Another limitation of this study is that we did not aim to perform a quality appraisal of the selected studies, also due to the fact that there are no validated guidelines to perform a quality check for COI studies. Researchers argued that the main driver behind the cost increases was the rise in the prevalence of overweight and obesity in Germany between 2002 and 2008. Moreover, we also collected information on types of obesity-related co-morbidities included in the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. [53] included 1,910,194 Korean individuals in their study to calculate the annual societal costs, which in 2005 amounted to US $1786 billion. While the U.S. has made some investments in prevention, with the First Ladys Lets Move initiative and Communities Putting Prevention to Work, these efforts represent relatively small steps forward, and future public health prevention funding remain under threat. Hughes D., McGuire A. A review of the economic analysis of obesity. (1) Cawley and Meyerhoefer also used MEPS data to make their estimates. [35] did not apply any discounting over a time frame of 11.5 years. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. Cost analyses of obesity in Canada: Scope, quality, and implications. When comparing these three study results, several limitations have to be pointed out: e.g., Bahia et al. The third-party payer perspective includes insurance companies, governmental agencies, and employers. Indirect costs of obesity: A review of the current literature. Indirect costs only were calculated in two studies [47,49]. Trends in morbid obesity and in bariatric surgeries covered by the Brazilian public health system. Withrow D, Alter DA. [44] and used the same method, perspective and target group in Germany. 9. Muller-Riemenschneider F., Reinhold T., Berghofer A., Willich S.N. Additionally, a propensity score matching method based on important confounders such as age, gender, socioeconomic status, smoking, physical activity, psychosocial stress and comorbidity, and a sensitivity analysis were performed, but the results did not change. Furthermore, some reviews have included studies that were specific to a single country or continent, e.g., the USA [18,26], Canada [24] or Europe [21,22,27], and have excluded studies from all over the world. Health-economic burden of obesity in Europe. The reported costs due to cancers need to be interpreted with the knowledge that different types of cancer were included in the different studies, which may have led to over- or underestimation of costs. De Oliveira et al. Tsai A.G., Williamson D.F., Glick H.A. McCormick B., Stone I. Su et al. Additional publications were searched on Google Scholar from the reference lists of included studies and reviews by backward and forward snowball searches. sharing sensitive information, make sure youre on a federal Two types of costs are associated with the treatment of obesity and obesity-related conditions: Direct costs are those that result from outpatient and inpatient health services (including surgery), laboratory and radiological tests, and drug therapy. The medical-care cost burden of obesity. Wang Y.C., Pamplin J., Long M.W., Ward Z.J., Gortmaker S.L., Andreyeva T. Severe obesity in adults cost state medicaid programs nearly $8 billion in 2013. While Andreyeva et al. As we stated previously, almost half of the worlds adult population will be overweight or obese by 2030 if the prevalence continues on the current trend [6] and consequently also the costs attributable to obesity will increase. Flow chart depicting the process of the study selection for the systematic review. These results were updated by Lehnert et al. Foreword Obesity is an increasingly serious issue for many nations across the world, including Australia. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. Direct medical cost of overweight and obesity in the USA: A quantitative systematic review. An age-period-cohort analysis of obesity and incident esophageal adenocarcinoma among white males. Therefore, these studies provide a good picture of the increase in the societal COO in Germany, from 9.8 million in 2002 to 12.2 million in 2008. Besides excess health care expenditure, obesity also imposes costs in the form of lost productivity and . [(accessed on 4 October 2016)]; Dobbs R., Sawers C., Thompson F., Manyika J., Woetzel J.R., Child P., McKenna S., Spatharou A. Overcoming Obesity: An Initial Economic Analysis. Moher D., Liberati A., Tetzlaff J., Altman D.G. This aspect should also be considered when including obesity-related diseases. (10) In middle-age men, treatment of five common obesity-related conditions (stroke, coronary artery disease, diabetes, hypertension, and elevated cholesterol) resulted in roughly $9,000 to $17,000 higher costs compared to normal-weight adults. One study [54] used population attributable prevalence (PAP), which takes into account that risk factors and their relative risks (RRs) can change over time. 2. Kortt M.A., Langley P.C., Cox E.R. Systematic review and bias-adjusted meta analysis. Estimates of future direct (medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will impose a significant economic burden to individuals and society as a whole. Approach: We will use a cost-of-illness approach to estimate the economic impacts of obesity in eight pilot countries, then produce estimates for a larger set of countries. The https:// ensures that you are connecting to the Thompson and colleagues concluded that, over the course of a lifetime, per-person costs for obesity were similar to those for smoking. For example, Lehnert et al. 2008; 9:489-500. Rtveladze K., Marsh T., Barquera S., Sanchez Romero L.M., Levy D., Melendez G., Webber L., Kilpi F., McPherson K., Brown M. Obesity prevalence in Mexico: Impact on health and economic burden. Furthermore, we considered obesity to be a fixed condition even though it has been discussed in the recent literature that obesity may be a transient state, e.g., depending on age cohorts or period effects [81]. Building upon evidence from several other reports, it identifies an action agenda for countries to follow, with support from the World Bank and the international development community. Li J., Song J., Zaytseva Y.Y., Liu Y., Rychahou P., Jiang K., Starr M.E., Kim J.T., Harris J.W., Yiannikouris F.B., et al. Effertz et al. According to Vigo et al. [(accessed on 4 October 2016)]; Centers for Disease Control and Prevention Overweight & Obesity. (6). The report concludes that, with support from development partners such as the World Bank, countries are well positioned to address the economic and health consequences of obesity. Cost of illness (COI) studies help policy makers understand the economic burden of a specific disease. But they used a different and potentially more accurate method for calculating costs, called the instrumental variable approach. This method takes into account the two-way relationship between obesity and chronic disease, by using a biological childs body mass index as a surrogate variable for the individuals body mass index. Out of nine studies, in eight studies [42,44,45,46,47,49,50,53] researchers used the human capital approach (HCA) to calculate the indirect costs. Jo C. Cost-of-illness studies: Concepts, scopes, and methods. [53] only included colon cancer as an obesity-related disease, while Konnopka et al. An assessment of its costs may be useful in providing recommendations for policy and decision makers. Comparative Quantification of Health Risks. Parallel to rising obesity rates is an increase in costs associated with excess weight. Bahia et al. A limitation of this review is that we only used Medline, Web of Science and Google Scholar to search for studies, which may have limited the number of potentially eligible studies. . [44] excluded respiratory and musculoskeletal disorders in the costing approach, which may explain some of the variation in estimated costs. Obesity-related diseases included in the studies. After removing studies that met the exclusion criteria during the initial screening, the full text of the remaining studies was assessed against the inclusion criteria and any differences were discussed and a consensus was reached. In 2016, more than 2 billion people worldwide were overweight or obese, and over 70 percent of them lived in low- or middle-income countries. Kang J.H., Jeong B.G., Cho Y.G., Song H.R., Kim K.A. De Oliveira M.L., Santos L.M., Da Silva E.N. Therefore, diabetes and CVDs were the most commonly considered comorbidities of obesity in the selected studies. Murphy C.C., Claire Yang Y., Shaheen N.J., Hofstetter W.L., Sandler R.S. [38] selected co-morbidities based on two conditions: firstly, those RRs are 1.20 for diseases and secondly, that RRs are 1.10 but <1.20 for diseases that are a substantial problem for public health due to high prevalence rate. Goldblatt, Moore, and Stunkard published the seminal article "Social Factors in Obesity" fifty years ago (2015) and the prevalence of overweight and obesity has dramatically increased in the US since its publication.In 1960-1962, the age adjusted prevalence of obesity and extreme obesity (body mass index; BMI (KG/M 2) 40) among adults was 13.4% and 0.9% . Obesity is broadly preventable, and it is caused by complex multifaceted interaction between genetics, environmental and human behaviour factors. Dinsa G.D., Goryakin Y., Fumagalli E., Suhrcke M. Obesity and socioeconomic status in developing countries: A systematic review. Mora T., Gil J., Sicras-Mainar A. [(accessed on 27 November 2016)]; Ezzati M., Lopez A. 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/m, for the whole selected country. Bahia et al. Obesity is a condition in which fat accumulates in the body to a point where it is a risk factor or marker for a number of chronic diseases including diabetes, cardiovascular diseases (CVDs) and cancer, and has adverse effects on overall health [1,2,3]. [45] who used a similar approach to estimate the annual COO in Canada. This artic We also recommend that additional obesity-related diseases be considered in further COO studies, such as liver and mental diseases which have mostly been neglected so far. In one of the earliest analyses, Colditz looked at the direct and indirect costs in the U.S. of six common obesity-related conditions-type 2 diabetes, high blood pressure, cardiovascular disease, gallbladder disease, colon cancer, and postmenopausal breast cancer-and determined what percentage of those costs were due to obesity. Other information was gathered as well, such as perspective, study time frame, sample size, target group, inclusion of cost items, and discount rate. The Pain of Obesity. 1999; 159:2177-83. Another microsimulation model (Markov-based microsimulation) was developed by Su et al. There was also variation in the calculation of indirect costs. Obesity also affects military readiness. A doctor will usually suggest that a person has obesity if . In six studies [42,44,45,46,50,53], both direct and indirect costs were included and therefore a societal perspective was used. Health Aff (Millwood). This systematic review has been performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [34]. In two-part models, the probability of the medical expenditures is calculated first; thereafter it is multiplied by the amount of expenses conditional on the presence of these expenses. 73-75 The 2009 report by the Institute of Medicine on food deserts also points to total consumption: "greater fruit and vegetable consumption alone will not reduce weight without the qualification to moderate . However, one of these studies [43] described this method as a societal perspective rather than a health care perspective. Finkelstein and colleagues found that in 2006, per capita medical spending for obese individuals was an additional $1,429 (42 percent higher) compared to individuals of normal weight. Nevertheless, there is still a methodological heterogeneity within COO studies and a lack of systematic reviews examining the different obesity-related diseases included in these studies. While it can lead to preventable chronic diseases like heart disease, type 2 diabetes and some forms of cancer, it can also impact mental health, as well as social and economic opportunities. All of the abovementioned diseases were included only in the studies by Pitayatienanan et al. 3. Obesity is thought to affect bone health through a variety of mechanisms, including body weight, fat volume, bone formation/resorption, proinflammatory cytokines together with bone marrow microenvironment. In addition, we only examined articles published in English. 10. [45] using data from the 2012 Canadian Community Health Survey. just as a variety of health factors may affect the accuracy of BMI to predict how much . [46] aimed to update the study by Konnopka et al. Arch Intern Med. The results indicate that there is a bidirectional relationship between obesity and depression. The economic burden of obesity worldwide: A systematic review of the direct costs of obesity. It . Moderate and severe obesity have large differences in health care costs. There were six studies from Germany [42,43,44,46,47,54], six from the USA [31,36,37,39,51,52], three from Brazil [30,38,40] and two from Canada [35,45]. Such COI studies identify different components of costs of specific diseases or disease-related complications in different sectors of the society, which may have been saved if the disease had not existed. ); es.ul.dem@ahas.bijnas (S.S.), 3Centre for Primary Health Care Research, Faculty of Medicine, Lund University/Region Skne, Skne University Hospital, S-22241 Lund, Skne, Sweden, 4Department of Economics, Lund University, S-22363 Lund, Skne, Sweden, 5Department of Clinical Sciences, Lund University, Skne University Hospital, S-20502 Malm, Skne, Sweden; es.ul.dem@nosslin.retep. More than a quarter of Australia's adult population is obese, one of the highest prevalence rates in the world. Furthermore, COI studies have a significant role in public health in formulating and prioritizing health care policies and allocating health care resources by estimating the amount of costs attributable to a disease [15]. For example, whereas An [36] included out-of-pocket expenses, inpatient and outpatient costs, office-based medical provider services, emergency room services and medication, Effertz et al. [45] excluded hypertension while Konnopka et al. Obesity is defined as excessive body fat that increases your risk of health problems. Alter D.A., Wijeysundera H.C., Franklin B., Austin P.C., Chong A., Oh P.I., Tu J.V., Stukel T.A. 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. Economic Impact Military Readiness References People who have obesity, compared to those with a healthy weight, are at increased risk for many serious diseases and health conditions. It is possible that a clearer understanding of the cost of obesity will spur larger and more urgent programs to prevent and treat it. Heterogeneity is a major limitation among the COI literature in general and the COO literature in particular, which hinders a conclusive comparison of the different studies. (9) (See table, A Snapshot of Obesity-Related Costs. Economic Costs Paying the Price for Those Extra Pounds Excess weight harms health in many ways. FOIA In 2016, more than 2 billion people worldwide were overweight or obese, and over 70 percent of them lived in low- or middle-income countries. Hubert H.B., Feinleib M., McNamara P.M., Castelli W.P. Abbreviations: CVDs = cardiovascular diseases; CZ = Czech Republic; DE = Germany; NL = The Netherlands. This series of studies from Germany, using the same methods to measure the COO, may provide a valid statement about the development of COO between these two time points and gives a good example of how COO studies can be conducted in a structured and valid way. Weinstein M., Siegel J., Gold M., Kamlet M., Russell L. Cost-Effectiveness in Health and Medicine. Systematic reviews in the context of cost of obesity (COO) summarize the results of available studies in order to provide a high level of evidence on the cost burden due to obesity, which may help decision makers to develop policies to tackle the burden of obesity [16]. Los Angeles - Dec. 7, 2020 - The economic and social impact of obesity has risen to nearly $1.4 trillion dollars, up from $976 billion in 2014 according to the Milken Institute's newest report, " Weighing Down America: 2020 Update ." the contents by NLM or the National Institutes of Health. 8600 Rockville Pike Cost of illness studies on reproductive, maternal, newborn, and child health: A systematic literature review. Besides excess health care expenditure, obesity also imposes costs in the form of lost productivity and foregone economic growth as a result of lost work days, lower productivity at work, mortality and permanent disability. (3) Subsequent reports on obesity-related medical spending (direct costs) have charted a steady rise in obesitys cost over the years, as the epidemic has grown. Obesity is a chronic medical condition caused by excess visceral fat. Summary. Inclusion in an NLM database does not imply endorsement of, or agreement with, Colditz GW, Wang, YC. The authors declare no conflict of interest. [(accessed on 27 November 2016)]; Butland B., Jebb S., Kopelman P., McPherson K., Thomas S., Mardell J., Parry V. Tackling Obesities: Future Choices-Project Report. Nervous system Respiratory system Digestive system Cardiovascular system Endocrine system Reproductive system Skeletal and muscular systems Skin Mental. Economy; Education; Environment + Energy; . Aug 31, 2012 By Cheryl Ann Borne The Stigma of Obesity: Humiliation is Hard to Shed As a child, the start of a new school year was my least favorite time of the year. [31]. Konnopka et al. Eleven studies [29,30,38,39,40,44,45,46,50,53,54] used a top-down (population-based) approach and eleven studies applied a bottom-up (person-based) approach [31,35,36,37,41,42,43,47,48,51,52] to calculate the costs attributable to obesity. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Liu J.L.Y., Maniadakis N., Gray A., Rayner M. The economic burden of coronary heart disease in the UK. The problem of obesity becomes easily framed within this explanation as one of quantity and personal gluttony and laziness: either energy intake is too high, energy expenditure is too low, or both. [43] estimated the average 3-month individual health care costs (also including informal care) in Germany to be 1244 (2008) using questionnaire data from an 8-year follow-up contact of a large population-based prospective cohort study titled Epidemiologische Studie zu Chancen der Verhtung, Frherkennung und optimierten Therapie chronischer Erkrankungen in der lteren Bevlkerung (the ESTHER study). If the incidence continues at this rate, almost half of the worlds adult population will be overweight or obese by 2030 [6]. Krueger et al. The influence of obesity and overweight on medical costs: A panel data perspective. [(accessed on 6 September 2016)]; Saha S., Gerdtham U.G. Moreover, the Campbell and Cochrane Economics Methods Group guidelines have been followed including search criteria, data extraction, synthesis and critical analysis. We provide a wide array of financial products and technical assistance, and we help countries share and apply innovative knowledge and solutions to the challenges they face. Obesity: Preventing and Managing the Global Epidemic. Shrestha N., Pedisic Z., Neil-Sztramko S., Kukkonen-Harjula K.T., Hermans V. The Impact of obesity in the workplace: A review of contributing factors, consequences and potential solutions. In 2014 the global economic impact of obesity was estimated to be US $2.0 trillion or 2.8% of the global gross domestic product (GDP) [6]. Bierl M., Marsh T., Webber L., Brown M., McPherson K., Rtveladze K. Apples and oranges: A comparison of costing methods for obesity. Studies also varied in terms of inclusion of direct costs and indirect costs, i.e., in terms of perspective of analysis (Table 1). Alter et al. [(accessed on 14 November 2012)]; Vigo D., Thornicroft G., Atun R. Estimating the true global burden of mental illness. Lehnert T., Stuhldreher N., Streltchenia P., Riedel-Heller S.G., Konig H.H. Costs of illness in cost-effectiveness analysis. Su W., Huang J., Chen F., Iacobucci W., Mocarski M., Dall T.M., Perreault L. Modeling the clinical and economic implications of obesity using microsimulation. Whereas Konnopka et al. The study suggested that social deprivation, interacting with chronic pain to impair cognitive ability, including memory and concentration, can make day-to-day activities, such as going shopping . The details of the searching strategy with key words and initial hits are provided in Appendix A to ensure reproducibility and transparency of the work. Socioeconomic costs of overweight and obesity in Korean adults. It generally occurs when more energy is consumed through eating and drinking than is expended What does obesity cost th e economy? Another characteristic of studies included in this review was the limited time frame of the analyses. Although there is a substantial international literature on COO, we have found that a review and synthesis of the results based on homogeneous methods and costing approaches is hindered by a wide range of sources, as well as methodological approaches, perspectives, target groups and included diseases, used to estimate the prevalence of obesity. Therefore, it may be beneficial to calculate indirect costs both using HCA and FCA approach. Since 2011, however, advanced methods such as microsimulation modelling [29,30,31] have been used and have led to new findings, requiring further, systematic exploration. Kang et al. 1, 2 The prevalence of obesity has increased by threefold since the mid 70s of last century and If the current global trend continues, it is predicted that over a billion of the world population will b. Marchesini G., Moscatiello S., Di Domizio S., Forlani G. Obesity-associated liver disease. The costs of diabetes were included in all of these 14 studies, three of which [35,51,53] included both Type 1 and Type 2 diabetes. Accessed January 25, 2012. Treating obesity and obesity-related conditions costs billions of dollars a year. Obesity also imposes a large economic burden on the individual, and on families and nations [7,8].