direct and indirect costs of obesity

Of this amount, nearly $140 billion was for medical costs and $164 billion was for indirect costs associated with lost earnings. State-level estimates of. Patients with a normal BMI diagnosis code were not chosen for the reference cohort because preliminary assessments identified a possible selection bias, where this group represents a higher proportion of female patients compared with a random sample of patients without diagnosis or BMI codes for overweight or obesity, and a higher proportion of patients with disability claims compared with obesity class I and II patients. The authors argue that these costs may be unavoidable, with currently existing technologies unable to reduce significantly the likely future consequences of current adolescent overweight. Gu JK, Charles LE, Bang KM, et al. Direct per-capita costs of obesity were reported in seven studies [31,35,36,37,43,48,52] and indirect per-capita costs were calculated in one study in Sweden . A multi-worksite analysis of the relationships among, 7. Whitlock EP, Williams SB, Gold R, Smith P, Shipman S. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Jul. 2022 Jun 10;2(6):e0000515. Epub 2016 Jan 12. Finally, measures of academic performance can provide an estimate of the relationship between obesity and the quality of education, potentially affecting human capital accumulation independently of educational attainment. MeSH The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. Epub 2008 Mar 5. The health insurance-related costs of obesity were estimated to be $7.7 billion. The, 12. In order to determine whether there is a welfare loss caused by this externality, the authors consider two models of health insurance: one in which there is complete, employer-provided, pooled insurance, and another in which premiums are risk adjusted. Tsai et al27 find that the productivity losses to Shell Oil Company alone due to absenteeism effects of obesity were worth $11.2 million per year. They compare total medical care charges over an 18-month period across BMI categories, controlling for age, race, sex, and chronic disease status. Disability costs were calculated for employees as short- and long-term disability data multiplied by the workers recorded wages. They use self-reported data on both medical conditions and BMI from two nationally representative surveys (the National Medical Expenditure survey and the Household Component of the MEPS), and construct a two-part regression controlling for key individual variables (such as demography, smoking, and insurance status). The direct and indirect costs of both overweight and obesity: A systematic review CC BY 4.0 Authors: Anne Dee Health Service Executive Karen Kearns Ciaran O'Neill Queen's University Belfast. Prevalence of overweight and obesity in Nigeria: Systematic review and meta-analysis of population-based studies. Among employees with obesity (BMI more than or equal to 30), highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Sensitivity of case ascertainment. Among employees with obesity, the numerically highest total costs were observed in the GERS industry ($14,578 PPPY for class I, $25,382 PPPY for class II, and $34,089 PPPY for class III obesity), other industries (ie, food services, entertainment, and other services; $14,129 PPPY for class I, $24,737 PPPY for class II, and $35,220 for class III obesity), and technology industry ($13,382 PPPY for class I, $21,642 PPPY for class II, and $31,334 PPPY for class III obesity). This site needs JavaScript to work properly. 1998 Jul;52(7):445-50. doi: 10.1136/jech.52.7.445. Kopelman P. Health risks associated with overweight and, 6. Please enable scripts and reload this page. Federal government websites often end in .gov or .mil. Li Q, Blume SW, Huang JC, Hammer M, Ganz ML. Journal of Occupational and Environmental Medicine61(11):877-886, November 2019. More research is needed to determine obesity's causal role in increasing indirect costs, especially for workers' compensation and presenteeism. Obes Rev. Although this study does not estimate the fraction of these diabetes costs that are attributable to obesity, other evidence suggests it may be substantial (see above). The direct and indirect costs of both overweight and obesity: a systematic review. eCollection 2023. 2007 Sep;8(5):467-73. doi: 10.1111/j.1467-789X.2007.00394.x. Studies by Ricci and Chee31 and Pronk et al15 both include measures of presenteeism in addition to absenteeism. Consequently, people with obesity have higher healthcare resource utilization (HRU) rates than individuals with normal BMI, leading to considerable excess healthcare costs.513 Obesity is also associated with substantial indirect costs, such as those related to disability, workers compensation, absenteeism (absence from work, such as sick leave), and presenteeism (reduction in productivity while at work).1119 According to a report by the Milken Institute, in 2016, obesity/overweight and its associated chronic diseases were estimated to account for more than $480 billion in direct healthcare costs and $1.24 trillion in indirect work loss costs in the US.20 To this end, obesity has a large impact on both affected employees and their employers. The https:// ensures that you are connecting to the This study was conducted using data from the Optum Health Reporting and Insights employer claims database (Employer database) from January 1, 2010 to March 31, 2017. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies. The .gov means its official. 1994;5(Suppl 1):34-7 Exclusion criteria included health maintenance organization (HMO) coverage during the study period, for which complete cost information may not be available; Medicare coverage during the study period, for which payment information may not be available; and the presence of any pregnancy-related indication for female patients (eg, any claim with the CPT code: 59xxx; ICD-9-CM: V22.x; ICD-10-CM: Z34.xx). Spine J. The studies reviewed in the final two sections of our paper suggest that these effects may be significant, but further work is needed to explore their full extent and assign consistent economic cost to them. Novo Nordisk Inc., Plainsboro, New Jersey (Ms Ramasamy, Dr Aktavoukian, Dr Smolarz, Dr Ganguly); Groupe danalyse, Lte, Montral, QC, Canada (Mr Lalibert, Mr Lejeune); Analysis Group, Inc., Boston, Massachusetts (Dr DerSarkissian, Ms Cavanaugh, Dr Duh). A review of the literature. An official website of the United States government. However, alternative specifications do not have large effects on the major results. This study reviews the recent literature on the relationship between obesity and indirect (non-medical) costs. Self-esteem and intelligence were also measured at baseline. These issues should be considered in the formulation of policies and activities aimed at preventing obesity. Chukwuonye II, Ohagwu KA, Ogah OS, John C, Oviasu E, Anyabolu EN, Ezeani IU, Iloh GUP, Chukwuonye ME, Raphael CO, Onwuchekwa U, Okafor UH, Oladele C, Obi EC, Okwuonu CG, Iheji O, Nwabuko OC, Nnoli MA, Okpechi IG. Obesity increases lifetime medical care costs for these diseases by 50% above baseline, and severe obesity can almost double them. Employees with yearly healthcare costs or medical-related absenteeism and disability costs at the 80th percentile and above were classified as high-cost employees. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Physical inactivity also costs the nation $117 billion a year for related health care. Finkelstein et al16 use data from the 1998 and 2006 Medical Expenditure Panel Surveys (MEPS) along with National Health Expenditure Accounts data on health spending to construct a regression that controls for demography, smoking status, and insurance status. Consistent with the literature,610,1215,17,19 increasing BMI was found to be associated with increasing direct and indirect healthcare costs in the present study. Multivariate generalized linear models (GLM) with a logit link for binary outcomes were used to estimate the association between obesity classes and high healthcare costs by type of industry. The site is secure. Rather than giving an exhaustive review of absenteeism studies, we summarize here key findings and methodological differences across several recent papers that have addressed the relationship between obesity and absenteeism and the associated costs. GPA is measured by combining self-reported grades received in English/language arts and Math. 19. HHS Vulnerability Disclosure, Help Clin Therapeut. Howard JT, Potter LB. Direct/indirect costs were reported per-patient-per-year (PPPY). Colditz GA, Willett WC, Rotnitzky A, Manson JE. This retrospective study provides further evidence of the strong association between obesity and high costs among US employees, and underscores the unmet need for employers to address this issue and work to alleviate its burden on employees using comprehensive methods. Exp Clin Endocrinol Diabetes. In addition, for 42 of the 84 companies, some work loss data for employees (approximately 4.4 million lives) are available, including short- and long-term disability claims. Obesity has been estimated to cost our nation nearly $173 billion annually in medical costs. Available at: 28. Terms in this set (9) Direct Costs. Am J Ind Med. Overweight and obesity on the island of Ireland: an estimation of costs. Complex systems modeling for obesity research. Moderate and severe, 11. The most common definitions of obesity are based on body mass index (BMI), defined as weight in kilograms divided by height in meters squared. Obesity-related health care accounts for. Conclusion: This approach allows for direct study of individual medical histories (and charged costs) with no aggregation, but relies on self-report for BMI and other initial data. Careers. BMI is assumed to be constant at its initial value for all individuals, with other risk factors adjusted for each year of aging. Relationship of, 32. In this quantitative review of 33 studies, we estimated that the annual direct medical cost of overweight is approximately $266 higher, and the incremental cost of obesity $1723 higher, than that of normal weight persons. 19 While the term direct cost refers to the resources consumed when providing healthcare services (e.g. Keywords: obesity, direct cost, indirect cost, economic burden 1. Diabetes Metab Syndr Obes. The https:// ensures that you are connecting to the PMC Baseline characteristics were measured in 1979, with obesity defined as a BMI over the 95th percentile of the distribution in NHANES, given an individuals age and sex. Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry. obesity, economic impact, United States, economic cost. Unauthorized use of these marks is strictly prohibited. sharing sensitive information, make sure youre on a federal The IP6K Inhibitor LI-2242 Ameliorates Diet-Induced Obesity, Hyperglycemia, and Hepatic Steatosis in Mice by Improving Cell Metabolism and Insulin Signaling. Dall et al argue that the costs of diabetes are borne by all Americans, not only those with diabetes, and amount to a per-person cost of around $700 a year. Identification of employee subpopulations with particularly large obesity burdens may be a way to mitigate obesity-related costs through the introduction of intensive interventions targeted to these groups. A comprehensive review of both the direct and indirect consequences of this condition is necessary to identify the most appropriate measures to be taken, e.g. Generally, studies allow for a nonlinear relationship when modeling the effects of weight on absenteeism by dividing BMI into categories such as under-weight, normal weight, overweight, and obese. Indirect Costs. -, Trogdon J, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ. Caban AJ, Lee DJ, Fleming LE, Gomez-Marin O, LeBlanc W, Pitman T. 22. The incidence of the healthcare costs of obesity. Obesity has taken a toll on health care costs across the countryestimated between $147 billion and $210 billion in direct and indirect health care costs, as of 2010. Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Currently, there are 236 diseases that are associated with obesity including type 2 diabetes, hypertension, and depression. Moreover, studies have shown that the prevalence of obesity varies across different employment indus-tries,21,22 suggesting that occupation-specific nuances may be asso- 2017 United Benefit Advisors Health Plan Survey; 2017. aA rapidly growing body of research has arisen to evaluate potential costs and benefits of specific interventions. A gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Baseline characteristics were evaluated in the 12 months pre-index date (baseline period), while outcomes were evaluated from the index date up to the end of health plan eligibility or end of data availability on March 31, 2017, whichever was earliest (observation period). Sick leave costs were calculated from employees resource utilization. As a library, NLM provides access to scientific literature. sharing sensitive information, make sure youre on a federal Additionally, the role of BMI as a predictor of high healthcare costs was evaluated within each of the industries of employment. What are they? MeSH Van Nuys K, Globe D, Ng-Mak D, Cheung H, Sullivan J, Goldman D. Am J Health Promot. Likewise, they were less likely to be married, had lower household incomes, and higher rates of poverty. Direct healthcare and indirect work loss costs were calculated and expressed as mean cost per-patient-per-year (PPPY). The direct health care costs of obesity in the United States. We systematically review current evidence on each set of costs in turn, and discuss important gaps for future research along with potential trends in future economic impacts of obesity. Wolf AM. 26. The burden of overweight and obesity-related ill health in the UK. . Shrestha N, Pedisic Z, Neil-Sztramko S, Kukkonen-Harjula KT, Hermans V. The impact of, 33. 1993 Sep 30;329(14):1008-12 Private payers bear the majority of estimated costs, although public-sector spending is also substantial Medicare spending would be an estimated 8.5% lower and Medicaid spending 11.8% lower in the absence of obesity. Given existing trends, this amount is projected to range from US$860.7-956.9 billion in healthcare costs by 2030. to maintaining your privacy and will not share your personal information without Jacobson and McLay40 provide a similar annual estimate of the fuel-use impact of obesity in the US. Accessibility Gortmaker et al43 include a broad set of outcome variables, following a cohort from the NLSY (16 to 24 year-olds) for seven years to determine whether membership in a high-BMI category leads to lower income or educational attainment, more health conditions, or lower self-esteem. Clipboard, Search History, and several other advanced features are temporarily unavailable. 8600 Rockville Pike FOIA Patients in the reference cohort were also required to have no diagnosis or BMI code for obesity, overweight, or underweight. 2017 Oct 5;7(10):e014632. Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry. HHS Vulnerability Disclosure, Help Discuss current knowledge of direct and indirect costs associated with obesity, including previous studies of variability between industries. 2023 Mar 29;68:1605595. doi: 10.3389/ijph.2023.1605595. Obesity burdens families, governments, and companies with a variety of direct costs for healthcare, and also indirect costs in lower product Objective: Wang F, McDonald T, Champagne LJ, Edington DW. Potential cost savings could be attained if preventive programs effectively targeted . Compared with non-obese workers, obese workers miss more workdays due to illness, injury, or disability. Their regression analysis concludes that many of the health care costs associated with obesity are passed on to obese workers with employer-sponsored health insurance in the form of lower cash wages. EphA3 deficiency in the hypothalamus promotes high-fat diet-induced obesity in mice. J Biomed Opt. Zhou Y, Mukherjee S, Huang D, Chakraborty M, Gu C, Zong G, Stashko MA, Pearce KH, Shears SB, Chakraborty A, Wang H, Wang X. J Med Chem. Additionally, obesity (especially class III) was significantly associated with higher odds of incurring the highest direct healthcare, medical-related absenteeism, and disability costs across all industries and within most industry types. 2023 Jan 26;15:51-62. doi: 10.2147/CEOR.S392276. Accessibility Evaluation of the direct and indirect costs of obesity by employment industry revealed especially high costs among employees of the GERS, other, and technology industries. Lost some, save some: obesity, automobile demand, and gasoline consumption in the United States. Although cautious in drawing definitive conclusions, they use sales data from 19992005 to estimate that a 10 percentage point increase in overweight/obesity rates reduces average MPG of new vehicles sold by approximately 2.5%. Several papers have estimated the total economic cost of obesity, differentiating only between direct and indirect costs. Regression analysis based on nationally representative surveys is another widely-used approach in the literature on health care costs associated with obesity. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 1992 Feb;55(2 Suppl):503S-507S These examples illustrate the substantial differences found across studies that provide disaggregated estimates for direct and indirect costs of obesity, as well as absenteeism and other sub-categories of indirect costs. The results for nonwhite females are roughly similar in size and significance, with an even lower relative mean GPA among the obese group. 2022 Nov 28;37(3):179-193. doi: 10.7555/JBR.36.20220168. Many of these categories relate to productivity loss originating in the labor market, including absenteeism (first-order productivity costs due to employees being absent from work for obesity-related health reasons) and presenteeism (decreased productivity of employees while at work). Disclaimer. Michaelowa A, Dransfield B. Iran J Public Health. While patients in the reference cohort were chosen because they had no claims for BMI in obesity or overweight categories, this does not guarantee that they did not have undiagnosed obesity, which could have potentially led to an overestimation of cost in the reference cohort and an underestimation of the burden of obesity. The productivity costs of obesity have been well-documented in a variety of studies, with widespread consensus that such costs are substantial, but with important differences in magnitude between the individual estimates. doi: 10.1111/j.1467-789X.2008.00472.x. However, direct comparison of results across studies is difficult due to such factors as the date of measurement, representativeness of the sample, and scope of measurement. Epub 2014 Nov 8. Direct costs include those discussed in the first section of this paper, while indirect costs focus on premature mortality, higher disability insurance premiums, and labor market productivity. Smith MH, Myrick JW, Oyageshio O, Uren C, Saayman J, Boolay S, van der Westhuizen L, Werely C, Mller M, Henn BM, Reynolds AW. Despite the variability in job demands, mobility, and work conditions of each of the industries studied, class III obesity significantly increased the odds of having high direct and indirect costs in employees across all industries. While extrapolated workers compensation costs were relatively minimal compared with other cost components, as similarly observed in previous reports,12,13 extrapolated presenteeism costs accounted for 20% to 30% of the total direct and indirect costs in the overall population with obesity. Unable to load your collection due to an error, Unable to load your delegates due to an error. Several of the studies reviewed focus on only a subset of these effects, and there is extensive variation in cost estimates. The relationship between relative weight and school attendance among elementary schoolchildren. Third, important additional economic impacts of obesity can be found in the form of transportation costs and human capital accumulation costs. Of that, $2.4 billion was spent on paid sick leave, $1.8 billion on life insurance, and $0.8 billion on disability insurance. After controlling for age, sex, smoking and exercise, they compare statistical differences in mean QWB scores between obese and nonobese BMI groups. National Library of Medicine Durden et al29 show that obese workers were 194% more likely to use paid time off than their counterparts. Flegal KM, Carroll MD, Ogden CL, et al. 2015 Mar 16;5(3):e006189. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz W. Social and economic consequences of overweight in adolescence and young adult-hood. Bethesda, MD 20894, Web Policies Scuderi GJ, Sherman AL, Brusovanik GV, Pahl MA, Vaccaro AR. labor for providing medical services), the term indirect cost refers to the loss in economic production caused by illness (e.g. Burkhauser and Cawley32 study the effects of obesity both on self-reported work impairment and Social Security Disability Insurance. These results were based on the four highest quality studies. Michaelowa and Dransfield42 conduct an Organization for Economic Co-operation and Development (OECD)-wide study of the impact of obesity on greenhouse gas emissions through three channels: higher fuel consumption needed to transport heavier people, greater food production needed to feed a population with higher caloric intake, and higher methane emissions resulting from the greater organic waste generated by a heavier population. Effects of obesity and overweight on educational attainment both quantity and quality of schooling also represent a potential economic impact, one that may become increasingly significant as rates of childhood and adolescent obesity climb. Direct and indirect healthcare costs (including extrapolated presenteeism and workers compensation) varied across each of the eight industries studied, but a general trend of increasing costs with increasing BMI was observed (Fig. The results are mostly not statistically significant, though when they are, the effects are quite large. This site needs JavaScript to work properly. Of note, the Employer database contains no information to measure the indirect impact costs of obesity on presenteeism and workers compensation. National Library of Medicine Future direct and indirect costs of obesity and the influence of gaining weight: results from the MONICA/KORA cohort studies, 1995-2005. 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. 4) and medical-related absenteeism and disability costs (Fig. Losses in productivity due to illnesses associated with obesity are considerable. Wolf14 and Pronk et al15 studied health care costs among a stratified random sample (n = 5,689) drawn from members of a managed care organization in Minnesota aged 40 and older. Patients were included in the study if they were aged 18 to 64 years at the index date and had continuous health plan enrollment in the 12 months prior to the index date (baseline period) and 3 months after the index date. Careers. To do this, the authors measure the change in the highest grade completed by an individual between ages t-1 and t. The study includes respondents aged 14 to 17, and models the effects of obesity on grade progression separately for each age, using three different models. Epidemiological correlates of overweight and obesity in the Northern Cape Province, South Africa. In the class I cohort, employees of the finance and insurance industry had the highest odds of incurring high direct costs (OR [95% CI] = 1.72 [1.26; 2.35]), while employees of the retail stores and consumer goods industry had the highest odds of incurring high medical-related absenteeism and disability costs (5.17 [2.04; 13.14]; both P < 0.05). Of these, effects on productivity play the largest role empirically. and transmitted securely. The Employer database includes administrative claims for over 19.1 million privately insured individuals covered by 84 self-insured Fortune 500 companies in the US for services provided from 1999 through the first quarter of 2017. J R Soc Health. The overweight (BMI 2529) had 37% higher prescription costs and 13% higher primary-care costs than the healthy-weight group. Future research could effectively parse the source of the differences across studies, making results more comparable in order to get a better sense of the total and relative magnitudes of obesitys likely economic impacts. There is a consistent negative relationship between weight and GPA among females, though the magnitude is not very large. Pharmacoeconomics. BMJ Open. The https:// ensures that you are connecting to the Econ Hum Biol. Unauthorized use of these marks is strictly prohibited. Please enable it to take advantage of the complete set of features! This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. For women, the increased probability of receiving disability is 5.64 percentage points, which is the equivalent of losing 16.7 years of education. Studies vary by the measures used to identify obesity the most common is BMI, but several studies use weight directly (and control for height in regression analysis). The result most consistently identified across the studies is a positive and statistically significant correlation between obesity and measures of absenteeism, even after controlling for the covariates discussed above. doi: 10.1136/bmjopen-2014-006189. A pair of recent studies examines who ultimately bears the health care costs associated with obesity. 1997;53(2):253263. The cost differences were $1775 (95% CI = 1166; 2537) PPPY between the obesity class I and reference cohorts, $3468 (2704; 4336) PPPY between class II and reference, and $11,481 (10,752; 12,213) PPPY between class III and reference (P < 0.05 for all comparisons). Epub 2022 Apr 25. At a prevailing price of $0.79/gal, they calculate the extra airline fuel cost due to higher obesity to be approximately $275 million in the year 2000 alone. 2022 Apr 5;15:1031-1039. doi: 10.2147/DMSO.S345973. 2008 Sep;9(5):489-500. doi: 10.1111/j.1467-789X.2008.00472.x. 2023 Apr 18;12(8):e026777. PMC Unable to load your collection due to an error, Unable to load your delegates due to an error. We conducted a broad search of the literature that addresses potential economic costs of obesity. Prevalence of obesity, diabetes, and obesity-related health risk factors. Based on Kleinman et al,12 workers compensation costs were calculated as 0.27-times the short- and long-term disability costs for the reference cohort and as 0.43-times the short- and long-term disability costs for the obesity class I, II, and III cohorts. Indirect costs of obesity: a review of the current literature. Dall TM, Zhang Y, Chen YJ, Quick WW, Yangh WG, Fogli J. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. Screening and Interventions for Childhood Overweight [Internet]. Epub 2015 Dec 23. Over the past several decades, obesity has grown into a major global epidemic. The impact of obesity on illness absence and productivity in an industrial population of petrochemical workers.

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