Abstract
BackgroundThe rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. 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. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included.MethodsA computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies.ResultsFive published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs.ConclusionA gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.
Highlights
The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy
This review examines the literature that has focussed on both the direct and indirect costs of overweight and obesity
The healthcare costs associated with obesity are typically calculated using two main approaches, a top down method based on estimation of population attributable fractions (PAF method) and two “bottom up” methods, based on analyses of cross-sectional and longitudinal datasets respectively
Summary
The rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by topdown approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The longitudinal approach may provide the most accurate estimates of the cost of overweight and obesity as the occurrence of health outcomes and sickness related absenteeism is measured directly in a group of individuals who are followed over time Such data are rare and resource intense in collection, the duration of follow-up required to accrue sufficient events is typically in decades and participants in longitudinal cohort studies are often poorly representative of the wider population, thereby constraining the generalisability of the findings
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