Sick leave days and costs associated with overweight and obesity in Germany

Social costs of obesity in the Czech Republic

Increasing prevalence of obesity (BMI > 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1 billion people. Increasing trend in the prevalence of obesity in adults and children generates large social costs. The main aim of this study is to estimate both direct and indirect costs of obesity in the Czech Republic. Social costs of obesity are estimated using the cost-of-illness approach. Direct costs (healthcare utilization costs and costs of pharmacotherapy of 20 comorbidities) are estimated using the top-down approach, while indirect costs (absenteeism, presenteeism and premature mortality) are estimated using the human capital approach. In aggregate, the annual costs attributable to obesity in the Czech Republic in 2018 were 40.8 bn CZK (1.6 bn EUR, 0.8% GDP). Direct costs were 14.5 bn CZK (0.6 bn EUR) and accounted for 3.4% of Czech healthcare expenditures. The highest healthcare utilization costs were attributable to type II diabetes (20.6%), ischemic heart disease (18.8%) and osteoarthritis (16.7%). The largest indirect costs were attributable to premature mortality (10 bn CZK/0.39 bn EUR), absenteeism (9.2 bn CZK/0.36 bn EUR) and presenteeism (7.1 bn CZK/0.27 bn EUR). This article demonstrates that obesity is a serious problem with considerable costs. Several preventive interventions should be applied in order to decrease the prevalence of obesity and achieve cost savings.

Obesity inequality and well-being in Germany

Using 2002-2018 German Socio-Economic Panel (GSOEP) data for German adults aged 18 + , this study measures changes in the body mass index (BMI) distribution and obesity inequality to estimate the relation between the latter and subjective well-being. In addition to documenting a significant association between the various measures of obesity inequality and subjective well-being, especially among women, we show a significant increase in obesity inequality, particularly among females and those with low education and/or low income. This rising inequality points to the need to combat obesity through initiatives targeted at specific sociodemographic groups.

Smartphone-supported behavioural weight loss treatment in adults with severe obesity: study protocol for an exploratory randomised controlled trial (SmartBWL)

INTRODUCTION

Behavioural weight loss (BWL) treatment is the standard evidence-based treatment for severe obesity (SO; body mass index ≥40.0 kg/m² or ≥35.0 kg/m² with obesity-related comorbidity), leading to moderate weight loss which often cannot be maintained in the long term. Because weight loss depends on patients' use of weight management skills, it is important to support them in daily life. In an ecological momentary intervention design, this clinical trial aims to adapt, refine and evaluate a personalised cognitive-behavioural smartphone application (app) in BWL treatment to foster patients' weight management skills use in everyday life. It is hypothesised that using the app is feasible and acceptable, improves weight loss and increases skills use and well-being.

METHODS AND ANALYSIS

In the pilot phase, the app will be adapted, piloted and optimised for BWL treatment following a participatory patient-oriented approach. In the subsequent single-centre, assessor-blind, exploratory randomised controlled trial, 90 adults with SO will be randomised to BWL treatment over 6 months with versus without adjunctive app. Primary outcome is the amount of weight loss (kg) at post-treatment (6 months), compared with pretreatment, derived from measured body weight. Secondary outcomes encompass feasibility, acceptance, weight management skills use, well-being and anthropometrics assessed at pretreatment, midtreatment (3 months), post-treatment (6 months) and 6-month follow-up (12 months). An intent-to-treat linear model with randomisation arm, pretreatment weight and stratification variables as covariates will serve to compare arms regarding weight at post-treatment. Secondary analyses will include linear mixed models, generalised linear models and regression and mediation analyses. For safety analysis (serious) adverse events will be analysed descriptively.

ETHICS AND DISSEMINATION

The study was approved by the Ethics Committee of the University of Leipzig (DE-21-00013674) and notified to the Federal Institute for Drugs and Medical Devices. Study results will be disseminated through peer-reviewed publications.

REGISTRATION

This study was registered at the German Clinical Trials Register (DRKS00026018), www.drks.de.

TRIAL REGISTRATION NUMBER

DRKS00026018.

The intangible costs of overweight and obesity in Germany

BACKGROUND

Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany.

METHODS

By applying a life satisfaction-based compensation value analysis to 2002-2018 German Socio-Economic Panel Survey data for adults aged 18-65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity.

RESULTS

The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002.

CONCLUSIONS

Our results underscore how existing research into obesity's economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.

Economic impacts of overweight and obesity: current and future estimates for 161 countries

INTRODUCTION

The scope of the challenge of overweight and obesity (OAO) has not been fully realised globally, in part because much of what is known about the economic impacts of OAO come from high-income countries (HICs) and are not readily comparable due to methodological differences. Our objective is to estimate the current and future national economic impacts of OAO globally.

METHODS

We estimated economic impacts of OAO for 161 countries using a cost-of-illness approach. Direct and indirect costs of OAO between 2019 and 2060 were estimated from a societal perspective. We assessed the effect of two hypothetical scenarios of OAO prevalence projections. Country-specific data were sourced from published studies and global databases.

RESULTS

The economic impact of OAO in 2019 is estimated at 2.19% of global gross domestic product (GDP) ranging on average from US$20 per capita in Africa to US$872 per capita in the Americas and from US$6 in low-income countries to US$1110 in HICs.If current trends continue, by 2060, the economic impacts from OAO are projected to rise to 3.29% of GDP globally. The biggest increase will be concentrated in lower resource countries with total economic costs increasing by fourfold between 2019 and 2060 in HICs, whereas they increase 12-25 times in low and middle-income countries. Reducing projected OAO prevalence by 5% annually from current trends or keeping it at 2019 levels will translate into average annual reductions of US$429 billion or US$2201 billion in costs, respectively, between 2020 and 2060 globally.

CONCLUSION

This study provides novel evidence on the economic impact of OAO across different economic and geographic contexts. Our findings highlight the need for concerted and holistic action to address the global rise in OAO prevalence, to avert the significant risks of inaction and achieve the promise of whole-of-society gains in population well-being.

Weight Reduction Interventions Using Digital Health for Employees with Obesity: A Systematic Review

PURPOSE

This study aimed to systematically review the literature on randomized controlled trials on weight reduction interventions using digital health for employees with obesity.

METHODS

All relevant articles published until September 2021 were systematically identified from six electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, RISS, and KISS. Data selection and extraction were independently performed by three researchers. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. The results were narratively synthesized.

RESULTS

Eleven studies were included in the systematic review. All studies had a low risk of bias. The settings and sample sizes of the included studies were different. The contents of the interventions included nutrition, physical activity, behavioral change, incentives, and motivation. Four studies were based on social cognitive theory. A total of ten studies delivered web-based intervention, while the other used tele-monitoring device. A wide range of intervention strategies was used including providing online resources, tele-counseling, and patient-tailored advice. As a result of the intervention, a total of seven studies showed a significant weight reduction in both the intervention and comparison groups, with significant differences between groups.

CONCLUSION

Until now, use of digital health in weight reduction interventions for employees with obesity has been conducted on a web-based. Various contents such as nutrition, physical activity and theories were explored. Further study is required using more diverse delivery methods such as mobile application, use of wearable devices.

Patterns and predictors of sick leave among Swedish non-hospitalized healthcare and residential care workers with Covid-19 during the early phase of the pandemic

Healthcare and residential care workers represent two occupational groups that have, in particular, been at risk of Covid-19, its long-term consequences, and related sick leave. In this study, we investigated the predictors of prolonged sick leave among healthcare and residential workers due to non-hospitalized Covid-19 in the early period of the pandemic. This study is based on a patient register (n = 3209) and included non-hospitalized healthcare or residential care service workers with a positive RT- PCR for SARS-CoV-2 (n = 433) between March and August 2020. Data such as socio-demographics, clinical characteristics, and the length of sick leave because of Covid-19 and prior to the pandemic were extracted from the patient’s electronic health records. Prolonged sick leave was defined as sick leave ≥ 3 weeks, based on the Swedish pandemic policy. A generalized linear model was used with a binary distribution, adjusted for age, gender, and comorbidity in order to predict prolonged sick leave. Of 433 (77% women) healthcare and residential care workers included in this study, 14.8% needed longer sick leave (> 3 weeks) due to Covid-19. Only 1.4% of the subjects were on sick leave because of long Covid. The risk of sick leave was increased two-fold among residential care workers (adjusted RR 2.14 [95% CI 1.31–3.51]). Depression/anxiety (adjusted RR 2.09 [95% CI 1.31–3.34]), obesity (adjusted RR 1.96 [95% CI 1.01–3.81]) and dyspnea at symptom onset (adjusted RR 2.47 [95% CI 1.55–3.92]), sick leave prior to the pandemic (3–12 weeks) (adjusted RR 2.23 [95% CI 1.21–4.10]) were associated with longer sick leave. From a public health perspective, considering occupational category, comorbidity, symptoms at onset, and sick leave prior to the pandemic as potential predictors of sick leave in healthcare may help prevent staff shortage.

Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study

BACKGROUND

People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants' health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D).

METHODS

This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables.

RESULTS

The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (- 2.33, 95% CI: - 3.10 to - 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = - 0.34, 95% CI: - 0.65 to - 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = - 0.02, 95% CI: - 0.04 to 0.001) and work absence (B = - 0.01, 95% CI: - 0.02 to - 0.002). The regression model explained 71.8% of the HRQoL variance.

CONCLUSION

The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended.

TRIAL REGISTRATION

Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374 , registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=.

Incidence and Length of Sickness Absence among Hierarchical Occupational Classes and Non-Wage-Earners: A Register Study of 1.6 Million Finns

Socioeconomic differences in sickness absence are well known, but previous studies have tended to focus on wage earners only. This study examined incidence and length of sickness absence comparing the employee groups of upper and lower non-manual employees and manual workers, but also entrepreneurs, the unemployed and other non-wage-earners. The study utilized register data on a nationally representative 70% sample of Finns aged 25–62 at the end of year 2012 (N = 1,615,352). Sickness absence spells compensated by sickness allowance and initiated during 2013 were retrieved from the register of the Social Insurance Institution of Finland (SIIF) and followed until the end of each episode and linked to socio-demographic covariates collected from the registers of the SIIF and of Statistics Finland. Zero-inflated negative binomial regression was used in multivariate models. After adjusting for age, marital status, region and income, there were clear differences in the occurrence and length of sickness absence across socioeconomic groups. Compared to upper non-manual employees, lower non-manual employees and especially manual workers had higher cumulative annual incidence of sickness absence among both men and women, but the entrepreneurs, the unemployed and other non-wage-earners had a clearly higher expected number of sickness absence days. Results varied by diagnostic group. The results highlight the importance of different types of preventive measures for reducing the occurrence of sickness absence and for preventing prolongations of sickness absence spells in different socioeconomic groups.

Lifestyle and Work-Related Factors Associated with Work Ability and Work Participation for People with Obesity: A Prospective Observational Study After Vocational Rehabilitation

PURPOSE

We aimed to investigate which changes in the explanatory factors that were associated with positive change in the work ability score (WAS) and degree of work participation (DWP) for participants in a new 1-year vocational rehabilitation (VR) program for people on or at risk of sick leave due to obesity or obesity-related problems.

PATIENTS AND METHODS

This prospective observational study included 95 participants with a body mass index (BMI) above 30 kg/m². The 1-year multidisciplinary VR program with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by five meetings. Differences between baseline and 12-month follow-up data were analyzed for the change in explanatory variables WAS, DWP, health-related quality of life (HRQoL), BMI, and return-to-work self-efficacy (RTWSE). The primary outcome was measured by multiple linear regression for predicting WAS and DWP.

RESULTS

We found significant changes in WAS (1.51, 95% CI: 0.83 to 2.20, p<0.001), DWP (18.69, 95% CI: 8.35 to 29.02, p<0.001), HRQoL (2.57, 95% CI: 1.35 to 3.79, p<0.001), BMI (-2.33, 95% CI: -3.10 to -1.56, p<0.001), and in RTWSE (15.89, 95% CI: 4.07 to 27.71, p = 0.009). Regression analysis yielded a strong association between WAS at 12-month follow-up with an increase in HRQoL (β=0.27, 95% CI: 0.16 to 0.38, p<0.001) and WAS baseline (β=0.49, 95% CI: 0.28 to 0.71, p<0.001). Further, regression analysis demonstrated a strong association between DWP at 12-month follow-up with return-to-work expectancy (RTWEXP) (β=-10.62, 95% CI: -15.25 to -6.03, p<0.001).

CONCLUSION

The results indicate positive changes in WAS, DWP, HRQoL, BMI, and RTWSE from baseline to 12-month follow-up. For people with BMI above 30 kg/m², changes in HRQoL are important for an increase in WAS, and a high RTWEXP is essential to achieve work participation. Future studies examining VR programs with lifestyle interventions for people with obesity are recommended.

Lifetime cost-effectiveness and equity impacts of the Healthy Primary School of the Future initiative

BACKGROUND

This study estimated the lifetime cost-effectiveness and equity impacts associated with two lifestyle interventions in the Dutch primary school setting (targeting 4-12 year olds).

METHODS

The Healthy Primary School of the Future (HPSF; a healthy school lunch and structured physical activity) and the Physical Activity School (PAS; structured physical activity) were compared to the regular Dutch curriculum (N = 1676). An adolescence model, calculating weight development, and the RIVM Chronic Disease Model, calculating overweight-related chronic diseases, were linked to estimate the lifetime impact on chronic diseases, quality adjusted life years (QALYs), healthcare, and productivity costs. Cost-effectiveness was expressed as the additional costs/QALY gained and we used €20,000 as threshold. Scenario analyses accounted for alternative effect maintenance scenarios and equity analyses examined cost-effectiveness in different socioeconomic status (SES) groups.

RESULTS

HPSF resulted in a lifetime costs of €773 (societal perspective) and a lifetime QALY gain of 0.039 per child versus control schools. HPSF led to lower costs and more QALYs as compared to PAS. From a societal perspective, HPSF had a cost/QALY gained of €19,734 versus control schools, 50% probability of being cost-effective, and beneficial equity impact (0.02 QALYs gained/child for low versus high SES). The cost-effectiveness threshold was surpassed when intervention effects decayed over time.

CONCLUSIONS

HPSF may be a cost-effective and equitable strategy for combatting the lifetime burden of unhealthy lifestyles. The win-win situation will, however, only be realised if the intervention effect is sustained into adulthood for all SES groups.

TRIAL REGISTRATION

Clinicaltrials.gov ( NCT02800616 ). Registered 15 June 2016 - Retrospectively registered.

Weight Reduction by the Low-Insulin-Method-A Randomized Controlled Trial

Continuous high insulin levels are associated with weight gain and lead to cardiometabolic diseases. Therefore, we have developed the Low-Insulin-Method and integrated it into the multi-component, occupational healthcare program SHAPE-AND-MOTION-Medical-Accompanied-Slimming (SAMMAS) to reduce daily insulin levels for long-term weight reduction in overweight or obesity. Employees were randomized into a starting intervention group (SI, n = 15) or waiting list control group (WL, n = 15). SAMMAS consisted of group-based seminars, low-carbohydrate nutrition including formula diet, continuous glucose monitoring, telemetric monitoring, and telemedical coaching. Both groups received telemetric devices at baseline. Intention-to-treat analyses were performed after 12, 26, and 52 weeks. The estimated treatment difference in weight reduction after 12 weeks, which is the primary endpoint of the study, showed a pronounced effect in favour of SI (−6.3 kg with (95% confidence interval) (−7.4; −4.5) (p < 0.001)) after 12 weeks. Furthermore, SI improved fasting blood glucose, HbA1c, quality of life, fasting insulin, blood pressure, and eating behaviour (all p < 0.05) in the within-group analysis, while WL did not. After 26 and 52 weeks, weight reduction could be maintained in the whole group (both groups together) by −6.7 kg (−9.5; −3.8) (p < 0.001) and −6.1 kg (−9.2; −2.7) (p < 0.01). SAMMAS supports clinically relevant weight reduction and long-term weight loss maintenance in individuals with overweight or obesity.

Gender differences in the longitudinal association between obesity, and disability with workplace absenteeism in the Australian working population

Background

Excess weight can increase absenteeism of workers and can have a negative influence on their productivity. Current evidence on this association is mostly based on cross-sectional data and there is little evidence concerning the longitudinal relationship between obesity, and disability with workplace absenteeism. Further, gender differences in this association have often ignored in the existing literature.

Objectives

This study aims to examine gender differences in the longitudinal association between obesity, and disability with absenteeism in the workplace.

Methods

Data from thirteen waves (2006 to 2018) of the Household, Income and Labour Dynamics in Australia (HILDA) survey were pooled, resulting in 117,769 observations for 19,851 adult employees. The Zero-Inflated Negative Binomial (ZINB) regression model was deployed to investigate the links between obesity, and disability with workplace absenteeism for the total sample and stratified by gender.

Results

The findings showed that overweight (Incidence Rate Ratio [IRR]: 1.23, 95% confidence interval [CI]: 1.02–1.47), obesity (IRR: 1.35, 95% CI: 1.12–1.64) and disability (IRR: 2.83, 95% CI: 2.36–3.38) were associated with prolonged workplace absenteeism irrespective of gender. This study found that the multiplicative interaction between weight status and gender is significantly associated with absenteeism. The results reveal that the rate of absenteeism was 2.79 times (IRR: 2.79, 95% CI: 1.96–3.97) and 1.73 times (IRR: 1.73, 95% CI: 1.20–2.48) higher among overweight and obese women than male counterparts, respectively. Moreover, this study found that the weight status of male workers is not associated with absenteeism. However, disability (IRR: 3.14, 95% CI: 2.43–4.05) is positively associated with longer days of absence among male workers. Finally, the study results showed that the rate of absenteeism is 1.82 (IRR: 1.82, 95% CI: 1.36–2.44), 1.61 (IRR: 1.61, 95% CI: 1.21–2.13), and 2.63 (IRR: 2.63, 95% CI: 1.99–3.48) times higher among overweight, obese, and female workers with a disability, respectively, compared with their lower weight counterparts.

Conclusions

Workplace absenteeism is significantly associated with overweight and obesity among Australian workers. An active workplace health promotion program is very important for weight management of overweight and obese workers and thus to reduce workplace absenteeism. For example, employers may provide incentives for maintaining recommended body weights, encourage exercise, and promote healthy diets amongst their workers.

Telemedical coaching for weight loss in overweight employees: a three-armed randomised controlled trial

OBJECTIVES

We examined the effect of a telemedical coaching (TMC) programme accompanied with or without telemonitoring on weight loss in an occupational healthcare setting with a three-armed randomised controlled trial (NCT01837134 'Pre-results').

METHODS

Overweight employees (n=104, body mass index [BMI] ≥25 kg/m²) were invited by their medical corporate department and randomised into either a TMC group (n=34) or in one of the two control groups (C1, n=34; C2, n=36). TMC and C1 were equipped with telemonitoring devices (scales and pedometers) at baseline, and C2 after 6 months. Telemonitoring devices automatically transferred data into a personalised online portal. TMC was coached with weekly care calls in months 3-6 and monthly calls from months 7 to 12. C2 had a short coaching phase in months 6-9. C1 received no further support. After the 12-month intervention phase, participants could take advantage of further company health promotion offers. Follow-up data were determined after 12 months of intervention and per-protocol (PP) and intention-to-treat (ITT) analyses were performed. Weight change was followed up after 36 months. Estimated treatment difference (ETD) was calculated for weight reduction.

RESULTS

ETD from TMC to C1 (-3.6 kg 95% CI -7.40 to -0.1, p=0.047) and to C2 (-4.2 kg [-7.90 to -0.5], p=0.026) was significantly different at the 12 months follow-up in the PP-analysis, but lost significance in the ITT analysis. All groups reduced weight after 12 months (-3.3 to -8.4 kg [5.5-10.3 kg], all p<0.01) and sustained it during the 36 months follow-up (-4.8 to -7.8 kg [5.6-12.8 kg], all p<0.01). ETD analyses revealed no difference between all groups neither in the PP nor in the ITT analysis at the 3 years follow-up. All groups reduced BMI, systolic and diastolic blood pressure and improved eating behaviour in the PP or ITT analyses.

CONCLUSIONS

TMC and/or telemonitoring support long-term weight reduction in overweight employees. The combination of both interventions points towards an additional effect.

TRIAL REGISTRATION NUMBER

NCT01837134.

Estimating the impact of obesity and metabolic phenotype on sickness absence. Results from the ICARIA study

BACKGROUND AND AIMS

To assess the impact of obesity and being overweight on sickness absence (SA) as a function of healthy/unhealthy metabolic phenotype.

METHODS AND RESULTS

A total of 173 120 healthy workers who underwent a routine check-up, consisting of a structured interview, anthropometric measurements and blood pressure and fasting blood analysis, were included as the study sample (67.1% males; 49.2% manual workers; mean age 40.6 ± 21.9 years). Workers were classified according to their body mass index (BMI) and metabolic phenotype. A metabolically unhealthy phenotype was defined as the presence of three or more of the following criteria: glycaemia ≥110 mg/dL or previously diagnosed type I/II diabetes or treatment for diabetes; triglycerides ≥150 mg/dL or lipid-lowering therapy; HDL <40/50 mg/dL M/F; blood pressure ≥130/85 mmHg or previously diagnosed hypertension or antihypertensive therapy; waist circumference >102/88 cm M/F. A one-year follow-up was conducted to evaluate the incidence of work-related and non-work-related SA (WRSA/NWRSA). The association of BMI with SA was tested using Poisson regression (standard error correction), segmenting on the basis of metabolic phenotype. The overall percentages of workers who were overweight, obese and/or had a metabolically unhealthy phenotype were 37.7%, 16.3% and 8.8%, respectively. BMI was associated with increased incidence of NWRSA in both phenotypes. It was also associated with WRSA in subjects with a BMI in the range of 35-39.99 kg/m² and in metabolically healthy individuals. WRSA was lower in subjects with a BMI ≥40 kg/m² and among metabolically unhealthy individuals.

CONCLUSION

Obesity is associated with health problems that have a significant impact on SA.

Telemedical Coaching Improves Long-Term Weight Loss in Overweight Persons: A Randomized Controlled Trial

Background

Lifestyle interventions have shown to be effective when continuous personal support was provided. However, there is lack of knowledge whether a telemedical-approach with personal coaching contributes to long-term weight losses in overweight employees. We, therefore, tested the hypothesis that telemedical-based lifestyle interventions accompanied with telemedical coaching lead to larger weight losses in overweight persons in an occupational health care setting.

Methods

Overweight employees (n=180) with a body mass index (BMI) of >27 kg/m² were randomized into either a telemedical (TM) group (n=61), a telemedical coaching (TMC) group (n=58), or a control group (n=61). Both intervention groups were equipped with scales and pedometers automatically transferring the data into a personalized online portal, which could be monitored from participants and coaches. Participants of the TMC group received additionally one motivational care call per week by mental coaches to discuss the current data (current weight and steps) and achieving goals such as a healthy lifestyle or weight reduction. The control group remained in routine care. Clinical and anthropometric data were determined after the 12-week intervention. Additionally, weight change was followed up after 12 months.

Results

Participants of TMC (-3.1 ± 4.8 kg, p<0.0001) and TM group (-1.9 ± 4.0 kg; p=0.0012) significantly reduced weight and sustained it during the 1-year follow-up, while the control group showed no change. Compared to the control group only weight loss in the TMC group was significantly different (p<0.001) after 12 months. TMC and TM group also reduced BMI, waist circumference, and LDL cholesterol. Moreover, TMC group improved additionally systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, and HbA1c.

Conclusions

Telemedical devices in combination with telemedical coaching lead to significant long-term weight reductions in overweight persons in an occupational health care setting. This study is registered with NCT01868763, ClinicalTrials.gov.

Obesity and sickness absence: results from a longitudinal nationally representative sample from Germany

OBJECTIVES

The current study aimed at investigating the longitudinal association between obesity and sickness absence in women and men in Germany.

METHODS

Data were derived from the German Socio-Economic Panel (GSOEP) which is a nationally representative, longitudinal study of private households in Germany. We draw on data from 2002 to 2012. Information on self-rated body mass index has been collected every second wave since 2002. Sick leave days (total number of working days missed due to illness in the past calendar year) and sick from work for more than 6 weeks in the preceding 12 months (yes/no) were used as outcome measures. Fixed-effects (FE) regression models were used for the total sample and stratified by sex. Gender differences were examined using interaction terms (sex × weight category).

RESULTS

Controlling for several potential confounders, Poisson FE regression analysis showed that transitions from normal weight to obesity were associated with an increase in sick leave days in women (incidence rate ratio (IRR) 1.27, 95% CI 1.02 to 1.57) but not in men (IRR 0.85, 95 % CI 0.68 to 1.06)-with significant gender differences (sex × obesity, p<0.01). Moreover, conditional FE logistic regressions showed that transitions from normal weight to overweight were associated with an increase in the probability of long-term absenteeism in women (overweight, OR 1.41, 95% CI 1.08 to 1.85) but not in men (overweight, OR 0.84, 95% CI 0.65 to 1.09). Gender differences were significant (sex × overweight, p<0.01).

CONCLUSIONS

Our findings stress the longitudinal association between excess weight and increased likelihood of sick leave days as well as long-term absenteeism in women.

Dietary interventions to prevent and manage diabetes in worksite settings: a meta-analysis

OBJECTIVES

The translation of lifestyle intervention to improve glucose tolerance into the workplace has been rare. The objective of this meta-analysis is to summarize the evidence for the effectiveness of dietary interventions in worksite settings on lowering blood sugar levels.

METHODS

We searched for studies in PubMed, Embase, Econlit, Ovid, Cochrane, Web of Science, and Cumulative Index to Nursing and Allied Health Literature. Search terms were as follows: (1) Exposure-based: nutrition/diet/dietary intervention/health promotion/primary prevention/health behavior/health education/food /program evaluation; (2) Outcome-based: diabetes/hyperglycemia/glucose/HbA1c/glycated hemoglobin; and (3) Setting-based: workplace/worksite/occupational/industry/job/employee. We manually searched review articles and reference lists of articles identified from 1969 to December 2016. We tested for between-studies heterogeneity and calculated the pooled effect sizes for changes in HbA1c (%) and fasting glucose (mg/dl) using random effect models for meta-analysis in 2016.

RESULTS

A total of 17 articles out of 1663 initially selected articles were included in the meta-analysis. With a random-effects model, worksite dietary interventions led to a pooled -0.18% (95% CI, -0.29 to -0.06; P<0.001) difference in HbA1c. With the random-effects model, the interventions resulted in 2.60 mg/dl lower fasting glucose with borderline significance (95% CI: -5.27 to 0.08, P=0.06). In the multivariate meta-regression model, the interventions with high percent of female participants and that used the intervention directly delivered to individuals, rather the environment changes, were associated with more effective interventions.

CONCLUSION

Workplace dietary interventions can improve HbA1c. The effects were larger for the interventions with greater number of female participants and with individual-level interventions.

Productivity loss due to overweight and obesity: a systematic review of indirect costs

OBJECTIVE

The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity.

METHODS

A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality.

RESULTS

Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies.

CONCLUSION

The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.

Economic Burden of Obesity: A Systematic Literature Review

Background: The rising prevalence of obesity represents an important public health issue. An assessment of its costs may be useful in providing recommendations for policy and decision makers. This systematic review aimed to assess the economic burden of obesity and to identify, measure and describe the different obesity-related diseases included in the selected studies. Methods: A systematic literature search of studies in the English language was carried out in Medline (PubMed) and Web of Science databases to select cost-of-illness studies calculating the cost of obesity in a study population aged ≥18 years with obesity, as defined by a body mass index of ≥30 kg/m², for the whole selected country. The time frame for the analysis was January 2011 to September 2016. Results: The included twenty three studies reported a substantial economic burden of obesity in both developed and developing countries. There was considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives. This prevents an informative comparison between most of the studies. Specifically, there was great variety in the included obesity-related diseases and complications among the studies. Conclusions: There is an urgent need for public health measures to prevent obesity in order to save societal resources. Moreover, international consensus is required on standardized methods to calculate the cost of obesity to improve homogeneity and comparability. This aspect should also be considered when including obesity-related diseases.

Übergewicht und Adipositas als Public Health-Problem

In Deutschland ist mehr als die Hälfte der Erwachsenen übergewichtig, fast ein Viertel ist adipös. Als Risikofaktor für viele Erkrankungen geht Übergewicht mit einer hohen individuellen Krankheitslast und, infolge dessen, erhöhten Versorgungskosten und Produktivitätsverlusten einher. Aufgrund der hohen Krankheitslast und weiten Verbreitung gehört Übergewicht zu den relevantesten Risikofaktoren in Deutschland. Der Beitrag konzentriert sich auf die gesundheitsökonomischen Folgen des Übergewichtes.

The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies

OBJECTIVE

To estimate the excess costs of obese compared to normal-weight persons in Germany based on self-reported resource utilisation and work absence.

METHODS

Five cross sectional surveys of cohort studies in southern Germany were pooled resulting in 9,070 observations for 6,731 individuals (31-96 years). BMI was measured in the study centre. Self-reported health care utilisation and work absence was used to estimate direct and indirect costs for the year 2011 based on unit costs. Using regression analyses, adjusted costs for different BMI groups were calculated.

RESULTS

Overweight and obese people showed significantly higher odds of health care utilisation and productivity losses compared with normal-weight people in most categories. Total direct/indirect costs were significantly higher with increasing severity of obesity (pre-obese (1.05 (0.90-1.23) / 1.38 (1.11-1.71)), obesity level I (1.18 (1.00-1.39) / 1.33 (1.02-1.73)), obesity level II (1.46 (1.14-1.87) / 1.77 (1.18-2.65)) or level III (2.04 (1.40-2.97) / 1.99 (1.20-3.30)) compared to normal-weight participants. In particular, higher obesity classes were significantly associated with increased costs for medication, general practitioner utilisation and work absence.

CONCLUSION

Our results show that overweight and obesity are associated with enormous societal direct and indirect costs in Germany. This supports the evidence from previous top-down studies, but provides important new information based on a large pooled data set and measured BMI.

Health burden and costs of obesity and overweight in Germany: an update

In 2011, Konnopka et al. (Eur J Health Econ 12:345-352, 2011) published a top-down cost of illness study on the health burden, and direct and indirect costs of morbidity and mortality attributable to excess weight (BMI ≥25 kg/m(2)) in Germany in 2002. The objective of the current study was to update the 2002 estimates to the year 2008. To simplify comparisons, we closely followed the methods and assumptions of the original study, using 2008 data for most input parameters (e.g. prevalence, mortality, resource use, costs). Excess weight related deaths increased by 31% (from 36,653 to 47,964) and associated years of potential life lost (from 428,093 to 588,237) and quality adjusted life years lost (from 367,722 to 505,748) by about 37%, respectively. Excess weight caused €16,797 million in total costs in 2008 (+70%), of which €8,647 million were direct costs (corresponding to 3.27% of total German health care expenditures in 2008). About 73% (€12,235 million) of total excess weight related costs were attributable to obesity (BMI ≥30 kg/m(2)). The main drivers of direct costs were endocrinological (44%) and cardiovascular (38%) diseases. Indirect costs amounted to €8,150 million in 2008 (+62%), of which about two-thirds were indirect costs from unpaid work. The great majority of indirect costs were due to premature mortality (€5,669 million). The variation of input parameters (univariate sensitivity analyses) resulted in attributable costs between €8,978 million (-47% compared to base case) and €25,060 million (+49%). The marked increase in excess weight related costs can largely be explained by increases in the prevalence of overweight and obesity, and to a lesser extent from increases in resource consumption, as well as increases in (unit) costs and wages (comprising 5.5% inflation).

A Computerized Lifestyle Application to Promote Multiple Health Behaviors at the Workplace: Testing Its Behavioral and Psychological Effects

BACKGROUND

Preventive health behaviors, such as regular physical activity and healthy nutrition, are recommended to maintain employability and to facilitate the health of employees. Theory-based workplace health promotion needs to include psychological constructs and consider the motivational readiness (so-called stages of change) of employees. According to the stages, people can be grouped as nonintenders (not motivated to change and not performing the goal behavior), intenders (decided to adopt the goal behavior but not started yet), or actors (performing the goal behavior already). The tailoring to these stages can be done computer based and should make workplace health promotion more effective.

OBJECTIVE

It was tested whether a parsimonious computer-based health promotion program implemented at the workplace was effective in terms of lifestyle changes and psychological outcomes as well as body weight. We hypothesized that the stage-matched intervention would outperform the one-size-fits-all active control condition (standard care intervention).

METHODS

In a randomized controlled trial, a total of 1269 employees were recruited by a trained research assistant at their workplace during a routine medical examination. After excluding noneligible employees, 560 completed Time 1 (T1), and 384 also completed Time 2 (T2), achieving a retention rate of 68.6%. Two fully automated computer-based treatments were adopted: (1) an active control condition with information about benefits of exercise and healthy nutrition (n=52), or (2) a stage-matched multiple-behavior intervention that provided different psychological treatments to 9 subgroups, addressing stages of change (nonintenders, intenders, and actors per behavior; n=332). Baseline assessments (T1) on behavior, psychological constructs, and body weight were repeated after 4 weeks (T2).

RESULTS

The stage-matched intervention outperformed the active control condition for lifestyle changes containing physical activity and nutrition (χ(2) 1=3.5; P=.04, for N=384) as well as psychological variables (physical activity intention, P=.04; nutrition intention, P=.03; nutrition planning, P=.02; and general social support to live healthily, P=.01). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR, 2.25, 95% CI 1.73-2.92; P<.01) and the intervention (OR 1.96, 95% CI 1.00-3.82; P=.05) were found to be significant predictors. Physical activity planning mediated the effect of the intervention on the adoption of an overall healthy lifestyle (consisting of activity and nutrition, R(2) adj=.08; P<.01), indicating that if the stage-matched intervention increased planning, the adoption of a healthy lifestyle was more likely.

CONCLUSIONS

Matching an intervention to the motivational readiness of employees can make a health promotion program effective. Employees' motivation, planning, social support, and lifestyle can be supported by a stage-matched intervention that focuses on both physical activity and healthy nutrition. Occupational settings provide a potential to implement parsimonious computer-based health promotion programs and to facilitate multiple behavior change.

Workplace slip, trip and fall injuries and obesity

The objective of this study was to examine the relationship between slip, trip and fall injuries and obesity in a population of workers at the Idaho National Laboratory (INL) in Idaho Falls, Idaho. INL is an applied engineering facility dedicated to supporting the US Department of Energy's mission. An analysis was performed on injuries reported to the INL Medical Clinic to determine whether obesity was related to an increase in slip, trip and fall injuries. Records were analysed that spanned a 6-year period (2005-2010), and included 8581 employees (mean age, 47 ± 11 years and body mass index [BMI], 29 ± 5 kg/m(2); 34% obesity rate). Of the 189 people who reported slip, trip and fall injuries (mean age, 48 ± 11 years), 51% were obese (P < 0.001 compared with uninjured employees), and their mean BMI was 31 ± 6 kg/m(2) (P < 0.001). Obesity in this population was associated with a greater rate of slip, trip and fall injuries.