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Health Economics

Economic costs of obesity: a systematic review

International Journal of Obesity volume 48, pages 33–43 (2024)Cite this article

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Abstract

Introduction

Obesity is a growing public health problem leading to substantial economic impact. This study aimed to summarize the economic impact of obesity and to critically analyze the methods used in the cost-of-illness (COI) studies on obesity.

Methods

We conducted systematic search in PubMed and Scopus from September 1, 2016, to July 22, 2022. Original COI studies estimating the economic cost of obesity and/or overweight in at least one country, published in English were included. To facilitate the comparison of estimates across countries, we converted the cost estimates of different years to 2022 purchasing power parity (PPP) values using each country’s consumer price index (CPI) and PPP conversion rate.

Results

Nineteen studies were included. All studies employed a prevalence-based approach using Population Attributable Fraction (PAF) methodology. About half of the included studies (53%) were conducted in high-income countries while the others (47%) were conducted in middle-income countries. The economic burden of obesity ranged between PPP 15 million in Brazil to PPP 126 billion in the USA, in the year 2022. Direct medical costs accounted for 0.7% to 17.8% of the health system expenditure. Furthermore, the total costs of obesity ranged from 0.05% to 2.42% of the country’s gross domestic product (GDP). Of the seven studies that estimated both direct and indirect costs, indirect costs accounted for the largest portion of five studies. Nevertheless, a variety in methodology across studies was identified. The number of co-morbidities included in the analysis varied across studies.

Conclusions

Although there was a variety of methodologies across studies, consistent evidence indicated that the economic burden of obesity was substantial. Obesity prevention and control should be a public health priority, especially among countries with high prevalence of obesity.

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Fig. 1: PRISMA flow diagram of search procedure.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. WHO. Obesity and overweight. Key facts. In, 2021.

  2. Chu D-T, Minh Nguyet NT, Dinh TC, Thai Lien NV, Nguyen K-H, Nhu Ngoc VT, et al. An update on physical health and economic consequences of overweight and obesity. Diab Metab Syndr: Clin Res Rev. 2018;12:1095–1100.

    Article  Google Scholar 

  3. Park A. Pathophysiology and aetiology and medical consequences of obesity. Medicine. 2019;47:169–74.

    Article  Google Scholar 

  4. Bray GA, Kim KK, Wilding JPH. On behalf of the World Obesity F. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017;18:715–23.

    Article  CAS  PubMed  Google Scholar 

  5. OECD. The heavy burden of obesity: the economics of prevention, OECD Health Policy Studies, OECD Publishing, Paris, OECD, 2019.

  6. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol. 2014;20:327–37.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dobbs R, Sawers C, Thompson F, Manyika J, Woetzel JR, Child P, et al. Overcoming obesity: an initial economic analysis, McKinsey global institute, 2014.

  8. Greenberg D, Mohamed Ibrahim MI, Boncz I. What Are the Challenges in Conducting Cost-of-Illness Studies? Value Health Reg Issues. 2014;4:115–6.

    Article  PubMed  Google Scholar 

  9. Onukwugha E, McRae J, Kravetz A, Varga S, Khairnar R, Mullins CD. Cost-of-Illness Studies: An Updated Review of Current Methods. Pharmaco Econ. 2016;34:43–58.

    Article  Google Scholar 

  10. Dee A, Kearns K, O’Neill C, Sharp L, Staines A, O’Dwyer V, et al. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes. 2014;7:242.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Goettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open. 2017;7:e014632.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obes Rev: Official J Int Assoc Study Obes. 2017;18:869–79.

    Article  Google Scholar 

  13. Specchia M, Veneziano M, Cadeddu C, Ferriero A, Mancuso A, Ianuale C, et al. Economic impact of adult obesity on health systems: A systematic review. Eur J Public Health. 2014;25:255–62.

    Article  PubMed  Google Scholar 

  14. Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economic Burden of Obesity: A Systematic Literature Review. Int J Environ Res Public Health. 2017;14:435.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev: Official J Int Assoc Study Obes. 2011;12:131–41.

    Article  CAS  Google Scholar 

  16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ding D, Kolbe-Alexander T, Nguyen B, Katzmarzyk PT, Pratt M, Lawson KD. The economic burden of physical inactivity: a systematic review and critical appraisal. Br J Sports Med. 2017;51:1392–409.

    Article  PubMed  Google Scholar 

  18. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health. 2013;16:e1–5.

    Article  PubMed  Google Scholar 

  19. International Monetary Fund (IMF). World Economic Outlook Database. In, 2022.

  20. Oanda Corporation. Forex data services. Currency Converter. Foreign echange rates. In, 2023.

  21. Aboulghate M, Elaghoury A, Elebrashy I, Elkafrawy N, Elshishiney G, Abul-Magd E, et al. The Burden of Obesity in Egypt. Front Public Health. 2021;9:718978.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Andersson E, Eliasson B, Steen, Carlsson K. Current and future costs of obesity in Sweden. Health policy (Amsterdam, Netherlands). 2022;126:558–64.

    Article  PubMed  Google Scholar 

  23. Boachie MK, Thsehla E, Immurana M, Kohli-Lynch C, Hofman KJ. Estimating the healthcare cost of overweight and obesity in South Africa. Global Health Action. 2022;15:2045092.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Coker T, Saxton J, Retat L, Alswat K, Alghnam S, Al-Raddadi RM, et al. The future health and economic burden of obesity-attributable type 2 diabetes and liver disease among the working-age population in Saudi Arabia. PloS one. 2022;17:e0271108.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Corrêa Ferreira da Silva R, Bahia LR, Machado da Rosa MQ, Malhão TA, Mendonça EP, Rosa RDS, et al. Costs of cancer attributable to excess body weight in the Brazilian public health system in 2018. PloS one. 2021;16:e0247983.

    Article  PubMed  PubMed Central  Google Scholar 

  26. d’Errico M, Pavlova M, Spandonaro F. The economic burden of obesity in Italy: a cost-of-illness study. Eur J Health Econ: HEPAC: Health Econ Prevention Care. 2022;23:177–92.

    Article  Google Scholar 

  27. Destri K, Alves J, Gregório MJ, Dias SS, Henriques AR, Mendonça N, et al. Obesity- attributable costs of absenteeism among working adults in Portugal. BMC Public Health. 2022;22:978.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ferrari G, Giannichi B, Resende B, Paiva L, Rocha R, Falbel F, et al. The economic burden of overweight and obesity in Brazil: perspectives for the Brazilian Unified Health System. Public Health. 2022;207:82–87.

    Article  CAS  PubMed  Google Scholar 

  29. Gearon E, Backholer K, Lal A, Nusselder W, Peeters A. The case for action on socioeconomic differences in overweight and obesity among Australian adults: modelling the disease burden and healthcare costs. Australian New Zealand J Public Health. 2020;44:121–8.

    Article  Google Scholar 

  30. Gil-Rojas Y, Garzón A, Hernández F, Pacheco B, González D, Campos J, et al. Burden of Disease Attributable to Obesity and Overweight in Colombia. Value Health Reg Issues. 2019;20:66–72.

    Article  PubMed  Google Scholar 

  31. Hoque ME, Molla AA, Hoque DM, Long KZ, Mamun AA. Health care cost of overweight-related diseases in Bangladesh. Public Health Nutr. 2020;23:2395–401.

    Article  PubMed  Google Scholar 

  32. Krueger H, Andres EN, Koot JM, Reilly BD. The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada. Curr Oncol (Toronto, Ont.). 2016;23:241–9.

    CAS  Google Scholar 

  33. Lee JE, Nam CM, Lee SG, Park S, Kim TH, Park EC. The economic burden of cancer attributable to obesity in Korea: A population-based cohort study. Eur J Cancer Care. 2019;28:e13084.

    Article  Google Scholar 

  34. Lee JW, Choi YE, Kim DW, Lee S, Cho KH. Trends in socioeconomic costs of morbid obesity among Korean adults, 2009-13: Data from National Health Insurance Service. Obes Res Clin Practice. 2018;12:389–93.

    Article  Google Scholar 

  35. Malkin JD, Baid D, Alsukait RF, Alghaith T, Alluhidan M, Alabdulkarim H, et al. The economic burden of overweight and obesity in Saudi Arabia. PloS one. 2022;17:e0264993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Okunogbe A, Nugent R, Spencer G, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for eight countries. BMJ Glob Health. 2021;6:e006351.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Rezende LFM, Malhão TA, da Silva Barbosa R, Schilithz AOC, da Silva RCF, Moreira LGM, et al. The future costs of cancer attributable to excess body weight in Brazil, 2030-40. BMC Public Health. 2022;22:1236.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Riantoro BD, Kristina SA, Endarti D. Estimating Premature Mortality Cost of Cancers Attributable to Obesity in Indonesia. Asian Pacific J Cancer Prev: APJCP. 2019;20:87–90.

    Article  Google Scholar 

  39. van den Broek-Altenburg E, Atherly A, Holladay E. Changes in healthcare spending attributable to obesity and overweight: payer- and service-specific estimates. BMC Public Health. 2022;22:962.

    Article  PubMed  PubMed Central  Google Scholar 

  40. World Obesity Federation, World Obesity Atlas. In, 2023.

  41. Danaei G, Robins JM, Young JG, Hu FB, Manson JE, Hernán MA. Weight Loss and Coronary Heart Disease: Sensitivity Analysis for Unmeasured Confounding by Undiagnosed Disease. Epidemiology. 2016;27:302–10.

    PubMed  PubMed Central  Google Scholar 

  42. Haase CL, Lopes S, Olsen AH, Satylganova A, Schnecke V, McEwan P. Weight loss and risk reduction of obesity-related outcomes in 0.5 million people: evidence from a UK primary care database. Int J Obes. 2021;45:1249–58.

    Article  Google Scholar 

  43. Bray GA, Kim KK, Wilding JPH. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev: Official J Int Assoc Study Obes. 2017;18:715–23.

    Article  CAS  Google Scholar 

  44. Jastreboff AM, Kotz CM, Kahan S, Kelly AS, Heymsfield SB. Obesity as a Disease: The Obesity Society 2018 Position Statement. Obesity (Silver Spring, Md.). 2019;27:7–9.

    Article  PubMed  Google Scholar 

  45. Ciciurkaite G, Moloney ME, Brown RL. The Incomplete Medicalization of Obesity: Physician Office Visits, Diagnoses, and Treatments, 1996-2014. Public health reports (Washington, D.C. : 1974). 2019;134:141–9.

    Article  PubMed  Google Scholar 

  46. de Heer H, Kinslow B, Lane T, Tuckman R, Warren M. Only 1 in 10 Patients Told to Lose Weight Seek Help From a Health Professional: A Nationally Representative Sample. American journal of health promotion: AJHP. 2019;33:1049–52.

    Article  PubMed  Google Scholar 

  47. Tucker S, Bramante C, Conroy M, Fitch A, Gilden A, Wittleder S, et al. The Most Undertreated Chronic Disease: Addressing Obesity in Primary Care Settings. Current obesity reports. 2021;10:396–408.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Camilleri M, Malhi H, Acosta A. Gastrointestinal Complications of Obesity. Gastroenterology. 2017;152:1656–70.

    Article  PubMed  Google Scholar 

  49. Pugliese G, Liccardi A, Graziadio C, Barrea L, Muscogiuri G, Colao A. Obesity and infectious diseases: pathophysiology and epidemiology of a double pandemic condition. Int J Obes. 2022;46:449–65.

    Article  CAS  Google Scholar 

  50. Sarwer DB, Polonsky HM. The Psychosocial Burden of Obesity. Endocrinol Metaboli Clin North America. 2016;45:677–88.

    Article  Google Scholar 

  51. Ewing E. Weight bias and stigmatisation: what is it and what can we do about it? Br J Gen Prac:J Royal College of General Practitioners. 2019;69:349.

    Article  Google Scholar 

  52. Singh K, Russell-Mayhew S, von Ranson K, McLaren L. Is there more to the equation? Weight bias and the costs of obesity. Canadian J Public Health. 2019;110:17–20.

    Article  Google Scholar 

  53. Lobstein T, Brinsden H, Neveux M World Obesity Atlas 2022. In, 2022.

  54. Brooks-Pollock E, Danon L. Defining the population attributable fraction for infectious diseases. Int J Epidemiol. 2017;46:976–82.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Greenland S. Concepts and pitfalls in measuring and interpreting attributable fractions, prevented fractions, and causation probabilities. Ann Epidemiol. 2015;25:155–61.

    Article  PubMed  Google Scholar 

  56. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380:219–29.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Khosravi A, Mansournia MA. Methodological issues estimating population attributable fraction related to ‘Health care cost of overweight-related diseases in Bangladesh’. Public Health Nutr. 2021;24:4195–4195.

    Article  PubMed  Google Scholar 

  58. Khosravi A, Nielsen RO, Mansournia MA. Methods matter: population attributable fraction (PAF) in sport and exercise medicine. Br J Sports Med. 2020;54:1049.

    Article  PubMed  Google Scholar 

  59. Lin C-K, Chen S-T. Estimation and application of population attributable fraction in ecological studies. Environmental Health. 2019;18:52.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Poole C. A History of the Population Attributable Fraction and Related Measures. Ann Epidemiol. 2014;25:147–54.

    Article  PubMed  Google Scholar 

  61. Rezende L, Eluf-Neto J. Population attributable fraction: planning of diseases prevention actions in Brazil. Revista de Saúde Pública 2016;50:30.

  62. Berger NA. Young Adult Cancer: Influence of the Obesity Pandemic. Obesity. 2018;26:641–50.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to gratefully acknowledge Health Technology Assessment international (HTAi), Alberta- Canada and Mahidol University, Bangkok- Thailand. The findings, interpretations and conclusions expressed in this article do not necessarily reflect the views of the aforementioned agencies.

Author information

Authors and Affiliations

  1. Doctor of Philosophy Program in Social, Economic and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

    Mouaddh Abdulmalik Nagi

  2. Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen

    Mouaddh Abdulmalik Nagi & Hanan Ahmed

  3. Master of Public Health, Faculty of Public Health, Mahidol University, Bangkok, Thailand

    Hanan Ahmed

  4. Master of Public Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Mustafa Ali Ali Rezq

  5. Faculty of Pharmacy, Sana’a University, Sana’a, Yemen

    Mustafa Ali Ali Rezq

  6. Social and Administrative Pharmacy Excellence Research (SAPER) unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

    Sermsiri Sangroongruangsri, Usa Chaikledkaew & Montarat Thavorncharoensap

  7. Prince Sattam Bin Abdulaziz University, Department of Clinical Pharmacy, Al-Kharj, Riyadh, Saudi Arabia

    Ziyad Almalki

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Contributions

All authors attest they meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship. All authors contributed to the study conception and design. Searching were performed by MAN. Study selection, quality assessment, and data extraction were performed by MAN, HA, and MAAR. All authors contributed to the data analysis and interpretation. The first draft of the manuscript was written by MAN. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Montarat Thavorncharoensap.

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Competing interests

MAN, HA, MAAR, SS, MT, UC, and ZA declare that they have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Nagi, M.A., Ahmed, H., Rezq, M.A.A. et al. Economic costs of obesity: a systematic review. Int J Obes 48, 33–43 (2024). https://doi.org/10.1038/s41366-023-01398-y

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