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Original Article

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

Yates N.a · Teuner C.M.a · Hunger M.a · Holle Ra, b · Stark R.a · Laxy M.a, b · Hauner Hc · Peters Ab, d · Wolfenstetter S.B.a

Author affiliations

aInstitute of Health Economics and Health Care Management, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany; bGerman Centre for Diabetes Research, Neuherberg, Germany; cInstitute for Nutritional Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; dInstitute of Epidemiology II, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany

Corresponding Author

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

christina.teuner@helmholtz-muenchen.de

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Obes Facts 2016;9:397-409

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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.

© 2016 The Author(s) Published by S. Karger GmbH, Freiburg


References

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  3. Centers for Disease Control and Prevention: Adult Overweight and Obesity. www.cdc.gov/obesity/adult/index.html (last accessed December 1, 2016).
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  5. Schneider HJ, Friedrich N, Klotsche J, Pieper L, Nauck M, John U, Dorr M, Felix S, Lehnert H, Pittrow D, Silber S, Volzke H, Stalla GK, Wallaschofski H, Wittchen HU: The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010;95:1777-1785.
  6. Bertakis KD, Azari R: Obesity and the use of health care services. Obes Res 2005;13:372-379.
  7. Hauner H, Koster I, von Ferber L: Frequency of ‘obesity' in medical records and utilization of out-patient health care by ‘obese' subjects in Germany. An analysis of health insurance data. Int J Obes Relat Metab Disord 1996;20:820-824.
    External Resources
  8. Lehnert T, Stuhldreher N, Streltchenia P, Riedel-Heller SG, Konig HH: Sick leave days and costs associated with overweight and obesity in Germany. J Occup Environ Med 2014;56:20-27.
  9. Renna F, Thakur N: Direct and indirect effects of obesity on u.S. Labor market outcomes of older working age adults. Soc Sci Med 2010;71:405-413.
  10. Gates DM, Succop P, Brehm BJ, Gillespie GL, Sommers BD: Obesity and presenteeism: the impact of body mass index on workplace productivity. J Occup Environ Med 2008;50:39-45.
  11. Konnopka A, Bodemann M, Konig HH: Health burden and costs of obesity and overweight in Germany. Eur J Health Econ 2011;12:345-352.
  12. Sander B, Bergemann R: Economic burden of obesity and its complications in Germany. Eur J Health Econ 2003;4:248-253.
  13. Knoll KP, Hauner H: Kosten der Adipositas in der Bundesrepublik Deutschland - eine aktuelle Krankheitskostenstudie. Adipositas 2008;2:204-210.
  14. Aitken RJ, Allman-Farinelli MA, King LA, Bauman AE: Current and future costs of cancer, heart disease and stroke attributable to obesity in Australia - a comparison of two birth cohorts. Asia Pac J Clin Nutr 2009;18:63-70.
  15. Lal A, Moodie M, Ashton T, Siahpush M, Swinburn B: Health care and lost productivity costs of overweight and obesity in New Zealand. Aust N Z J Public Health 2012;36:550-556.
  16. Wirth A, Holle R, Teuner CM: Ökonomische Aspekte der Adipositas; in Wirth A, Hauner H (eds): Adipositas - Ätiologe, Folgekrankheiten, Diagnostik, Therapie. Berlin, Springer, 2013, pp 41-43.
  17. von Lengerke T, Krauth C: Economic costs of adult obesity: a review of recent European studies with a focus on subgroup-specific costs. Maturitas 2011;69:220-229.
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  33. Withrow D, Alter DA: The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12:131-141.
  34. Tsai AG, Williamson DF, Glick HA: Direct medical cost of overweight and obesity in the USA: A quantitative systematic review. Obes Rev 2011;12:50-61.
  35. Arterburn DE, Maciejewski ML, Tsevat J: Impact of morbid obesity on medical expenditures in adults. Int J Obes 2005;29:334-339.
  36. Wee CC, Phillips RS, Legedza AT, Davis RB, Soukup JR, Colditz GA, Hamel MB: Health care expenditures associated with overweight and obesity among us adults: Importance of age and race. Am J Public Health 2005;95:159-165.
  37. Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ: Indirect costs of obesity: a review of the current literature. Obes Rev 2008;9:489-500.
  38. Golinvaux NS, Bohl DD, Basques BA, Fu MC, Gardner EC, Grauer JN: Limitations of administrative databases in spine research: a study in obesity. Spine J 2014;14:2923-2928.
  39. Martin BJ, Chen G, Graham M, Quan H: Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies. BMC Health Serv Res 2014;14:70.
  40. Evans C, Crawford B: Patient self-reports in pharmacoeconomic studies. Their use and impact on study validity. Pharmacoeconomics 1999;15:241-256.
  41. Cawley J, Meyerhoefer C: The medical care costs of obesity: an instrumental variables approach. J Health Econ 2012;31:219-230.

Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: March 16, 2016
Accepted: October 03, 2016
Published online: December 13, 2016
Issue release date: December 2016

Number of Print Pages: 13
Number of Figures: 1
Number of Tables: 4

ISSN: 1662-4025 (Print)
eISSN: 1662-4033 (Online)

For additional information: https://www.karger.com/OFA

References

  1. Ng M, Fleming T, Robinson M, et al: Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the global burden of disease study 2013. The Lancet 2014;384:766-781.
  2. Mensink GB, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C: Overweight and obesity in Germany: results of the German health interview and examination survey for adults (DEGS1) (in German). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 2013;56:786-794.
  3. Centers for Disease Control and Prevention: Adult Overweight and Obesity. www.cdc.gov/obesity/adult/index.html (last accessed December 1, 2016).
  4. Bray GA: Medical consequences of obesity. J Clin Endocrinol Metab 2004;89:2583-2589.
  5. Schneider HJ, Friedrich N, Klotsche J, Pieper L, Nauck M, John U, Dorr M, Felix S, Lehnert H, Pittrow D, Silber S, Volzke H, Stalla GK, Wallaschofski H, Wittchen HU: The predictive value of different measures of obesity for incident cardiovascular events and mortality. J Clin Endocrinol Metab 2010;95:1777-1785.
  6. Bertakis KD, Azari R: Obesity and the use of health care services. Obes Res 2005;13:372-379.
  7. Hauner H, Koster I, von Ferber L: Frequency of ‘obesity' in medical records and utilization of out-patient health care by ‘obese' subjects in Germany. An analysis of health insurance data. Int J Obes Relat Metab Disord 1996;20:820-824.
    External Resources
  8. Lehnert T, Stuhldreher N, Streltchenia P, Riedel-Heller SG, Konig HH: Sick leave days and costs associated with overweight and obesity in Germany. J Occup Environ Med 2014;56:20-27.
  9. Renna F, Thakur N: Direct and indirect effects of obesity on u.S. Labor market outcomes of older working age adults. Soc Sci Med 2010;71:405-413.
  10. Gates DM, Succop P, Brehm BJ, Gillespie GL, Sommers BD: Obesity and presenteeism: the impact of body mass index on workplace productivity. J Occup Environ Med 2008;50:39-45.
  11. Konnopka A, Bodemann M, Konig HH: Health burden and costs of obesity and overweight in Germany. Eur J Health Econ 2011;12:345-352.
  12. Sander B, Bergemann R: Economic burden of obesity and its complications in Germany. Eur J Health Econ 2003;4:248-253.
  13. Knoll KP, Hauner H: Kosten der Adipositas in der Bundesrepublik Deutschland - eine aktuelle Krankheitskostenstudie. Adipositas 2008;2:204-210.
  14. Aitken RJ, Allman-Farinelli MA, King LA, Bauman AE: Current and future costs of cancer, heart disease and stroke attributable to obesity in Australia - a comparison of two birth cohorts. Asia Pac J Clin Nutr 2009;18:63-70.
  15. Lal A, Moodie M, Ashton T, Siahpush M, Swinburn B: Health care and lost productivity costs of overweight and obesity in New Zealand. Aust N Z J Public Health 2012;36:550-556.
  16. Wirth A, Holle R, Teuner CM: Ökonomische Aspekte der Adipositas; in Wirth A, Hauner H (eds): Adipositas - Ätiologe, Folgekrankheiten, Diagnostik, Therapie. Berlin, Springer, 2013, pp 41-43.
  17. von Lengerke T, Krauth C: Economic costs of adult obesity: a review of recent European studies with a focus on subgroup-specific costs. Maturitas 2011;69:220-229.
  18. Holle R, Happich M, Lowel H, Wichmann HE: KORA - a research platform for population based health research (in German). Gesundheitswesen 2005;67(suppl 1):S19-25.
  19. Wolfenstetter SB: Future direct and indirect costs of obesity and the influence of gaining weight: Results from the MONICA/KORA cohort studies, 1995-2005. Econ Hum Biol 2012;10:127-138.
  20. von Lengerke T, Reitmeir P, John J: Direct medical costs of (severe) obesity: a bottom-up assessment of over- vs. normal-weight adults in the KORA-study region (Augsburg, Germany) (in German). Gesundheitswesen 2006;68:110-115.
  21. Teuner CM, Menn P, Heier M, Holle R, John J, Wolfenstetter SB: Impact of BMI and BMI change on future drug expenditures in adults: Results from the MONICA/KORA cohort study. BMC Health Services Res 2013;13:424.
  22. Bock JO, Brettschneider C, Seidl H, Bowles D, Holle R, Greiner W, König HH: Calculation of standardised unit costs from a societal perspective for health economic evaluation (in German). Gesundheitswesen 2015;77:53-61.
  23. Wissenschaftliches Institut der AOK (WIdO): Arzneimittel. 2014. www.wido.de/arzneimittel.html (last accessed November 30, 2016).
  24. Statistisches Bundesamt: Verbraucherpreisindex: Deutschland, Monate, Klassifikation der Verwendungszwecke des Individualkonsums. Wiesbaden, 2014 www-genesis.destatis.de/genesis/online/logon?sequenz=tabelleErgebnis&selectionname=61111-0004&sachmerkmal=CC98A4&sachschluessel=CC06*&zeitscheiben=3 (last accessed November 30, 2016).
  25. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG): Arbeitspapier Kostenbestimmung 2009, Version 1.0. www.iqwig.de/download/Arbeitspapier_Kostenbestimmung_v_1_0.pdf (last accessed November 30, 2016).
  26. Krauth C, Hessel F, Hansmeier T, Wasem J, Seitz R, Schweikert B: Empirical standard costs for health economic evaluation in Germany - a proposal by the working group methods in health economic evaluation (in German). Gesundheitswesen 2005;67:736-746.
  27. Statistisches Bundesamt: VGR der Länder - Arbeitnehmerentgelt, Bruttolöhne und -Gehälter in den Ländern der Bundesrepublik Deutschland 2000 bis 2014. Reihe 1, band 2. Stuttgart, 2015. /www.Destatis.De/de/publikationen/thematisch/volkswirtschaftlichegesamtrechnungen/vgrderlaender/vgr_laenderergebnisseband2.html. (last accessed November 30, 2016).
  28. Fuchs J HM, Hutter C, Klinger S, Wanger S, Weber E, Weigand R, Zika G: Arbeitsmarkt 2014/2015. Robust, aber risikobehaftet. http://doku.Iab.De/kurzber/2014/kb1814.Pdf (last accessed November 30, 2016).
  29. WHO Collaborating Centre for Drug Statistics Methodology: Definition and general considerations 2016. www.whocc.no/ddd/definition_and_general_considera/ (last accessed November 30, 2016).
  30. Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L: The friction cost method for measuring indirect costs of disease. J Health Econ 1995;14:171-189.
  31. Institut für Arbeitsmarkt- und Berufsforschung (IAB): Arbeitslosigkeit sinkt trotz Beschäftigungsrekord nur wenig. http://doku.iab.de/kurzber/2013/kb1813.pdf (last accessed November 30, 2016).
  32. Institut für Arbeitsmarkt- und Berufsforschung (IAB): Strukturwandel und Demografie prägten die Personalsuche. www.iab.de/194/section.aspx/Publikation/k130819303 (last accessed November 30, 2016).
  33. Withrow D, Alter DA: The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 2011;12:131-141.
  34. Tsai AG, Williamson DF, Glick HA: Direct medical cost of overweight and obesity in the USA: A quantitative systematic review. Obes Rev 2011;12:50-61.
  35. Arterburn DE, Maciejewski ML, Tsevat J: Impact of morbid obesity on medical expenditures in adults. Int J Obes 2005;29:334-339.
  36. Wee CC, Phillips RS, Legedza AT, Davis RB, Soukup JR, Colditz GA, Hamel MB: Health care expenditures associated with overweight and obesity among us adults: Importance of age and race. Am J Public Health 2005;95:159-165.
  37. Trogdon JG, Finkelstein EA, Hylands T, Dellea PS, Kamal-Bahl SJ: Indirect costs of obesity: a review of the current literature. Obes Rev 2008;9:489-500.
  38. Golinvaux NS, Bohl DD, Basques BA, Fu MC, Gardner EC, Grauer JN: Limitations of administrative databases in spine research: a study in obesity. Spine J 2014;14:2923-2928.
  39. Martin BJ, Chen G, Graham M, Quan H: Coding of obesity in administrative hospital discharge abstract data: accuracy and impact for future research studies. BMC Health Serv Res 2014;14:70.
  40. Evans C, Crawford B: Patient self-reports in pharmacoeconomic studies. Their use and impact on study validity. Pharmacoeconomics 1999;15:241-256.
  41. Cawley J, Meyerhoefer C: The medical care costs of obesity: an instrumental variables approach. J Health Econ 2012;31:219-230.
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This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.