Socioeconomic costs of overweight and obesity in Korean adults

Ultra-Processed Food Consumption and Obesity: A Narrative Review of Their Association and Potential Mechanisms

Obesity is a major global health concern, with diet playing a crucial role in its development and treatment. Ultra-processed foods (UPFs) have become prevalent in diets due to changes in the food environment. These foods are energy-dense; high in fat, sugars, or salt; and low in fiber, protein, vitamins, and minerals, raising concerns about their effects on health. In addition to traditional research focused on nutrients, food, and dietary quality, growing evidence has linked UPF consumption to obesity. Therefore, this study provides a comprehensive review of the levels and trends of UPF consumption, current epidemiological evidence on the association between UPF consumption and obesity, and UPFs' potential role in the etiology of obesity and weight gain. Additionally, this study reviews strategies for reducing UPF consumption and outlines future studies of the link between UPF consumption and obesity.

Anthropometric Changes in Female Participants Enrolled in a Combined Aerobic and Resistance Training Program for Longer than 1 Year: A Cohort Study

Background

To analyze the anthropometric changes in women who had participated in a combined resistance and aerobic training program for more than a year and to determine the effect of the exercise on weight loss.

Methods

A total of 9,128 women aged between 20 and 60 years who registered in the Curves program, which employs a combination of resistance and aerobic training exercises, and who participated for more than 1 year were included in our analysis. The women were divided into groups according to exercise frequency: <1, 1, 2, and ≥3 days/week. Weight and waist circumference were measured at the beginning and end of the follow-up period.

Results

The average follow-up duration was 625.3±151.2 days. Waist circumference and body weight decreased more on average in those who participated more frequently in exercise. The achievement of more than 5% weight reduction became more likely with increasing frequency of exercise participation. The odds ratios of more than 5% weight reduction between the exercise groups were 1.47, 1.58, and 2.05 for the 1, 2, and ≥3 days/week exercise groups, respectively.

Conclusion

Women who participated in a combined resistance and aerobic training program for more than a year lost weight in a dose-dependent manner.

Population attributable fractions of modifiable cancer risk factors in Korea: A systematic review

OBJECTIVES

The population attributable fraction (PAF), an epidemiologic measure of exposures and health outcomes, can provide information on the public health impacts of exposures in populations. This study aimed to systematically summarize the PAF estimates of modifiable cancer risk factors in Korea.

METHODS

This review included studies that determined PAFs of modifiable risk factors for cancer in Korea. We performed systematic searches in EMBASE, MEDLINE, Cochrane library, and Korean databases for studies published up to July 2021. Two reviewers independently screened studies for eligibility, extracted data, and performed quality assessments of the included studies. Due to high variability among the data acquisition methods and PAF estimates, we presented the results qualitatively and did not perform quantitative data synthesis.

RESULTS

We reviewed 16 studies that reported the PAFs of risk factors for cancer, including smoking, alcohol consumption, obesity, and various cancer sites. We found considerable variability in the PAF estimates across exposure and cancer pairs. However, PAF estimates for smoking and respiratory cancer were consistently high in men. PAF estimates were higher in men than in women for smoking and alcohol consumption but higher in women for obesity. We found limited evidence for other exposures and cancers.

CONCLUSION

Our findings may be used to prioritize and plan strategies to reduce cancer burden. We encourage further and updated assessments of cancer risk factors, including those not addressed in the studies included in this review, and their potential contributions to cancer burden to better inform strategies for cancer control.

Triglyceride-glucose index is capable of identifying metabolically obese, normal-weight older individuals

BACKGROUND

The concept of metabolically obese, normal weight (MONW) has emerged to describe individuals with a normal body mass index (BMI) who are at a relatively high risk of chronic diseases. However, BMI itself is a suboptimal index for the assessment of the health risks associated with visceral fat. The triglyceride-glucose (TyG) index is considered to be a reliable and cost-effective marker of insulin resistance. Therefore, in the present study, we aimed to determine the TyG index cut-off values that could be used to define MONW in older people and to determine the usefulness of these values for the prediction of chronic diseases.

METHODS

A total of 4,721 participants in the Korea National Health and Nutritional Examination Survey who were ≥ 60 years of age and did not have underweight or obesity were included. MONW was defined using the criteria for metabolic syndrome (MS), and the TyG index was calculated on the basis of the fasting plasma triglyceride and glucose concentrations. Chronic diseases, including T2DM, hypertension, and non-alcoholic fatty liver disease (NAFLD), were diagnosed.

RESULTS

The prevalence of MS increased from the lowest to the highest TyG index tertile. The cut-off values of the TyG index for MONW were calculated as 8.88 and 8.80 for males and females, respectively. MONW, defined using these cut-off values, was associated with high odds ratios for NAFLD, T2DM, and hypertension in both males and females.

CONCLUSIONS

The TyG index cut-off values calculated in the present study can be used to discriminate individuals with MONW from other older individuals without obesity and to predict the risk of chronic diseases. These findings show that the TyG index is an effective and cost-efficient method of assessing the risk of chronic diseases in people with MONW.

Social costs of obesity in the Czech Republic

Increasing prevalence of obesity (BMI > 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1 billion people. Increasing trend in the prevalence of obesity in adults and children generates large social costs. The main aim of this study is to estimate both direct and indirect costs of obesity in the Czech Republic. Social costs of obesity are estimated using the cost-of-illness approach. Direct costs (healthcare utilization costs and costs of pharmacotherapy of 20 comorbidities) are estimated using the top-down approach, while indirect costs (absenteeism, presenteeism and premature mortality) are estimated using the human capital approach. In aggregate, the annual costs attributable to obesity in the Czech Republic in 2018 were 40.8 bn CZK (1.6 bn EUR, 0.8% GDP). Direct costs were 14.5 bn CZK (0.6 bn EUR) and accounted for 3.4% of Czech healthcare expenditures. The highest healthcare utilization costs were attributable to type II diabetes (20.6%), ischemic heart disease (18.8%) and osteoarthritis (16.7%). The largest indirect costs were attributable to premature mortality (10 bn CZK/0.39 bn EUR), absenteeism (9.2 bn CZK/0.36 bn EUR) and presenteeism (7.1 bn CZK/0.27 bn EUR). This article demonstrates that obesity is a serious problem with considerable costs. Several preventive interventions should be applied in order to decrease the prevalence of obesity and achieve cost savings.

A cross-sectional study on the use of big data for the past H1N1 influenza epidemic in obesity after COVID-19: Focused on the body slimming cream and leptin via DTC gene test

BACKGROUND

Based on the big data of 2010, 2011, and 2012, when H1N1 influenza was prevalent around the world in the past, this study investigated the obesity rate, weight change, and dietary methods of Korean dieters based on the historical situation of the past H1N1 influenza epidemic in Republic of Korea. This is intended to be the data for utilizing the prognostic evaluation of coronavirus disease-19 (COVID-19).

OBJECTIVE

After COVID-19, research on obesity should be conducted systematically, and to prevent obesity, nutrition education, customized inner beauty & cosmetics, and the development of body slimming cream and leptin for proper diet should be done at the national level. This study was conducted to investigate the relationship between methods of weight control, generation, and gender, which have not yet been evaluated in the Korean adult population.

METHODS

The cross-sectional study was comprised of 25 534 Korean who participated in the Fifth Korean National Health and Nutrition Examination Survey (KNHNES) conducted in 2010, 2011, and 2012.

RESULTS

A 17 876 of the 19 375 respondents 20 years of age or older in the KNHNES answered about diet method. Two thousand and fifty-seven (15.63%) men and 4134 (25.77%) women thought of themselves as fat. However, 11 973 people (66.96%) did not change weight in the past year, 2536 people (14.19%) had increase in weight, and 3.164 (17.70%) reduced weight. A total of 7176 people (48.11%) indicated that they attempted to reduce weight through exercising, while 5553 people (37.23%) did so through reduced food intake.

CONCLUSIONS

This study was based on big data at the time of the H1N1 influenza epidemic in Korean population. The results of the present study will be helpful in the development of the body slimming cream and leptin via direct to consumer (DTC) gene test (GT) due to the rapid increase in obesity due to COVID-19 pandemic.

Economic burden of cancer attributable to overweight in the Brazilian Unified Health System

BACKGROUND

Alongside the rising prevalence of overweight and obesity in Brazil, there is expected to be increased direct healthcare costs of cancers. Herein, we estimated the economic costs of cancer attributable to overweight in the Brazilian Unified Health System (SUS), according to sex, type of cancer and geographic location (Federative Units).

METHODS

The population attributable fraction (PAF) of fifteen types of cancer were estimated using body mass index (BMI) data of 85,715 adults (≥ 20 years) involved in the 2019 National Health Survey and relative risks of cancers from a meta-analysis. Inpatients and outpatient procedures and costs of cancer treatment were obtained from the SUS systems.

RESULTS

Costs of cancers included in this study were Int$ 1 billion in 2019, of which 9 % or Int$ 95 million were attributable to overweight and obesity. PAFs were higher in men (11 %) than in women (8 %), while the attributable cancer costs were higher in women (Int$ 55 million) than in men (Int$ 40 million). Cancers with the highest PAFs were endometrial cancer (40 %) and esophageal cancer (26 %), whereas cancers with the highest attributable costs were colorectal cancer (Int$ 25 million) and breast cancer (Int$ 24 million).

CONCLUSION

Overweight was responsible for approximately Int$ 95 million (9 %) cancer direct healthcare cost in Brazil. Public policies and programs aimed at encouraging healthy diets and physical activity may decrease the economic burden of cancer in Brazil.

Economic impacts of overweight and obesity: current and future estimates for eight countries

BACKGROUND

Obesity is a growing public health challenge worldwide with significant health and economic impacts. However, much of what is known about the economic impacts of obesity comes from high-income countries and studies are not readily comparable due to methodological differences. Our objective is to demonstrate a method for estimating current and future national economic impacts of obesity and apply it across a sample of heterogeneous contexts globally.

METHODS

We estimated economic impacts of overweight and obesity for eight countries using a cost-of-illness approach. Direct and indirect costs of obesity from 2019 to 2060 were estimated from a societal perspective as well as the effect of two hypothetical scenarios of obesity prevalence projections. Country-specific data were sourced from published studies and global databases.

RESULTS

In per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia. These economic costs are comparable to 1.8% of gross domestic product (GDP) on average across the eight countries, ranging from 0.8% of GDP in India to 2.4% in Saudi Arabia. By 2060, with no significant changes to the status quo, the economic impacts from obesity are projected to grow to 3.6% of GDP on average ranging from 2.4% of GDP in Spain to 4.9% of GDP in Thailand. Reducing obesity prevalence by 5% from projected levels or keeping it at 2019 levels will translate into an average annual reduction of 5.2% and 13.2% in economic costs, respectively, between 2020 and 2060 across the eight countries.

CONCLUSION

Our findings demonstrate that the economic impacts of obesity are substantial across countries, irrespective of economic or geographical context and will increase over time if current trends continue. These findings strongly point to the need for advocacy to increase awareness of the societal impacts of obesity, and for policy actions to address the systemic roots of obesity.

Economic burden of alcohol-related cancers in the Republic of Korea

BACKGROUND

Cancer is a major burden of disease and alcohol consumption is one of the major risk factors of cancer. This study aimed to estimate the economic burden of cancer types attributable to alcohol consumption in the Republic of Korea.

METHODS

This study estimates the direct and indirect costs of cancer types attributable to alcohol consumption by applying cost-of-illness methods using the human capital approach and prevalence-based estimates. Claims data from the National Health Insurance Service for 2011-2016 were used.

RESULTS

In Korea, there were 297,304 alcohol consumption-related cancer cases, of which 14,186 (4.8 %) were attributable to alcohol consumption in 2016. From 2011-2016, the socioeconomic burden of cancer attributable to alcohol consumption in Korea has increased steadily, even considering inflation adjustment. The total economic burden of cancer attributable to alcohol consumption in 2016 in Korea was approximately $476 million, of which $119 million were direct costs and $357 million were indirect costs. According to our analysis of annual cost per patient, the average costs were $37,432 for men and $11,930 for women.

CONCLUSIONS

The economic burden of cancer types attributable to alcohol consumption in Korea is substantial and has increased between 2011 and 2016, mainly due to an increased number of patients.

Health care cost of overweight-related diseases in Bangladesh

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.

Efficacy and safety of Euiiyin-tang in Korean women with obesity: A randomized, double-blind, placebo-controlled, multicenter trial

BACKGROUND

Obesity is a global health problem and its incidence is on the rise. Euiiyin-tang is an herbal medicinal formula that is often used in the clinical treatment of obesity. The purpose of the present study was to evaluate the efficacy and safety of Euiiyin-tang in obesity treatment.

METHODS

A randomized, double-blind, placebo-controlled, multicenter trial was conducted. Participants with obesity were randomly assigned to receive Euiiyin-tang or placebo 3 times daily for 12-weeks. The primary outcome was weight reduction between the baseline and 12 weeks. The secondary outcomes included the rate of weight loss compared to baseline, and changes in body mass index, lipid profiles, and questionnaires related to the quality of life and diet. Safety factors, such as vital signs and laboratory parameters, were also measured.

RESULTS

A total of 149 participants were randomly distributed to either the Euiiyin-tang group (n = 76) or the placebo group (n = 73). Weight reduction in the Euiiyin-tang group was significantly greater than that in the placebo group (2.50 kg in the Euiiyin-tang group vs. 0.82 kg in the placebo group). The participant response rates of ≥3% weight loss compared to baseline was 36.8 % in the Euiiyin-tang group and 17.8 % in the placebo group. Body mass index, waist circumference, and hip circumference showed a greater change in the Euiiyin-tang group than in the placebo group (1.00, 3.23, and 2.00 in the Euiiyin-tang group vs. 0.33, 1.96, and 0.86 in the placebo group). Questionnaires, lipid profiles, and safety factors did not show significant differences between groups.

CONCLUSION

The results of this study suggest that Euiiyin-tang has beneficial effects on weight loss.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01724099.

Impact of overweight or obesity trajectory on health expenditure in Korea

BACKGROUND

This study aimed to identify the effect of the overweight or obesity (OWOB) trajectory on current health care expenditure in South Korea.

METHODS

Ten years of publicly released data (2002-12) were obtained in 2016 from a retrospective cohort of National Health Insurance System claims. This study included 51,844 adults (aged 30-59 years in 2002) and 21,196 elderly adults (aged ≥ 60 years in 2002).

RESULTS

Compared with adults who maintained normal weight (NW), higher yearly total health expenditures were estimated for adults who lost weight over the 10-year period: by 11.5% (95% confidence interval (CI): 0.18-22.96%) when changing from NW to underweight (UW) and 6.2% (95% CI: 0.47-12.01%) from OWOB to UW/NW. Elderly adults had higher health expenditures when they lost weight by 14.0% (95% CI: 0.37-27.70%) from NW to UW and 6.8% (95% CI: 0.13-13.51%) from OWOB to UW/NW compared with when they maintained NW.

CONCLUSIONS

These findings indicate the importance of early intervention to control OWOB, particularly because people in late adulthood have greater health care needs for reasons other than OWOB.

Trends for weight control strategies in Korean adults using the Korea National Health and Nutrition Examination Survey from 2007 to 2017

BACKGROUND

Obesity is an increasing global health problem and is associated with various diseases including stroke, respiratory diseases, diabetes mellitus, and hypertension. Various weight control strategies such as exercise, calorie-restricted diet, anti-obesity medication, herbal medicine, and functional food are being used. The present study aimed to investigate the trends of weight control strategies in Korean adults METHODS: This was a cross-sectional study that used data from the Korea National Health and Nutrition Examination Survey from 2007 to 2017. A total of 64,207 participants were analyzed. The body mass index (BMI), subjective judgment of body appearance, practice of weight control, and methods to control weight were analyzed according to year and sex.

RESULTS

The prevalence rate of obesity in men based on a BMI of 25 or higher was slightly increased from 37.0% in 2007 to 41.1% in 2017. Among the weight control strategies, use of exercise decreased from 83.8% to 80.5% in men, and from 73.4% to 69.5% in women, reduction in the amount of food consumed increased from 47.1% to 60.5% in men and from 65.1% to 70.6% in women, consumption of functional food increased from 3% to 6.2% in men and from 3.2% to 8.7% in women, and rate of skipping meals increased from 6.1% to 12.0% in men and from 11.5% to 14.0% in women.

CONCLUSION

The present study showed that exercise has decreased and dietary control and functional food consumption have increased as weight control strategies in Korean adults during the past decade.

Trends in Obesity Prevalence by Occupation Based on Korean National Health and Nutrition Examination Survey From 1998 to 2015

BACKGROUND

It is well known that the prevalence of obesity in Korea is increasing over time, however it is not known how the trends among occupational groups and sex differ in such increasing trends. This study was designed to provide recent trends of obesity among workers in Korea and to identify whether there were differences among occupational groups.

METHODS

We used data from the Korean National Health and Nutrition Examination Survey, Phases I to VI (1998-2015), to analyze trends in the prevalence of obesity in adult Korean workers. Obesity was defined as a body mass index of 25 kg/m2 or higher. Occupations were classified into 3 groups: (a) nonmanual workers, (b) service/sales workers, and (c) manual workers.

RESULTS

During the period of the Korean National Health and Nutrition Examination Survey Phases I to VI, the prevalence of obesity in male workers increased in all occupations (31.1% to 39.5% in manual workers, 32.3% to 38.2% in service/sales workers, and 25.3% to 39.7% in manual workers). However, female workers did not show any particular tendency toward obesity, except for a significant decrease in the prevalence rate in service/sales workers (30.8% to 23.9%, p for trend = 0.0048).

CONCLUSION

The trends of obesity prevalence by sex and occupation were different. For male manual workers, the prevalence rate increased steadily during the data period, while it decreased steadily in female sales/service workers.

Association between Body Mass Index and Prevalence of Asthma in Korean Adults

We evaluated the association between body mass index (BMI) and the prevalence of asthma. Using data from the 2015 Korean Community Health Survey, 214,971 participants aged between 19 and 106 years were included in this study. Asthma was defined based on the self-report of physician diagnosis. BMI was classified as underweight (<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<23.0 kg/m²), overweight (23.0 kg/m²≤ BMI<27.4 kg/m²), and obese (≥27.5 kg/m²) based on the BMI categories for Asians by the World Health Organization. Multiple logistic regression analysis was performed with sampling weights to evaluate the association between BMI and asthma after adjusting for age, educational level, income, type of residential area, smoking status, alcohol consumption, physical activity, hypertension, and diabetes. In men, BMI had an inverted J-shaped association with the prevalence of asthma, with an odds ratio of 1.88 (95% confidence interval [CI]: 1.89-2.24) for underweight and 1.12 (95% CIs: 0.97-1.29) for obesity. In women, BMI had a J-shaped association with the prevalence of asthma, with an odds ratio of 1.05 (95% CIs: 0.91-1.22) for underweight and 2.29 (95% CIs: 2.06-2.56) for obesity. In conclusion, in a nationally representative sample of Korean adults, the association between BMI and the prevalence of asthma varied between the sexes. This suggests that malnutrition and obesity are involved in the pathophysiology of asthma.

A pilot study exploring the efficacy and safety of herbal medicine on Korean obese women with metabolic syndrome risk factors: Double blinded, randomized, multicenter, placebo controlled study protocol clinical trial

BACKGROUND

Obesity is associated with metabolic syndrome, a condition that increases one's risk for heart disease and other conditions. The prevalence of obesity and associated diseases have steadily increased among Korean adults. The effect of the herbal medicines Daesiho-tang (DSHT) and Chowiseungcheng-tang (CST) on obesity have been reported. The purpose of this study is to evaluate the efficacy and safety of Daesiho-tang and Chowiseungcheng-tang on obese Korean women with high risk for metabolic syndrome.

METHODS/DESIGN

This study is a randomized, double-blinded, placebo-controlled, multi-center, 3-arm, parallel group clinical trial. A total of 120 participants will be enrolled and randomly assigned to the Daesiho-tang group, the Chowiseungcheng-tang group, or the placebo group in a 1:1:1 ratio using an internet-based randomization system at visit 2. Each group will be administered DSHT, CST, or placebo 3 times per day for 12 weeks. The primary outcome is to evaluate the changes in mean body weight of participants in the DSHT and CST groups and compare with those in the placebo group, and determine their statistical significance, if any, after 12 weeks. The secondary outcomes are the following: changes in body fat percentage and body fat mass, changes in waist circumference, waist-to-hip ratio, and body mass index, changes in serum lipids, fasting blood sugar, blood pressure, and C-reactive proteins (CRP) levels between visit 1 and visit 5 measurements. Changes in visceral fat volume determined through abdominal computed tomography, patient-reported health outcomes surveys-the Korean version of the Obesity-related Quality of Life and the Korean version of Eating Attitudes Test.

DISCUSSION

This study will provide research methodologies for evaluating the efficacy and safety of Daesiho-tang and Chowiseungcheng-tang on obese Korean women with high risk for metabolic syndrome.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02651454. Registered on 11 January 2016.Protocol version: The final approved version of the trial protocol is V1.3.(2017.11.10).

Age moderates the effect of socioeconomic status on physical activity level among south Korean adults: cross-sectional analysis of nationally representative sample

BACKGROUND

In a nationally representative sample of South Korean adults, we investigated the association between socioeconomic status (SES) and physical activity level, and whether this association varied by age group.

METHODS

We used data from 5065 subjects aged ≥19 years who participated in the 6th Korea National Health and Nutrition Examination Survey. Weighted logistic regression examined the SES-physical activity association. Using the International Physical Activity Questionnaire short form, physical activity level was categorized into two groups: meeting the guideline (≥150 min/week of moderate intensity physical activity) and not meeting the guideline. Annual household income quartile (first quartile = highest income) and education (elementary, middle school, high school, and college graduates) were used as SES indicators. Sociodemographic covariates included in the adjusted models were marital status, town type (rural/urban), dwelling type, perceived health, federal allowance support (yes/no), and working- and sleeping-hours.

RESULTS

In unadjusted models, low income and low education were both associated with significantly lower odds of meeting the physical activity guideline. The income-physical activity association was moderated by age group in both unadjusted and adjusted models. Specifically, among those age < 45 years, those in the third quartile group had 41% higher odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. In contrast, among those age ≥ 45 years, those in the third quartile group had 16% lower odds (p < 0.01) of meeting the physical activity guideline compared with the first quartile group, after adjusting for covariates. Furthermore, the education-physical activity association was moderated by age but only in the adjusted model. Specifically, among those age < 45 years, high school graduates had a 21% higher odds of meeting the physical activity guideline compared with college graduates (p = 0.08). In contrast, among those age ≥ 45 years, high school graduates had a 23% lower odds of meeting the physical activity guideline compared with college graduates (p = 0.01).

CONCLUSION

Future policies that aim to address SES-related health disparities in physical activity among adults in South Korea should consider the different patterns of physical activity in accordance with SES and age.

Influence of Neighborhood Environment on Korean Adult Obesity Using a Bayesian Spatial Multilevel Model

Previous studies using spatial statistical modeling that account for spatial associations between geographic areas are scarce. Therefore, this study examines the association between neighborhood environment and obesity using a Bayesian spatial multilevel model. Data from 78,014 adults living in Gyeonggi province in Korea were drawn from the 2013–2014 Korean Community Health Survey. Korean government databases and ArcGIS software (version 10.1, ESRI, Redlands, CA) were used to measure the neighborhood environment for 546 administrative districts of Gyeonggi province. A Bayesian spatial multilevel model was implemented across gender and age groups. The findings indicate that women aged 19–39 years who lived in neighborhoods farthest away from parks were more likely to be obese. Men aged 40–59 years who lived in neighborhoods farther from public physical activity facilities and with lower population density were more likely to be obese. Obesity for women aged 19–39 years was the most spatially dependent, while obesity for women aged 40–59 years was the least spatially dependent. The results suggest that neighborhood environments that provide more opportunities for physical activity are negatively related to obesity. Therefore, the creation of physical activity in favorable neighborhood environments, considering gender and age, may be a valuable strategy to reduce obesity.

Development and Usability of a Life-Logging Behavior Monitoring Application for Obese Patients

Background

Obesity is a global epidemic. Behavior change monitoring using a smartphone application (app) can support weight management in obese patients. These apps must undergo usability testing, which is an important step in mobile healthcare app development. The current study aimed to develop a mobile app for behavioral monitoring and to test its usability including technical effectiveness, user efficiency, and user satisfaction for obese adults.

Methods

Development of the Dr. Youth app components included information on behavioral monitoring indicators and their obesity subtypes. The usability of the app was tested with 50 obese adults in a university hospital. Participants were asked to complete eight tasks for evaluating the technical effectiveness of the app. The time to complete each task was measured to test user efficiency. To explore user satisfaction, each participant completed the System Usability Scale (SUS). Descriptive statistics were used to examine the mean user efficiency and SUS scores.

Results

Fifty adults (14 men and 36 women, aged 20–59 years) who are obese (body mass index ≥25 kg/m²) were recruited. The mean age of participants was 42.6 years (standard deviation [SD], 10.8 years); their mean body mass index was 29.6 kg/m² (SD, 5.7 kg/m²). The tasks were completed with a 99% success rate. The overall mean SUS score was 76.65 (SD, 15.43).

Conclusion

The Dr. Youth app shows acceptable technical effectiveness, user efficiency, and user satisfaction. Future study is warranted to establish the app’s clinical efficacy.

Measuring Socioeconomic Inequalities in Obesity among Korean Adults, 1998⁻2015

Obesity is a prominent global public health challenge as its prevalence has grown. Even though the increase in prevalence of obesity in Korea has been relatively low, it is expected to continually increase in the next several years, leading to social and economic burdens. This study aimed to assess socioeconomic inequalities in obesity among Korean adults. Using nationally representative survey datasets, the concentration index (CI) and decomposition of the CI were used to capture and quantify obesity-related inequalities from 1998 to 2015. The results suggested that pro-poor inequalities in obesity existed in Korea, indicating that obesity was more concentrated among individuals with lower income. In a gender-stratified model, obesity was more concentrated among women with lower income and men with higher income, showing that the trend and magnitude of inequalities in obesity each vary by gender. The decomposition approach revealed that, over the past 17 years, the main contributors to the existing inequalities were higher education and higher income levels. These findings suggest that comprehensive and multifaceted interventions at the local and national levels should be considered to address the identified income- and education-related barriers with respect to obesity among Korean adults.

2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m2. Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m2 and for Korean patients with BMI ≥30 kg/m2 who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

An update on physical health and economic consequences of overweight and obesity

Overweight and obesity (OW and OB) have been on the increase globally and posed health risks to the world's population of all ages, including pre-born babies, children, adolescents, adults and elderly people, via their comorbid conditions. Excellent examples of comorbidities associated with obesity include cancer, cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM). In this article, we aimed to review and update scientific evidence regarding the relationships between obesity and its common physical health consequences, including CVD, T2DM, hypertension, ischemic stroke, cancer, dyslipidemia and reproductive disorders. In addition, the economic burden of OW and OB will be discussed. Abundant evidence is found to support the associations between obesity and other diseases. In general, the odd ratios, risk ratios or hazard ratios are often higher in OW and OB people than in the normal-weight ones. However, the molecular mechanism of how OW and OB induce the development of other diseases has not been fully understood. Figures also showed that obesity and its-related disorders exert enormous pressure on the economy which is projected to increase. This review highlights the fact that obesity can lead to numerous lethal health problems; therefore, it requires a lot of economic resources to fight against this epidemic.

Health-related costs in a sample of premenopausal non-diabetic overweight or obese females in Antwerp region: a cost-of-illness analysis

Background

People with overweight or obesity are at increased risk for disease later in life which cause important health costs.

The aim of this study was to estimate the health status and the corresponding costs in a sample of females with overweight or obesity which were participating in a Randomized Controlled Trial (RCT) exploring the effect of lifestyle habits changes on ectopic adipose tissue.

Methods

Sixty-two non-diabetic premenopausal females without major comorbidities of overweight and obesity were recruited among patients visiting endocrinologists at the obesity clinic of the University Hospital of Antwerp and the University of Antwerp.

A RCT-embedded cost-of-illness approach with societal perspective, based on self-reported questionnaires and cost diaries (3 months recall) was applied to estimate the prevalence of different comorbidities and the related direct and indirect costs in this sample of overweight or obese females. The European Quality-of-Life-5D questionnaire was used to define the health state and the corresponding utility index of the participants.

Results

The average direct health costs and health utilities observed in this sample were comparable with the general Flemish female population. This may partially be explained by the strict inclusion criteria of the RCT (i.e. overweight or obesity without diabetes type 2 or cardiovascular diseases). However, 15% of the participants had five or more comorbidities resulting in higher average costs and lower average health utility as compared to the general population, only 3 participants were diagnozed with the metabolic syndrome. In this subsample productivity was low due to high average absenteeism, yielding important total costs for the society.

Conclusion

Secondary prevention to avoid health deterioration in overweight or obese females without major comorbidies is needed to contain health care costs.

Trial registration

ClinicalTrials.gov: NCT02831621, approval of the ethics committee of the University Hospital of Antwerp (number: 14/17/205 -ref: 7543075363).

Prediction of future weight change with the dopamine transporter

The brain plays a critical role in controlling and inhibiting pre-potent responses to foods. We investigated the predictive value of dopamine transporter (DAT) availability in the striatum of healthy subjects using ¹²³I-FP-CIT single-photon emission computed tomography (SPECT). In total, 84 participants with available data on their weight for the 60 months after SPECT were included. Specific binding of ¹²³I-FP-CIT to DAT was calculated using region-of-interest analysis, and the putamen-to-caudate nucleus ratio (PCR) was determined. After comparing the weights at 12, 24, 36, 48, and 60 months after SPECT with the baseline weight, we categorized participants into three groups: weight gain (> 5%), stable (-5%-5%), and weight loss (< -5%). PCRs of the weight-loss, stable, and weight-gain groups significantly differed at 36 and 48 months. According to post-hoc analysis, PCRs were lower in the weight gain group at 36 and 48 months compared with at the remaining time points. Overall, our results suggest that PCRs calculated based on DAT availability could be used to predict future weight changes. It is possible that the interactions between the caudate nucleus and the putamen, rather than the individual behavior of each structure, might play an important role in weight regulation. Further studies are needed to investigate the time-dependence of the predictive value of DAT.

The Risk of Microalbuminuria by Obesity Phenotypes according to Metabolic Health and Obesity: The Korean National Health and Nutrition Examination Survey 2011-2014

BACKGROUND

The present study aimed at identifying the difference in the risk of microalbuminuria among individuals with various obesity phenotypes in terms of metabolic health and obesity.

METHODS

This cross-sectional study included 15,268 individuals and used data from the National Health and Nutrition Survey conducted from 2011 to 2014. Obesity was defined as body mass index ≥25 kg/m². Metabolically unhealthy was defined as meeting two or more of the following criteria: systolic and diastolic blood pressure ≥130/85 mm Hg or current use of hypertensive drugs; triglyceride level ≥150 mg/dL; high-density lipoprotein level <40/50 mg/dL (in both men and women); and fasting blood glucose level ≥100 mg/dL or current use of oral antidiabetic medications. The participants were further classified into four subgroups: metabolically healthy non-obese (MHNO), metabolically healthy obese (MHO), metabolically unhealthy non-obese (MUNO), and metabolically unhealthy obese (MUO).

RESULTS

A significant difference was observed in the microalbuminuria ratio among the four groups. The MHNO group was considered as the reference group, and the MHO, MUNO, and MUO groups were at an increased risk for microalbuminuria by 1.42 fold (95% confidence interval [95% CI], 1.03-1.96), 2.02 fold (95% CI, 1.61-2.53), and 3.40 fold (95% CI, 2.70-4.26), respectively, after adjusting confounding factors.

CONCLUSION

The MUNO group had a higher risk of developing microalbuminuria than the MHNO group. Thus, based on this result, differences were observed in the risk of developing microalbuminuria among individuals with various obesity subtypes.

Productivity loss due to overweight and obesity: a systematic review of indirect costs

OBJECTIVE

The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity.

METHODS

A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality.

RESULTS

Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies.

CONCLUSION

The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.

Development and Evaluation of an Obesity Ontology for Social Big Data Analysis

Objectives

The aim of this study was to develop and evaluate an obesity ontology as a framework for collecting and analyzing unstructured obesity-related social media posts.

Methods

The obesity ontology was developed according to the ‘Ontology Development 101’. The coverage rate of the developed ontology was examined by mapping concepts and terms of the ontology with concepts and terms extracted from obesity-related Twitter postings. The structure and representative ability of the ontology was evaluated by nurse experts. We applied the ontology to the density analysis of keywords related to obesity types and management strategies and to the sentiment analysis of obesity and diet using social big data.

Results

The developed obesity ontology was represented by 8 superclasses and 124 subordinate classes. The superclasses comprised ‘risk factors,’ ‘types,’ ‘symptoms,’ ‘complications,’ ‘assessment,’ ‘diagnosis,’ ‘management strategies,’ and ‘settings.’ The coverage rate of the ontology was 100% for the concepts and 87.8% for the terms. The evaluation scores for representative ability were higher than 4.0 out of 5.0 for all of the evaluation items. The density analysis of keywords revealed that the top-two posted types of obesity were abdomen and thigh, and the top-three posted management strategies were diet, exercise, and dietary supplements or drug therapy. Positive expressions of obesity-related postings has increased annually in the sentiment analysis.

Conclusions

It was found that the developed obesity ontology was useful to identify the most frequently used terms on obesity and opinions and emotions toward obesity posted by the geneal population on social media.

Effect of a herbal extract powder (YY-312) from Imperata cylindrica Beauvois, Citrus unshiu Markovich, and Evodia officinalis Dode on body fat mass in overweight adults: a 12-week, randomized, double-blind, placebo-controlled, parallel-group clinical trial

BACKGROUND

YY-312 is a herbal extract powder from Imperata cylindrica Beauvois, Citrus unshiu Markovich, and Evodia officinalis Dode, which have health promoting effects, including body fat reduction. We aimed to evaluate the efficacy and safety of YY-312 for body fat reduction in overweight adults.

METHODS

This was a 12-week, randomized, double-blind, placebo-controlled, parallel-group clinical trial performed in overweight Korean adults aged 19-60 years with a body mass index of 25.0-29.9 kg/m². The daily dose of YY-312 was 2400 mg (containing 1800 mg of active herbal extract and 600 mg of cyclodextrin). Primary outcomes were reductions in body fat mass (BFM) and body fat percentage (BF%) after 12 weeks. Secondary outcomes included reductions in body weight and waist circumference (WC) after 12 weeks.

RESULTS

After 12 weeks, BFM (1.6 kg vs. 0.1 kg; P = 0.023) and BF% (1.5% vs. -0.2%; P = 0.018) decreased significantly more in the YY-312 group than in the placebo group, as did body weight (2.7 kg vs. 1.0 kg; P = 0.014) and WC (2.2 cm vs. 0.8 cm; P = 0.049). All safety parameters were within normal limits; no serious adverse events occurred in either group.

CONCLUSIONS

In a 12-week clinical trial in overweight adults, YY-312 resulted in significantly greater reduction in body fat vs. placebo, while being safe and well tolerated.

TRIAL REGISTRATION

cris.nih.go.kr: ( KCT0001225 ).

Estimated Costs of Clinical and Surgical Treatment of Severe Obesity in the Brazilian Public Health System

BACKGROUND

Obesity is a major global epidemic and a burden to society and health systems. This study aimed to estimate and compare the anual costs of clinical and surgical treatment of severe obesity from the perspective of the Brazilian Public Health System.

METHODS

An observational and cross-sectional study was performed in three reference centers. Data collection on health resources utilization and productivity loss was carried out through an online questionnaire. Participants were divided in clinical (waiting list for a bariatric surgery) and surgical groups (open Roux-en-Y gastric bypass), and then allocated by the time of surgery (up to 1 year; 1-2 years; 2-3 years; and >3 years). Costs of visits, medications, exams, and surgeries were obtained from government sources. Data on non-medical costs, such as transportation, special diets, and caregivers, were also colleted. Productivity loss was estimated using self-reported income. Costs in local currency (Real) were converted to international dollars (Int$ 2015).

RESULTS

Two hundred and seventy-four patients, 140 in surgical group and 134 in clinical group were included. In first postoperative year, the surgical group had higher costs than clinical group (Int$6005.47 [5000.18-8262.36] versus 2148.14 [1412.2-3506.8]; p = 0.0002); however, from the second year, the costs decreased progressively. In the same way, indirect costs decreased significantly after surgery (259.08 [163.63-662.72] versus 368.17 [163.62-687.27]; p = 0.06).

CONCLUSION

Total costs were higher in the surgical group in the first 2 years after surgery. However, from the third year on, the costs were lower than in the clinical group.

Euiiyin-tang in the treatment of obesity: study protocol for a randomised controlled trial

Background

Obesity is a public health concern in many countries due to its increasing prevalence. Euiiyin-tang is an herbal medicine formula often used as a clinical treatment for obesity. It acts to eliminate humidity and purify the blood, the causes of obesity identified by the theoretical framework of Korean medicine. The purpose of this study is to evaluate the efficacy and safety of Euiiyin-tang in treating obesity.

Methods/design

This study is a randomised, double-blinded and placebo-controlled, multicentre trial. It has two parallel arms: the Euiiyin-tang group and the placebo group. A total of 160 obese adult women will be enrolled in the trial. The participants will be randomly divided at a 1:1 ratio at visit 2 (baseline). The participants will be administered Euiiyin-tang or placebo for 12 weeks. The primary endpoint is the change in weight occurring between baseline and post-treatment. The secondary outcomes include average weight reduction, changes in body fat, waist and hip circumferences, body mass index, and lipid profile, and the results of questionnaires such as the Korean version of Obesity-related Quality of Life, the Korean version of Eating Attitudes Test, the Social Readjustment Rating Scale, and the Stress Reaction Inventory.

Discussion

The present study will provide research methodologies for evaluating the efficacy and safety of Euiiyin-tang in patients with obesity. In addition, it will provide evidence of correlation between obesity and Sasang constitutional medicine.

Trial registration

ClinicalTrials.gov, NCT01724099. Registered on 2 November 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2039-8) contains supplementary material, which is available to authorized users.

Trends in socioeconomic costs of morbid obesity among Korean adults, 2009-2013: Data from National Health Insurance Service

As the prevalence of morbid obesity increased in Korea, the estimation of the accurate socioeconomic costs by morbid obesity was required; we analysed national medical costs through the big data. From 2009 year to 2013 year, Direct Costs (DC) for medical costs, transit costs and nursing costs and Indirect Costs (IC) for Future Income Loss (FIL) and Productivity Loss (PL) of morbid obesity (BMI≥30) were calculated, and socioeconomic costs were estimated by applying Population Attributable Risk (PAR) proportion according to obesity related diseases. From 10 year follow up research, Relative risk (RR) for morbid obesity related disease was analysed in comparison with control group. The high RR disease were congestive heart failure (RR 3.204 CI 2.421-3.987), hypertension (RR 3.13 CI 3.058-3.202), type 2 DM (RR 3.112 CI 2.973-3.251), pulmonary embolism (RR 2.969 CI 1.812-4.126), dyslipidemia (RR 2.283 CI 2.221-2.345) and ischaemic heart disease (RR 2.187 CI 2.068-2.306) in order. The socioeconomic costs by morbid obesity tended to increase 1.47 times from 2009 year (492 billion KRW) to 2013 year (726.2 billion KRW). The growth of the prevalence and the socioeconomic costs by morbid obesity in Korea are required not only the personal care issue but also social and national strategies for the future morbid obesity control.

Economic Burden of Obesity: A Systematic Literature Review

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

Mortality, hospital days and treatment costs of current and reduced sugar consumption in Israel

BACKGROUND

Consumption of sugar causes tooth decay, overweight and obesity related morbidities. This paper in response to the Minister of Health's request, provides estimates of the mortality, morbidity and health care costs attributable to sugar consumption in Israel along with the effects of reducing sugar consumption.

METHODS

Gender specific relative risks of many diseases from overweight (25 < =BMI < 30) and obesity (BMI > =30) were applied to the national gender specific prevalence rates of overweight and obesity in order to calculate the population attributable fraction (PAF) from overweight and obesity. National expenditure on these related diseases was calculated by applying disease-specific data from a recent Canadian study to estimates of disease specific general hospital expenditures in Israel. Disease specific costs attributable to overweight and obesity were estimated from the product of these expenditures and PAF. In addition national costs of treating caries in persons under 18 years of age from sugar were calculated. Similar calculations were made to estimate the burden from sugar in terms of mortality and hospital utilisation. A recent UK modelling study was used to estimate the effect of a national program to reduce calorific consumption of sugar from 12.45 to 10% in 5 years.

RESULTS

Conditions associated with overweight or obesity accounted annually for 6402 deaths (95% CI 3296-8760) and 268,009 hospital days. Dental costs attributable to sugar consumption were 264 million NIS. In total, obesity, overweight and sugar consumption accounted for 2449 million in direct treatment costs (0.21% of GDP), rising to 4027 million (0.35% of GDP) when indirect costs were included. A national program of reducing energy from sugar consumption from 12.45 to 10% over 5 years is considered have a very feasible short-term goal. Even if the program does not impose taxes on sugar consumption, this would save 778 million NIS as well as 1184 lives.

CONCLUSION

Sugar consumption causes a huge monetary and mortality burden. Estimates of potential decreases in this burden justify the current prioritisation given by the health minister of creating and implementing a national program to reduce sugar consumption, which is likely to be cost-saving (ie: averted treatment costs will exceed intervention costs).

Incremental impact of body mass status with modifiable unhealthy lifestyle behaviors on pharmaceutical expenditure

BACKGROUND

Overweight/obesity is a growing health risk in Korea. The impact of overweight/obesity on pharmaceutical expenditure can be larger if individuals have multiple risk factors and multiple comorbidities. The current study estimated the combined effects of overweight/obesity and other unhealthy behaviors on pharmaceutical expenditure.

METHODS

An instrumental variable quantile regression model was estimated using Korea Health Panel Study data. The current study extracted data from 3 waves (2009, 2010, and 2011).

RESULTS

The final sample included 7148 person-year observations for adults aged 20 years or older. Overweight/obese individuals had higher pharmaceutical expenditure than their non-obese counterparts only at the upper quantiles of the conditional distribution of pharmaceutical expenditure (by 119% at the 90th quantile and 115% at the 95th). The current study found a stronger association at the upper quantiles among men (152%, 144%, and 150% at the 75th, 90th, and 95th quantiles, respectively) than among women (152%, 150%, and 148% at the 75th, 90th, and 95th quantiles, respectively). The association at the upper quantiles was stronger when combined with moderate to heavy drinking and no regular physical check-up, particularly among males.

CONCLUSION

The current study confirms that the association of overweight/obesity with modifiable unhealthy behaviors on pharmaceutical expenditure is larger than with overweight/obesity alone. Assessing the effect of overweight/obesity with lifestyle risk factors can help target groups for public health intervention programs.

Medication Adherence and the Occurrence of Complications in Patients with Newly Diagnosed Hypertension

BACKGROUND AND OBJECTIVES

In this retrospective cohort study, we sought to elucidate the relationship between medication adherence (MA) and the incidence of complications in patients with newly diagnosed hypertension.

SUBJECTS AND METHODS

Using claims data from the National Health Insurance Service, we measured health outcomes based on levels of MA, analyzed the incidence of complications in patients with a good MA, and clarified factors that may affect or predict MA.

RESULTS

In 2008, a total of 4294773 patients were diagnosed with hypertension and were subsequently prescribed anti-hypertensive medications. In the present study, we enrolled 564782 patients who met our inclusion/exclusion criteria. The 40-59% medication possession ratio (MPR) group had a 1.36 times higher risk of developing complications (95% confidence interval [CI]: 1.27-1.45) than did the MPR≥ 80% group, as revealed through Cox's proportional hazards analysis. Similarly, the <20% MPR group was 2.01 times more likely to develop complications than the good MA group (95% CI: 1.82-2.23). Overall, patients who had a lower level of MA had a higher risk of developing complications.

CONCLUSION

Our results demonstrate that MA is tightly correlated with hypertension health outcomes. Improving MA could be one strategy for reducing the risk of cerebrovascular disease complications and the loss of productivity in these patients.

Economic burden of underweight and overweight among adults in the Asia-Pacific region: a systematic review

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.

Health care costs attributable to overweight calculated in a standardized way for three European countries

This article presents a tool to calculate health care costs attributable to overweight in a comparable and standardized way. The purpose is to describe the methodological principles of the tool and to put it into use by calculating and comparing the costs attributable to overweight for The Netherlands, Germany and Czech Republic. The tool uses a top-down and prevalence-based approach, consisting of five steps. Step one identifies overweight-related diseases and age- and gender-specific relative risks. Included diseases are ischemic heart disease, stroke, hypertension, type 2 diabetes mellitus, colorectal cancer, postmenopausal breast cancer, endometrial cancer, kidney cancer and osteoarthritis. Step two consists of collecting data on the age- and gender-specific prevalence of these diseases. Step three uses the population-attributable prevalence to determine the part of the prevalence of these diseases that is attributable to overweight. Step four calculates the health care costs associated with these diseases. Step five calculates the costs of these diseases that are attributable to overweight. Overweight is responsible for 20-26% of the direct costs of included diseases, with sensitivity analyses varying this percentage between 15-31%. Percentage of costs attributable to obesity and preobesity is about the same. Diseases with the highest percentage of costs due to overweight are diabetes, endometrial cancer and osteoarthritis. Disease costs attributable to overweight as a percentage of total health care expenditures range from 2 to 4%. Data are consistent for all three countries, resulting in roughly a quarter of costs of included diseases being attributable to overweight.

A review of accessibility of administrative healthcare databases in the Asia-Pacific region

OBJECTIVE

We describe and compare the availability and accessibility of administrative healthcare databases (AHDB) in several Asia-Pacific countries: Australia, Japan, South Korea, Taiwan, Singapore, China, Thailand, and Malaysia.

METHODS

The study included hospital records, reimbursement databases, prescription databases, and data linkages. Databases were first identified through PubMed, Google Scholar, and the ISPOR database register. Database custodians were contacted. Six criteria were used to assess the databases and provided the basis for a tool to categorise databases into seven levels ranging from least accessible (Level 1) to most accessible (Level 7). We also categorised overall data accessibility for each country as high, medium, or low based on accessibility of databases as well as the number of academic articles published using the databases.

RESULTS

Fifty-four administrative databases were identified. Only a limited number of databases allowed access to raw data and were at Level 7 [Medical Data Vision EBM Provider, Japan Medical Data Centre (JMDC) Claims database and Nihon-Chouzai Pharmacy Claims database in Japan, and Medicare, Pharmaceutical Benefits Scheme (PBS), Centre for Health Record Linkage (CHeReL), HealthLinQ, Victorian Data Linkages (VDL), SA-NT DataLink in Australia]. At Levels 3-6 were several databases from Japan [Hamamatsu Medical University Database, Medi-Trend, Nihon University School of Medicine Clinical Data Warehouse (NUSM)], Australia [Western Australia Data Linkage (WADL)], Taiwan [National Health Insurance Research Database (NHIRD)], South Korea [Health Insurance Review and Assessment Service (HIRA)], and Malaysia [United Nations University (UNU)-Casemix]. Countries were categorised as having a high level of data accessibility (Australia, Taiwan, and Japan), medium level of accessibility (South Korea), or a low level of accessibility (Thailand, China, Malaysia, and Singapore). In some countries, data may be available but accessibility was restricted based on requirements by data custodians.

CONCLUSIONS

Compared with previous research, this study describes the landscape of databases in the selected countries with more granularity using an assessment tool developed for this purpose. A high number of databases were identified but most had restricted access, preventing their potential use to support research. We hope that this study helps to improve the understanding of the AHDB landscape, increase data sharing and database research in Asia-Pacific countries.

The Economic Burden of Cancers Attributable to Metabolic Syndrome in Korea

OBJECTIVES

Metabolic syndrome is an important etiologic factor in the development of certain types of cancers. The economic cost of the treatment of cancer has been steadily increasing. We therefore estimated the economic burden of cancers attributable to metabolic syndrome in Korea.

METHODS

We reviewed metabolic syndrome-related cancers and relative risk and then calculated population attributable fractions. We analyzed insurance claims data for metabolic syndrome-related cancers in 2012 in order to estimate the direct costs associated with these cancers, including hospitalization, outpatient visits, transportation costs, and caregivers' costs as well as indirect costs such as loss of productivity due to cancer treatment and premature death.

RESULTS

In 2012, 18,070 patients in Korea had cancers attributable to metabolic syndrome. The economic burden was USD 199.8 million and the direct and indirect costs were USD 124.5 million and USD 75.3 million, respectively.

CONCLUSIONS

We estimated the economic burden of cancers attributable to metabolic syndrome in Korea and the efforts are necessary to reduce this burden.

Economic impact of adult obesity on health systems: a systematic review

BACKGROUND

Obesity represents an important public health issue. An assessment of its costs would be useful to provide recommendations for policy and decision-making strategies. The aims of our study were to carry out a systematic review to assess the economic burden of adult obesity in terms of direct and indirect costs and to perform a quality appraisal of the analysed studies.

METHODS

A literature search was carried out on PubMed, Scopus and Cochrane Library to retrieve cost-of-illness (COI) analyses focused on adult (aged 18 years or more) overweight or obese people and published up to 2013. COI analyses that considered direct and indirect costs were included. Each included manuscript was independently appraised by three groups of researchers on the basis of the British Medical Journal Drummond's checklist.

RESULTS

Approximately 2044 articles were initially retrieved, and 17 were included in the current review. The included studies showed a medium-high-quality level. The available studies seemed to be heterogeneous both in terms of methodology and results reporting. However, as many studies have been conducted from the payer perspective, just direct medical costs can be considered exhaustive. As only three studies included considered also indirect costs, there is no strong evidence to give a comprehensive picture of this phenomenon also from the societal perspective.

CONCLUSION

The review confirmed that obesity absorbs a huge amount of health-care resources. Further research is therefore needed to better understand the economic impact and to identify and promote public health strategies to tackle obesity.

Economic costs of obesity in Thailand: a retrospective cost-of-illness study

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.

Patient time costs attributable to healthcare use in diabetes: results from the population-based KORA survey in Germany

AIMS

Patient time costs have been described to be substantial; however, data are highly limited. We estimated patient time costs attributable to outpatient and inpatient care in study participants with diagnosed diabetes, previously undetected diabetes, impaired glucose regulation and normal glucose tolerance.

METHODS

Using data of the population-based KORA S4 study (55-74 years, random sample of n = 350), we identified participants' stage of glucose tolerance by oral glucose tolerance test. To estimate mean patient time costs per year (crude and standardized with respect to age and sex), we used data regarding time spent with ambulatory visits including travel and waiting time and with hospital stays (time valued at a 2011 net wage rate of €20.63/h). The observation period was 24 weeks and data were extrapolated to 1 year.

RESULTS

Eighty-nine to 97% of participants in the four groups (diagnosed diabetes, undetected diabetes, impaired glucose regulation and normal glucose tolerance.) had at least one physician contact and 4-14% at least one hospital admission during the observation period. Patient time [h/year (95% CI)] was 102.0 (33.7-254.8), 53.8 (15.0-236.7), 59.3 (25.1-146.8) and 28.6 (21.1-43.7), respectively. Age-sex standardized patient time costs per year (95% CI) were €2447.1 (804.5-6143.6), €880.4 (259.1-3606.7), €1151.6 (454.6-2957.6) and €589.2 (435.8-904.8).

CONCLUSIONS

Patient time costs were substantial--even higher than medication costs in the same study population. They are higher in participants with diagnosed diabetes, but also in those with undetected diabetes and impaired glucose regulation compared with those with normal glucose tolerance. Research is needed in larger populations to receive more precise and certain estimates that can be used in health economic evaluation.

The costs of overweight and obesity-related diseases in the Brazilian public health system: cross-sectional study

BACKGROUND

Obesity is a major global epidemic and a burden to society and health systems. It is well known risk factor for a number of chronic medical conditions with high morbidity and mortality. This study aimed to provide an estimate of the direct costs associated to outpatient and inpatient care of overweight and obesity related diseases in the perspective of the Brazilian Health System (SUS).

METHODS

Population attributable risk (PAR) was calculated for selected diseases related to overweight and obesity and with the following parameters: Relative risk (RR) ≥ 1.20 or RR ≥ 1.10 and < 1.20, but important problem of public health due its high prevalence. After a broad search in the literature, two meta-analysis were selected to provide RR for PAR calculation. The prevalence rates of overweight and obesity in Brazilians with ≥ 18 years were obtained from large national survey. The national health database (DATASUS) was used to estimate the annual cost of the Brazilian Unified Health System (SUS) with the diseases included in the analysis. The extracted values were stratified by sex, type of service (inpatient or outpatient care) and year. Data were collected from 2008 to 2010 and the results reflect the average of 3 years. Brazilian costs were converted into US dollars during the analysis using a purchasing power parity basis (2010).

RESULTS

The estimated total costs in one year with all diseases related to overweight and obesity are US$ 2,1 billion; US$ 1,4 billion (68.4% of total costs) due to hospitalizations and US$ 679 million due to ambulatory procedures. Approximately 10% of these cost is attributable to overweight and obesity.

CONCLUSION

The results confirm that overweight and obesity carry a great economic burden for Brazilian health system and for the society. The knowledge of these costs will be useful for future economic analysis of preventive and treatment interventions.