An economy of scales: A selective review of obesity's economic causes, consequences, and solutions

Does college selectivity reduce obesity? A partial identification approach

We use data from the National Longitudinal Study of Adolescent to Adult Health to investigate whether the quality of tertiary education -measured by college selectivity-causally affects obesity prevalence in the medium run (by age 24-34) and in the longer run (about 10 years later). We use partial identification methods, which allow us, while relying on weak assumptions, to overcome the potential endogeneity of college selectivity as well as the potential violation of the stable unit treatment value assumption due to students interacting with each other, and to obtain informative identification regions for the average treatment effect of college selectivity on obesity. We find that attending a more selective college causally reduces obesity, both in the medium and in the longer run. We provide evidence that the mechanisms through which the impact of college selectivity on obesity operates include an increase in income, a reduction in physical inactivity and in the consumption of fast food and sweetened drinks.

The hidden cost of sophistication: economic complexity and obesity

Obesity has become a global health crisis, affecting people of all ages, regions, and socio-economic backgrounds. While individual behaviour and genetic factors contribute to obesity, the role of economic complexity in the evolution of obesity rates has not yet been empirically studied. Using a large panel of 110 countries over the period 1976-2015, this article estimates the linear and non-linear links between obesity and economic complexity. According to baseline results, an improvement in economic complexity will lead to an increase in obesity up to a certain threshold. Beyond this turning point, any further increase in economic complexity will significantly contribute to obesity reduction. The issue of simultaneity is tackled using the two-stage instrumental variable method. Our findings support the Obesity Kuznets Curve (OKC) pattern, which suggests that economic progress and obesity have an inverted U-shaped relationship. Our results suggest that greater embeddedness of knowledge in the products produced and exported by a country increases the likelihood of obesity in society, at least up to a threshold. From these results, some important policy implications are discussed.

The association between body mass index and health-related quality of life in the 2017 and 2018 health survey of England data: A cross-sectional observational analysis

AIM

To provide an updated estimate of the association between body mass index (BMI) and health-related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions.

MATERIALS AND METHODS

The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity-related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling.

RESULTS

The study found a significant association between HRQoL and BMI, which exhibited an inverted U-shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification.

CONCLUSIONS

Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity-related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity.

Geographical patterns of implementing a government subsidy program: implications for health outcomes and nutrient intake in Iran

Introduction

The lack of access to a diverse and nutritious diet has significant health consequences worldwide. Governments have employed various policy mechanisms to ensure access, but their success varies.

Method

In this study, the impact of changes in food assistance policy on food prices and nutrient security in different provinces of Iran, a sanctioned country, was investigated using statistical and econometric models.

Results

Both the old and new policies were broad in scope, providing subsidized food or cash payments to the entire population. However, the implementation of these policies led to an increase in the market price of food items, resulting in a decline in the intake of essential nutrients. Particularly, the policy that shifted food assistance from commodity subsidies to direct cash payments reduced the price sensitivity of consumers. Consequently, the intake of key nutrients such as Vitamin C and Vitamin A, which are often constrained by their high prices, decreased. To improve the diets of marginalized populations, it is more effective to target subsidies towards specific nutrient groups and disadvantaged populations, with a particular focus on food groups that provide essential nutrients like Vitamin A and Vitamin C in rural areas of Iran.

Discussion

More targeted food assistance policies, tailored to the specific context of each province and income level, are more likely to yield positive nutritional outcomes with minimal impact on food prices.

Peer effects in weight-related behaviours of young people: A systematic literature review

Individual preferences and beliefs are perpetually shaped by environmental influences, with peers playing a key role in this dynamic process. Compelling evidence from qualitative and quantitative studies has highlighted the significant impact of peer influence on health-related decisions. This systematic literature review critically synthesises findings from 45 studies published between 2011 and 2022, providing a comprehensive understanding of the nature of peer effects on dietary, physical activity and sleep behaviours during youth. The majority of studies indicated that social norms drive directional changes in eating and physical activity. Yet, our analysis revealed a notable gap in exploring alternative mechanisms, including social comparison and social identity, despite their potential relevance. Studies, generally classified as moderate to high quality, predominantly relied on self-reported data, potentially affecting the validity and reliability of measures. Meta-regression analyses suggest a small, but significant association of sample size with the magnitude, sign and significance of the reported peer effects. Moreover, studies focusing on physical activity are more likely to report significant outcomes, whereas findings on peer influence on sleep-related studies tend to reveal less pronounced effects, compared to studies on dietary behaviours. Experimental designs do not appear to increase the likelihood of finding significant effects when compared to other study designs. In conclusion, this synthesis emphasises the need for further research into the underlying mechanisms on peer effects to better inform policy-makers in designing effective policies for improving weight-related behaviours in young people.

Lifetime costs of overweight and obesity in Italy

We use longitudinal electronic clinical data on a large representative sample of the Italian population to estimate the lifetime profile costs of different BMI classes - normal weight, overweight, and obese (I, II, and III) - in a primary care setting. Our research reveals that obese patients generate the highest cost differential throughout their lives compared to normal weight patients. Moreover, we show that overweight individuals spend less than those with normal weight, primarily due to reduced expenditures beginning in early middle age. Our estimates could serve as a vital benchmark for policymakers looking to prioritize public interventions that address the obesity pandemic while considering the increasing obesity rates projected by the OECD until 2030.

Fast food proximity and weight gain in childhood and adolescence: Evidence from Great Britain

We study the relationship between proximity to fast food restaurants and weight gain from late childhood to early adolescence. We use the Millennium Cohort Study, a UK-wide nationally representative longitudinal study, linked with granular geocoded food outlet data to measure the presence of fast food outlets around children's homes and schools from ages 7 to 14. We find that proximity to fast food outlets is associated with increased weight (body mass index, overweight, obese, body fat, weight), but only among those with maternal education below degree level. Within this sample, those with lower levels of emotional regulation are at heightened risk of weight gain.

Research trends in contemporary health economics: a scientometric analysis on collective content of specialty journals

INTRODUCTION

Health economics is a thriving sub-discipline of economics. Applied health economics research is considered essential in the health care sector and is used extensively by public policy makers. For scholars, it is important to understand the history and status of health economics-when it emerged, the rate of research output, trending topics, and its temporal evolution-to ensure clarity and direction when formulating research questions.

METHODS

Nearly 13,000 articles were analysed, which were found in the collective publications of the ten most specialised health economic journals. We explored this literature using patterns of term co-occurrence and document co-citation.

RESULTS

The research output in this field is growing exponentially. Five main research divisions were identified: (i) macroeconomic evaluation, (ii) microeconomic evaluation, (iii) measurement and valuation of outcomes, (iv) monitoring mechanisms (evaluation), and (v) guidance and appraisal. Document co-citation analysis revealed eighteen major research streams and identified variation in the magnitude of activities in each of the streams. A recent emergence of research activities in health economics was seen in the Medicaid Expansion stream. Established research streams that continue to show high levels of activity include Child Health, Health-related Quality of Life (HRQoL) and Cost-effectiveness. Conversely, Patient Preference, Health Care Expenditure and Economic Evaluation are now past their peak of activity in specialised health economic journals. Analysis also identified several streams that emerged in the past but are no longer active.

CONCLUSIONS

Health economics is a growing field, yet there is minimal evidence of creation of new research trends. Over the past 10 years, the average rate of annual increase in internationally collaborated publications is almost double that of domestic collaborations (8.4% vs 4.9%), but most of the top scholarly collaborations remain between six countries only.

Childhood circumstances, social mobility and the obesity transition: Evidence from South Africa

The distribution of obesity tends to shift from rich to poor individuals as countries develop, in a process of shifting sociodemographic patterns of obesity that has been called the 'obesity transition'. This change tends to happen with economic development, but little is known about the specific mechanisms that drive the change. We propose that improvements in childhood circumstances with economic development may be one of the drivers of the obesity transition. We explore whether the social gradient in body weight differs by childhood socioeconomic status (SES), proxied by the respondent's mother having Grade 12, using South Africa's nationally representative panel National Income Dynamics Study. In support of our hypothesis, we find that the social gradient in body weight is less positive for adults who had a high childhood SES, and already appears to have reversed among high-SES women who also had a high childhood SES. Upward social mobility over an individual's life course or across a single generation is associated with higher body weight compared to a stable high SES. But a high SES sustained in childhood and adulthood - or across more than one generation - may decrease adult obesity risk, and result in a reversal of the social gradient in body weight. Random effects within-between models show that the social gradient in body weight and its interaction with childhood SES are driven more by differences in income between individuals than by short-run changes in income within individuals, again suggesting that the obesity transition is driven by long-run changes rather than by very short-run changes. Our results are broadly robust to using several alternative measures of body weight, childhood SES and adult SES. Our results are consistent with the hypothesis that widespread improvements in childhood circumstances and nutrition with economic development may contribute to the shift to later stages of the obesity transition.

The impact of overweight and obesity on unemployment duration among young American workers

Obesity has a profound effect on the working careers of Americans. Prior studies pertaining to workers in other countries report that obese women experienced longer spells of unemployment than normal weight peers. However, the effect of obesity on unemployment duration has not been studied for American workers. To address this gap in the literature, we report estimates of the effects of overweight and obesity from a proportional hazards model of unemployment duration that controls for unobserved individual characteristics. Using a data sample of young workers drawn from the National Longitudinal Survey of Youth (1997), our findings indicate that, on average, overweight and obese job seekers experienced significantly longer spells of unemployment. The effects differed by race, sex, and ethnicity: Overweight and obese White and Black women experienced significantly longer spells than White women with normal body mass index (BMI) levels. Although overweight White and Black men had longer unemployment spells compared to White men with normal BMI levels, the magnitudes were smaller than those for White and Black women. In contrast, overweight Hispanic women had shorter duration of unemployment spells compared to White women with normal BMI levels.

Soda expansion in the tropics: The effect on obesity rates among women without piped water at home

Obesity rates and soda consumption are increasing at a worrisome pace in developing countries. In particular, soda companies seem to be targeting areas with poor access to clean water. This paper exploits a natural experiment in Peru and finds evidence that changes in the price of soda generate important effects in terms of obesity among individuals without piped water at home. These significant effects are driven by a combination of a large effect in the consumption of soda and an effect close to zero in the consumption of potential substitutes high in calories. This paper also provides some evidence that a reduction in price of soda reduces diarrhea prevalence, suggesting that some individuals substitute away contaminated water. This evidence suggests that soda taxes might be particularly beneficial among this population in terms of the prevention of obesity and possibly related diseases such as diabetes and cardiovascular diseases. The potential trade-off between obesity and diarrhea needs to be investigated in greater depth.

Causal effect of obesity on the probability of employment in women in Turkey

This study aims to investigate the causal effect of obesity on the employment probability of women in Turkey via the instrumental variable approach by using data from the 2018 Turkey and Demographic Health Survey. Obesity prevalence in the area of living and the overweight status of the oldest child, which are the most common types of instruments seen in the literature, are used as instruments. Consistent with the OLS result, the 2SLS estimate indicates that obese women are statistically significantly less likely to be employed when the overweight status of the child is used as an instrument. On the other hand, the statistically significant effect of obesity disappears when the area level obesity prevalence is used as the instrument. In addition, obesity in women decreases the likelihood of employment in the services sector and full-time jobs and employment with social security. Although the results of this study do not indicate the source of the effect found, the presence of a causal relationship for women should not be ignored when the economic burden of obesity for Turkey is considered.

How has the strict lockdown during the SARS-COV-2 outbreak changed the diet of Spaniards?

Purpose

We investigate the impact of a specific macroeconomic shock that occurred as a response to the SARS-COV-2 outbreak, namely the strict lockdown imposed in Spain on the March 14, 2020.

Methods

We use fortnightly purchase data relating to over 50,000 households from a supermarket chain in Catalonia from March to June in 2019 and 2020. Using a panel data approach, we analyse the impact of the lockdown on the caloric content, sugar composition, and alcohol content in beverages and food purchases bought before and after lockdown. We corrected our results to take into account the likelihood of stockpiling.

Results

The lockdown is related to an increase in unhealthy beverage and food purchases. We find heterogeneous effects across groups of the sample based on cardholder characteristics. Families with children or babies and those in the upper two income quintiles had the unhealthiest changes. As the lockdown went through phases of relaxation, households made better food decisions but maintained unhealthy beverage choices.

Conclusions

The very restrictive lockdown negatively impacted the characteristics of food and beverage purchases made by Spaniards. However, we are unsure whether there was substitution to restaurant and bar visits. Additional work to find out whether there were permanent changes in purchasing behaviour after lockdown ended is needed in the future.

Does obesity Kuznets curve exist in developing economies? Evidence from 38 African countries based on heterogeneous panel data analysis on income-level classification

Introduction

The global pandemic disease known as the obesity epidemic has spread throughout the planet. Particularly, Africa is facing a growing problem of obesity, and the trend is rising. This is a result of a ticking time bomb. Given the claim that multiple socio-economic factors significantly affect the diversity in obesity rates between nations, economic development can be seen as a key contributor to this variation.

Methods

Relying on the aforementioned avowal, this extant research examines the relationship between obesity and economic growth using urbanization, trade openness, and unemployment as intermittent variables within the Obesity Kuznets Curve (OKC) framework. Using panel data from 1990 to 2020, a panel of 38 African countries subdivided into income levels (Low income, Lower-middle income, and Upper-middle income) were analyzed. With the presence of residual cross-sectional reliance and slope heterogeneity, the Augmented Mean Group (AMG) econometric approach is employed.

Results

Key outcomes from the mentioned estimation method unveiled that economic growth positively impacts obesity among all the study panels. Variably, unemployment was evidenced to have a palpable positive impact on obesity concerning Low-income economies whereas on the side of the Lower-middle income panel together with Upper-middle income economies and the aggregated panel, a significant negative relationship is observed with obesity. Further, urbanization enhanced obesity in the Low-income panel and the aggregated panel of African nations, whereas an adverse effect is identified in both the Lower-middle and Upper-middle economies in Africa. Moreover, except for Low-income African economies, all the other panels of African nations in terms of income levels were noted to have a significant negative effect on obesity from trade openness.

Discussion

Finally, the long-run coefficients indicated that the OKC is valid among all panels of African countries. The study thus preferably suggests in African economies that addressing the inverted U-shape relationship between obesity and economic growth requires a multifaceted approach that considers the evolving dynamics of both factors. Policy makers should, therefore, aim to balance promoting economic growth and safeguarding public health through targeted interventions and long-term strategies.

Updating the association between socioeconomic status and obesity in low-income and lower-middle-income sub-Saharan African countries: A literature review

Globally, the literature tends to emphasize negative associations between socioeconomic status (SES) and bodyweight in countries improving their economic development. However, little is known about the social distribution of obesity in sub-Saharan Africa (SSA) where economic growth has been highly heterogeneous the last decades. This paper reviews an exhaustive set of recent empirical studies examining its association in low-income and lower-middle-income countries in SSA. Although there is evidence of a positive association between SES and obesity in low-income countries, we found mixed associations in lower-middle-income countries, potentially providing evidence of a social reversal of the obesity burden.

Exploring the relationship between unemployment perception and health during COVID-19: a comparative study of rural and urban adults in China

Introduction

The COVID-19 pandemic has significantly impacted global economies and individual health. This study uses data from the China Family Panel Data (CFPS) in 2018 (before the pandemic) and 2020 (during the pandemic) to a) estimate the relationships between the perceived risk of unemployment and individuals' mental health, physical health, and health behaviors; and b) explore the variations of these relationships between rural and urban adults in China.

Methods

Ordinary linear regression models or Logit models are employed, depending on the nature (continuous vs. discrete) of the dependent variables.

Results

We find that the perceived risk of unemployment was statistically and positively associated with the risk of depression, and the association was greater for rural adults than for urban adults. Rural-urban variations were observed in various dimensions. For rural adults, the perceived risk of unemployment was statistically and negatively associated with life satisfaction, the probability of gaining weight and becoming obese, the probability of having adequate sleep, and computer-based screen time. These associations were statistically insignificant for urban adults. On the other hand, the perceived risk of unemployment was statistically and negatively associated with self-rated very-good-to-excellent health condition and health-compromising behaviors (e.g., smoking and drinking) for urban adults; but such associations were statistically insignificant for rural adults.

Discussion

These findings suggest that rural and urban adults exhibited different psychological and behavioral responses to the unemployment risk during the COVID-19 pandemic. Public policies aiming to improve health and employment should be strategically designed to address the unique needs of urban and rural populations.

Obesity and labour market outcomes in Italy: a dynamic panel data evidence with correlated random effects

This paper investigates the effects of obesity, socio-economic variables, and individual-specific factors on work productivity across Italian regions. A dynamic panel data with correlated random effects is used to jointly deal with incidental parameters, endogeneity issues, and functional forms of misspecification. Methodologically, a hierarchical semiparametric Bayesian approach is involved in shrinking high dimensional model classes, and then obtaining a subset of potential predictors affecting outcomes. Monte Carlo designs are addressed to construct exact posterior distributions and then perform accurate forecasts. Cross-sectional Heterogeneity is modelled nonparametrically allowing for correlation between heterogeneous parameters and initial conditions as well as individual-specific regressors. Prevention policies and strategies to handle health and labour market prospects are also discussed.

Long-term health effects of a school construction program

Non-communicable diseases (NCDs) disproportionately affect people in low- and middle-income countries (LMICs), yet context-specific evidence on policies that impact NCD risk factors is lacking. We estimate the impact of a massive Indonesian primary school expansion program in the 1970s on NCD risk factors in later life using data from two surveys with very large sample sizes. We find that in non-Java regions of Indonesia, the program led to significant increases in the likelihood of overweight and high waist circumference among women, but not among men. The increase for women can be partly explained by increased consumption of high-calorie packaged and take-away meals. We find no meaningful impacts on high blood pressure for either sex. Despite the increase in body weight, the program had a negligible impact on diabetes and cardiovascular disease diagnosis. It led to an improvement in women's self-reported health outcomes in their early-40s, but these benefits largely disappeared once they reached their mid-40s.

Life satisfaction and body mass index: estimating the monetary value of achieving optimal body weight

According to the World Health Organization, obesity is one of the greatest public-health challenges of the 21st century. Body weight is also known to affect individuals' self-esteem and interpersonal relationships, including romantic ones. We estimate the "utility-maximizing" Body Mass Index (BMI) and calculate the implied monetary value of changes in both individual and spousal BMI, using the compensating income variation method and data from the Swiss Household Panel. We employ the Oster's method (Oster, 2019) to estimate the degree of omitted variable bias in the effect of BMI on life satisfaction. Results suggest that the optimal own BMI is 27.1 and 20.1 for men and women, respectively. The annual value of reaching optimal weight ranges from $7069 for women with underweight to $88,709 for women with obesity and between $95,165 for men with underweight to $32,644 for men with obesity. On average, women value reduction in their own BMI about four times higher than reduction in their spouse's BMI. Men, on the other hand, value a reduction in their spouse's BMI almost twice as much compared to a reduction in their own BMI. This highlights important gender differences and relative effects based on spousal BMI.

Predicting nutritional status for women of childbearing age from their economic, health, and demographic features: A supervised machine learning approach

BACKGROUND

Malnutrition imposes enormous costs resulting from lost investments in human capital and increased healthcare expenditures. There is a dearth of research focusing on the prediction of women's body mass index (BMI) and malnutrition outcomes (underweight, overweight, and obesity) in developing countries. This paper attempts to fill out this knowledge gap by predicting the BMI and the risks of malnutrition outcomes for Bangladeshi women of childbearing age from their economic, health, and demographic features.

METHODS

Data from the 2017-18 Bangladesh Demographic and Health Survey and a series of supervised machine learning (SML) techniques are used. Additionally, this study circumvents the imbalanced distribution problem in obesity classification by utilizing an oversampling approach.

RESULTS

Study findings demonstrate that the support vector machine and k-nearest neighbor are the two best-performing methods in BMI prediction based on the coefficient of determination (R2), root mean square error (RMSE), and mean absolute error (MAE). The combined predictor algorithms consistently yield top specificity, Cohen's kappa, F1-score, and AUC in classifying the malnutrition status, and their performance is robust to alternative standards. The feature importance ranking based on several nonparametric and combined predictors indicates that socioeconomic status, women's age, and breastfeeding status are the most important features in predicting women's nutritional outcomes. Furthermore, the conditional inference trees corroborate that those three features, along with the partner's educational attainment and employment status, significantly predict malnutrition risks.

CONCLUSION

To the best of our knowledge, this is the first study that predicts BMI and one of the pioneer studies to classify all three malnutrition outcomes for women of childbearing age in Bangladesh, let alone in any lower-middle income country, using SML techniques. Moreover, in the context of Bangladesh, this paper is the first to identify and rank features that are critical in predicting nutritional outcomes using several feature selection algorithms. The estimators from this study predict the outcomes of interest most accurately and efficiently compared to other existing studies in the relevant literature. Therefore, study findings can aid policymakers in designing policy and programmatic approaches to address the double burden of malnutrition among Bangladeshi women, thereby reducing the country's economic burden.

Earnings and work loss from 5 years before to 5 years after bariatric surgery: A cohort study

BACKGROUND

The personal economic impact of bariatric surgery is not well-described.

OBJECTIVES

To examine earnings and work loss from 5 years before to 5 years after bariatric surgery compared with the general population.

SETTING

Nationwide matched cohort study in the Swedish health care system.

METHODS

Patients undergoing primary bariatric surgery (n = 15,828) and an equal number of comparators from the Swedish general population were identified and matched on age, sex, place of residence, and educational level. Annual taxable earnings (primary outcome) and annual work loss (secondary outcome combining months with sick leave and disability pension) were retrieved from Statistics Sweden. Participants were included in the analysis until the year of study end, emigration or death.

RESULTS

From 5 years before to 5 years after bariatric surgery, earnings increased for patients overall and in subgroups defined by education level and sex, while work loss remained relatively constant. Bariatric patients and matched comparators from the general population increased their earnings in a near parallel fashion, from 5 years before (mean difference -$3,489 [95%CI -3,918 to -3,060]) to 5 years after surgery (-$4,164 [-4,709 to -3,619]). Work loss was relatively stable within both groups but with large absolute differences both at 5 years before (1.09 months, [95%CI 1.01 to 1.17]) and 5 years after surgery (1.25 months, [1.11 to 1.40]).

CONCLUSIONS

Five years after treatment, bariatric surgery had not reduced the gap in earnings and work loss between surgery patients and matched comparators from the general population.

Sweet or not: Using information and cognitive dissonance to nudge children toward healthier food choices

In the interest of public health, it is important to nudge children toward healthier food choices (e.g., beverages with less added sugar). We conducted a field experiment in a peri-urban region in Vietnam to evaluate the effects of information and cognitive dissonance on the food choices of children. Our sample consisted of more than 1200 primary school children, randomly assigned into three groups: control, health information, and health information plus hypocrisy inducement. The third group was intended to raise cognitive dissonance by illustrating the gap between what people know they should do (socially desired behaviors) and what they actually do (transgressions). The results indicate that health information increased the likelihood of selecting milk with less sugar by around 30 %, as compared to the control group. Hypocrisy inducement did not make any additional contribution to healthier food choices. The treatment effects declined when there was a delay between the treatment and the behavioral choice. We discuss the practical implications of our findings for short-term intervention field studies.

Association between socio-economic factors and the risk of overweight and obesity among Chinese adults: a retrospective cross-sectional study from the China Health and Nutrition Survey

BACKGROUND

With the rising prevalence of obesity and overweight, increasing number of scholars paid attention to the negative effects on human health and life. Recent years, many studies have focused on the relation of socio-economic factors with the risk of overweight or obesity, but findings have been inconsistent. This study investigated the relationship between socio-economic factors and the risk of overweight and obesity among Chinese adults.

METHODS

This study was based on the survey of the China Health and Nutrition Survey in 2015, with 9245 Chinese adults aged 18-65 years old. Overweight and obesity were assessed by physical measurements of weight, height, and waist circumference. Multiple logistic models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the association.

RESULTS

Overall, the prevalence rates of general obesity and abdominal obesity were 15.5% and 22.6%, respectively. We found that education and per capita household income were positively associated with overweight and obesity risk in men. However, the association between education and obesity status was negative in women [general obesity: OR = 0.64, 95% CI (0.50-0.81); abdominal obesity: OR = 0.62, 95% CI (0.51-0.76)]. Occupational status was only associated with general overweight in men.

CONCLUSIONS

Results suggested that higher education and per capita household income were associated with an increased risk of overweight and obesity among Chinese men, whereas the associations were negative for women. We recommended that men with high levels of education and income, women with low levels of education, can engage in some physical activity, modify dietary, and adopt a new way of life to maintain their weight and general health.

Temporary and persistent overweight and long-term labor market outcomes

We study how the duration of being overweight earlier in life is related to subsequent long-term labor market outcomes. Our data on fraternal and identical twins born and raised in the same household contain weight measurements of the twins during their early adulthood measured in 1975, 1981, and 1990 and is linked to register-based administrative data on the earnings and employment from 1990 to 2009. When combined, these data enable an empirical strategy that controls for the family environment and genes shared by twins. We find that being persistently overweight during early adulthood is negatively associated with long-term earnings for both women and men. We find that for women, the association is driven by a decrease in labor market-attachment, whereas for men, the association is driven by lower annual earnings.

How distorted food prices discourage a healthy diet

Public policy making for the prevention of diet-related disease is impeded by a lack of evidence on whether poor diets are a matter of personal responsibility or a choice set narrowed by environmental conditions. An important element of the environment is market imperfections in food retail that distort prices. We use a rich dataset on quantities and prices of food purchases in the United States and a structural model of dietary choices to examine variation in diets across households that have different levels of income and live in different neighborhoods. We find that price distortions account for one-third of the gap between the recommended and actual intake of fruits and vegetables. A feasible fiscal intervention that remedies these distortions makes all consumers better off.

Body mass index and healthcare costs: using genetic variants from the HUNT study as instrumental variables

Background

Past studies have found associations between obesity and healthcare costs, however, these studies have suffered from bias due to omitted variables, reverse causality, and measurement error.

Methods

We used genetic variants related to body mass index (BMI) as instruments for BMI; thereby exploiting the natural randomization of genetic variants that occurs at conception. We used data on measured height and weight, genetic information, and sociodemographic factors from the Nord-Trøndelag Health Studies (HUNT), and individual-level registry data on healthcare costs, educational level, registration status, and biological relatives. We studied associations between BMI and general practitioner (GP)-, specialist-, and total healthcare costs in the Norwegian setting using instrumental variable (IV) regressions, and compared our findings with effect estimates from ordinary least squares (OLS) regressions. The sensitivity of our findings to underlying IV-assumptions was explored using two-sample Mendelian randomization methods, non-linear analyses, sex-, healthcare provider-, and age-specific analyses, within-family analyses, and outlier removal. We also conducted power calculations to assess the likelihood of detecting an effect given our sample 60,786 individuals.

Results

We found that increased BMI resulted in significantly higher GP costs; however, the IV-based effect estimate was smaller than the OLS-based estimate. We found no evidence of an association between BMI and specialist or total healthcare costs.

Conclusions

Elevated BMI leads to higher GP costs, and more studies are needed to understand the causal mechanisms between BMI and specialist costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07597-z.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

Built and social environments and overweight among Brazilian adults from medium-sized city: CUME Project

Abstract A cross-sectional study enrolled participants from the CUME project (n = 289) who lived in Viçosa, Brazil. The neighborhood unit adopted was the buffer (200 meters), considering the participant’s residence as central point. We measure the number of public and private facilities inside the buffer as well as violent criminal occurrences. Food establishments were categorized into establishments with predominant sale of natural or minimally processed foods, mixed establishments, and establishments with predominant sale of ultra-processed foods. Those who attended the face-to-face interview filled two scales of perception of the environment. Overall, 33.6% of participants reported overweight. We observed a higher concentration of individuals close to the central region of the city. Access to different establishments, food environments, and criminal occurrences differed between normal-weight and overweight individuals. The groups deferred in the perception of the location of squares, open public spaces, clubs, and soccer fields. The results indicate the association between environmental characteristics and overweight in Brazilian adults.

Body shape and stable employment opportunity analysis of China's nonagricultural labor market

Based on the integrated data of the China General Social Survey (CGSS) from 2010 to 2017, this study observes that body shape - being overweight or underweight - is important for labor market outcomes. Body shape significantly affects the employment opportunities of Chinese individuals, and this effect differs by gender and across the occupational hierarchy. Women face both slim premium and obesity penalty effects. Slim women, those with normal and lower but not excessively lower body weight, are more likely to gain long-term employment contracts in the labor market, while the opposite is observed for overweight individuals. The relationship between women's body shape and employment opportunities also varies by occupation. The obesity penalty is more pronounced in occupations with a higher International Socio-Economic Index (ISEI), while the slim premium is more evident in occupations with a low ISEI. The results suggest that the Chinese labor market is highly demanding regarding women's figures, while it is relatively tolerant of men's figures. By mechanism analysis, health capital is found to be the leading cause of the body shape effect. In addition, socialization is also a possible pathway of action. This paper has extended implications for the study of stature and employment stability, enriching the empirical research on labor market discrimination.

Bariatric surgery and exercise: A pilot study on postural stability in obese individuals

This study aimed to analyze the changes in postural stability of individuals with obesity after bariatric surgery, and the effect of three months of regular exercise on the static postural stability. Twenty-two subjects (7 females and 15 males) aged 31 to 68 years (Body mass index 35-55 kg.m-2) completed the study. Participants were divided into two groups: one group participated in an exercise program after the bariatric surgery (n = 10; age 48.9 ± 7.5 years; Body mass index 42 ± 5.6 kg.m-2) while the second group did not exercise at all after bariatric surgery (n = 12; age 44.7 ± 13.6 years, Body mass index 42.6 ± 6.0 kg.m-2). Static postural stability was measured using a Tekscan MobileMat pressure plate before and 4 months after the bariatric surgery. The exercise program included exercising three times a week including: one hour of strengthening, one hour of aerobic group exercise and at least one session of individual exercise at home. There were no significant differences in Center of force sway, Center of force ranges and average speed before and 4 months after bariatric surgery. Also, no effect of exercise was found. Post-pre differences of some parameters were negatively related to age (r from-0.46 to-0.72). Further studies are needed to explore this topic in depth.

Productivity, obesity, and human capital: Panel data evidence

The consequences of obesity for adults and children are well documented in the extant literature. We use panel data of 105 countries from 1990 to 2019 to estimate the effect of obesity on economic performance. We predict obesity using lagged values of child obesity as instruments. Predicted obesity has a negative and significant effect on productivity. This effect is independent of the effect of human capital and other macroeconomic determinants of economic performance. There is only weak evidence that this effect operates through the deterioration of human capital formation caused by childhood obesity.

Mendelian randomization analysis of the causal impact of body mass index and waist-hip ratio on rates of hospital admission

We analyze how measures of adiposity - body mass index (BMI) and waist hip ratio (WHR) - causally influence rates of hospital admission. Conventional analyses of this relationship are susceptible to omitted variable bias from variables that jointly influence both hospital admission and adipose status. We implement a novel quasi-Poisson instrumental variable model in a Mendelian randomization framework, identifying causal effects from random perturbations to germline genetic variation. We estimate the individual and joint effects of BMI, WHR, and WHR adjusted for BMI. We also implement multivariable instrumental variable methods in which the causal effect of one exposure is estimated conditionally on the causal effect of another exposure. Data on 310,471 participants and over 550,000 inpatient admissions in the UK Biobank were used to perform one-sample and two-sample Mendelian randomization analyses. The results supported a causal role of adiposity on hospital admissions, with consistency across all estimates and sensitivity analyses. Point estimates were generally larger than estimates from comparable observational specifications. We observed an attenuation of the BMI effect when adjusting for WHR in the multivariable Mendelian randomization analyses, suggesting that an adverse fat distribution, rather than a higher BMI itself, may drive the relationship between adiposity and risk of hospital admission.

Social acceptability of standard and behavioral economic inspired policies designed to reduce and prevent obesity

The obesity epidemic is a significant public policy issue facing the international community, resulting in substantial costs to individuals and society. Various policies have been suggested to reduce and prevent obesity, including those informed by standard economics (a key feature of which is the assumption that individuals are rational) and behavioral economics (which identifies and harness deviations from rationality). It is not known which policy interventions taxpayers find acceptable and would prefer to fund via taxation. We provide evidence from a discrete choice experiment on an Australian sample of 996 individuals to investigate social acceptability of eight policies: mass media campaign; traffic light nutritional labeling; taxing sugar sweetened beverages; prepaid cards to purchase healthy food; financial incentives to exercise; improved built environment for physical activity; bans on advertising unhealthy food and drink to children; and improved nutritional quality of food sold in public institutions. Latent class analysis revealed three classes differing in preferences and key respondent characteristics including capacity to benefit. Social acceptability of the eight policies at realistic levels of tax increases was explored using post-estimation analysis. Overall, 78% of the sample were predicted to choose a new policy, varying from 99% in those most likely to benefit from obesity interventions to 19% of those least likely to benefit. A policy informed by standard economics, traffic light labeling was the most popular policy, followed by policies involving regulation: bans on junk food advertising to children and improvement of food quality in public institutions. The least popular policies were behaviorally informed: prepaid cards for the purchase of only healthy foods, and financial incentives to exercise.

Economic Perspectives on Food Choices, Marketing, and Consumer Welfare

This contribution reviews the main normative and positive arguments that can used in the assessment of the costs and benefits of food marketing restrictions, focusing specifically on theoretical and empirical developments in the economics of advertising, consumer behaviour and industrial organization since the 70s.

The effect of gender-specific labor market conditions on children's weight

BACKGROUND

Macroeconomic conditions are widely known to influence health outcomes through direct behavioral change or indirect mental effects of individuals. However, they have not received much attention in relation to childhood obesity.

METHODS

Using gender-specific predicted employment growth rates as an index for labor market conditions, we analyze how economic shocks affect children's weight status in Arkansas. To understand the underlying mechanisms behind these results, we use data on individual time use to examine how economic shocks are related to activities related to children's weight.

RESULTS

Improvement in the female labor market is associated with an increase in body mass index (BMI) and the probability that a child is overweight or obese, while an improvement in the male labor market has no significant effects on children's weight. This impact is particularly evident among female children, older children, and African-American children. We also find a negative effect of improvements in the female labor market on time spent on preparation for foods at home.

CONCLUSIONS

These results suggest that a decrease in time spent preparing home-cooked foods might be a plausible explanation for the pro-cyclical relationship between children's weight and improvement in the labor market conditions. Thus, the policy implications of our paper should be aimed at mitigating the adverse effects of women's labor participation.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Bittersweet: How prices of sugar-rich foods contribute to the diet-related disease epidemic in Mexico

I provide new evidence on how price changes of nutritionally similar foods, such as those rich in sugar or fats, change obesity and diet-related diseases in the context of Mexico between 1996-2010. I merge a bar-code level price dataset with product-specific nutritional composition to two datasets with health outcomes: state-level administrative and nationally representative individual-level panel data. Exploiting within-city variation in prices using fixed effects models, I show that decreased prices of sugar-rich foods increase obesity, type 2 diabetes, and hypertension prevalence; yet the prices of foods rich in other nutrients do not. Health responses to price changes are the largest for those abdominally obese or at the highest risk for chronic disease. The association between prices of sugary foods and chronic disease is meaningful: I estimate that in Mexico, price reductions of sugary foods explain roughly 15 percent of the rise in obesity and diabetes during the 15-year study period.

Economic inequality in malnutrition: a global systematic review and meta-analysis

OBJECTIVE

To describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition.

METHODS

We conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15-49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses.

RESULTS

From 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX -0.15 (95% CI -0.19 to -0.11)) and wasting (-0.03 (95% CI -0.05 to -0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI -0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (-0.02 (95% CI -0.08 to 0.05)) or North America (-0.04 (95% CI -0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)).

CONCLUSIONS

There is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed.

PROSPERO REGISTRATION NUMBER

CRD42020201572.

Measuring the impact of calorie labeling: The mechanisms behind changes in obesity

Learning the true calorie content of fast food may induce consumers to change behavior, yet recent evidence is mixed on whether calorie labels cause consumers to order healthier meals. Especially for individuals for whom consumption of highly caloric fast-food is habitual, a rational response to calorie labeling may instead be to maintain consumption levels but increase physical activity. Using American Time Use Survey data from 2004 to 2012, we show that the 2008 New York City Calorie Labeling Mandate significantly improved several measures of physical activity, including overall metabolic equivalents of task units and minutes of sedentary activity. Our results translate to an average extra 28 calories burned per day or a 0.6 kg weight decrease for the average person over one year. These results provide a plausible mechanism for calorie labeling mandates to lower obesity rates, which we demonstrate in the New York City context.

The effects of graduated driver licensing on teenage body weight

The graduated driver licensing (GDL) program requires teenage drivers to pass through an intermediate stage, which contains specific driving restrictions such as a night curfew or a limit on the number of teen passengers to be carried, before earning full driving privileges. Using individual data from the 1999 to 2017 biennial Youth Risk Behavior Surveillance System (YRBS) combined with state-level GDL policy variations, we estimate the effects of GDL on teenage body weight in the United States. We find that the presence of GDL raises adolescents' body mass index Z-score and their likelihood of being overweight or obese. Among the restrictions imposed, a night curfew implemented together with a passenger restriction makes the most significant impact. These estimated effects are concentrated among states with more restrictive GDL policies. We also find that the presence of GDL reduces adolescent physical activity and heavy smoking, while increasing their time spent watching TV and milk intake, perhaps contributing to youth weight gain. An event study analysis reveals that the effects of GDL on adolescent weight increase may be transitory.

Understanding the link between obesity and headache- with focus on migraine and idiopathic intracranial hypertension

BACKGROUND

Obesity confers adverse effects to every system in the body including the central nervous system. Obesity is associated with both migraine and idiopathic intracranial hypertension (IIH). The mechanisms underlying the association between obesity and these headache diseases remain unclear.

METHODS

We conducted a narrative review of the evidence in both humans and rodents, for the putative mechanisms underlying the link between obesity, migraine and IIH.

RESULTS

Truncal adiposity, a key feature of obesity, is associated with increased migraine morbidity and disability through increased headache severity, frequency and more severe cutaneous allodynia. Obesity may also increase intracranial pressure and could contribute to headache morbidity in migraine and be causative in IIH headache. Weight loss can improve both migraine and IIH headache. Preclinical research highlights that obesity increases the sensitivity of the trigeminovascular system to noxious stimuli including inflammatory stimuli, but the underlying molecular mechanisms remain unelucidated.

CONCLUSIONS

This review highlights that at the epidemiological and clinical level, obesity increases morbidity in migraine and IIH headache, where weight loss can improve headache morbidity. However, further research is required to understand the molecular underpinnings of obesity related headache in order to generate novel treatments.

Snacks, nudges and asymmetric peer influence: Evidence from food choice experiments with children in Indonesia

Many children in low- and middle-income countries are growing up during a rapid nutrition transition. Experimental evidence on food choice in developing countries is scarce, while it is unclear to what extent evidence from high-income countries can be generalized. Children participated in a snack choice experiment. We expose some children to emoji labels encouraging healthy snacks, while others observe healthy or unhealthy snacking by peers. While emoji labels moderately promote healthy snacking, the adverse effect of observing a peer eating the unhealthy snack is very large. The effect associated with observing a healthy peer is insignificant. Additionally, cross-randomized blocks of children watched a nutrition video to study the interaction of information provision and nudging. The video independently improves healthy choices but does not aid the emoji nudge and cannot counter the strong negative peer effect. We compare our findings to studies conducted in developed countries and discuss policy implications.

Birth weight and adult income: An examination of mediation through adult height and body mass

This paper examines the causal links between early human endowments and socioeconomic outcomes in adulthood. We use a genotyped longitudinal survey (Cardiovascular Risk in Young Finns Study) that is linked to the administrative registers of Statistics Finland. We focus on the effect of birth weight on income via two anthropometric mediators: body mass index (BMI) and height in adulthood. We find that (i) the genetic instruments for birth weight, adult height, and adult BMI are statistically powerful; (ii) there is a robust total effect of birth weight on income for men but not for women; (iii) the total effect of birth weight on income for men is partly mediated via height but not via BMI; and (iv) the share of the total effect mediated via height is substantial, of approximately 56%.

The curse of modernization? Western fast food and Chinese children's weight

The income-adjusted price of fast food in China is five times more than in the United States, yet we show that the introduction of Western fast-food restaurants to China still leads to significant weight gain in children. Using the community-year-level presence of Western fast-food outlets, difference-in-differences estimations find a 4.8-percentage-point increase in the prevalence of overweight/obese children after controlling for child and year fixed effects. The effect decreases at a distance of 3-4 km from a fast-food restaurant, and we find no further weight gain 2 years after the restaurant's introduction. The underweight rate is not affected by fast-food introduction. The increase in fat share of energy intake serves as the channel for weight gain. Children in high-income families, younger than 11 years, and girls are more affected than other Chinese children.

The relationship between body mass index and income: Using genetic variants from HUNT as instrumental variables

Several studies have estimated effects of body mass index (BMI) on labour market outcomes, and these studies have mixed findings. A significant challenge has been to adequately control for omitted variables, selection, reverse causality, and measurement error. We examine the impact of BMI on income using genetic variants as instrumental variables for BMI. Individual-level pre-tax income from tax records was merged with health survey data containing measured height and weight, and data on genetic variants. The analyses were stratified by sex and a variety of methods were used to explore the sensitivity and validity of the instrumental variable (IV) strategy. For females we found that BMI had a negative effect on the logarithm of income. The effect estimated from the IV models (-0.02) was larger than the effect estimated from naïve ordinary least squares regressions (-0.01). For males, the coefficients for the effect of BMI on income were imprecise, and both positive and negative coefficients were estimated depending on the estimation method. Our results suggest that females are susceptible to reduced income levels following increased BMI.

Do employers discriminate against obese employees? Evidence from individuals who are simultaneously self-employed and working for an employer

We test whether the lower wages of obese employees result from employer discrimination using a novel empirical strategy. Using data from two nationally representative surveys from the US, we analyze the wages of individuals who are simultaneously self-employed and working for an employer. While lower productivity and customer discrimination against obese individuals may affect wages in both types of jobs, employer discrimination cannot affect the wages of solo entrepreneurs. Our estimates suggest that, even after controlling for productivity (proxied by their concurrent wage in self-employment), white women (men) who are obese earn 11.4% (9.7%) less than their healthy-weight counterparts in their paid employment jobs. We also find that white women (but not men) who are overweight earn 9.1% less than their healthy-weight counterparts. We do not find any evidence of significant bodyweight discrimination among black and Hispanic workers. These results suggest that white workers, especially white women, are likely to face bodyweight discrimination in their workplaces. We report the results for a series of robustness checks to rule out alternative explanations, such as reverse causality, differences in healthcare costs, and occupation-specific customer discrimination.

Body shape matters: Evidence from machine learning on body shape-income relationship

The association between physical appearance and income has been of central interest in social science. However, most previous studies often measured physical appearance using classical proxies from subjective opinions based on surveys. In this study, we use novel data, called CAESAR, which contains three-dimensional (3D) whole-body scans to mitigate possible reporting and measurement errors. We demonstrate the existence of significant nonclassical reporting errors in the reported heights and weights by comparing them with measured counterparts, and show that these discrete measurements are too sparse to provide a complete description of the body shape. Instead, we use a graphical autoencoder to obtain intrinsic features, consisting of human body shapes directly from 3D scans and estimate the relationship between body shapes and family income. We also take into account a possible issue of endogenous body shapes using proxy variables and control functions. The estimation results reveal a statistically significant relationship between physical appearance and family income and that these associations differ across genders. This supports the hypothesis on the physical attractiveness premium in labor market outcomes and its heterogeneity across genders.

Job Absenteeism Costs of Obesity in the United States: National and State-Level Estimates

OBJECTIVE

To estimate the causal effect of obesity on job absenteeism and the associated lost productivity in the United States, both nationwide and by state.

METHODS

We conducted a retrospective pooled cross-sectional analysis using the 2001 to 2016 Medical Expenditure Panel Survey and estimated two-part models of instrumental variables.

RESULTS

Obesity, relative to normal weight, raises job absenteeism due to injury or illness by 3.0 days per year (128%). Annual productivity loss due to obesity ranges from $271 to $542 (lower/upper bound) per employee with obesity, with national productivity losses ranging from $13.4 to $26.8 billion in 2016. Trends in state-level estimates mirror those at the national level, varying across states.

CONCLUSIONS

Obesity significantly raises job absenteeism. Reductions in job absenteeism should be included when calculating the cost-effectiveness of interventions to prevent or reduce obesity among employed adults.