The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme

The effects of smoking, alcohol consumption, obesity, and physical inactivity on healthcare costs: a longitudinal cohort study

BACKGROUND

Research indicates major risk factors including smoking, alcohol consumption, obesity and physical inactivity contribute significantly to global disease burden and healthcare costs. However, these studies have challenges, such as increased bias and uncertainty arising from use of population attributable fractions (PAF) and the issue of reverse causality in cross-sectional data. This study aims to evaluate the long-term healthcare costs associated with these behaviors using a longitudinal cohort.

METHODS

This longitudinal cohort study used the Korean National Health Insurance Service-National Sample Cohort database (NHIS-NSC 2.0), covering 2002-2019. The cohort included individuals aged 40-69 years who underwent health examinations in 2002-2004 and had no pre-existing risk factor-related diseases. Cumulative healthcare costs during 2010-2019 were analyzed using a generalized linear model with log-link function and gamma distribution, adjusted for other health behaviors and sociodemographic factors.

RESULTS

Smoking, alcohol consumption, obesity, and physical inactivity significantly increased healthcare costs for both sexes. Male current smokers incurred 13.8% higher costs than never-smokers, while female smokers spent 18.6% more. Former smokers had lower costs than current smokers, with reductions of 9.9% for males and 13.2% for females. Almost daily alcohol consumption raised costs by 21.4% for males and 31.8% for females. Costs varied by BMI categories, with severe obesity increasing expenditures by 26.9% for males and 46.5% for females compared to normal weight. Overweight status showed contrasting effects between sexes, with a 3.4% decrease in healthcare costs for males but a 7.6% increase for females. Exercising 1-4 times weekly reduced costs by 7.6% for males and 7.4% for females compared to non-exercisers.

CONCLUSIONS

The study underscores the economic impact of health risk behaviors and supports the need for targeted public health interventions. The findings highlight the importance of targeted interventions for high-risk groups for reducing healthcare costs.

Unlocking Fertility: How Nitric Oxide Pathways Connect Obesity and Reproductive Health-The Role of Bariatric Surgery

This study examines the relationship between obesity, oxidative stress, and reproductive dysfunction. It focuses on the effects of sleeve gastrectomy on gene expression and hormone profiles in 29 women with severe obesity (BMI ≥ 40 kg/m2). Pre- and post-surgical investigations revealed significant differences in major gene expressions and hormonal markers. CART expression reduced significantly from 0.27 ± 4.43 to -3.42 ± 1.14 (p < 0.001), while leptin expression decreased from -1.87 ± 1.75 to -0.13 ± 1.55 (p < 0.001), indicating better metabolic regulation. In contrast, eNOS expression increased considerably from -4.87 ± 1.70 to 1.18 ± 2.31 (p = 0.003), indicating improved endothelial function and nitric oxide bioavailability, which is critical for vascular health and reproduction. Correlation research before surgery indicated no significant relationships between eNOS, CART, or leptin and clinical indicators, implying that these genes function independently in pre-surgical metabolism. While most associations remained negligible after surgery, a significant negative connection between eNOS expression and SHBG levels appeared (r = -0.365, p = 0.049), indicating potential interactions in hormonal regulation pathways following metabolic improvements. These findings emphasize the importance of bariatric surgery in reducing the negative effects of obesity on reproductive health by altering critical cellular pathways. Significant increases in CART, leptin, and eNOS expression indicate reduced oxidative stress, improved vascular tone, and hormonal balance, all of which contribute to increased reproductive capacity. This study sheds light on the molecular processes that link obesity, metabolic health, and fertility, underlining bariatric surgery's therapeutic potential for women experiencing obesity-related infertility.

Bariatric Surgery as a Molecular Modulator: The Role of FSHR Polymorphisms in Enhancing eNOS Expression and Reproductive Hormone Dynamics in Women with Severe Obesity

BACKGROUND/OBJECTIVES

Severe obesity (BMI > 40 kg/m2) has a severe influence on vascular health and reproduction. This study looks at how bariatric surgery affects endothelial nitric oxide synthase (eNOS) expression and reproductive hormone regulation across different follicle-stimulating hormone receptor (FSHR) polymorphism groups in women with extreme obesity.

METHODS

Twenty-nine women with extreme obesity had bariatric surgery. Pre- and post-surgery levels of eNOS and reproductive hormones such as follicle-stimulating hormone (FSH), sex hormone-binding globulin (SHBG), anti-Müllerian hormone (AMH), and antral follicle count (AFC) were assessed. Patients were divided into three FSHR polymorphism groups (Ser/Ser, Asn/Asn, and Ser/Asn), and results were compared between them. Statistical techniques were used to determine changes and relationships.

RESULTS

Bariatric surgery led to substantial increases in eNOS expression across all FSHR polymorphism groups (p < 0.0001), with the Ser/Ser group exhibiting the most variability. Prior to surgery, the Ser/Ser group had substantially higher FSH levels (7.41 ± 0.60 mIU/mL) than the Asn/Asn group (5.20 ± 0.63 mIU/mL, p < 0.001). Following surgery, FSH levels rose in the Ser/Ser group (9.45 ± 0.87 mIU/mL), with significant differences between the Ser/Ser and Ser/Asn groups (mean difference = 0.97, p = 0.019). SHBG levels had a negative connection with eNOS expression after surgery (r = -0.365, p = 0.049). AMH and AFC remained constant throughout polymorphism groups. BMI decreased uniformly, with an average of 15.2 ± 1.8 kg six months after surgery.

CONCLUSIONS

Bariatric surgery improves vascular health and regulates reproductive hormones, especially in individuals with the Ser/Ser genotype. These findings indicate the possibility of combining genetic testing and bariatric therapies to improve infertility treatment in obese women.

Whether Pension Program Stimulates the Consumption of Addictive Products: Evidence from China's New Rural Pension Scheme

Much attention has been paid to evaluating the policy effects of pension programs, but few studies have focused on possible inefficiencies stemming from their implementation. Drawing on a quasi-natural experiment associated with the adoption of China's New Rural Pension Scheme (NRPS), this study explores the impact of the NRPS on food consumption among rural residents. A difference-in-differences (DID) analysis is performed using panel data from the 2009 and 2013 National Rural Fixed Observation survey. Results show that participation in the NRPS improves residents' dietary quality by increasing the consumption of recommended foods and decreasing the consumption of non-recommended foods. However, the results also show that the NRPS is associated with increased consumption of addictive and unhealthy products, especially in households with lower average levels of education, poorer self-reported health, and older adults over age 60. Findings suggest that when examining the possible health effects of new pension policies, it is essential to account for potential increases in the intake of unhealthy and addictive products, such as cigarettes and alcohol.

Quality of Life in Female Breast Cancer Patients and Survivors in a South African Municipality

Background

Breast cancer diagnosis and treatment processes affect patients physically and mentally, and have an impact on their quality of life, even years after receiving treatment.

Objectives

The objective of this study was to determine the quality of life in female breast cancer patients and survivors in a South African context. The municipality within which participants were recruited for this study was Ekurhuleni, based in the Gauteng province, South Africa.

Design

This study followed a cross-sectional research design. Quantitative data was collected.

Methods

The Quality-of-Life Patient/Cancer Survivor Version (2012) was used to determine participants' quality of life in 4 subscales, namely, physical, psychological, social, and spiritual. The questionnaire was accessible to participants via the online Google Forms platform as well as in hard-copy format at local medical facilities. The Statistical Package for Social Sciences (SPSS) was used to compute statistics, and the level of significance was set at 95% (P < .05).

Results

One hundred female breast cancer patients and survivors from the region of Ekurhuleni, South Africa, took part in this study. The findings demonstrate that the quality-of-life subscale with the highest score was spiritual well-being (6.66 ± 2.07) and the lowest was psychological well-being (4.91 ± 1.93). No significant difference was found between quality of life and type of facility attended. Significant differences were found in quality-of-life ratings between breast cancer patient and breast cancer survivor populations.

Conclusion

Breast cancer can result in a compromised quality of life, and with the increased prevalence and survival rate of breast cancer patients, both the short- and long-term effects of the condition and its treatments are heightened.

Physical activity levels in female breast cancer patients and survivors in Ekurhuleni, South Africa

Background

By using complementary therapies, such as exercise rehabilitation during and after cancer treatment, breast cancer patients and survivors can improve their quality of life and overall health while also negating the deleterious effects of breast cancer and its treatment.

Objectives

The aim of this study was to determine the physical activity levels of female breast cancer patients and survivors in Ekurhuleni, South Africa.

Methods

The International Global Physical Activity Questionnaire (2002) determined participants' physical activity levels during work, travel and leisure. The questionnaire was disseminated to medical facilities in hard copy format and online via the Google Forms platform. Statistics were computed using the Statistical Package for Social Science (SPSS) with the level of significance set at 95% (p < 0.05).

Results

One hundred female breast cancer patients and survivors with a mean age of 55 years from Ekurhuleni, South Africa participated in this study. The findings reflected that most participants (59%) were meeting the American College of Sports Medicine's physical activity guidelines when considering activity done during work, travel and leisure. No significant difference was seen in physical activity participation between breast cancer patients and breast cancer survivors, or those attending private and public facilities.

Conclusion

For the breast cancer patient, physical activity and exercise may be a promising and effective adjuvant treatment both during and after anticancer therapies, improving quality of life, playing a role in increasing treatment tolerance, mitigating a range of symptoms and side effects brought on by cancer diagnosis and treatments and enhancing outcomes.

Morbid obesity impacts mortality among inpatients with type a aortic dissection: an analysis of the national inpatient sample

BACKGROUND

Stanford type A aortic dissection (T(A)AD) is one of the most dangerous cardiovascular diseases and morbid obesity is associated with the prognosis of many cardiovascular diseases. The aim of this study is to investigate the impact of morbid obesity on in-hospital mortality, total hospital costs and discover the prevalence of morbid obesity among inpatients with T(A)AD.

METHODS

Patients with a primary diagnosis of T(A)AD were identified from the National Inpatient Sample database (NIS) from 2008 to 2017. These patients were categorized into non-obesity, obesity and morbid obesity. Multivariable regression models were utilized to assess the association between obesity/morbid obesity and in-hospital mortality, total cost and other clinical factors. The temporal trend in prevalence of obesity/morbid obesity in T(A)ADs and the trend of in-hospital mortality among different weight categories were also explored.

RESULTS

From the NIS database 8489 T(A)AD inpatients were identified, of which 7230 (85.2%) patients were non-obese, 822 (9.7%) were obese and 437 (5.1%) were morbid obese. Morbid obesity was associated with increased risk of in-hospital mortality (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.03-1.86), 8% higher total cost compared with the non-obese patients. From 2008 to 2017, the rate of obesity and morbid obesity in patients with T(A)AD have significantly increased from 7.36 to 11.33% (P < 0.001) and from 1.95 to 7.37% (P < 0.001). Factors associated with morbid obesity in T(A)ADs included age, female, elective admission, hospital region, dyslipidemia, smoking, rheumatoid arthritis/collagen vascular diseases, chronic pulmonary disease, diabetes and hypertension.

CONCLUSIONS

Morbid obesity are connected with worse clinical outcomes and more health resource utilization in T(A)AD patients. Appropriate medical resource orientation and weight management education for T(A)AD patients may be necessary.

The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample

Background

Indonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia.

Methods

Secondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity.

Results

Being obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05).

Conclusion

Combined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08546-6.

The impact of current smoking, regular drinking, and physical inactivity on health care-seeking behavior in China

Background

People with lifestyle behaviors, such as current smoking, regular drinking, and physical inactivity, may experience a lack of or delayed health care, leading to severe sickness and higher health care expenditures in the future. Hence, the current study aims to ascertain the effects of current smoking, regular drinking, and physical inactivity on health care-seeking behavior among adults who report physical discomfort in China.

Methods

The data used in this study were obtained from the China Family Panel Studies (CFPS). The final sample consisted of 44,362 individuals who participated in all five waves of data collection. Logistic regression models were used for the analysis.

Results

The results of fixed effects logistic regression showed that among those who reported physical discomfort, adults who currently smoked cigarettes were 0.65 times less likely to seek health care than those who formerly smoked. Compared to nondrinkers, adults who regularly drank alcohol had a decreased likelihood of seeking health care. Adults who never engaged in physical exercise had 24% lower odds of seeking health care than those who engaged in physical exercise.

Conclusions

Current smoking, regular drinking, and physical inactivity decreased the probability of seeking health care among adults who reported physical discomfort. Therefore, screening and brief advice programs should be delivered by primary-level care and should pay more attention to individuals who engage in lifestyle behaviors such as current smoking, regular drinking, and physical inactivity, thus avoiding missed opportunities to treat chronic conditions and detect new diseases early.

Health service utilization and direct healthcare costs associated with obesity in older adult population in Ghana

Obesity is a major risk factor for many chronic diseases and disabilities, with severe implications on morbidity and mortality among older adults. With an increasing prevalence of obesity among older adults in Ghana, it has become necessary to develop cost-effective strategies for its management and prevention. However, developing such strategies is challenging as body mass index (BMI)-specific utilization and costs required for cost-effectiveness analysis are not available in this population. Therefore, this study examines the associations between health services utilization as well as direct healthcare costs and overweight (BMI ≥25.00 and &lt;30.00 kg/m2) and obesity (BMI ≥30.00 kg/m2) among older adults in Ghana. Data were used from a nationally representative, multistage sample of 3350 people aged 50+ years from the World Health Organization’s Study on global AGEing and adult health (WHO-SAGE; 2014/15). Health service utilization was measured by the number of health facility visits over a 12-month period. Direct costs (2017 US dollars) included out-of-pocket payments and the National Health Insurance Scheme (NHIS) claims. Associations between utilization and BMI were examined using multivariable zero-inflated negative binomial regressions; and between costs and BMI using multivariable two-part regressions. Twenty-three percent were overweight and 13% were obese. Compared with normal-weight participants, overweight and obesity were associated with 75% and 159% more inpatient admissions, respectively. Obesity was also associated with 53% additional outpatient visits. One in five of the overweight and obese population had at least one chronic disease, and having chronic disease was associated with increased outpatient utilization. The average per person total costs for overweight was $78 and obesity was $132 compared with $35 for normal weight. The NHIS bore approximately 60% of the average total costs per person expended in 2014/15. Overweight and obese groups had significantly higher total direct healthcare costs burden of $121 million compared with $64 million for normal weight in the entire older adult Ghanaian population. Compared with normal weight, the total costs per person associated with overweight increased by 73% and more than doubled for obesity. Even though the total prevalence of overweight and obesity was about half of that of normal weight, the sum of their cost burden was almost doubled. Implementing weight reduction measures could reduce health service utilization and costs in this population.

Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1

This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94–5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41–3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.

Attitudes and perceptions among urban South Africans towards sugar-sweetened beverages and taxation

OBJECTIVE

A tax on sugar-sweetened beverages (SSB) was introduced in South Africa in April 2018. Our objective was to document perceptions and attitudes among urban South Africans living in Soweto on factors that contribute to their SSB intake and on South Africa's use of a tax to reduce SSB consumption.

DESIGN

We conducted six focus group discussions using a semi-structured guide.

SETTING

The study was conducted in Soweto, Johannesburg, South Africa, 3 months before South Africa's SSB tax was implemented.

PARTICIPANTS

Adults aged 18 years or above living in Soweto (n 57).

RESULTS

Participants reported frequent SSB consumption and attributed this to habit, addiction, advertising and wide accessibility of SSB. Most of the participants were not aware of the proposed SSB tax; when made aware of the tax, their responses included both beliefs that it would and would not result in reduced SSB intake. However, participants indicated cynicism with regard to the government's stated motivation in introducing the tax for health rather than revenue reasons.

CONCLUSIONS

While an SSB tax is a policy tool that could be used with other strategies to reduce people's high level of SSB consumption in Soweto, our findings suggest a need to complement the SSB tax with a multipronged behaviour change strategy. This strategy could include both environmental and individual levers to reduce SSB consumption and its associated risks.

The Role of Oxidative Stress and Hormones in Controlling Obesity

The accumulation of adipose tissue in the body occurs because the energy introduced with food and drink exceeds that expense, but to understand why this imbalance is established and why it is maintained over time, it is important to consider the main causes and risk factors of excess weight. In this review, we will refer to the main factors linked to obesity, starting from oxidative stress to hormonal factors including the role of obesity in breast cancer. Among the many hypotheses formulated on the etiopathology of obesity, a key role can be attributed to the relationship between stress oxidative and intestinal microbiota. Multiple evidences tend to show that genetic, epigenetic, and lifestyle factors contribute to determine in the obese an imbalance of the redox balance correlated with the alteration of the intestinal microbial flora. Obesity acts negatively on the wound healing, in fact several studies indicate morbid obesity significantly increased the risk of a post-operative wound complication and infection. Currently, in the treatment of obesity, medical interventions are aimed not only at modifying caloric intake, but also to modulate and improve the composition of diet with the aim of rebalancing the microbiota-redox state axis.

Associations of perceived neighbourhood safety from traffic and crime with overweight/obesity among South African adults of low-socioeconomic status

BACKGROUND

The relationship between perceived neighbourhood safety from traffic and crime with overweight/obesity can provide intervention modalities for obesity, yet no relevant study has been conducted in sub-Saharan African contexts. We investigated the association between perceived neighbourhood safety from traffic and crime with overweight/obesity among urban South African adults.

METHODS

This cross-sectional study included 354 adults aged ≥35 years drawn from the Prospective Urban Rural Epidemiology (PURE) cohort study. The Neighborhood Walkability Scale-Africa (NEWS-A) was used to evaluate the perceived neighbourhood safety. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to examine the associations between perceived neighborhood safety and overweight/obesity defined "normal weight" and "overweight/obese" using the 25 Kg/m2 cutoff criterion.

RESULTS

In the overall sample, adults who agreed that "the speed of traffic on most nearby roads in their neighborhood was usually slow" were less likely to be overweight/obese (adjusted OR = 0.42; 95%CI 0.23-0.76). Those who agreed that "there was too much crime in their neighborhood to go outside for walks or play during the day" were more likely to be overweight/obese (OR = 2.41; 1.09-5.29). These associations were driven by significant associations in women, and no association in men, with significant statistical interactions.

CONCLUSION

Perceived neighborhood safety from traffic and crime was associated with overweight/obesity among South African adults. Our findings provide preliminary evidence on the need to secure safer environments for walkability. Future work should also consider perceptions of the neighbourhood related to food choice.

Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15

Background

There is a global epidemic of overweight and obesity; however, this rate of increase is even greater in some low- and middle-income countries (LMIC). South Africa (SA) is undergoing rapid socioeconomic and demographic changes that have triggered a rapid nutrition transition. The paper focuses on the recent rate of change of body mass index (BMI) among children, adolescents and young adults, further stratified by key sociodemographic factors.

Methods

We analysed mean BMI of 28 247 individuals (including children) from 7301 households by age and year, from anthropometric data from four national cross-sectional (repeated panel) surveys using non-linear fitted curves and associated 95% confidence intervals.

Results

From 2008 to 2015, there was rapid rise in mean BMI in the 6-25 age band, with the highest risk (3-4+ BMI unit increase) among children aged 8-10 years. The increase was largely among females in urban areas and of middle-high socioeconomic standing. Prominent gains were also observed in certain rural areas, with extensive geographical heterogeneity across the country.

Conclusions

We have demonstrated a major deviation from the current understanding of patterns of BMI increase, with a rate of increase substantially greater in the developing world context compared with the global pattern. This population-wide effect will have major consequences for national development as the epidemic of related non-communicable disease unfolds, and will overtax the national health care budget. Our refined understanding highlights that risks are further compounded for certain groups/places, and emphasizes that urgent geographical and population-targeted interventions are necessary. These interventions could include a sugar tax, clearer food labelling, revised school feeding programmes and mandatory bans on unhealthy food marketing to children.The scenario unfolding in South Africa will likely be followed in other LMICs.

Body mass index and healthcare costs: a systematic literature review of individual participant data studies

Excess weight is associated with increased total healthcare costs, but it is less well known how the associations between excess weight and costs vary across different types of healthcare service. We reviewed studies using individual participant data to estimate associations between body mass index and healthcare costs, and summarized how annual healthcare costs for overweight (body mass index 25 to <30 kg/m2 ) and obese (≥30 kg/m2 ) individuals compared with those for healthy weight individuals (18.5 to <25 kg/m2 ). EMBASE and MEDLINE were searched from January 1990 to September 2016, and 75 studies were included in the review. Of these, 34 studies presented adequate information to contribute to a quantitative summary of results. Compared with individuals at healthy weight, the median increases in mean total annual healthcare costs were 12% for overweight and 36% for obese individuals. The percentage increases in costs were highest for medications (18% for overweight and 68% for obese), followed by inpatient care (12% and 34%) and ambulatory care (4% and 26%). Percentage increases in costs associated with obesity were higher for women than men. The substantial costs associated with excess weight in different healthcare settings emphasize the need for investment to tackle this major public health problem.

Reducing the Role of the Food, Tobacco, and Alcohol Industries in Noncommunicable Disease Risk in South Africa

Noncommunicable diseases (NCDs) impose a growing burden on the health, economy, and development of South Africa. According to the World Health Organization, four risk factors, tobacco use, alcohol consumption, unhealthy diets, and physical inactivity, account for a significant proportion of major NCDs. We analyze the role of tobacco, alcohol, and food corporations in promoting NCD risk and unhealthy lifestyles in South Africa and in exacerbating inequities in NCD distribution among populations. Through their business practices such as product design, marketing, retail distribution, and pricing and their business practices such as lobbying, public relations, philanthropy, and sponsored research, national and transnational corporations in South Africa shape the social and physical environments that structure opportunities for NCD risk behavior. Since the election of a democratic government in 1994, the South African government and civil society groups have used regulation, public education, health services, and community mobilization to modify corporate practices that increase NCD risk. By expanding the practice of health education to include activities that seek to modify the practices of corporations as well as individuals, South Africa can reduce the growing burden of NCDs.

Cost of inaction on sugar-sweetened beverage consumption: implications for obesity in South Africa

OBJECTIVE

To estimate the effect of increased sugar-sweetened beverage (SSB) consumption on future adult obesity prevalence in South Africa in the absence of preventive measures.

DESIGN

A model was constructed to simulate the effect of a 2·4 % annual increase in SSB consumption on obesity prevalence. The model computed the change in energy intake assuming a compounding increase in SSB consumption. The population distribution of BMI by age and sex was modelled by fitting measured data from the 2012 South African National Income Dynamics Survey to the log-normal distribution and shifting the mean values.

SETTING

Over the past decade the prevalence of obesity and related non-communicable diseases has increased in South Africa, as have the sales and availability of SSB. Soft drink sales in South Africa are projected to grow between 2012 and 2017 at an annual compounded growth rate of 2·4 % in the absence of preventive measures to curb consumption.

RESULTS

A 2·4 % annual growth in SSB sales alongside population growth and ageing will result in an additional 1 287 000 obese adults in South Africa by 2017, 22 % of which will be due to increased SSB consumption.

CONCLUSIONS

In order to meet the South African target of reducing the number of people who are obese and/or overweight by 10 % by 2020, the country cannot afford to delay implementing effective population-wide interventions. In the face of plans to increase growth of SSB, the country will soon face even greater challenges in overcoming obesity and related non-communicable diseases.

The influence of obesity and overweight on medical costs: a panel data perspective

This paper estimates the increase of direct medical costs of both severe and moderate obesity and overweight with respect to a normal-weight individual using a two-part generalised linear model and a longitudinal dataset of medical and administrative records of patients in primary and secondary healthcare centres followed up over seven consecutive years (2004-2010) in Spain. Our findings indicate that severe and moderate obesity imposes a substantial burden on the Spanish healthcare system. Specifically, being severely obese is associated with increases in medical costs of 26 % (instrumental variables (IV) estimate, 34 %) compared to a normal-weight individual. The effects of moderate obesity and overweight are more modest, raising medical costs by 16 % (IV estimate, 29 %) and 8.5 % (IV estimate, 23 %), respectively. These changes in costs are slightly higher for those patients below the median age and for the women. Notwithstanding, the effects found in this study are comparatively much lower than that reported for the USA, based basically on a private healthcare system and characterised by a more obese population.

The potential impact of a 20% tax on sugar-sweetened beverages on obesity in South African adults: a mathematical model

Background/Objectives

The prevalence of obesity in South Africa has risen sharply, as has the consumption of sugar-sweetened beverages (SSBs). Research shows that consumption of SSBs leads to weight gain in both adults and children, and reducing SSBs will significantly impact the prevalence of obesity and its related diseases. We estimated the effect of a 20% tax on SSBs on the prevalence of and obesity among adults in South Africa.

Methods

A mathematical simulation model was constructed to estimate the effect of a 20% SSB tax on the prevalence of obesity. We used consumption data from the 2012 SA National Health and Nutrition Examination Survey and a previous meta-analysis of studies on own- and cross-price elasticities of SSBs to estimate the shift in daily energy consumption expected of increased prices of SSBs, and energy balance equations to estimate shifts in body mass index. The population distribution of BMI by age and sex was modelled by fitting measured data from the SA National Income Dynamics Survey 2012 to the lognormal distribution and shifting the mean values. Uncertainty was assessed with Monte Carlo simulations.

Results

A 20% tax is predicted to reduce energy intake by about 36kJ per day (95% CI: 9-68kJ). Obesity is projected to reduce by 3.8% (95% CI: 0.6%–7.1%) in men and 2.4% (95% CI: 0.4%–4.4%) in women. The number of obese adults would decrease by over 220 000 (95% CI: 24 197–411 759).

Conclusions

Taxing SSBs could impact the burden of obesity in South Africa particularly in young adults, as one component of a multi-faceted effort to prevent obesity.

Analysis of NHANES 1999-2002 data reveals noteworthy association of alcohol consumption with obesity

BACKGROUND

With the obesity pandemic sweeping the globe and alcohol use on the rise worldwide, there is growing interest in how the two might be linked epidemiologically. The aim of the study was to use data from the NHANES registry from 1999-2002 to analyze the association between obesity and alcohol use.

METHODS

Multivariate logistic regression was used to assess the relationship between alcohol use and obesity. Risk was assessed separately for men and women.

RESULTS

Of the 9,193 individuals (49% males), 26.8% of males and 33.6% of females were obese. About 17% of males and 12% of females were never drinkers (less than 12 drinks in their lifetime). After adjusting for age, race, marital status, highest level of education of the individual and spouse, country of origin, annual household income and duration of physical activity in the past 30 days, the odds of obesity were higher in never drinkers compared to ever drinkers in both men and women. Consumption of alcohol for more than 45 days, binge drinking (>5 drinks/day) for more than 90 days and being "ever binge drinker" were associated with significantly higher odds of obesity (in both genders) than those who drank for shorter duration or were "never binge drinkers". Consumption of alcohol more than the recommended limit for moderate drinking (3 drinks/day in females and 4 drinks/day in males) was associated with increased (OR 1.074, 95% CI 1.072-1.076) and decreased (OR 0.970, 95%CI 0.968-0.972) obesity in females and males respectively.

CONCLUSION

Frequent or heavy alcohol consumption is associated with greater odds of being obese.