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Atella V, Belotti F, Giaccherini M, Medea G, Nicolucci A, Sbraccia P, Mortari AP. Lifetime costs of overweight and obesity in Italy. Econ Hum Biol 2024; 53:101366. [PMID: 38354596 DOI: 10.1016/j.ehb.2024.101366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- Vincenzo Atella
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy.
| | - Federico Belotti
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; CEIS Tor Vergata, Tor Vergata University of Rome, Italy
| | | | - Gerardo Medea
- Center for Outcomes Research and Clinical Epidemiology - CORESEARCH, Pescara, Italy
| | | | - Paolo Sbraccia
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Andrea Piano Mortari
- Department of Economics and Finance, Tor Vergata University of Rome, Italy; Department Programming, Ministry of Health, Rome, Italy
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Wong ES, Stechuchak KM, Smith VA, Hung A, Dennis PA, Hoerster KD, Maciejewski ML. Differences in healthcare costs over 10 years following discharge from military service by weight trajectory. Obes Res Clin Pract 2024; 18:88-93. [PMID: 38565463 DOI: 10.1016/j.orcp.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research related to the economic impacts of obesity has not examined health care costs following the transition into civilian life following military discharge. To address this evidence gap, this study sought to compare longitudinal costs over 10 years across weight categories among VA enrollees recently discharged from the military.
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Affiliation(s)
- Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA.
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Paul A Dennis
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Katherine D Hoerster
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA; Duke-Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708, USA
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Fabron C, Laville M, Aron-Wisnewsky J, Disse E, Gatta-Cherifi B, Jacobi D, Montastier E, Oppert JM, Gaillard L, Detournay B, Czernichow S. Out-of-Pocket Expenses in Households of People Living with Obesity in France. Obes Facts 2023; 16:606-613. [PMID: 37879296 PMCID: PMC10870127 DOI: 10.1159/000533342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/28/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND/OBJECTIVES Overweight and obesity result in a substantial economic burden in both low- and high-income countries. Moreover, this burden is often underestimated because it only partially accounts for unreimbursed out-of-pocket expenses (OOPE) related to obesity. The objective of our study was not only to evaluate OOPE incurred by people with obesity in relation to their disease with respect to direct medical expenditures and direct non-medical expenditures but also the proportion of people living with obesity who have forgone obesity-related healthcare due to the costs of such care. METHODS An observational descriptive survey was conducted among people with class II/III obesity attending six obesity treatment centers in France. Volunteer adult participants completed a written/phone questionnaire on their related expenditures over the last 6 months for current expenditures and over the last 5 years for occasional ones. The costs were expressed in 2022 EUR. RESULTS 299 people participated (age: 46 years [SD: 13.9], women: 72%, BMI ≥40 kg/m2: 62% and 48% with comorbidities). 65% had a professional activity. 83% declared that they had OOPE related to obesity representing annually EUR 2027/individual on average (5% of the household revenue), including weight loss and nutritional products, vitamins, meal programs, gym memberships, psychologists, but mainly adapted clothing, additional travel costs, and others. 15% of the respondents had to modify their professional activity due to obesity and 15% forwent some medical care in the last 12 months. CONCLUSIONS OOPE is a significant part of the economic burden of obesity. Despite some limitations due to the specificities of the participants and because some costs may be more related to social activities affected by obesity than to healthcare, it seems important to consider these expenditures in cost estimates for obesity.
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Affiliation(s)
| | - Martine Laville
- Endocrinology-Diabetology-Nutrition Department, F-CRIN-FORCE network, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon University, Pierre-Bénite, France
| | - Judith Aron-Wisnewsky
- Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France and INSERM UMRS 1269 NutriOmics, Sorbonne University, Paris, France
| | - Emmanuel Disse
- Endocrinology-Diabetology-Nutrition Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon University, Pierre-Bénite, France
| | - Blandine Gatta-Cherifi
- Endocrinology-Diabetology-Nutrition Department, Haut-Lévêque Hospital, Bordeaux University Hospital, France and Neurocentre Magendie, INSERMU1215, Bordeaux University, Bordeaux, France
| | - David Jacobi
- Nantes Université, CHU Nantes, CNRS, INSERM, L’institut du Thorax, Nantes, France
| | - Emilie Montastier
- Nantes University Hospital, CNRS, INSERM, L’institut du Thorax, Nantes University, Nantes, France
| | - Jean-Michel Oppert
- Nutrition Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France and INSERM UMRS 1269 NutriOmics, Sorbonne University, Paris, France
| | | | | | - Sébastien Czernichow
- Nutrition Department, Georges-Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, France and Paris Cité University, Paris, France
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Agarwal AK, Waddell KJ, Small DS, Evans C, Harrington TO, Djaraher R, Oon AL, Patel MS. Effect of Gamification With and Without Financial Incentives to Increase Physical Activity Among Veterans Classified as Having Obesity or Overweight: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116256. [PMID: 34241628 PMCID: PMC8271358 DOI: 10.1001/jamanetworkopen.2021.16256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Gamification is increasingly being used for health promotion but has not been well tested with financial incentives or among veterans. OBJECTIVE To test the effectiveness of gamification with social support, with and without a loss-framed financial incentive, to increase physical activity among veterans classified as having overweight and obesity. DESIGN, SETTING, AND PARTICIPANTS This 3-group randomized clinical trial had a 12-week intervention period and an 8-week follow-up period. Participants included veterans with a body mass index greater than or equal to 25 who were receiving care from a single site in Philadelphia, Pennsylvania. Participants underwent a remotely monitored intervention from March 19, 2019, to August 9, 2020. Data analyses were conducted between October 1, 2020, and November 14, 2020. INTERVENTIONS All participants received a wearable device to track step counts and selected a step goal. The control group received feedback from their devices only. Participants in the 2 gamification groups were entered into a 12-week game with points and levels designed using behavioral economic principles and selected a support partner to receive weekly updates. Participants in the loss-framed financial incentive group had $120 allocated to a virtual account and lost $10 if weekly goals were not achieved. MAIN OUTCOMES AND MEASURES The primary outcome was the change in mean daily steps from baseline during the intervention. Secondary outcomes include proportion of days goals were achieved and changes during follow-up. RESULTS A total of 180 participants were randomized, 60 to the gamification with social support group, 60 to the gamification with social support and loss-framed financial incentives group, and 60 to the control group. The participants had a mean (SD) age of 56.5 (12.9) years and a mean (SD) body mass index of 33.0 (5.6); 71 participants (39.4%) were women, 90 (50.0%) were White, and 67 (37.2%) were Black. During the intervention period, compared with control group participants, participants in the gamification with financial incentives group had a significant increase in mean daily steps from baseline (adjusted difference, 1224 steps; 95% CI, 451 to 1996 steps; P = .005), but participants in the gamification without financial incentives group did not (adjusted difference, 433 steps; 95% CI, -337 to 1203 steps; P = .81). The increase for the gamification with financial incentives group was not sustained during the follow-up period, and the step count was not significantly different than that of the control group (adjusted difference, 564 steps; 95% CI, -261 to 1389 steps; P = .37). Compared with the control group, participants in the intervention groups had a significantly higher adjusted proportion of days meeting their step goal during the main intervention and follow-up period (gamification with social support group, adjusted difference from control, 0.21 participant-day; 95% CI, 0.18-0.24 participant-day; P < .001; gamification with social support and loss-framed financial incentive group, adjusted difference from control, 0.34 participant-day; 95% CI, 0.31-0.37 participant-day; P < .001). CONCLUSIONS AND RELEVANCE Among veterans classified as having overweight and obesity, gamification with social support combined with loss-framed financial incentives was associated with a modest increase in physical activity during the intervention period, but the increase was not sustained during follow-up. Gamification without incentives did not significantly change physical activity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03563027.
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Affiliation(s)
- Anish K. Agarwal
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Kimberly J. Waddell
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Dylan S. Small
- Statistics Department,The Wharton School, The University of Pennsylvania, Philadelphia
| | - Chalanda Evans
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
| | - Tory O. Harrington
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
| | - Rachel Djaraher
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
| | - Ai Leen Oon
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
| | - Mitesh S. Patel
- Department of Emergency Medicine, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia
- The Penn Medicine Nudge Unit, The University of Pennsylvania, Philadelphia
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Health Care Management Department, The Wharton School, The University of Pennsylvania, Philadelphia
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Agrawal S, Wojtanowski AC, Tringali L, Foster GD, Finkelstein EA. Financial implications of New York City's weight management initiative. PLoS One 2021; 16:e0246621. [PMID: 33571249 PMCID: PMC7877753 DOI: 10.1371/journal.pone.0246621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To estimate potential annual savings in medical expenditures from a subsidized weight management program from the NYC Government perspective. Design Longitudinal observational study. Setting Employees of New York City (NYC) government and enrolled dependents. Sample 14,946 participants with overweight and obesity. Intervention WW (formerly Weight Watchers®) ‘Workshop’ and ‘Digital’ programs. Measures Participation rate, enrollment duration, weight change, and predicted gross and net total and per capita medical expenditure savings and return on investment (ROI). Analysis Participation rate, enrollment duration, weight change, and program costs are based on direct observation. Predicted savings are simulated based on published data relating weight loss to medical expenditure reductions. Results In total, 47% of participating employees and 50% of participating dependents lost weight during the enrollment period. Mean (median) enrollment duration for employees was 7.1 months (7.0) and for dependents was 6.9 months (6.0). Mean (median) weight losses for the employees in ‘Workshops’ and ‘Digital’ was 6.6 lbs (2.80) and 6.3 lbs (0.0). For dependents, weight losses were 7.4 lbs (3.59) and 11.6 lbs (2.0). Per capita and total predicted net savings to NYC Government from employees was estimated to be $120 and $1,486,102 for an ROI of 143%. Including dependents, predicted net savings increases to $1,963,431 for an ROI of 189%. Over 80% of savings came from participants in the Obese III category. Conclusion An evidence-based weight management program has the potential to generate a positive ROI for employers. Future studies should validate these estimates using actual data and more rigorous designs.
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Affiliation(s)
- Sagun Agrawal
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Laura Tringali
- WW International (formerly Weight Watchers), New York, NY, United States of America
| | - Gary D. Foster
- WW International (formerly Weight Watchers), New York, NY, United States of America
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia PA, United States of America
| | - Eric A. Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- * E-mail:
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Boutelle KN, Strong D, Liang J, Rhee KE, Rock CL, Wilfley D, Epstein L, Crow SJ. Comparative Costs of a Parent-Only and Parent and Child Treatment for Children with Overweight or Obesity. Obesity (Silver Spring) 2021; 29:388-392. [PMID: 33491321 PMCID: PMC9261273 DOI: 10.1002/oby.23069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Models such as family-based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent-based treatment (PBT; or parent-only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models. METHODS A total of 150 children with overweight and obesity and their parents were randomized to one of two 6-month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial-based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective. RESULTS Results suggest that PBT, compared with FBT, had lower costs per parent-child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279). CONCLUSIONS These findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.
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Affiliation(s)
- Kerri N Boutelle
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
- Department of Psychiatry, UC San Diego, San Diego, California, USA
| | - David Strong
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - June Liang
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Kyung E Rhee
- Department of Pediatrics, UC San Diego, La Jolla, California, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, UC San Diego, San Diego, California, USA
| | - Denise Wilfley
- Departent of Psychiatry, Washington University St Louis, St Louis, Missouri, USA
| | - Leonard Epstein
- Department of Pediatrics, University of Buffalo, Buffalo, New York, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
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Hunt CW, Chaturvedi R, Brown L, Stafford C, Cauley CE, Goldstone RN, Francone TD, Kunitake H, Bordeianou L, Ricciardi R. Diverticular Disease Epidemiology: Rising Rates of Diverticular Disease Mortality Across Developing Nations. Dis Colon Rectum 2021; 64:81-90. [PMID: 33306534 DOI: 10.1097/dcr.0000000000001804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of diverticular disease is growing in the Western world. However, the global burden of disease is unknown in the developing world. OBJECTIVE This study aimed to determine the global burden of diverticular disease as measured by disease-specific mortality while identifying indicators of rising disease rates. DESIGN We undertook an ecological analysis based on data from the World Health Organization Mortality Database. Then, we analyzed global age-adjusted mortality rates from diverticular disease and compared them to national rates of overweight adults, health expenditures, and dietary composition. SETTINGS National vital statistics data were collected. PATIENTS Diverticular disease deaths from January 1, 1994 through December 31, 2016 were evaluated. MAIN OUTCOME MEASURES The primary outcome measured was the national age-adjusted mortality rate. RESULTS The average age-adjusted mortality rate for diverticular disease was 0.51 ± 0.31/100,000 with a range of 0.11 to 1.75/100,000. During the study period, we noted that 57% of nations had increasing diverticular disease mortality rates, whereas only 7% had decreasing rates. More developed nations (40%) than developing nations (24%) were categorized as having high diverticular disease mortality burden over the time period of the study, and developed nations had higher percentages of overweight adults (58.9 ± 3.1%) than developing nations (50.6 ± 6.7%; p < 0.0001). However, developing nations revealed more rapid increases in diverticular disease mortality (0.027 ± 0.024/100,000 per year) than developed nations (0.005 ± 0.025/100,000 per year; p = 0.001), as well as faster expanding proportions of overweight adults (0.76 ± 0.12% per year) than in already developed nations (0.53 ± 0.10% per year; p<0.0001). LIMITATIONS Ecological studies cannot define cause and effect. CONCLUSIONS There is considerable variability in diverticular disease mortality across the globe. Developing nations were characterized by rapid increases in diverticular disease mortality and expanding percentages of overweight adults. Public health interventions in developing nations are needed to alter mortality rates from diverticular disease. See Video Abstract at http://links.lww.com/DCR/B397. EPIDEMIOLOGÍA DE LA ENFERMEDAD DIVERTICULAR: TASAS CRECIENTES DE MORTALIDAD POR ENFERMEDAD DIVERTICULAR EN LOS PAÍSES EN DESARROLLO: La incidencia de la enfermedad diverticular está creciendo en el mundo occidental. Sin embargo, la carga mundial de la enfermedad es desconocida en el mundo en desarrollo.Determinar la carga global de la enfermedad diverticular medida por la mortalidad específica de la enfermedad mientras se identifican los indicadores de aumento de las tasas de enfermedad.Realizamos un análisis ecológico basado en datos de la Base de datos de mortalidad de la Organización Mundial de la Salud. Luego, analizamos las tasas globales de mortalidad ajustadas por edad por enfermedad diverticular y las comparamos con las tasas nacionales de adultos con sobrepeso, gastos de salud y composición dietética.Datos nacionales de estadísticas vitales.Muertes por enfermedades diverticulares desde el 1 de enero de 1994 hasta el 31 de diciembre de 2016.Tasa nacional de mortalidad ajustada por edad.La tasa promedio de mortalidad ajustada por edad para la enfermedad diverticular fue de 0,51 ± 0,31 / 100,000 con un rango de 0,11 a 1,75 / 100,000. Durante el período de estudio, notamos que el 57% de las naciones tenían tasas crecientes de mortalidad por enfermedades diverticulares, mientras que solo el 7% tenían tasas decrecientes. Las naciones más desarrolladas (40%) que las naciones en desarrollo (24%) se clasificaron como que tienen una alta carga de mortalidad por enfermedad diverticular durante el período de tiempo del estudio, y las naciones desarrolladas tuvieron porcentajes más altos de adultos con sobrepeso (58.9 ± 3.1%) que las naciones en desarrollo (50,6 ± 6,7%) (p <0,0001). Sin embargo, las naciones en desarrollo revelaron aumentos más rápidos en la mortalidad por enfermedades diverticulares (0.027 ± 0.024 / 100,000 por año) que las naciones desarrolladas (0.005 ± 0.025 / 100,000 por año) (p = 0.001), así como proporciones de adultos con sobrepeso en expansión más rápida (0.76 ± 0.12% por año) que en las naciones ya desarrolladas (0.53 ± 0.10% por año) (p <0.0001).Los estudios ecológicos no pueden definir causa y efecto.Existe una considerable variabilidad en la mortalidad por enfermedad diverticular en todo el mundo. Los países en desarrollo se caracterizaron por un rápido aumento en la mortalidad por enfermedades diverticulares y porcentajes crecientes de adultos con sobrepeso. Se necesitan intervenciones de salud pública en los países en desarrollo para alterar las tasas de mortalidad por enfermedad diverticular. Consulte Video Resumen en http://links.lww.com/DCR/B397.
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Affiliation(s)
- Cameron W Hunt
- Section of Colon and Rectal Surgery, Division of General and Gastrointestinal Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Abstract
Observations from many countries indicate that multiple forms of malnutrition might coexist in a country, a household, and an individual. In this Series, the double burden of malnutrition (DBM) encompasses undernutrition in the form of stunting, and overweight and obesity. Health effects of the DBM include those associated with both undernutrition, such as impaired childhood development and greater susceptibility to infectious diseases, and overweight, especially in terms of increased risk of added visceral fat and increased risk of non-communicable diseases. These health effects have not been translated into economic costs for individuals and economies in the form of lost wages and productivity, as well as higher medical expenses. We summarise the existing approaches to modelling the economic effects of malnutrition and point out the weaknesses of these approaches for measuring economic losses from the DBM. Where population needs suggest that nutrition interventions take into account the DBM, economic evaluation can guide the choice of so-called double-duty interventions as an alternative to separate programming for stunting and overweight. We address the evidence gap with an economic analysis of the costs and benefits of an illustrative double-duty intervention that addresses both stunting and overweight in children aged 4 years and older by providing school meals with improved quality of diet. We assess the plausibility of our method and discuss how improved data and models can generate better estimates. Double-duty interventions could save money and be more efficient than single-duty interventions.
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Affiliation(s)
- Rachel Nugent
- RTI International, Seattle, WA, USA; University of Washington Department of Global Health, Seattle, WA, USA.
| | - Carol Levin
- University of Washington Department of Global Health, Seattle, WA, USA
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Mireku MO, Rodriguez A. Family Income Gradients in Adolescent Obesity, Overweight and Adiposity Persist in Extremely Deprived and Extremely Affluent Neighbourhoods but Not in Middle-Class Neighbourhoods: Evidence from the UK Millennium Cohort Study. Int J Environ Res Public Health 2020; 17:E418. [PMID: 31936305 PMCID: PMC7013671 DOI: 10.3390/ijerph17020418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/03/2020] [Accepted: 01/04/2020] [Indexed: 01/22/2023]
Abstract
We investigated whether family income gradients in obesity, overweight, and adiposity persist at geographic-level deprivation quintiles using a nationally representative cohort of UK adolescents. Data from 11,714 eligible adolescents from the sixth sweep of the Millennium Cohort Study (14 years old) were analysed in this study. The International Obesity Task Force age- and sex-specific thresholds were used to define obesity and overweight. Self-reported family income was standardized using the Organisation for Economic Co-operation and Development (OECD)'s equivalised income scale. Geographic-level deprivation was defined by the index of multiple deprivation 2004. Results showed that the prevalence of obesity and overweight was 8.0% and 27.2%, respectively. Mean percentage body fat was 16.9% (standard error, SE = 0.2%) in male and 27.3% (SE = 0.1%) in female adolescents. Risk of obesity, overweight, and adiposity increased with decreasing family income quintiles (p for trend <0.001). After stratifying by geographic-level deprivation quintiles, a U-shaped association emerged, whereby family income gradients in the risk of adolescent obesity and adiposity persisted in extremely affluent and extremely deprived neighbourhoods but attenuated to non-significance in middle-class neighbourhoods. These results focus on the findings from England. Recognition of the persistence of inequalities in the risk of obesity in the most deprived and affluent neighbourhoods may be necessary in planning public health resources and interventions.
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Affiliation(s)
- Michael Osei Mireku
- School of Psychology, University of Lincoln, Lincoln LN6 7TS, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
| | - Alina Rodriguez
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK;
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Manz KC, Waters TM, Clifton HE, Kocak M, Klesges RC, Talcott GW, Krukowski RA. Cost-Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military. Obesity (Silver Spring) 2020; 28:89-96. [PMID: 31773873 PMCID: PMC6925346 DOI: 10.1002/oby.22681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to assess whether a counselor-initiated (CI) adaptation of the Look AHEAD (Action for Health in Diabetes) intensive lifestyle intervention in a military setting was cost-effective relative to a self-paced (SP) adaptation. METHODS A cost-effectiveness analysis from a payer perspective was performed alongside a 2014-2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force base in Texas. Incremental cost-effectiveness ratios were calculated for weight loss, reductions in waist circumference, and quality-adjusted life-years (QALYs). RESULTS After 12 months, the CI adaptation cost more per participant compared with the SP adaptation ($1,081 vs. $120) but achieved greater weight loss (1.86 kg vs. 0.06 kg), greater reductions in waist circumference (1.85 cm vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The incremental cost-effectiveness ratio for the CI adaptation relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the CI adaptation was 45% and 49% likely to be cost-effective, respectively. CONCLUSIONS The CI delivery of the Look AHEAD Intensive Lifestyle Intervention may offer a cost-effective approach to tackle excess weight in the US military.
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Affiliation(s)
- Karina C. Manz
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Teresa M. Waters
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Hannah E. Clifton
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - G. Wayne Talcott
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Amiri S, Behnezhad S. Body mass index and risk of sick leave: A systematic review and meta-analysis. Clin Obes 2019; 9:e12334. [PMID: 31368657 DOI: 10.1111/cob.12334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/24/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022]
Abstract
Body mass index (BMI) is related to different health dimensions and can be a risk factor for diseases. Our objective was to systematically review and meta-analysis the association BMI and the risk of sick leave. Four databases were searched for articles until late December 2018 and the results of the studies were extracted and combined using random effects methods. Several sub-group analyses were conducted as well as bias of publication were measured. A total of 23 longitudinal studies entered into meta-analysis. BMI ≥ 25 was a risk factor for sick leave; the risk ratio (RR) is equal to 1.20 with confidence interval (CI): 1.14 to 1.28. In the overweight, this result was achieved: RR = 1.09 and CI = 1.04 to 1.15 (P = 0.001) and in the obesity, RR = 1.30 and CI = 1.19 to 1.42 (P < 0.001). In both men and women, overweight and obesity were both a risk factor for sick leave. A high BMI is a risk factor that threatens health in different dimensions and therefore, overweight/obesity prevention and treatment should be given increasing attention. This will reduce the burden of illness and its consequences.
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Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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12
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Headey DD, Alderman HH. The Relative Caloric Prices of Healthy and Unhealthy Foods Differ Systematically across Income Levels and Continents. J Nutr 2019; 149:2020-2033. [PMID: 31332436 PMCID: PMC6825829 DOI: 10.1093/jn/nxz158] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/27/2018] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Relative prices of healthy/unhealthy foods have been implicated in the obesity epidemic, but never extensively quantified across countries or empirically linked to undernutrition. OBJECTIVES This study compared relative caloric prices (RCPs) for different food categories across 176 countries and ascertained their associations with dietary indicators and nutrition outcomes. METHODS We converted prices for 657 standardized food products from the 2011 International Comparison Program into caloric prices using USDA Food Composition tables. We classified products into 21 specific food groups. We constructed RCPs as the ratio of the 3 cheapest products in each food group, relative to the weighted cost of a basket of starchy staples. We analyzed RCP differences across World Bank income levels and regions and used cross-country regressions to explore associations with Demographic Health Survey dietary indicators for women 15-49 y old and children 12-23 mo old and with WHO indicators of the under-5 stunting prevalence and adult overweight prevalence. RESULTS Most noncereal foods were relatively cheap in high-income countries, including sugar- and fat-rich foods. In lower-income countries, healthy foods were generally expensive, especially most animal-sourced foods and fortified infant cereals (FICs). Higher RCPs for a food predict lower consumption among children for 7 of 9 food groups. Higher milk and FIC prices were positively associated with international child stunting patterns: a 1-SD increase in milk prices was associated with a 2.8 percentage point increase in the stunting prevalence. Similarly, a 1-SD increase in soft drink prices was associated with a reduction in the overweight prevalence of ∼3.6 percentage points. CONCLUSIONS Relative food prices vary systematically across countries and partially explain international differences in the prevalences of undernutrition and overweight adults. Future research should focus on how to alter relative prices to achieve better dietary and nutrition outcomes.
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Affiliation(s)
- Derek D Headey
- International Food Policy Research Institute, Washington DC, USA
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Karkare S, Fridman M, Dang-Tan T, Lu J, Smolarz BG, DeKoven M, Iyer NN. Effect of Weight Change on Economic Outcomes Among Persons with Type 2 Diabetes Mellitus in the United States: Beyond Glycemic Control. J Manag Care Spec Pharm 2019; 25:658-668. [PMID: 30730232 PMCID: PMC10397686 DOI: 10.18553/jmcp.2019.18321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Previous studies report weight loss to be associated with significantly lower total health care costs among patients with type 2 diabetes mellitus (T2DM). The effect of weight change on health care costs, independent of glycemic control and after controlling for time-varying covariates among T2DM patients, remains unknown. OBJECTIVE To evaluate the effect of weight change, independent of glycemic control, on all-cause and T2DM-related health care resource utilization (HCRU) and costs among T2DM patients in the United States. METHODS A retrospective cohort study was conducted using a linked data extract composed of IQVIA's RWI Data Adjudicated Claims-US and Ambulatory Electronic Medical Record data. Adults (aged ≥ 18 years) with T2DM receiving ≥ 1 oral antidiabetic drug (OAD) medication, glucagon-like peptide-1 receptor agonist (GLP-1RA), and/or short- or long-acting insulin between January 1, 2010, and December 31, 2014 were included (the date of the first observed medical claim with a diagnosis code or medication prescription claim was the index date). Baseline characteristics were evaluated in the 6-month pre-index period. Weight loss (3%, 5%, or 7% from baseline) was evaluated over two 6-month periods (months 1-6 and 7-12) following the index date. Covariates included time-varying weight, hemoglobin A1c (A1c), costs, and HCRU within each 6-month period. Outcomes of interest (all-cause and T2DM-related HCRU and costs) were evaluated in the 6-month (months 13-18) and 12-month (months 13-24) periods following the initial 1- to 6-month and 7- to 12-month post-index periods. Structural nested mean models were used to evaluate the effect of weight change on these outcomes, independent of glycemic control. RESULTS 1,407 patients were included (mean age = 55 years; 55% male), with a mean baseline weight of 102.2 kg (median = 99.7 kg) and a mean baseline A1c of 7.4% (median = 6.9%). In adjusted analysis, weight loss was associated with significantly lower all-cause and T2DM-related annual total health care costs. Compared with those showing no weight change, a 3%, 5%, and 7% weight loss resulted in approximately $500, $800, and $1,100 in savings, respectively, in all-cause annual total health care costs per patient in the year following the weight loss. Similarly, compared with those with no weight change, a 3%, 5%, and 7% weight loss resulted in approximately $200, $300, and $400 in savings, respectively, in T2DM-related annual total health care costs per patient in the following year. Even greater savings (up to ~$2,000 and ~$800 in all-cause and T2DM-related annual costs per patient, respectively) were experienced by those who lost weight compared with those who gained weight. CONCLUSIONS After accounting for glycemic control, this study found that weight loss was associated with additional significant reductions in all-cause and T2DM-related annual total health care costs. Understanding the role of weight loss in T2DM may provide useful evidence for decision makers as they evaluate therapy options for T2DM. DISCLOSURES This study was funded by Novo Nordisk. Dang-Tan, Smolarz, and Iyer are employees of Novo Nordisk. Karkare and DeKoven (employees of IQVIA) and Fridman (employed by AMF Consulting) were contracted by Novo Nordisk to conduct this study. Fridman also reports personal fees from Shire, GSK, and CSL Behring, outside of the submitted work. Lu, an employee of IQVIA, accessed the database and conducted the statistical analysis for this study.
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Dong Y, Jan C, Ma Y, Dong B, Zou Z, Yang Y, Xu R, Song Y, Ma J, Sawyer SM, Patton GC. Economic development and the nutritional status of Chinese school-aged children and adolescents from 1995 to 2014: an analysis of five successive national surveys. Lancet Diabetes Endocrinol 2019; 7:288-299. [PMID: 30902266 DOI: 10.1016/s2213-8587(19)30075-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Socioeconomic development is widely regarded as contributing to improved nutrition in children. We aimed to assess the association between socioeconomic indicators and child and adolescent nutritional status, and the differences in this association between urban and rural areas. METHODS We extracted data from the 1995, 2000, 2005, 2010, and 2014 cycles of the Chinese National Survey on Students' Constitution and Health. We analysed these data for three nutritional outcomes-stunting, thinness, and overweight and obesity-in children and adolescents aged between 7 and 18 years, as defined by WHO standards and classifications. We included three socioeconomic indicators-gross domestic product (GDP) per capita, Engel coefficient (the proportion of household income spent on food), and urbanisation ratio-at both national and subnational levels for each survey year. We used logistic regression models to estimate the association between socioeconomic indicators and child nutritional status, and used prevalence odds ratios (ORs) to assess the urban-rural disparity for nutritional status over time. We also used generalised additive models to evaluate differences in associations between socioeconomic and nutritional status between urban and rural areas. FINDINGS We included 1 054 602 participants (204 932 in 1995; 209 167 in 2000; 225 213 in 2005; 208 136 in 2010; 207 154 in 2014) with complete records on age, sex, nationality, height, and weight in the final analyses, and the final dataset contained 29 provinces (Hong Kong, Macau, Taiwan, Chongqing, and Tibet were excluded) with complete socioeconomic indicator information and student nutritional status information. From 1995 to 2014, the mean stunting prevalence in Chinese children and adolescents decreased from 8·1% (95% CI 8·0-8·2) to 2·4% (2·4-2·5), and the mean thinness prevalence declined from 7·5% (7·4-7·6) to 4·1% (4·0-4·2). Overweight and obesity mean prevalence increased from 5·3% (5·2-5·4) to 20·5% (20·4-20·7). We observed an inverse association between socioeconomic indicators and mean stunting and thinness prevalence, and found a positive association between socioeconomic indicators and overweight and obesity prevalence. The urban-rural disparity in nutritional status gradually diminished, with the prevalence ORs approaching equivalence over time. More rapid improvement of socioeconomic indicators was associated with changed nutritional status in children and adolescents, but with differences across urban and rural settings. The association between socioeconomic status and overweight and obesity was stronger in rural than in urban areas. Improvements (reductions) in the Engel coefficient were accompanied by a greater reduction of stunting and thinness in rural than in urban areas. INTERPRETATION Although socioeconomic development has been accompanied by continued improvements in stunting and thinness, a marked increase has occurred in overweight and obesity in Chinese children and adolescents, particularly in rural areas. There is a pressing need for policy actions to extend beyond an emphasis on economic growth alone, and to focus on promotion of healthy diets and physical activity. FUNDING National Natural Science Foundation, The Research Special Fund for Public Welfare Industry of Health of the Ministry of Health of China, and China Scholarship Council.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Catherine Jan
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China; The George Institute for Global Health, School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Yide Yang
- School of Medicine, Hunan Normal University, Changsha, China
| | - Rongbin Xu
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yi Song
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Susan M Sawyer
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
| | - George C Patton
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia
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15
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Hernáez Á, Zomeño MD, Dégano IR, Pérez-Fernández S, Goday A, Vila J, Civeira F, Moure R, Marrugat J. Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System. ACTA ACUST UNITED AC 2018; 72:916-924. [PMID: 30473259 DOI: 10.1016/j.rec.2018.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/13/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Excess weight promotes the development of several chronic diseases and decreases quality of life. Its prevalence is increasing globally. Our aim was to estimate the trend in excess weight between 1987 and 2014 in Spanish adults, calculate cases of excess weight and its direct extra costs in 2006 and 2016, and project its trend to 2030. METHODS We selected 47 articles in a systematic literature search to determine the progression of the prevalence of overweight, nonmorbid obesity, and morbid obesity and average body mass index between 1987 and 2014. We projected the expected number of cases in 2006, 2016, and 2030 and the associated direct extra medical costs. RESULTS Between 1987 and 2014, the prevalence of overweight, obesity, and morbid obesity increased by 0.28%/y (P=.004), 0.50%/y (P <.001) and 0.030%/y (P=.006) in men, and by 0.10%/y (P=.123), 0.25%/y (P=.078), and 0.042%/y (P=.251) in women. The mean body mass index increased by 0.10 kg/m2/y in men (P <.001) and 0.26 kg/m2/y in women (significantly only between 1987 and 2002, P <.001). We estimated 23 500 000 patients with excess weight in 2016, generating 1.95 billion €/y in direct extra medical costs. If the current trend continues, between 2016 and 2030, there will be 3 100 000 new cases of excess weight, leading to 3.0 billion €/y of direct extra medical costs in 2030. CONCLUSIONS Excess weight in Spanish adults has risen since the creation of population registries, generating direct extra medical costs that represent 2% of the 2016 health budget. If this trend continues, we expect 16% more cases in 2030 and 58% more direct extra medical costs.
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Affiliation(s)
- Álvaro Hernáez
- Grupo de Investigación en Riesgo Cardiovascular, Nutrición y Envejecimiento, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, Barcelona, Spain; CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - M Dolores Zomeño
- Facultad de Ciencias de la Salud Blanquerna, Universitat Ramón Llull, Barcelona, Spain; Grupo de Investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Programa de Doctorado en Alimentación y Nutrición, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Irene R Dégano
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Pérez-Fernández
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alberto Goday
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Grupo de Investigación en Riesgo Cardiovascular y Nutrición-REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Servicio de Endocrinología, Hospital del Mar, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Vila
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Civeira
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Ricardo Moure
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Bioquímica y Biomedicina Molecular, Institut de Biomedicina IBUB, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Marrugat
- Grupo de investigación REGICOR, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
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Abstract
AIMS To assess and compare the direct healthcare and non-healthcare costs and government subsidies by body weight and diabetes status. METHODS The Australian Diabetes, Obesity and Lifestyle study collected health service utilization and health-related expenditure data at the 2011-2012 follow-up surveys. Costing data were available for 4,409 participants. Unit costs for 2016-2017 were used where available or were otherwise inflated to 2016-2017 dollars. Age- and sex-adjusted costs per person were estimated using generalized linear models. RESULTS The annual total direct cost ranged from $1,998 per person with normal weight to $2,501 per person with obesity in participants without diabetes. For those with diabetes, total direct costs were $2,353 per person with normal weight, $3,263 per person with overweight, and $3,131 per person with obesity. Additional expenditure as government subsidies ranged from $5,649 per person with normal weight and no diabetes to $8,085 per person with overweight and diabetes. In general, direct costs and government subsidies were higher for overweight and obesity compared to normal weight, regardless of diabetes status, but were more noticeable in the diabetes sub-group. The annual total excess cost compared with normal weight people without diabetes was 26% for obesity alone and 46% for those with obesity and diabetes. LIMITATIONS Participants included in this study represented a healthier cohort than the Australian population. The relatively small sample of people with both obesity and diabetes prevented a more detailed analysis by obesity class. CONCLUSION Overweight and obesity are associated with increased costs, which are further increased in individuals who also have diabetes. Interventions to prevent overweight and obesity or reduce weight in people who are overweight or obese, and prevent diabetes, should reduce the financial burden.
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Affiliation(s)
- Crystal Man Ying Lee
- a Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders , University of Sydney , NSW , Australia
- b School of Public Health , Curtin University , Perth , WA , Australia
| | | | | | - Jonathan E Shaw
- d Baker Heart and Diabetes Institute , Melbourne , VIC , Australia
| | | | - Stephen Colagiuri
- a Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders , University of Sydney , NSW , Australia
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Black N, Hughes R, Jones AM. The health care costs of childhood obesity in Australia: An instrumental variables approach. Econ Hum Biol 2018; 31:1-13. [PMID: 30064082 DOI: 10.1016/j.ehb.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 05/27/2023]
Abstract
The effect of childhood obesity on medical costs incurred by the Australian Government is estimated using five waves of panel data from the Longitudinal Study of Australian Children, which is linked to public health insurance administrative records from Medicare Australia. Instrumental variables estimators are used to address concerns about measurement error and selection bias. The additional annual medical costs due to overweight and obesity among 6 to 13 year olds is about $43 million (in 2015 AUD). This is driven by a higher utilisation of general practitioner and specialist doctors. The results suggest that the economic consequences of childhood obesity are much larger than previously estimated.
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Affiliation(s)
- Nicole Black
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Robert Hughes
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Andrew M Jones
- Centre for Health Economics, Monash Business School, Monash University, Australia; Department of Economics and Related Studies, University of York, United Kingdom
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Barnett AH, Arnoldini S, Hunt B, Subramanian G, Hoxer CS. Switching from sitagliptin to liraglutide to manage patients with type 2 diabetes in the UK: A long-term cost-effectiveness analysis. Diabetes Obes Metab 2018; 20:1921-1927. [PMID: 29652101 DOI: 10.1111/dom.13318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
AIMS The recent LIRA-SWITCH trial showed that switching from sitagliptin 100 mg to liraglutide 1.8 mg led to statistically significant and clinically relevant improvements in glycated haemoglobin (HbA1C) and body mass index (BMI). Based on these findings, the aim of the present study was to assess the long-term cost-effectiveness of switching from sitagliptin to liraglutide in patients with type 2 diabetes in the UK. MATERIALS AND METHODS The IQVIA CORE Diabetes Model Version 8.5+ was used to project costs and clinical outcomes over patients' lifetimes. Baseline cohort characteristics and treatment effects were derived from the LIRA-SWITCH trial. Future costs and clinical benefits were discounted at 3.5% annually. Costs were accounted in pounds sterling (GBP) and expressed in 2016 values. One-way and probabilistic sensitivity analyses were performed. RESULTS Model projections showed improved quality-adjusted life expectancy for patients with poorly controlled HbA1c upon switching from sitagliptin to liraglutide, compared with continuing sitagliptin treatment (9.18 vs 9.02 quality-adjusted life years [QALYs]). Treatment switching was associated with increased overall costs (GBP 24737 vs GBP 22362). Higher pharmacy costs were partially offset by reduced diabetes-related complication costs in patients who switched to liraglutide. Switching to liraglutide was associated with an incremental cost-effectiveness ratio of GBP 15423 per QALY gained vs continuing with sitagliptin treatment. CONCLUSIONS Switching from sitagliptin 100 mg to liraglutide 1.8 mg in patients with poor glycaemic control was projected to improve clinical outcomes and is likely to be considered cost-effective in the UK setting and, therefore, a good use of limited NHS resources.
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Affiliation(s)
- Anthony H Barnett
- Heart of England NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Simon Arnoldini
- Ossian Health Economics and Communications, Basel, Switzerland
| | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Lymer S, Schofield D, Cunich M, Lee CMY, Fuller N, Caterson I, Colagiuri S. The Population Cost-Effectiveness of Weight Watchers with General Practitioner Referral Compared with Standard Care. Obesity (Silver Spring) 2018; 26:1261-1269. [PMID: 30138545 DOI: 10.1002/oby.22216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 04/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to assess population-level cost-effectiveness of the Weight Watchers (WW) program with doctor referral compared with standard care (SC) for Australian adults with overweight and obesity. METHODS The target population was Australian adults ≥ 20 years old with BMI ≥ 27 kg/m2 , whose obesity status was subsequently modeled for 2015 to 2025. A microsimulation model (noncommunicable disease model [NCDMod]) was used to assess the incremental cost-effectiveness of WW compared with SC. A health system perspective was taken, and outcomes were measured by obesity cases averted in 2025, BMI units averted for 2015 to 2025, and quality-adjusted life years for 2015 to 2025. Univariate sensitivity testing was used to measure variations in the model parameters. RESULTS The WW intervention resulted in 60,445 averted cases of obesity in 2025 (2,311 more cases than for SC), extra intervention costs of A$219 million, and cost savings within the health system of A$17,248 million (A$82 million more than for SC) for 2015 to 2025 compared with doing nothing. The modeled WW had an incremental cost-effectiveness ratio of A$35,195 in savings per case of obesity averted in 2025. WW remained dominant over SC for the different scenarios in the sensitivity analysis. CONCLUSIONS The WW intervention represents good value for money. The WW intervention needs serious consideration in a national package of obesity health services.
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Affiliation(s)
- Sharyn Lymer
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Deborah Schofield
- Centre for Economic Impacts of Genomic Medicine, Macquarie University, Ryde, New South Wales, Australia
- Department of Economics, Macquarie University, Ryde, New South Wales, Australia
| | - Michelle Cunich
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Health Economic, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Crystal Man Ying Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Fuller
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Colagiuri
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- WHO Collaborating Centre on Physical Activity, Nutrition & Obesity, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Li H, Fujiura G, Magaña S, Parish S. Health care expenditures of overweight and obese U.S. adults with intellectual and developmental disabilities. Res Dev Disabil 2018; 75:1-10. [PMID: 29427860 PMCID: PMC9494707 DOI: 10.1016/j.ridd.2018.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 12/30/2017] [Accepted: 01/25/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND U.S. adults with intellectual and developmental disabilities (IDD) have poorer health status and greater risks for being overweight and obese, which are major drivers of health care expenditures in the general population. Health care expenditures and IDD have not been studied using nationally representative samples, and the impact of overweight and obesity have not been examined. AIM Using nationally representative data, we aimed to compare the health care expenditures of not-overweight, overweight and obese U.S. adults with IDD, and calculate model-adjusted expenditures. METHODS AND PROCEDURES Pooled data from the 2002-2011 Medical Expenditure Panel Survey linked to National Health Interview Survey (n = 1224) were analyzed. Two-part model regressions were conducted, with covariates being year of survey, age, sex, race/ethnicity, household income status, geographical region, urban/rural, marital status, insurance coverage, perceived health status, and perceived mental health status. OUTCOMES AND RESULTS Overall, obese adults with intellectual and developmental disabilities had higher expenditures than their non-obese peers. Being obese was associated with an estimated additional $2516 in mean expenditures and $1200 in median expenditures compared with the reference group, who were neither overweight nor obese. CONCLUSIONS AND IMPLICATIONS Obesity is an important predictor of higher health care costs among community-living adults with IDD Finding effective strategies and interventions to address obesity in this population has great financial and policy significance.
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Affiliation(s)
- Henan Li
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA.
| | - Glenn Fujiura
- Department of Disability and Human Development, The University of Illinois at Chicago, USA
| | - Sandra Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, USA
| | - Susan Parish
- Bouvé College of Health Sciences, Northeastern University, USA
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21
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Lee SM, Choi IS, Han E, Suh D, Shin EK, Je S, Lee SS, Suh DC. Incremental Treatment Costs Attributable to Overweight and Obesity in Patients with Diabetes: Quantile Regression Approach. Obesity (Silver Spring) 2018; 26:223-232. [PMID: 29178436 DOI: 10.1002/oby.22080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to estimate treatment costs attributable to overweight and obesity in patients with diabetes who were less than 65 years of age in the United States. METHODS This study used data from the Medical Expenditure Panel Survey from 2001 to 2013. Patients with diabetes were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification code (250), clinical classification codes (049 and 050), or self-reported physician diagnoses. Total treatment costs attributable to overweight and obesity were calculated as the differences in the adjusted costs compared with individuals with diabetes and normal weight. Adjusted costs were estimated by using generalized linear models or unconditional quantile regression models. RESULTS The mean annual treatment costs attributable to obesity were $1,852 higher than those attributable to normal weight, while costs attributable to overweight were $133 higher. The unconditional quantile regression results indicated that the impact of obesity on total treatment costs gradually became more significant as treatment costs approached the upper quantile. CONCLUSIONS Among patients with diabetes who were less than 65 years of age, patients with diabetes and obesity have significantly higher treatment costs than patients with diabetes and normal weight. The economic burden of diabetes to society will continue to increase unless more proactive preventive measures are taken to effectively treat patients with overweight or obesity.
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Affiliation(s)
- Seung-Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - In-Sun Choi
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Euna Han
- College of Pharmacy, Yonsei University, Incheon, South Korea
| | - David Suh
- School of Public Health, Columbia University, New York, New York, USA
| | - Eun-Kyung Shin
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Seyunghe Je
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Sung Su Lee
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Dong-Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul, South Korea
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Abstract
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.
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Affiliation(s)
- Andrea Goettler
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Grosse
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
- Department of Health Sciences, University of York, York, UK
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Fallah-Fini S, Adam A, Cheskin LJ, Bartsch SM, Lee BY. The Additional Costs and Health Effects of a Patient Having Overweight or Obesity: A Computational Model. Obesity (Silver Spring) 2017; 25:1809-1815. [PMID: 28948718 PMCID: PMC5679120 DOI: 10.1002/oby.21965] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/15/2017] [Accepted: 07/19/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This paper estimates specific additional disease outcomes and costs that could be prevented by helping a patient go from an obesity or overweight category to a normal weight category at different ages. This information could help physicians, other health care workers, patients, and third-party payers determine how to prioritize weight reduction. METHODS A computational Markov model was developed that represented the BMI status, chronic health states, health outcomes, and associated costs (from various perspectives) for an adult at different age points throughout his or her lifetime. RESULTS Incremental costs were calculated for adult patients with obesity or overweight (vs. normal weight) at different starting ages. For example, for a metabolically healthy 20-year-old, having obesity (vs. normal weight) added lifetime third-party payer costs averaging $14,059 (95% range: $13,956-$14,163), productivity losses of $14,141 ($13,969-$14,312), and total societal costs of $28,020 ($27,751-$28,289); having overweight vs. normal weight added $5,055 ($4,967-$5,144), $5,358 ($5,199-$5,518), and $10,365 ($10,140-$10,590). For a metabolically healthy 50-year-old, having obesity added $15,925 ($15,831-$16,020), $20,120 ($19,887-$20,352), and $36,278 ($35,977-$36,579); having overweight added $5,866 ($5,779-$5,953), $10,205 ($9,980-$10,429), and $16,169 ($15,899-$16,438). CONCLUSIONS Incremental lifetime costs of a patient with obesity or overweight (vs. normal weight) increased with the patient's age, peaked at age 50, and decreased with older ages. However, weight reduction even in older adults still yielded incremental cost savings.
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Affiliation(s)
- Saeideh Fallah-Fini
- Global Obesity Prevention Center (GOPC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Industrial and Manufacturing Engineering Department, California State Polytechnic University, Pomona, CA, USA
| | - Atif Adam
- Global Obesity Prevention Center (GOPC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence J. Cheskin
- Global Obesity Prevention Center (GOPC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah M. Bartsch
- Global Obesity Prevention Center (GOPC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bruce Y. Lee
- Global Obesity Prevention Center (GOPC) at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Sonntag D, Jarczok MN, Ali S. DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status. Obesity (Silver Spring) 2017; 25:1603-1609. [PMID: 28845610 DOI: 10.1002/oby.21913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). METHODS Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. RESULTS DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). CONCLUSIONS The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups.
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Affiliation(s)
- Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Department of Health Sciences, University of York, York, UK
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Shehzad Ali
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
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Kent S, Fusco F, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Body mass index and healthcare costs: a systematic literature review of individual participant data studies. Obes Rev 2017; 18:869-879. [PMID: 28544197 DOI: 10.1111/obr.12560] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/15/2017] [Accepted: 03/31/2017] [Indexed: 11/28/2022]
Abstract
Excess weight is associated with increased total healthcare costs, but it is less well known how the associations between excess weight and costs vary across different types of healthcare service. We reviewed studies using individual participant data to estimate associations between body mass index and healthcare costs, and summarized how annual healthcare costs for overweight (body mass index 25 to <30 kg/m2 ) and obese (≥30 kg/m2 ) individuals compared with those for healthy weight individuals (18.5 to <25 kg/m2 ). EMBASE and MEDLINE were searched from January 1990 to September 2016, and 75 studies were included in the review. Of these, 34 studies presented adequate information to contribute to a quantitative summary of results. Compared with individuals at healthy weight, the median increases in mean total annual healthcare costs were 12% for overweight and 36% for obese individuals. The percentage increases in costs were highest for medications (18% for overweight and 68% for obese), followed by inpatient care (12% and 34%) and ambulatory care (4% and 26%). Percentage increases in costs associated with obesity were higher for women than men. The substantial costs associated with excess weight in different healthcare settings emphasize the need for investment to tackle this major public health problem.
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Affiliation(s)
- Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Francesco Fusco
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Services, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Wentworth JM, Dalziel KM, O'Brien PE, Burton P, Shaba F, Clarke PM, Laiteerapong N, Brown WA. Cost-effectiveness of gastric band surgery for overweight but not obese adults with type 2 diabetes in the U.S. J Diabetes Complications 2017; 31:1139-1144. [PMID: 28462893 PMCID: PMC5528847 DOI: 10.1016/j.jdiacomp.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/21/2017] [Accepted: 04/10/2017] [Indexed: 12/15/2022]
Abstract
AIM To determine the cost-effectiveness of gastric band surgery in overweight but not obese people who receive standard diabetes care. METHOD A microsimulation model (United Kingdom Prospective Diabetes Study outcomes model) was used to project diabetes outcomes and costs from a two-year Australian randomized trial of gastric band (GB) surgery in overweight but not obese people (BMI 25 to 30kg/m2) on to a comparable population of U.S. adults from the National Health and Nutrition Examination Survey (N=254). Estimates of cost-effectiveness were calculated based on the incremental cost-effectiveness ratios (ICERs) for different treatment scenarios. Costs were inflated to 2015 U.S. dollar values and an ICER of less than $50,000 per QALY gained was considered cost-effective. RESULTS The incremental cost-effectiveness ratio for GB surgery at two years exceeded $90,000 per quality-adjusted life year gained but decreased to $52,000, $29,000 and $22,000 when the health benefits of surgery were assumed to endure for 5, 10 and 15 years respectively. The cost-effectiveness of GB surgery was sensitive to utility gained from weight loss and, to a lesser degree, the costs of GB surgery. However, the cost-effectiveness of GB surgery was affected minimally by improvements in HbA1c, systolic blood pressure and cholesterol. CONCLUSIONS GB surgery for overweight but not obese people with T2D appears to be cost-effective in the U.S. setting if weight loss endures for more than five years. Health utility gained from weight loss is a critical input to cost-effectiveness estimates and therefore should be routinely measured in populations undergoing bariatric surgery.
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Affiliation(s)
- John M Wentworth
- Centre for Obesity Research and Education, Monash University, Clayton, Australia; Walter and Eliza Hall Institute, Melbourne University, Parkville, Australia; Royal Melbourne Hospital Department of Medicine, Parkville, Australia.
| | - Kim M Dalziel
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Paul E O'Brien
- Centre for Obesity Research and Education, Monash University, Clayton, Australia
| | - Paul Burton
- Centre for Obesity Research and Education, Monash University, Clayton, Australia
| | - Frackson Shaba
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Philip M Clarke
- School of Population and Global Health, University of Melbourne, Parkville, Australia
| | | | - Wendy A Brown
- Centre for Obesity Research and Education, Monash University, Clayton, Australia
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Kent S, Green J, Reeves G, Beral V, Gray A, Jebb SA, Cairns BJ, Mihaylova B. Hospital costs in relation to body-mass index in 1·1 million women in England: a prospective cohort study. Lancet Public Health 2017; 2:e214-e222. [PMID: 29253487 PMCID: PMC6196771 DOI: 10.1016/s2468-2667(17)30062-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Excess weight is associated with poor health and increased health-care costs. However, a detailed understanding of the effects of excess weight on total hospital costs and costs for different health conditions is needed. METHODS Women in England aged 50-64 years were recruited into the prospective Million Women Study cohort in 1996-2001 through 60 NHS breast cancer screening centres. Participants were followed up and annual hospital costs and admission rates were estimated for April 1, 2006, to March 31, 2011, in relation to body-mass index (BMI) at recruitment, overall and for categories of health conditions defined by the International Classification of Diseases 10th revision chapter of the primary diagnosis at admission. Associations of BMI with hospital costs were projected to the 2013 population of women aged 55-79 years in England. FINDINGS 1 093 866 women who provided information on height and weight, had a BMI of at least 18·5 kg/m2, and had no previous cancer at recruitment, were followed up for an average of 4·9 years from April 1, 2006 (12·3 years from recruitment), during which time 1·84 million hospital admissions were recorded. Annual hospital costs were lowest for women with a BMI of 20·0 kg/m2 to less than 22·5 kg/m2 (£567 per woman per year, 99% CI 556-577). Every 2 kg/m2 increase in BMI above 20 kg/m2 was associated with a 7·4% (7·1-7·6) increase in annual hospital costs. Excess weight was associated with increased costs for all diagnostic categories, except respiratory conditions and fractures. £662 million (14·6%) of the estimated £4·5 billion of total annual hospital costs among all women aged 55-79 years in England was attributed to excess weight (BMI ≥25 kg/m2), of which £517 million (78%) arose from hospital admissions with procedures. £258 million (39%) of the costs attributed to excess weight were due to musculoskeletal admissions, mainly for knee replacement surgeries. INTERPRETATION Excess body weight is associated with increased hospital costs for middle-aged and older women in England across a broad range of conditions, especially knee replacement surgery and diabetes. These results provide reliable up-to-date estimates of the health-care costs of excess weight and emphasise the need for investment to tackle this public health issue. FUNDING Cancer Research UK; Medical Research Council; National Institute for Health Research.
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Affiliation(s)
- Seamus Kent
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Jane Green
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gillian Reeves
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Valerie Beral
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin J Cairns
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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28
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Turi BC, Codogno JS, Sarti FM, Anokye NK, Fernandes RA, Monteiro HL. Determinants of outpatient expenditure within primary care in the Brazilian National Health System. SAO PAULO MED J 2017; 135:205-212. [PMID: 28380203 PMCID: PMC10019845 DOI: 10.1590/1516-3180.2016.0224141116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP), Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests). Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01), hypertension (OR = 3.04; 95% CI: 1.91-4.82) and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81). Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47) and female sex (OR = 1.70; 95% CI: 1.14-2.55). CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.
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Affiliation(s)
- Bruna Camilo Turi
- MSc, PhD. Researcher, Postgraduate Program on Kinesiology, Universidade Estadual Paulista (UNESP), Rio Claro (SP), Brazil.
| | - Jamile Sanches Codogno
- MSc, PhD. Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Presidente Prudente (SP), Brazil.
| | - Flávia Mori Sarti
- MSc, PhD. Professor, Department of Food and Experimental Nutrition, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
| | - Nana Kwame Anokye
- PhD. Senior Research Fellow. Institute of Environment, Health and Societies, Brunel University, Uxbridge, London, United Kingdom.
| | - Rômulo Araújo Fernandes
- MSc, PhD. Researcher, Postgraduate Program on Kinesiology, Universidade Estadual Paulista (UNESP), Rio Claro (SP), Brazil.
| | - Henrique Luiz Monteiro
- MSc, PhD. Professor, Department of Physical Education, Universidade Estadual Paulista (UNESP), Bauru (SP), Brazil.
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29
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Shi J, Wang Y, Cheng W, Shao H, Shi L. Direct health care costs associated with obesity in Chinese population in 2011. J Diabetes Complications 2017; 31:523-528. [PMID: 27908605 DOI: 10.1016/j.jdiacomp.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/31/2016] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Abstract
AIMS Overweight and obesity are established major risk factors for type 2 diabetes, and major public health concerns in China. This study aims to assess the economic burden associated with overweight and obesity in the Chinese population ages 45 and older. METHODS The Chinese Health and Retirement Longitudinal Study (CHARLS) in 2011 included 13,323 respondents of ages 45 and older living in 450 rural and urban communities across China. Demographic information, height, weight, direct health care costs for outpatient visits, hospitalization, and medications for self-care were extracted from the CHARLS database. Health Care costs were calculated in 2011 Chinese currency. The body mass index (BMI) was used to categorize underweight, normal weight, overweight, and obese populations. Descriptive analyses and a two-part regression model were performed to investigate the association of BMI with health care costs. To account for non-normality of the cost data, we applied a non-parametric bootstrap approach using the percentile method to estimate the 95% confidence intervals (95% CIs). RESULTS Overweight and obese groups had significantly higher total direct health care costs (RMB 2246.4, RMB 2050.7, respectively) as compared with the normal-weight group (RMB 1886.0). When controlling for demographic characteristics, overweight and obese adults were 15.0% and 35.9% more likely to incur total health care costs, and obese individuals had 14.2% higher total health care costs compared with the normal-weight group. CONCLUSIONS Compared with the normal-weight counterparts, the annual total direct health care costs were significantly higher among obese adults in China.
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Affiliation(s)
- Jingcheng Shi
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078.
| | - Yao Wang
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
| | - Wenwei Cheng
- Department of Epidemiology and Medical Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China, 410078.
| | - Hui Shao
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA, 70112.
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Chang C, Lee SM, Choi BW, Song JH, Song H, Jung S, Bai YK, Park H, Jeung S, Suh DC. Costs Attributable to Overweight and Obesity in Working Asthma Patients in the United States. Yonsei Med J 2017; 58:187-194. [PMID: 27873513 PMCID: PMC5122636 DOI: 10.3349/ymj.2017.58.1.187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/22/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To estimate annual health care and productivity loss costs attributable to overweight or obesity in working asthmatic patients. MATERIALS AND METHODS This study was conducted using the 2003-2013 Medical Expenditure Panel Survey (MEPS) in the United States. Patients aged 18 to 64 years with asthma were identified via self-reported diagnosis, a Clinical Classification Code of 128, or a ICD-9-CM code of 493.xx. All-cause health care costs were estimated using a generalized linear model with a log function and a gamma distribution. Productivity loss costs were estimated in relation to hourly wages and missed work days, and a two-part model was used to adjust for patients with zero costs. To estimate the costs attributable to overweight or obesity in asthma patients, costs were estimated by the recycled prediction method. RESULTS Among 11670 working patients with a diagnosis of asthma, 4428 (35.2%) were obese and 3761 (33.0%) were overweight. The health care costs attributable to obesity and overweight in working asthma patients were estimated to be $878 [95% confidence interval (CI): $861-$895] and $257 (95% CI: $251-$262) per person per year, respectively, from 2003 to 2013. The productivity loss costs attributable to obesity and overweight among working asthma patients were $256 (95% CI: $253-$260) and $26 (95% CI: $26-$27) per person per year, respectively. CONCLUSION Health care and productivity loss costs attributable to overweight and obesity in asthma patients are substantial. This study's results highlight the importance of effective public health and educational initiatives targeted at reducing overweight and obesity among patients with asthma, which may help lower the economic burden of asthma.
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Affiliation(s)
| | - Seung Mi Lee
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Byoung Whui Choi
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Hwa Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Hee Song
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | - Sujin Jung
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Haedong Park
- College of Pharmacy, Chung-Ang University, Seoul, Korea
| | | | - Dong Churl Suh
- College of Pharmacy, Chung-Ang University, Seoul, Korea.
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Zomer E, Leach R, Trimmer C, Lobstein T, Morris S, James WP, Finer N. Effectiveness and cost-effectiveness of interventions that cause weight loss and reduce the risk of cardiovascular disease. Diabetes Obes Metab 2017; 19:118-124. [PMID: 27649286 DOI: 10.1111/dom.12792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overweight/obesity is associated with significant morbidity, mortality and costs. Weight loss has been shown to reverse some of these effects, reducing the risk of chronic diseases such as cardiovascular disease (CVD). AIM To determine the potential monies available, from an English National Health Service perspective, for weight loss interventions to be cost-effective in the prevention of CVD. METHODS A Markov model was developed, populated with overweight/obese individuals from the Health Survey for England, aged 30-74 years, free of pre-existing CVD and with available risk factor information to calculate CVD risk. All individuals were free of CVD at baseline and, with each annual cycle, could transition to other health states of primary CVD, secondary CVD or death according to transition probabilities for a maximum period of 10 years, or until death. Utilities, costs and the effects of weight loss on CVD risk factors were applied. The potential monies available for CVD prevention strategies, provided the incremental cost-effectiveness ratio met UK arbitrary limits of between £20 000 and £30 000, was determined. RESULTS Applying the effects of weight loss on CVD risk factors prevented 4 CVD events and saved 17 quality-adjusted life-years over 10 years per 1000 individuals. £34 to £51 was available per person per year for up to 10 years when meeting the UK arbitrary limits. CONCLUSIONS Individual annual financial allowances for weight loss interventions to be considered cost-effective is relatively low; however, as a large proportion of the population is affected, wide cheap societal interventions are important.
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Affiliation(s)
- Ella Zomer
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
- Department of Epidemiology and Preventive Medicine Monash University, Melbourne, Australia
| | - Rachel Leach
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Christine Trimmer
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Tim Lobstein
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Stephen Morris
- Department of Applied Health Research University College London, London, UK
| | - William P James
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
- Department of Population Health London School of Hygiene and Tropical Medicine, London, UK
| | - Nick Finer
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
- National Centre for Cardiovascular Preventions and Outcomes, University College London, London, UK
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Abstract
It has previously been reported that an individual's body mass index (BMI) contemporaneously penalizes wages for women, but has no effect and sometimes rewards wages for men. In young adults, we estimate the association of BMI status with initial wages to assess whether initial BMI at the beginning of an individual's career affects initial and later earnings. We pooled data from 388 men and 305 women, aged 20-40 years, with BMI information for the first year of employment, using the Korean Labor and Income Panel Study. A labor market penalty for a higher BMI among women was found only for overweight or obese segments, particularly those with relatively higher monthly wages. Meanwhile, a higher BMI in underweight or normal weight segments could reward employment probability for women and monthly wages for men. Such rewards of relatively higher monthly wages were also estimated for men in the overweight segment. Our findings suggest discrimination as one factor penalizing higher BMI in the labor market.
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Affiliation(s)
- Tae Hyun Kim
- a Graduate School of Public Health and Institute of Health Services Research , Yonsei University , Seoul , South Korea
| | - Euna Han
- b College of Pharmacy, Yonsei Institute of Pharmaceutical Science , Yonsei University , Incheon , South Korea
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Divisón Garrote JA, Escobar Cervantes C. [Framing financial incentives to increase physical activity among overweight and obese adults]. Semergen 2016; 43:234-235. [PMID: 27445219 DOI: 10.1016/j.semerg.2016.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 04/24/2016] [Indexed: 11/19/2022]
Affiliation(s)
- J A Divisón Garrote
- Atención Primaria, CS Casas Ibáñez, Albacete, España; Grado de Medicina, Universidad Católica San Antonio de Murcia (UCAM), Murcia, España.
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Greffeuille V, Sophonneary P, Laillou A, Gauthier L, Hong R, Hong R, Poirot E, Dijkhuizen M, Wieringa F, Berger J. Inequalities in Nutrition between Cambodian Women over the Last 15 Years (2000-2014). Nutrients 2016; 8:224. [PMID: 27104556 PMCID: PMC4848692 DOI: 10.3390/nu8040224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/16/2022] Open
Abstract
This study aimed to describe the trends over four nationally representative Demographic Health Surveys (2000, 2005, 2010, and 2014) of the nutritional status of women of reproductive age in Cambodia and to assess the main factors of inequality with regards to nutrition. The prevalence of undernutrition and over-nutrition evolved in opposite trends from 2000 to 2014, with a significant decrease in underweight and a significant increase in overweight women. This results in a shift, with overweight prevalence in women being higher than underweight for the first time in 2014. Anemia was constantly high and still affected 45% of women in 2014. Multivariate analysis showed that age, wealth index, maternal education, number of children, year of survey, and anemia were contributing factors for being underweight. Being overweight was positively related to increase in age, wealth index, number of children, and year of survey; and negatively related to anemia and increase in education level. The risk of anemia was higher in the poorest households and for less-educated women and women living in rural areas. Consequently, policies should target the most vulnerable women, especially the youngest, and support integrated interventions in the health, social, and agriculture sectors to reduce inequalities in nutrition between women.
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Affiliation(s)
| | - Prak Sophonneary
- National Nutrition Program, Maternal and Child Health Center, No 31A, Rue de France (St. 47), Phnom Penh 12202, Cambodia.
| | - Arnaud Laillou
- UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | | | - Rathmony Hong
- UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Rathavuth Hong
- ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA.
| | - Etienne Poirot
- UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia.
| | - Marjoleine Dijkhuizen
- Department of Human nutrition, Copenhagen University, Rolighedsvej 26, 1958 Frederiksberg, Denmark.
| | - Frank Wieringa
- JRU NUTRIPASS IRD-SupAgro-UM, Montpellier 34000, France.
| | - Jacques Berger
- JRU NUTRIPASS IRD-SupAgro-UM, Montpellier 34000, France.
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Apouey BH, Geoffard PY. Parents' education and child body weight in France: The trajectory of the gradient in the early years. Econ Hum Biol 2016; 20:70-89. [PMID: 26656206 DOI: 10.1016/j.ehb.2015.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 10/10/2015] [Accepted: 10/12/2015] [Indexed: 06/05/2023]
Abstract
This paper explores the relationship between parental education and offspring body weight in France. Using two large datasets spanning the 1991-2010 period, we examine the existence of inequalities in maternal and paternal education and reported child body weight measures, as well as their evolution across childhood. Our empirical specification is flexible and allows this evolution to be non-monotonic. Significant inequalities are observed for both parents' education--maternal (respectively paternal) high education is associated with a 7.20 (resp. 7.10) percentage points decrease in the probability that the child is reported to be overweight or obese, on average for children of all ages. The gradient with respect to parents' education follows an inverted U-shape across childhood, meaning that the association between parental education and child body weight widens from birth to age 8, and narrows afterward. Specifically, maternal high education is correlated with a 5.30 percentage points decrease in the probability that the child is reported to be overweight or obese at age 2, but a 9.62 percentage points decrease at age 8, and a 1.25 percentage point decrease at age 17. The figures for paternal high education are respectively 5.87, 9.11, and 4.52. This pattern seems robust, since it is found in the two datasets, when alternative variables for parental education and reported child body weight are employed, and when controls for potential confounding factors are included. The findings for the trajectory of the income gradient corroborate those of the education gradient. The results may be explained by an equalization in actual body weight across socioeconomic groups during youth, or by changes in reporting styles of height and weight.
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Affiliation(s)
- Bénédicte H Apouey
- Paris School of Economics - CNRS, 48, Boulevard Jourdan, 75014 Paris, France.
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Kral TVE, Bannon AL, Moore RH. Effects of financial incentives for the purchase of healthy groceries on dietary intake and weight outcomes among older adults: A randomized pilot study. Appetite 2016; 100:110-7. [PMID: 26879224 DOI: 10.1016/j.appet.2016.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 02/07/2023]
Abstract
Providing financial incentives can be a useful behavioral economics strategy for increasing fruit and vegetable intake among consumers. It remains to be determined whether financial incentives can promote intake of other low energy-dense foods and if consumers who are already using promotional tools for their grocery purchases may be especially responsive to receiving incentives. This randomized controlled trial tested the effects of offering financial incentives for the purchase of healthy groceries on 3-month changes in dietary intake, weight outcomes, and the home food environment among older adults. A secondary aim was to compare frequent coupon users (FCU) and non-coupon users (NCU) on weight status, home food environment, and grocery shopping behavior. FCU (n = 28) and NCU (n = 26) were randomly assigned to either an incentive or a control group. Participants in the incentive group received $1 for every healthy food or beverage they purchased. All participants completed 3-day food records and a home food inventory and had their height, weight, and waist circumference measured at baseline and after 3 months. Participants who were responsive to the intervention and received financial incentives significantly increased their daily vegetable intake (P = 0.04). Participants in both groups showed significant improvements in their home food environment (P = 0.0003). No significant changes were observed in daily energy intake or weight-related outcomes across groups (P < 0.12). FCU and NCU did not differ significantly in any anthropometric variables or the level at which their home food environment may be considered 'obesogenic' (P > 0.73). Increased consumption of vegetables did not replace intake of more energy-dense foods. Incentivizing consumers to make healthy food choices while simultaneously reducing less healthy food choices may be important.
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Affiliation(s)
- Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, United States; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, United States.
| | | | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, United States
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Fruhstorfer BH, Mousoulis C, Uthman OA, Robertson W. Socio-economic status and overweight or obesity among school-age children in sub-Saharan Africa - a systematic review. Clin Obes 2016; 6:19-32. [PMID: 26781602 DOI: 10.1111/cob.12130] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 11/14/2015] [Accepted: 11/24/2015] [Indexed: 12/24/2022]
Abstract
Childhood overweight and obesity have emerged as a public health concern in sub-Saharan Africa. We conducted a systematic review with the aim to examine the association between socio-economic status (SES) and overweight or obesity among school-age children in sub-Saharan Africa. In March 2014 we searched five electronic databases for reports which presented cross-sectional data on prevalence levels of overweight or obesity stratified by SES groups among school-age children in sub-Saharan Africa. We used a random-effect model to pool the relative indexes of inequality of the association from the individual studies. In total, 20 reports satisfied the inclusion criteria providing results of 21 datasets. The risk of overweight or obesity in children from highest SES households was 5.28 times as high as that of children from lowest SES households (95% confidence interval [CI] 2.62 to 10.66). On subgroup analysis, this association was statistically significant for household income and composite SES measures but not for parental educational attainment and occupation type. Similarly, the risk of overweight or obesity in children attending affluent (private) schools was 15.94 times as high as that of children going to either urban or rural public schools (95% CI 5.82 to 43.68). The magnitude of the association tended to be stronger for area or school-type compared with composite measures. In summary, children from higher SES households and those attending private schools tended to be overweight and obese.
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Affiliation(s)
- B H Fruhstorfer
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - C Mousoulis
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - O A Uthman
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - W Robertson
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Lette M, Bemelmans WJE, Breda J, Slobbe LCJ, Dias J, Boshuizen HC. Health care costs attributable to overweight calculated in a standardized way for three European countries. Eur J Health Econ 2016; 17:61-69. [PMID: 25432787 PMCID: PMC4705131 DOI: 10.1007/s10198-014-0655-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 11/04/2014] [Indexed: 06/02/2023]
Abstract
This article presents a tool to calculate health care costs attributable to overweight in a comparable and standardized way. The purpose is to describe the methodological principles of the tool and to put it into use by calculating and comparing the costs attributable to overweight for The Netherlands, Germany and Czech Republic. The tool uses a top-down and prevalence-based approach, consisting of five steps. Step one identifies overweight-related diseases and age- and gender-specific relative risks. Included diseases are ischemic heart disease, stroke, hypertension, type 2 diabetes mellitus, colorectal cancer, postmenopausal breast cancer, endometrial cancer, kidney cancer and osteoarthritis. Step two consists of collecting data on the age- and gender-specific prevalence of these diseases. Step three uses the population-attributable prevalence to determine the part of the prevalence of these diseases that is attributable to overweight. Step four calculates the health care costs associated with these diseases. Step five calculates the costs of these diseases that are attributable to overweight. Overweight is responsible for 20-26% of the direct costs of included diseases, with sensitivity analyses varying this percentage between 15-31%. Percentage of costs attributable to obesity and preobesity is about the same. Diseases with the highest percentage of costs due to overweight are diabetes, endometrial cancer and osteoarthritis. Disease costs attributable to overweight as a percentage of total health care expenditures range from 2 to 4%. Data are consistent for all three countries, resulting in roughly a quarter of costs of included diseases being attributable to overweight.
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Affiliation(s)
- M Lette
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - W J E Bemelmans
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - J Breda
- WHO Regional Office for Europe, Nutrition, Physical Activity and Obesity, Marmorvej 51, 2100, Copenhagen, Denmark.
| | - L C J Slobbe
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - J Dias
- Department of Clinical Sciences in Malmö, Lund University, Clinical Research Center 60:13:36, Jan Waldenströms Gata 35, 20502, Malmö, Sweden.
| | - H C Boshuizen
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
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Yates N, Teuner CM, Hunger M, Holle R, Stark R, Laxy M, Hauner H, Peters A, Wolfenstetter SB. The Economic Burden of Obesity in Germany: Results from the Population-Based KORA Studies. Obes Facts 2016; 9:397-409. [PMID: 27951530 PMCID: PMC5644792 DOI: 10.1159/000452248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Nichola Yates
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christina M. Teuner
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- *Dr. Christina M. Teuner, Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany,
| | - Matthias Hunger
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
| | - Renée Stark
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Diabetes Research, Neuherberg, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany, Neuherberg, Germany
| | - Annette Peters
- German Centre for Diabetes Research, Neuherberg, Germany
- Institute of Epidemiology II, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - Silke B. Wolfenstetter
- Institute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
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Johnson TJ, E Schoeny M, Fogg L, Wilbur J. The Cost of Increasing Physical Activity and Maintaining Weight for Midlife Sedentary African American Women. Value Health 2016; 19:20-7. [PMID: 26797232 PMCID: PMC4724643 DOI: 10.1016/j.jval.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 08/10/2015] [Accepted: 10/19/2015] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the marginal costs of increasing physical activity and maintaining weight for a lifestyle physical activity program targeting sedentary African American women. METHODS Outcomes included change in minutes of total moderate to vigorous physical activity, leisure-time moderate to vigorous physical activity and walking per week, and weight stability between baseline and maintenance at 48 weeks. Marginal cost-effectiveness ratios (MCERs) were calculated for each outcome, and 95% confidence intervals (CIs) were computed using a bootstrap method. The analysis was carried out from the societal perspective and calculated in 2013 US dollars. RESULTS For the 260 participants in the analysis, program costs were $165 ± $19, and participant costs were $164 ± $35, for a total cost of $329 ± $49. The MCER for change in walking was $1.50/min/wk (95% CI 1.28-1.87), for change in moderate to vigorous physical activity was $1.73/min/wk (95% CI 1.41-2.18), and for leisure-time moderate to vigorous physical activity was $1.94/min/wk (95% CI 1.58-2.40). The MCER for steps based on the accelerometer was $0.46 per step (95% CI 0.30-0.85) and weight stability was $412 (95% CI 399-456). CONCLUSIONS The Women's Lifestyle Physical Activity Program is a relatively low-cost strategy for increasing physical activity. The marginal cost of increasing physical activity is lower than for weight stability. The participant costs related to time in the program were nearly half the total costs, suggesting that practitioners and policymakers should consider the participant cost when disseminating a lifestyle physical activity program into practice.
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Sonntag D, Ali S, De Bock F. Lifetime indirect cost of childhood overweight and obesity: A decision analytic model. Obesity (Silver Spring) 2016; 24:200-6. [PMID: 26638187 DOI: 10.1002/oby.21323] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/05/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the indirect lifetime cost of childhood overweight and obesity for Germany. METHODS The lifetime cohort model consisted of two parts: (a) Model I used data from the German Interview and Examination Survey for Children on prevalence of BMI categories during childhood to evaluate BMI trajectories before the age of 18; and (b) Model II estimated lifetime excess indirect cost based on the history of childhood BMI. Indirect costs were defined as the opportunity cost of lost productivity due to mortality and morbidity and were identified through a systematic literature review. RESULTS Our analysis showed that the majority of children with overweight and obesity remained in the same BMI category during their adult life, resulting in significant indirect lifetime costs. We estimated that overweight and obesity during childhood resulted in an excess lifetime cost per person of €4,209 (men) and €2,445 (women). For the current prevalent German population, the excess lifetime cost was €145 billion. CONCLUSIONS Our study showed that childhood obesity results in significant economic burden on the society. Therefore, cost-effective strategies targeted at reducing the prevalence of obesity during the early years of life can significantly reduce both healthcare and nonhealthcare costs over the lifetime.
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Affiliation(s)
- Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Shehzad Ali
- Department of Health Sciences and Centre for Health Economics, University of York, York, United Kingdom
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Heidelberg University, Mannheim, Germany
- Department of Pediatrics, University Medicine Mannheim, Mannheim, Germany
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Lehnert T, Streltchenia P, Konnopka A, Riedel-Heller SG, König HH. Health burden and costs of obesity and overweight in Germany: an update. Eur J Health Econ 2015; 16:957-967. [PMID: 25381038 DOI: 10.1007/s10198-014-0645-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 10/17/2014] [Indexed: 06/04/2023]
Abstract
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).
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Affiliation(s)
- Thomas Lehnert
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- IFB AdiposityDiseases, University Medicine Leipzig, University of Leipzig, Leipzig, Germany.
| | - Pawel Streltchenia
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Steffi G Riedel-Heller
- IFB AdiposityDiseases, University Medicine Leipzig, University of Leipzig, Leipzig, Germany
- Department for Social Medicine, Occupational Medicine, and Public Health, University of Leipzig, Phillip-Rosenthal-Str. 55, 04103, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Whiteman VE, Salemi JL, Mejia De Grubb MC, Ashley Cain M, Mogos MF, Zoorob RJ, Salihu HM. Additive effects of Pre-pregnancy body mass index and gestational diabetes on health outcomes and costs. Obesity (Silver Spring) 2015; 23:2299-308. [PMID: 26390841 DOI: 10.1002/oby.21222] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/11/2015] [Accepted: 06/19/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pre-pregnancy obesity and gestational diabetes mellitus (GDM) are increasingly prevalent independent risk factors for maternal and infant morbidities. However, there is a paucity of information on their joint effects on health outcomes and healthcare costs. METHODS A population-based retrospective cohort study was conducted in Florida using a validated statewide database covering 1,057,647 infants born between 2004 and 2009. Using generalized linear modeling, joint associations between levels of pre-pregnancy body mass index (BMI) and GDM and maternal complications of pregnancy, adverse birth outcomes, and healthcare costs were examined. The relative excess risk due to interaction was used to describe the direction and magnitude of the BMI-GDM interaction on the additive scale. RESULTS Increasing pre-pregnancy BMI conferred increasing odds of adverse consequences, as did GDM, and the BMI-GDM interaction was greater than additive for 9 of 14 outcomes. The cost for infants born to women with GDM/obesity-III was 34% higher during the first year compared with those born to women with normal BMI and without GDM. The costs of maternal and infant inpatient care associated with overweight/obesity and GDM totaled over $351 million. CONCLUSIONS These findings provide further evidence of the importance of lifestyle modifications to decrease rates of obesity and risk factors from GDM.
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Affiliation(s)
- Valerie E Whiteman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Maria C Mejia De Grubb
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Mary Ashley Cain
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Mulubrhan F Mogos
- Department of Community and Health Systems, School of Nursing, University of Indiana, Indianapolis, Indiana, USA
| | - Roger J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Hamisu M Salihu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
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Raine KD. Reducing the economic burden of chronic disease requires major investment in public health. Can J Public Health 2015; 106:e167-e170. [PMID: 26285185 PMCID: PMC6972109 DOI: 10.17269/cjph.106.5214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 07/24/2015] [Accepted: 07/23/2015] [Indexed: 06/04/2023]
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Dackehag M, Gerdtham UG, Nordin M. Productivity or discrimination? An economic analysis of excess-weight penalty in the Swedish labor market. Eur J Health Econ 2015; 16:589-601. [PMID: 24903023 PMCID: PMC4464599 DOI: 10.1007/s10198-014-0611-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/12/2014] [Indexed: 05/23/2023]
Abstract
This article investigates the excess-weight penalty in income for men and women in the Swedish labor market, using longitudinal data. It compares two identification strategies, OLS and individual fixed effects, and distinguishes between two main sources of excess-weight penalties, lower productivity because of bad health and discrimination. For men, the analysis finds a significant obesity penalty related to discrimination when applying individual fixed effects. We do not find any significant excess-weight penalty for women.
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Affiliation(s)
- Margareta Dackehag
- Department of Economics, Lund University, P.O. Box 7082, 220 07, Lund, Sweden,
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46
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König HH, Lehnert T, Brenner H, Schöttker B, Quinzler R, Haefeli WE, Matschinger H, Heider D. Health service use and costs associated with excess weight in older adults in Germany. Age Ageing 2015; 44:616-23. [PMID: 25829392 DOI: 10.1093/ageing/afu120] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/11/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND excess weight is a risk factor for numerous co-morbidities that predominantly occur in later life. This study's purpose was to analyse the association between excess weight and health service use/costs in the older population in Germany. METHODS this cross-sectional analysis used data of n = 3,108 individuals aged 58-82 from a population-based prospective cohort study. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated based on clinical examinations. Health service use was measured by a questionnaire for a 3-month period. Corresponding costs were calculated applying a societal perspective. RESULTS 21.8% of the sample were normal weight, 43.0% overweight, 25.5% obese class 1 and 9.6% obese class ≥2 according to BMI. In 42.6%, WHtR was ≥0.6. For normal weight, overweight, obese class 1 and obese class ≥2 individuals, mean costs (3-month period) of outpatient care were 384€, 435€, 475€ and 525€ (P < 0.001), mean costs of inpatient care were 284€, 408€, 333€ and 652€ (P = 0.070) and mean total costs 716€, 891€, 852€ and 1,244€ (P = 0.013). For individuals with WHtR <0.6 versus ≥0.6, outpatient costs were 401€ versus 499€ (P < 0.001), inpatient costs 315€ versus 480€ (P = 0.016) and total costs 755€ versus 1,041€ (P < 0.001). Multiple regression analyses controlling for sociodemographic variables showed a significant effect of obesity on costs of outpatient care (class 1: +72€; class ≥2: +153€) and total costs (class ≥2: +361€) while the effect of overweight was not significant. WHtR ≥0.6 significantly increased outpatient costs by +79€ and total costs by +189€. CONCLUSIONS excess weight is associated with increased service use and cost in elderly individuals, in particular in obese class ≥2 individuals.
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Affiliation(s)
- Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Lehnert
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Renate Quinzler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Herbert Matschinger
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Charokopou M, McEwan P, Lister S, Callan L, Bergenheim K, Tolley K, Postema R, Townsend R, Roudaut M. The cost-effectiveness of dapagliflozin versus sulfonylurea as an add-on to metformin in the treatment of Type 2 diabetes mellitus. Diabet Med 2015; 32:890-8. [PMID: 25817050 DOI: 10.1111/dme.12772] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/11/2022]
Abstract
AIMS To assess the cost-effectiveness of dapagliflozin, a sodium-glucose co-transporter-2 (SGLT-2) inhibitor, compared with a sulfonylurea, when added to metformin for treatment of UK people with Type 2 diabetes mellitus inadequately controlled on metformin alone. METHODS Clinical inputs sourced from a head-to-head randomized controlled trial (RCT) informed the Cardiff diabetes decision model. Risk equations developed from the United Kingdom Prospective Diabetes Study (UKPDS) were used in conjunction with the clinical inputs to predict disease progression and the incidence of micro- and macrovascular complications over a lifetime horizon. Cost and utility data were generated to present the incremental cost-effectiveness ratio (ICER) for both treatment arms, and sensitivity and scenario analyses were conducted to assess the impact of uncertainty on the final model results. RESULTS The dapagliflozin treatment arm was associated with a mean incremental benefit of 0.467 quality-adjusted life years (QALYs) [95% confidence interval (CI): 0.420; 0.665], with an incremental cost of £1246 (95% CI: £613; £1637). This resulted in an ICER point estimate of £2671 per QALY gained. Incremental costs were shown to be insensitive to parameter variation, with only treatment-related weight change having a significant impact on the incremental QALYs. Probabilistic sensitivity analysis determined that dapagliflozin had a 100% probability of being cost-effective at a willingness-to-pay threshold of £20,000 per QALY. CONCLUSIONS Dapagliflozin in combination with metformin was shown to be a cost-effective treatment option compared with sulfonylurea from a UK healthcare perspective for people with Type 2 diabetes mellitus who are inadequately controlled on metformin monotherapy.
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Affiliation(s)
- M Charokopou
- Pharmerit International, Rotterdam, The Netherlands
| | - P McEwan
- Centre for Health Economics, Swansea University, Monmouth, UK
- HEOR, Monmouth, UK
| | - S Lister
- Bristol-Myers Squibb Pharmaceuticals, Uxbridge, UK
| | | | | | - K Tolley
- Tolley Health Economics, Buxton, UK
| | - R Postema
- Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | - M Roudaut
- Bristol-Myers Squibb, Rueil-Malmaison, France
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Almeida FA, You W, Harden SM, Blackman KCA, Davy BM, Glasgow RE, Hill JL, Linnan LA, Wall SS, Yenerall J, Zoellner JM, Estabrooks PA. Effectiveness of a worksite-based weight loss randomized controlled trial: the worksite study. Obesity (Silver Spring) 2015; 23:737-45. [PMID: 25678325 PMCID: PMC4380658 DOI: 10.1002/oby.20899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine the effectiveness of an individually targeted Internet-based intervention with monetary incentives (INCENT) at reducing weight of overweight and obese employees when compared with a less-intensive intervention (Livin' My Weigh [LMW]) 6 months after program initiation. METHODS Twenty-eight worksites were randomly assigned to either INCENT or LMW conditions. Both programs used evidence-based strategies to support weight loss. INCENT was delivered via daily e-mails over 12 months while LMW was delivered quarterly via both newsletters and on-site educational sessions. Generalized linear mixed models were conducted for weight change from baseline to 6 months post-program and using an intention-to-treat analysis to include all participants with baseline weight measurements. RESULTS Across 28 worksites, 1,790 employees (M = 47 years of age; 79% Caucasian; 74% women) participated. Participants lost an average of 2.27 lbs (P < 0.001) with a BMI decrease of 0.36 kg/m(2) (P < 0.001) and 1.30 lbs (P < 0.01) with a BMI decrease of 0.20 kg/m(2) (P < 0.01) in INCENT and LMW, respectively. The differences between INCENT and LMW in weight loss and BMI reduction were not statistically significant. CONCLUSIONS This study suggests that INCENT and a minimal intervention alternative may be effective approaches to help decrease the overall obesity burden within worksites.
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Affiliation(s)
- Fabio A. Almeida
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Wen You
- Fralin Translational Obesity Research Center, Virginia Tech
- Virginia Tech, Department of Agriculture and Applied Economics
| | | | | | - Brenda M. Davy
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jennie L. Hill
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Laura A. Linnan
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | - Sarah S. Wall
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | | | - Jamie M. Zoellner
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
| | - Paul A. Estabrooks
- Virginia Tech, Department of Human Nutrition, Foods & Exercise
- Fralin Translational Obesity Research Center, Virginia Tech
- Carilion Clinic, Department of Family and Community Medicine
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Legler J, Fletcher T, Govarts E, Porta M, Blumberg B, Heindel JJ, Trasande L. Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union. J Clin Endocrinol Metab 2015; 100:1278-88. [PMID: 25742518 PMCID: PMC4399302 DOI: 10.1210/jc.2014-4326] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Obesity and diabetes are epidemic in the European Union (EU). Exposure to endocrine-disrupting chemicals (EDCs) is increasingly recognized as a contributor, independent of diet and physical activity. OBJECTIVE The objective was to estimate obesity, diabetes, and associated costs that can be reasonably attributed to EDC exposures in the EU. DESIGN An expert panel evaluated evidence for probability of causation using weight-of-evidence characterization adapted from that applied by the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and burden of disease. Cost estimation as of 2010 utilized published cost estimates for childhood obesity, adult obesity, and adult diabetes. Setting, Patients and Participants, and Intervention: Cost estimation was performed from the societal perspective. RESULTS The panel identified a 40% to 69% probability of dichlorodiphenyldichloroethylene causing 1555 cases of overweight at age 10 (sensitivity analysis: 1555-5463) in 2010 with associated costs of €24.6 million (sensitivity analysis: €24.6-86.4 million). A 20% to 39% probability was identified for dichlorodiphenyldichloroethylene causing 28 200 cases of adult diabetes (sensitivity analysis: 28 200-56 400) with associated costs of €835 million (sensitivity analysis: €835 million-16.6 billion). The panel also identified a 40% to 69% probability of phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costs. Phthalate exposure was also found to have a 40% to 69% probability of causing 20 500 new-onset cases of diabetes in older women with €607 million in associated costs. Prenatal bisphenol A exposure was identified to have a 20% to 69% probability of causing 42 400 cases of childhood obesity, with associated lifetime costs of €1.54 billion. CONCLUSIONS EDC exposures in the EU contribute substantially to obesity and diabetes, with a moderate probability of >€18 billion costs per year. This is a conservative estimate; the results emphasize the need to control EDC exposures.
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Affiliation(s)
- Juliette Legler
- Department of Chemistry and Biology (J.L.), Institute for Environmental Studies, VU University, 1081 HV Amsterdam, The Netherlands; London School of Tropical Hygiene (T.F.), London WC1E 7HT, United Kingdom; Environmental Risk and Health (E.G.), Flemish Institute for Technological Research, 2400 Mol, Belgium; School of Medicine (M.P.), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; Hospital del Mar Institute of Medical Research (M.P.), 08003 Barcelona, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP) (M.P.), 28029 Madrid, Spain; Department of Developmental and Cell Biology (B.B.), University of California, Irvine, Irvine, California 92697; National Institute of Environmental Health Sciences (J.J.H.), Research Triangle Park, North Carolina 27709; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; NYU Steinhardt School of Culture, Education, and Human Development (L.T.), Department of Nutrition, Food & Public Health, New York, New York 10003; and NYU Global Institute of Public Health (L.T.), New York, New York 10003
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50
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Legler J, Fletcher T, Govarts E, Porta M, Blumberg B, Heindel JJ, Trasande L. Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union. J Clin Endocrinol Metab 2015; 100:1278-1288. [PMID: 25742518 PMCID: PMC4399302 DOI: 10.1210/jc.2014-4326#sthash.tw9g4zig.dpuf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/25/2015] [Indexed: 06/07/2023]
Abstract
CONTEXT Obesity and diabetes are epidemic in the European Union (EU). Exposure to endocrine-disrupting chemicals (EDCs) is increasingly recognized as a contributor, independent of diet and physical activity. OBJECTIVE The objective was to estimate obesity, diabetes, and associated costs that can be reasonably attributed to EDC exposures in the EU. DESIGN An expert panel evaluated evidence for probability of causation using weight-of-evidence characterization adapted from that applied by the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and burden of disease. Cost estimation as of 2010 utilized published cost estimates for childhood obesity, adult obesity, and adult diabetes. Setting, Patients and Participants, and Intervention: Cost estimation was performed from the societal perspective. RESULTS The panel identified a 40% to 69% probability of dichlorodiphenyldichloroethylene causing 1555 cases of overweight at age 10 (sensitivity analysis: 1555-5463) in 2010 with associated costs of €24.6 million (sensitivity analysis: €24.6-86.4 million). A 20% to 39% probability was identified for dichlorodiphenyldichloroethylene causing 28 200 cases of adult diabetes (sensitivity analysis: 28 200-56 400) with associated costs of €835 million (sensitivity analysis: €835 million-16.6 billion). The panel also identified a 40% to 69% probability of phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costs. Phthalate exposure was also found to have a 40% to 69% probability of causing 20 500 new-onset cases of diabetes in older women with €607 million in associated costs. Prenatal bisphenol A exposure was identified to have a 20% to 69% probability of causing 42 400 cases of childhood obesity, with associated lifetime costs of €1.54 billion. CONCLUSIONS EDC exposures in the EU contribute substantially to obesity and diabetes, with a moderate probability of >€18 billion costs per year. This is a conservative estimate; the results emphasize the need to control EDC exposures.
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Affiliation(s)
- Juliette Legler
- Department of Chemistry and Biology (J.L.), Institute for Environmental Studies, VU University, 1081 HV Amsterdam, The Netherlands; London School of Tropical Hygiene (T.F.), London WC1E 7HT, United Kingdom; Environmental Risk and Health (E.G.), Flemish Institute for Technological Research, 2400 Mol, Belgium; School of Medicine (M.P.), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; Hospital del Mar Institute of Medical Research (M.P.), 08003 Barcelona, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP) (M.P.), 28029 Madrid, Spain; Department of Developmental and Cell Biology (B.B.), University of California, Irvine, Irvine, California 92697; National Institute of Environmental Health Sciences (J.J.H.), Research Triangle Park, North Carolina 27709; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; NYU Steinhardt School of Culture, Education, and Human Development (L.T.), Department of Nutrition, Food & Public Health, New York, New York 10003; and NYU Global Institute of Public Health (L.T.), New York, New York 10003
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