Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Paper
  • Published:

Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study

International Journal of Obesity volume 26, pages 184–192 (2002)Cite this article

Abstract

BACKGROUND: Although intentional weight reduction improves obesity-related comorbidities, the associations between weight reduction, medication and related costs are rarely studied. This study investigates the long-term effects of weight change on medication for diabetes and cardiovascular disease (CVD) in severely obese subjects.

METHODS: In the intervention study Swedish Obese Subjects, 510 surgically and 455 conventionally treated obese patients have so far been followed for 6 y. Changes in the use and costs of medication were analyzed in relation to treatment and weight change.

RESULTS: In comparison with controls, larger fraction of surgically treated patients discontinued the use of medication for CVD and diabetes at 2 and 6 y (risk ratios 0.56–0.77). Among subjects not initially on medication, surgery reduced the frequency of started treatments (risk ratios 0.08–0.80). Relative weight loss ≥10% was necessary to reduce costs of medication for CVD and diabetes among subjects with such treatment at baseline. To reduce initiation of new treatment against the two conditions, weight loss ≥15% was required. Over 6 y, the average annual cost for diabetes and CVD medication increased by 463 SEK (96%) in subjects with weight loss <5%, and decreased by 39 SEK(8%) in the weight loss group ≥15%.

CONCLUSION: Long-term intentional weight loss is associated with reduced medication and medication costs for diabetes and CVD. The effects appear to be more marked among subjects who are initially on medication for these conditions, whereas greater weight reduction is needed to prevent new subjects from starting on medication.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Simmons G, Jackson R, Swinburn B, Yee RL . The increasing prevalence of obesity in New Zealand: is it related to recent trends in smoking and physical activity? NZ Med J 1996 109: 90–92.

    CAS  Google Scholar 

  2. Wolk A, Rössner S . Effects of smoking and physical activity on body weight: developments in Sweden between 1980 and 1989 J Intern Med 1995 237: 287–291.

    Article  CAS  Google Scholar 

  3. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL . Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991. JAMA 1994 272: 205–211.

    Article  CAS  Google Scholar 

  4. Sprafka JM, Burke GL, Folsom AR, Luepker RV, Blackburn H . Continued decline in cardiovascular disease risk factors: results of the Minnesota Heart Survey, 1980–1982 and 1985–1987 Am J Epidemiol 1990 132: 489–500.

    Article  CAS  Google Scholar 

  5. WHO . Obesity: preventing and managing the global epidemic Report of a WHO consultation on obesity World Health Organization: Geneva 1998.

    Google Scholar 

  6. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH . The disease burden associated with overweight and obesity JAMA 1999 282: 1523–1529.

    Article  CAS  Google Scholar 

  7. Burton BT, Foster WR, Hirsch J, Van Itallie TB . Health implications of obesity: an NIH Consensus Development Conference Int J Obes 1985 9: 155–170.

    CAS  PubMed  Google Scholar 

  8. Bray GA . Complications of obesity Ann Intern Med 1985 103: 1052–1062.

    Article  CAS  Google Scholar 

  9. Garfinkel L . Overweight and cancer Ann Intern Med 1985 103: 1034–1036.

    Article  CAS  Google Scholar 

  10. Wolf AM, Colditz GA . Current estimates of the economic cost of obesity in the United States Obes Res 1998 6: 97–106.

    Article  CAS  Google Scholar 

  11. Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH . The cost of obesity in Canada Can Med Assoc J 1999 160: 483–488.

    CAS  Google Scholar 

  12. Detournay B, Fagnani F, Phillippo M, Pribil C, Charles MA, Sermet C, Basdevant A, Eschwege E . Obesity morbidity and health care costs in France: an analysis of the 1991–1992 Medical Care Household Survey Int J Obes Relat Metab Disord 2000 24: 151–155.

    Article  CAS  Google Scholar 

  13. Segal L, Carter R, Zimmet P . The cost of obesity. The Australian perspective PharmacoEconomics 1994 5(Suppl 1): 45–52.

    Article  CAS  Google Scholar 

  14. Seidell JC, Deerenberg I . Obesity in Europe. Prevalence and consequences for use of medical care PharmacoEconomics 1994 5(Suppl 1): 38–44.

    Article  CAS  Google Scholar 

  15. Swinburn B, Ashton T, Gillespie J, Cox B, Menon A, Simmons D, Birkbeck J . Health care costs of obesity in New Zealand Int J Obes Relat Metab Disord 1997 21: 891–896.

    Article  CAS  Google Scholar 

  16. Ashley FW Jr, Kannel WB . Relation of weight change to changes in atherogenic traits: the Framingham Study J Chron Dis 1974 27: 103–114.

    Article  Google Scholar 

  17. Sjöström CD, Lissner L, Wedel H, Sjöström L . Reduction in incidence of diabetes, hypertension and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study Obes Res 1999 7: 477–484.

    Article  Google Scholar 

  18. Eriksson KF, Lindgärde F . Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. The 6-year Malmo feasibility study Diabetologia 1991 34: 891–898.

    Article  CAS  Google Scholar 

  19. Schotte DE, Stunkard AJ . The effects of weight reduction on blood pressure in 301 obese patients Arch Intern Med 1990 150: 1701–1704.

    Article  CAS  Google Scholar 

  20. Greenway FL, Ryan DH, Bray GA, Rood JC, Tucker EW, Smith SR . Pharmaceutical cost savings of treating obesity with weight loss medications Obes Res 1999 7: 523–531.

    Article  CAS  Google Scholar 

  21. Collins RW, Anderson JW . Medication cost savings associated with weight loss for obese non-insulin-dependent diabetic men and women Prev Med 1995 24: 369–374.

    Article  CAS  Google Scholar 

  22. Sjöström L, Larsson B, Backman L, Bengtsson C, Bouchard C, Dahlgren S, Hallgren P, Jonsson E, Karlsson J, Lapidus L et al. Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state Int J Obes Relat Metab Disord 1992 16: 465–79.

    PubMed  Google Scholar 

  23. Deitel M . Surgery for the morbidly obese patient Lea & Febiger: Philadelphia, PA 1989.

    Google Scholar 

  24. Sullivan M, Karlsson J, Sjöström L, Backman L, Bengtsson C, Bouchard C, Dahlgren S, Jonsson E, Larsson B, Lindstedt S et al. Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined Int J Obes Relat Metab Disord 1993 17: 503–512.

    CAS  PubMed  Google Scholar 

  25. FASS, 1999 . Läkemedel i Sverige (FASS 1999. Pharmaceutics in Sweden). LINFO Läkemedelsinformation AB: Stockholm 1999.

    Google Scholar 

  26. Wacholder S . Binomial regression in GLIM: estimating risk ratios and risk differences Am J Epidemiol 1986 123: 174–184.

    Article  CAS  Google Scholar 

  27. Cytel . StatXact-4 Cytel Software Corporation: Cambridge, MA 1998.

    Google Scholar 

  28. Efron B, Tibshirani R . An Introduction to the Bootstrap Monographs on Statistics and Applied Probability 57 Chapman & Hall: New York 1993.

    Chapter  Google Scholar 

  29. StataCorp . Stata Statistical Software: Release 7.0 Stata Corporation: College Station, TX 2001.

    Google Scholar 

  30. Sjöström CD, Peltonen M, Wedel H, Sjöström L . Differentiated long-term effects of intentional weight loss on diabetes and hypertension Hypertension 2000 36: 20–25.

    Article  Google Scholar 

  31. Narbro K, Jonsson E, Larsson B, Waaler H, Wedel H, Sjöström L . Economic consequences of sick-leave and early retirement in obese Swedish women Int J Obes Relat Metab Disord 1996 20: 895–903.

    CAS  PubMed  Google Scholar 

  32. Narbro K, Ågren G, Jonsson E, Larsson B, Näslund I, Wedel H, Sjöström L . Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study Int J Obes Relat Metab Disord 1999 23: 619–624.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to members of the steering, laboratory, and safety monitoring committees of the SOS. Furthermore, we are indebted to the staff at 25 surgical clinics and 480 primary healthcare centers in Sweden for their excellent help and cooperation. This study was supported by grants from The Swedish Medical Research Council (grant no. 05239), Stockholm, Sweden; and Hoffmann-La Roche Ltd, Basel, Switzerland. Support was also obtained from The Volvo Research Foundation, Göteborg; CEFOS, Göteborg; The Swedish Social Welfare Board, Stockholm; Ministry of Education, Stockholm; Scandia Insurance, Stockholm; and the Research Committee of Örebro County Council, all in Sweden.

Author information

Authors and Affiliations

  1. Department of Surgery, Örebro Medical Centre Hospital, Örebro, Sweden

    G Ågren & I Näslund

  2. Department of Medicine, Göteborg University, Sahlgrenska University Hospital, Göteborg, Sweden

    K Narbro, L Sjöström & M Peltonen

Authors
  1. G Ågren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Narbro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I Näslund
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Sjöström
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M Peltonen
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ågren, G., Narbro, K., Näslund, I. et al. Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int J Obes 26, 184–192 (2002). https://doi.org/10.1038/sj.ijo.0801864

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ijo.0801864

Keywords

This article is cited by

Search

Advanced search

Quick links