] [Indexed: 01/18/2023]
Abstract
Although overweight and obesity have long been recognised as major risk factors for a number of chronic diseases, lifestyle developments have led to substantial increases in bodyweight worldwide. In addition to their negative effects on health and quality of life, obesity and associated comorbidities may have a considerable impact on healthcare expenditures. The aim of this systematic review was to summarise cost estimates and compare costs attributable to obesity across different European countries. A structured search in MEDLINE, EMBASE, and all EBM Reviews was conducted to identify relevant literature. Two researchers independently assessed publications according to pre-defined inclusion criteria and with regard to study methodology. Costs attributable to obesity were extracted from the included studies and calculated relative to country-specific gross domestic income. Out of 797 publications that met our search criteria, 13 studies investigating 10 Western European countries were determined to be relevant and included in our review. Obesity-related healthcare burdens of up to 10.4 billion euros were found. Reported relative economic burdens ranged from 0.09% to 0.61% of each country's gross domestic product (GDP). Obesity appears to be responsible for a substantial economic burden in many European countries, and the costs identified in the available studies presumably reflect conservative estimates. There remains a great need for prospective and standardised studies to provide more accurate estimates of costs for all European countries.
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Affiliation(s)
- Falk Müller-Riemenschneider
- Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany,
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Pratt DS, Jandzio M, Tomlinson D, Kang X, Smith E. The 5-10-25 challenge: an observational study of a web-based wellness intervention for a global workforce. ACTA ACUST UNITED AC 2008; 9:284-90. [PMID: 17044762 DOI: 10.1089/dis.2006.9.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted and evaluated a 4-year, web-based wellness program involving 2498 global employees. The program was designed to encourage improvement in diet, exercise level, and weight control. Each month, after enrollment, participants were prompted to log on and enter personal data. Four years' worth of nonparametric data were analyzed. Seventy-seven percent of participants were men, 53% were overweight or obese, and mean beginning body mass index (BMI) was 25.9. Only 35% of starting participants ate five or more servings of fruit and vegetables daily, and fewer than 38% engaged in 30 min of activity or 10,000 steps. At the end of the intervention, there was a statistically significant (p < 0.05) improvement in the diet, exercise habits, and weight of participants. Results suggests that our web-based wellness intervention was successful in improving key health indicators for a mobile, global workforce.
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Affiliation(s)
- David S Pratt
- General Electric Energy Health Services, Schenectady, New York 12345, USA.
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31
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Zhao W, Zhai Y, Hu J, Wang J, Yang Z, Kong L, Chen C. Economic burden of obesity-related chronic diseases in Mainland China. Obes Rev 2008; 9 Suppl 1:62-7. [PMID: 18307701 DOI: 10.1111/j.1467-789x.2007.00440.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objectives of the present study are: (i) to estimate annual direct medical costs of chronic diseases attributable to overweight and obesity among adults in China and (ii) to predict the medical costs if the epidemic continues developing. Using 2002 National Nutrition and Health Survey (n = 39,834), the prevalence of overweight [24 > or = body mass index (BMI) < 28] and obesity (BMI > or = 28), and population attributable risks (PARs) for hypertension, type 2 diabetes, coronary heart disease and stroke were calculated. The 2003 third National Health Services Survey (n = 143,521) was used to derive direct medical costs including costs for outpatient visits, physician services, inpatient stays, rehabilitation services, nursing fees and medications. The medical costs attributable to overweight and obesity were estimated by multiplying the disease costs by PAR for each disease. The total medical cost attributable to overweight and obesity was estimated at 21.11 billion Yuan (RMB) (approximately $2.74 billion) accounting for 25.5% of the total medical costs for the four chronic diseases, or 3.7% of national total medical costs in 2003. The medical cost associated with overweight and obesity could increase to 37 billion Yuan (RMB) (approximately $4.8 billion), a 75% increase, if the epidemic developed speedily and the ratio of overweight to obesity approached 1.1:1. The high economic burden of overweight and obesity suggests an urgent need to develop effective interventions for controlling the obesity epidemic and consequently the prevention of chronic diseases.
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Affiliation(s)
- W Zhao
- Chinese Centre for Diseases Control and Prevention, Beijing, China.
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Abstract
BACKGROUND To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. METHOD A prospective cohort of 31,840 subjects aged 50-64 years at baseline had health status, lifestyle and socio-economic aspects assessed at entry. Individual data on health care consumption and associated costs were extracted from registers for the subsequent 7 years. Participants were stratified by presence of chronic disease at entry. RESULTS Increased waist circumference at baseline was associated with higher future health care costs. For increased and substantially increased waist circumference health care costs rise at a rate of 1.25% in women and 2.08% in men, per added centimetre above normal waistline. Thus, as an example, a woman with a waistline of 95 cm and without co-morbidities can be expected to incur an added future cost of approximately USD 397.- per annum compared to a woman in the normal waist circumference group, corresponding to 22% higher health care costs. CONCLUSIONS Future health care costs are higher for persons who have an increased waist circumference, which suggests that there may be a potential for significant resource savings through prevention of abdominal obesity.
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Affiliation(s)
- Betina Højgaard
- Danish Institute for Health Services Research, Copenhagen University Hospital, Centre for Health and Society, Copenhagen, Denmark.
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Hamilton S, Mhurchu CN, Priest P. Food and nutrient availability in New Zealand: an analysis of supermarket sales data. Public Health Nutr 2007; 10:1448-55. [PMID: 17605835 DOI: 10.1017/s1368980007000134] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo examine food and nutrient availability in New Zealand using supermarket sales data in conjunction with a brand-specific supermarket food composition database (SFD).DesignThe SFD was developed by selecting the top-selling supermarket food products and linking them to food composition data from a variety of sources, before merging with individualised sales data. Supermarket food and nutrient data were then compared with data from national nutrition and household budget/economic surveys.SettingA supermarket in Wellington, New Zealand.SubjectsEight hundred and eighty-two customers (73% female; mean age 38 years) who shopped regularly at the participating supermarket store and for whom electronic sales data were available for the period February 2004–January 2005.ResultsTop-selling supermarket food products included full-fat milk, white bread, sugary soft drinks and butter. Key food sources of macronutrients were similar between the supermarket sales database and national nutrition surveys. For example, bread was the major source of energy and contributed 12–13% of energy in all three data sources. Proportional expenditure on fruit, vegetables, meat, poultry, fish, farm products and oils, and cereal products recorded in the Household Economic Survey and supermarket sales data were within 2% of each other.ConclusionsElectronic supermarket sales data can be used to evaluate a number of important aspects of food and nutrient availability. Many of our findings were broadly comparable with national nutrition and food expenditure survey data, and supermarket sales have the advantage of being an objective, convenient, up-to-date and cost-effective measure of household food purchases.
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Affiliation(s)
- Sally Hamilton
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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Andreyeva T, Michaud PC, van Soest A. Obesity and health in Europeans aged 50 years and older. Public Health 2007; 121:497-509. [PMID: 17544467 DOI: 10.1016/j.puhe.2006.11.016] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Revised: 09/16/2006] [Accepted: 11/16/2006] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity is increasing globally across all population groups. Limited data are available on how obesity patterns differ across countries. OBJECTIVE To document the prevalence of obesity and related health conditions for Europeans aged 50 years and older, and to estimate the association between obesity and health outcomes across 10 European countries. METHODS Data were obtained from the 2004 Survey of Health, Ageing and Retirement in Europe, a cross-national survey of 22,777 Continental Europeans over the age of 50 years. The health outcomes included self-reported health, disability, doctor-diagnosed chronic health conditions and depression. Multivariate regression analysis was used to predict health outcomes across weight classes (defined by body mass index [BMI] from self-reported weight and height) in the pooled sample and individually in each country. RESULTS The prevalence of obesity (BMI >or=30) ranged from 12.8% in Sweden to 20.2% in Spain for men and from 12.3% in Switzerland to 25.6% in Spain for women. Adjusting for compositional differences across countries changed little in the observed large heterogeneity in obesity rates throughout Europe. Compared with normal weight individuals, men and women with greater BMI had significantly higher risks for all chronic health conditions examined except heart disease in overweight men. Depression was linked to obesity in women only. Particularly pronounced risks of impaired health and chronic health conditions were found among severely obese people. The effects of obesity on health did not vary significantly across countries. CONCLUSIONS Cross-country differences in the prevalence of obesity in older Europeans are substantial and exceed socio-demographic differentials in excessive body weight. Obesity is associated with significantly poorer health outcomes among Europeans aged 50 years and over, with effects similar across countries. Large heterogeneity in obesity throughout Europe should be investigated further to identify areas for effective public policy.
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Affiliation(s)
- T Andreyeva
- Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards Street, New Haven, CT 06520-8369, USA.
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The impact of morbid obesity on the state economy: an initial evaluation. Surg Obes Relat Dis 2006; 2:504-8. [DOI: 10.1016/j.soard.2006.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 05/18/2006] [Accepted: 05/22/2006] [Indexed: 11/18/2022]
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Kuriyama S. Impact of overweight and obesity on medical care costs, all-cause mortality, and the risk of cancer in Japan. J Epidemiol 2006; 16:139-44. [PMID: 16837764 PMCID: PMC7603910 DOI: 10.2188/jea.16.139] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We conducted three prospective cohort studies that examined the association between body mass index (BMI) and health outcomes in Japan. Our studies found statistically significant relationships between excess body weight and increased medical costs, all-cause mortality, and risk of cancer incidence. There was a U-shaped association between BMI and mean total costs. The estimated excess costs attributable to overweight and obesity was 3.2% of the total costs. This 3.2% is within the range reported in studies in Western countries (0.7%-6.8%). We observed statistically significant elevations in mortality risk in obese (BMI> or = 30.0 kg/m(2)) women and lean (BMI<18.5 kg/m(2)) men and women. Our prospective cohort study found statistically significant relationships between excess weight and increased risk in women of all cancers. The population attributable fraction (PAF) of all incident cancers in this population that were attributable to overweight and obesity were 4.5% in women, which were within the range reported from Western populations, from 3.2% for US women to 8.8% for Spanish women. Our data suggests that excess body weight is a problem not only in Western countries but also in Japan.
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Affiliation(s)
- Shinichi Kuriyama
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Japan.
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van Dijk L, Otters HB, Schuit AJ. Moderately overweight and obese patients in general practice: a population based survey. BMC FAMILY PRACTICE 2006; 7:43. [PMID: 16827937 PMCID: PMC1564048 DOI: 10.1186/1471-2296-7-43] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 07/07/2006] [Indexed: 01/22/2023]
Abstract
Background Obesity is a main threat to public health in the Western world and is associated with diseases such as diabetes mellitus and coronary heart diseases. Up to now a minority of research studied the relation between obesity and the use of primary health care. In the Netherlands the general practitioner (GP) is the main primary health care provider. The objective of this article is to evaluate GP consultation and prescription of drugs in moderate and severely overweight (obese) persons in the Netherlands. Methods Data were used from a representative survey of morbidity in Dutch general practice in 2001. Our study sample consisted of 8,944 adult respondents (18+ years) who participated in an extensive health interview. Interview data were linked to morbidity and prescription registration data from 95 general practices where respondents were listed. Body mass index (BMI) was calculated using self-reported height and weight. Analyses were controlled for clustering within practices as well as for socio-demographic and life style characteristics. Results Obesity (BMI ≥ 30 kg/m2) was observed in 8.9% of men and 12.4% of women; for moderate overweight (BMI 25-<30 kg/m2) these percentages were 42.2% and 30.4% respectively. Obese men and women were more likely to consult their GP than persons without overweight. This especially holds for diseases of the endocrine system, the cardiovascular system, the musculoskeletal system, the gastro-intestinal system, and skin problems. Related to this, obese men and women were more likely to receive drugs for the cardiovascular system, the musculoskeletal system, alimentary tract and metabolism (including, for example, antidiabetics), and dermatologicals, but also antibiotics and drugs for the respiratory system. For moderately overweight men and women (BMI 25-<30 kg/m2) smaller but significant differences were found for diseases of the endocrine system, the cardiovascular system, and the musculoskeletal system. Conclusion Obesity increases the workload of Dutch general practitioners and the use of prescribed medication. The current increase in the prevalence of obesity will further increase the use of health care and related costs. Since a large majority of Dutch persons visit their GP over the course of one year, GPs' potential role in effective prevention strategies cannot be denied.
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Affiliation(s)
- Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Hanneke B Otters
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Albertine J Schuit
- National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
- Institute of Health Science, Free University, Amsterdam, The Netherlands
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Affiliation(s)
- Thomas A Gaziano
- Division of Cardiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
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Akobundu E, Ju J, Blatt L, Mullins CD. Cost-of-illness studies : a review of current methods. PHARMACOECONOMICS 2006; 24:869-90. [PMID: 16942122 DOI: 10.2165/00019053-200624090-00005] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The number of cost-of-illness (COI) studies has expanded considerably over time. One outcome of this growth is that the reported COI estimates are inconsistent across studies, thereby raising concerns over the validity of the estimates and methods. Several factors have been identified in the literature as reasons for the observed variation in COI estimates. To date, the variation in the methods used to calculate costs has not been examined in great detail even though the variations in methods are a major driver of variation in COI estimates. The objective of this review was to document the variation in the methodologies employed in COI studies and to highlight the benefits and limitations of these methods. The review of COI studies was implemented following a four-step procedure: (i) a structured literature search of MEDLINE, JSTOR and EconLit; (ii) a review of abstracts using pre-defined inclusion and exclusion criteria; (iii) a full-text review using pre-defined inclusion and exclusion criteria; and (iv) classification of articles according to the methods used to calculate costs. This review identified four COI estimation methods (Sum_All Medical, Sum_Diagnosis Specific, Matched Control and Regression) that were used in categorising articles. Also, six components of direct medical costs and five components of indirect/non-medical costs were identified and used in categorising articles.365 full-length articles were reflected in the current review following the structured literature search. The top five cost components were emergency room/inpatient hospital costs, outpatient physician costs, drug costs, productivity losses and laboratory costs. The dominant method, Sum_Diagnosis Specific, was a total costing approach that restricted the summation of medical expenditures to those related to a diagnosis of the disease of interest. There was considerable variation in the methods used within disease subcategories. In several disease subcategories (e.g. asthma, dementia, diabetes mellitus), all four estimation methods were represented, and in other cases (e.g. HIV/AIDS, obesity, stroke, urinary incontinence, schizophrenia), three of the four estimation methods were represented. There was also evidence to suggest that the strengths and weaknesses of each method were considered when applying a method to a specific illness. Comparisons and assessments of COI estimates should consider the method used to estimate costs both as an important source of variation in the reported COI estimates and as a marker of the reliability of the COI estimate.
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Affiliation(s)
- Ebere Akobundu
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
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Abstract
In a number of countries, including Taiwan, the prevalence of childhood obesity has been steadily increasing. A study to assess school nurses' perspective on their role in supporting children and preventing childhood obesity in Taiwan is currently being undertaken. A search of the literature reveals that most research publications come from the West and these studies have been useful. However, it is important to isolate the research and policy materials that take into account the contextually and culturally relevant factors in Taiwan and neighboring countries. Findings from a review of the Taiwanese literature are presented in this paper. The literature reveals the factors associated with the prevalence of childhood obesity and prevention strategies. A significant proportion of the research is medical and focuses on cardiovascular disease rather than health promotion and education. However, there are findings in this review that generally support health promotion activities and programs that are school based. There appears to be an urgent need for investment in research that assesses the long-term effectiveness of interventions designed to promote the maintenance of healthy weight during childhood in the Taiwanese society. Western literature is referred to occasionally in this paper in order to introduce an issue or to compare with a Taiwanese paper.
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Affiliation(s)
- Pei-Lin Hsieh
- Chang Gung Institute of Technology, School of Nursing, Tao-Yuan County, Taiwan
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Lacey LA, Wolf A, O'shea D, Erny S, Ruof J. Cost-effectiveness of orlistat for the treatment of overweight and obese patients in Ireland. Int J Obes (Lond) 2005; 29:975-82. [PMID: 15852050 DOI: 10.1038/sj.ijo.0802947] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of orlistat plus a calorie-controlled diet compared with a calorie-controlled diet alone for the treatment of overweight and obese patients in Ireland. DESIGN Economic modelling techniques using published international efficacy data and Irish cost data were used to estimate the cost-effectiveness of orlistat in obese patients when only responders to treatment (ie achieve 5% weight loss after 3 months of treatment) continue orlistat after 3 months. The model incorporated known relationships between weight loss and quality of life (utility) gain, and weight loss and reduction in risk of type 2 diabetes (T2DM) to predict the impact of weight loss on quality-adjusted-life-years (QALYs) gained and on the onset of T2DM. The costs associated with each treatment arm included the acquisition cost of orlistat, cost of a calorie-controlled dietary programme and monitoring and treatment costs associated with T2DM. An Irish health-care perspective was taken for the analysis, based on 2003 costs. SUBJECTS Weight loss data on 1386 patients from five pivotal orlistat clinical trials with at least 12 months duration were pooled (two American and three primarily European studies). All the studies were randomized, placebo-controlled, multicentre trials with a similar design. The inclusion criteria were BMI > or =28 kg / m(2), age > or =18 y, no diagnosed T2DM and the ability to lose 2.5 kg in weight during the introductory period. MEASUREMENTS Cost effectiveness was modelled from these data and presented as incremental cost per QALY. RESULTS When orlistat treatment plus a calorie-controlled diet was compared with a calorie-controlled diet alone, the incremental cost per year was euro 478. The number needed to treat (NNT) to gain one QALY was estimated to be 35. The incremental cost per QALY gained was within the range considered cost-effective at euro 16,954. Sensitivity analysis demonstrated an incremental cost per QALY of euro 11,000-35,000 under a variety of assumptions. CONCLUSIONS Our model suggests that orlistat is effective and cost-effective in obese patients, if after 3 months of treatment, only treatment responders continue treatment.
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Affiliation(s)
- L A Lacey
- Lacey Solutions Ltd, Dublin, Ireland.
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Kuriyama S, Hozawa A, Ohmori K, Suzuki Y, Nishino Y, Fujita K, Tsubono Y, Tsuji I. Joint impact of health risks on health care charges: 7-year follow-up of National Health Insurance beneficiaries in Japan (the Ohsaki Study). Prev Med 2004; 39:1194-9. [PMID: 15539055 DOI: 10.1016/j.ypmed.2004.04.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of this study was to examine the joint impact of modifiable health-risk factors such as smoking, obesity, and physical inactivity on direct health care charges. METHOD We conducted a population-based prospective cohort study, with follow-up from 1995 to 2001. The participants were Japanese National Health Insurance (NHI) beneficiaries (26,110 men and women aged 40-79 years). RESULTS 'No risk' group defined as never-smoking, body mass index (BMI) 20.0-24.9 kg/m(2), and walking for >/=1 h/day had mean health care charges of 171.6 dollars after adjustment for potential confounders. Compared with this group, the presence of smoking (SM; ever-smoking) alone, obesity alone (OB; BMI >/=25.0 kg/m(2)), or physical inactivity (PI; walking for <1 h/day) alone were associated with a 8.3%, 7.1%, or 8.0% increase in health care charges, respectively. The combinations of the risks of SM and OB, SM and PI, OB and PI, and SM and OB and PI were associated with a 11.7%, 31.4%, 16.4%, and 42.6% increase in charges, respectively. CONCLUSION Interventions to improve modifiable health-risk factors may be a cost-effective approach for reducing health care charges as well as improving people's health.
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Affiliation(s)
- Shinichi Kuriyama
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
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Wang F, McDonald T, Champagne LJ, Edington DW. Relationship of body mass index and physical activity to health care costs among employees. J Occup Environ Med 2004; 46:428-36. [PMID: 15167389 DOI: 10.1097/01.jom.0000126022.25149.bf] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study examined the relationship between physical activity and health care costs by different weight groups. The study sample consisted of 23,490 active employees grouped into normal weight, overweight, and obese categories. After adjustment for covariates, physically moderately active (1 to 2 times/week) and very active (3 + times/week) employees had approximately $250 less paid health care costs annually than sedentary employees (0 time/week) across all weight categories. The difference was approximately $450 in the obese subpopulation. The maximum possible savings was estimated to be 1.5% of the total health care costs if all obese sedentary employees would adapt a physically active lifestyle. As a strategy to control escalating health care costs, wellness programs should facilitate engagement in moderate physical activity of at least 1 to 2 times a week among sedentary obese people and help them to maintain this more active lifestyle.)
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Affiliation(s)
- Feifei Wang
- Health Management Research Center, University of Michigan, Ann Arbor, Michigan, USA.
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Abstract
Obesity represents one of the most serious global health issues with approximately 310 million people presently affected. It develops because of a mismatch between energy intake and expenditure that results from behavior (feeding behavior and time spent active) and physiology (resting metabolism and expenditure when active). Both of these traits are affected by environmental and genetic factors. The dramatic increase in the numbers of obese people in Western societies reflects mostly changing environmental factors and is linked to reduced activity and perhaps also increased food intake. However, in all societies and subpopulations, there are both obese and nonobese subjects. These differences are primarily a consequence of genetic factors as is revealed by the high heritability for body mass index. Most researchers agree that energy balance and, hence, body weight are regulated phenomena. There is some disagreement about exactly how this regulation occurs. However, a common model is the "lipostatic" regulation system, whereby our energy stores generate signals that are compared with targets encoded in the brain, and differences between these drive our food intake levels, activity patterns, and resting and active metabolisms. Considerable advances were made in the last decade in understanding the molecular basis of this lipostatic system. Some obese people have high body weight because they have broken lipostats, but these are a rare minority. This suggests that for the majority of obese people, the lipostat is set at an inappropriately high level. When combined with exposure to an environment where there is ready availability of food at low energy costs to obtain it, obesity develops. The evolutionary background to how such a system might have evolved involves the evolution of social behavior, the harnessing of fire, and the development of weapons that effectively freed humans from the risks of predation. The lipostatic model not only explains why some people become obese whereas others do not, but also allows us to understand why energy-controlled diets do not work. Drug-based solutions to the obesity problem that work with the lipostat, rather than against it, are presently under development and will probably be in regular use within 5-10 y. However, several lines of evidence including genetic mapping studies of quantitative trait loci associated with obesity suggest that our present understanding of the regulatory system is still rudimentary. In particular, we know nothing about how the target body weight in the brain is encoded. As our understanding in this field advances, new drug targets are likely to emerge and allow us to treat this crippling disorder.
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Affiliation(s)
- John R Speakman
- Aberdeen Centre for Energy Regulation and Obesity, Division of Energy Balance and Obesity, Rowett Research Institute, Aberdeen AB21 9SB, Scotland.
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Swinburn BA, Caterson I, Seidell JC, James WPT. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004; 7:123-46. [PMID: 14972057 DOI: 10.1079/phn2003585] [Citation(s) in RCA: 589] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To review the evidence on the diet and nutrition causes of obesity and to recommend strategies to reduce obesity prevalence. DESIGN The evidence for potential aetiological factors and strategies to reduce obesity prevalence was reviewed, and recommendations for public health action, population nutrition goals and further research were made. RESULTS Protective factors against obesity were considered to be: regular physical activity (convincing); a high intake of dietary non-starch polysaccharides (NSP)/fibre (convincing); supportive home and school environments for children (probable); and breastfeeding (probable). Risk factors for obesity were considered to be sedentary lifestyles (convincing); a high intake of energy-dense, micronutrient-poor foods (convincing); heavy marketing of energy-dense foods and fast food outlets (probable); sugar-sweetened soft drinks and fruit juices (probable); adverse social and economic conditions-developed countries, especially in women (probable). A broad range of strategies were recommended to reduce obesity prevalence including: influencing the food supply to make healthy choices easier; reducing the marketing of energy dense foods and beverages to children; influencing urban environments and transport systems to promote physical activity; developing community-wide programmes in multiple settings; increased communications about healthy eating and physical activity; and improved health services to promote breastfeeding and manage currently overweight or obese people. CONCLUSIONS The increasing prevalence of obesity is a major health threat in both low- and high income countries. Comprehensive programmes will be needed to turn the epidemic around.
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Affiliation(s)
- B A Swinburn
- Physical Activity and Nutrition Research Unit, School of Health Sciences, Deakin University, Melbourne, Australia.
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Kuriyama S, Tsuji I, Ohkubo T, Anzai Y, Takahashi K, Watanabe Y, Nishino Y, Hisamichi S. Medical care expenditure associated with body mass index in Japan: the Ohsaki Study. Int J Obes (Lond) 2002; 26:1069-74. [PMID: 12119572 DOI: 10.1038/sj.ijo.0802021] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2001] [Revised: 12/17/2001] [Accepted: 02/11/2002] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the impact of body mass index (BMI) upon medical care use and its costs in Japan. DESIGN A population-based prospective cohort study from 1995 to 1998. SUBJECTS A cohort of 41 967 Japanese adults aged 40-79 y. Subjects who died during the first year of follow-up, or who at baseline reported having had cancer, myocardial infarction, stroke or kidney disease were excluded. MEASUREMENTS Medical care use and its costs, actual charges, by linkage with the National Health Insurance claim history files after adjustment of smoking, drinking and physical functioning status. RESULTS There was a U-shaped association between BMI and total medical costs. The nadir of the curve was found at a BMI of 21.0-22.9 kg/m(2). Relative to the nadir, total costs were 9.8% greater among those with BMIs of 25.0-29.9 (rate ratio, 1.10; 95% confidence interval (CI), 1.03-1.17), and 22.3% greater among those with BMIs of 30.0 or higher (rate ratio, 1.22; 95% CI, 1.08-1.37). Estimated excess direct costs attributable to overweight (BMI of 25.0-29.9 kg/m(2)) and obesity (BMI of 30.0 kg/m(2) or higher) represent 3.2% of total health expenditure in the present study, which is within the range reported in Western countries (0.7-6.8%). CONCLUSION Our prospective data demonstrate that the impact of overweight and obesity upon medical care costs in Japan is as large as in Western countries, despite the much lower mean BMI in Japanese populations.
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Affiliation(s)
- S Kuriyama
- Department of Public Health, Tohoku University School of Medicine, Sendai, Japan.
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Agren G, Narbro K, Näslund I, Sjöström L, Peltonen M. Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int J Obes (Lond) 2002; 26:184-92. [PMID: 11850749 DOI: 10.1038/sj.ijo.0801864] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2001] [Revised: 07/16/2001] [Accepted: 07/31/2001] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although intentional weight reduction improves obesity-related comorbidities, the associations between weight reduction, medication and related costs are rarely studied. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects. METHODS In the intervention study Swedish Obese Subjects, 510 surgically and 455 conventionally treated obese patients have so far been followed for 6 y. Changes in the use and costs of medication were analyzed in relation to treatment and weight change. RESULTS In comparison with controls, larger fraction of surgically treated patients discontinued the use of medication for CVD and diabetes at 2 and 6 y (risk ratios 0.56-0.77). Among subjects not initially on medication, surgery reduced the frequency of started treatments (risk ratios 0.08-0.80). Relative weight loss >or=10% was necessary to reduce costs of medication for CVD and diabetes among subjects with such treatment at baseline. To reduce initiation of new treatment against the two conditions, weight loss >or=15% was required. Over 6 y, the average annual cost for diabetes and CVD medication increased by 463 SEK (96%) in subjects with weight loss <5%, and decreased by 39 SEK(8%) in the weight loss group >or=15%. CONCLUSION Long-term intentional weight loss is associated with reduced medication and medication costs for diabetes and CVD. The effects appear to be more marked among subjects who are initially on medication for these conditions, whereas greater weight reduction is needed to prevent new subjects from starting on medication.
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Affiliation(s)
- G Agren
- Department of Surgery, Orebro Medical Centre Hospital, Orebro, Sweden
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van Walraven C, Dent R. The effect of participation in a weight loss programme on short-term health resource utilization. J Eval Clin Pract 2002; 8:37-44. [PMID: 11882100 DOI: 10.1046/j.1365-2753.2002.00320.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervised weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervised weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization.
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Affiliation(s)
- Carl van Walraven
- Department of Medicine, Institute for Clinical Evaluative Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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Abstract
Recent years have seen a dramatic rise in the prevalence of obesity in many countries, stimulating interest in the health and economic consequences of this phenomenon. In this article, we provide a systematic review of the literature on the medical-care cost burden of obesity. Relevant studies were identified using a computerized search of the medical literature for English-language articles published between 1990 and 2001. The 18 studies that met all criteria for inclusion in the review can be classified as modelling or database studies and further distinguished as cross-sectional or longitudinal in nature. The majority of studies that have been conducted are cross-sectional modelling studies, including 10 studies reporting the burden of obesity to national health systems. These suggest that obesity accounts for 5.5-7.0% of national health expenditures in the United States and 2.0-3.5% in other countries for which estimates have been reported. Other studies highlight the burden of obesity from other perspectives, including employers and health plans, as well as the impact of obesity on future disease risks and associated medical-care costs. Despite various methodological limitations, discussed herein, this body of research leads to the inescapable conclusion that obesity exacts an immense economic toll in various countries throughout the world.
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Affiliation(s)
- D Thompson
- Innovus Research Inc., 10 Cabot Road, Suite 102, Medford, Massachusetts 02155, USA.
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50
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Detournay B, Fagnani F, Phillippo M, Pribil C, Charles MA, Sermet C, Basdevant A, Eschwège E. Obesity morbidity and health care costs in France: an analysis of the 1991-1992 Medical Care Household Survey. Int J Obes (Lond) 2000; 24:151-5. [PMID: 10702764 DOI: 10.1038/sj.ijo.0801099] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the direct medical costs associated with obesity in France. DESIGN Analysis of the French 1991-1992 National Household Survey database comprising a representative sample of 14, 670 individuals aged 18 y and over. A subgroup of subjects with a body mass index (BMI)>/=30 kg/m2 was compared with a control group of normal-weight individuals (BMI 18.5-25 kg/m2) matched on age, gender and education level. MEASUREMENTS Self-reported weight and height used to calculate individual body mass index and health expenditures in a 3 month period, and morbidity as declared by respondents to the national household survey and verified on medical records. RESULTS The direct cost attributable to obesity (BMI>/=30 kg/m2) was estimated to be in the range 4.2-8.7 billion French Francs (FF) in 1992 value, that is between 0.7 and 1.5% of total health expenditures. CONCLUSION These results were of the same order of magnitude as similar estimates obtained by a top-down approach for the same year and setting. International Journal of Obesity (2000) 24, 151-155
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Affiliation(s)
- B Detournay
- Cemka, 43 Boulevard Maréchal Joffre, 92340 Bourg-la-Reine, France.
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