Costs Associated With Obesity
Overview
The impact of obesity on mortality rates and healthcare resource utilization (HCRU) is profound, with significant variations based on demographic factors such as age, gender, and local socioeconomic status. This study aimed to assess the lifetime costs of obesity across different demographic groups and geographic areas in England, utilizing published data on mortality rates and HCRU within integrated care boards (ICBs) and considering the costs of therapeutic interventions.
Data on population demographics and expected mortality rates were obtained nationally, while obesity prevalence was derived from the Health of the Nation study. Using established associations between obesity and mortality/HCRU across age, gender, and socioeconomic strata, estimates were made for life years lost and lifetime HCRU, categorized by sex, age group, and body mass index (BMI) class for each ICB. The study period was set in 2019 to avoid COVID-19 pandemic influences on obesity rates, with HCRU values from 2022/23 applied.
Comparisons were made across BMI classes (normal/underweight, overweight, obese class I and II, and obese class III) against a benchmark of the entire population having a BMI <25 kg/m². Additionally, comparisons were made among the 42 ICBs. Future life years lost due to obesity-related deaths were also estimated annually.
In essence, this study provides unique insights into the extensive costs of obesity across various demographic groups and regions in England, shedding light on the substantial burden it imposes on both mortality rates and healthcare resource utilization.
Introduction
The global surge in obesity poses a formidable challenge to healthcare systems worldwide, as it is intricately linked to a plethora of chronic conditions spanning various organ systems. These conditions include cardiovascular diseases, metabolic disorders such as diabetes, digestive issues, respiratory ailments like sleep apnea, neurological disorders, musculoskeletal problems such as osteoarthritis, and even infectious diseases.
The collective burden of managing these obesity-related conditions amounts to a staggering £1.3 trillion annually, which constitutes approximately 2.8% of the global economic activity.
Also read: Obesity Treated With Expandable Oral Capsules
Data from the United States underscore the substantial economic impact of obesity, revealing that individuals with obesity incur twice the annual medical care costs compared to those with a healthy body mass index (BMI <25 kg/m²).
Moreover, medical care costs escalate significantly with higher obesity class levels. For instance, individuals with severe obesity, defined as a BMI ≥40 kg/m², bear medical care costs more than double those of individuals with a BMI <25 kg/m².
Similar trends are observed in the UK, where an analysis of health records indicates a marked disparity in healthcare costs between individuals with varying BMIs. Notably, individuals with class 3 obesity, characterized by a BMI ≥40 kg/m², impose a substantially higher financial burden on the National Health Service (NHS) compared to those with lower BMIs.
The prevalence of obesity in England has witnessed a steady rise over the years, surging from 15% in 1993 to 28% in 2019, based on pre-pandemic data. This upward trajectory is particularly pronounced among individuals with severe obesity, comprising 3% of the total population.
Regional disparities further compound the issue, with obesity rates being notably higher in the northeast and northwest regions compared to the southeast and London. Moreover, socioeconomic inequalities exacerbate these regional differences, with women residing in deprived areas bearing a disproportionately higher burden of obesity.
Despite the grim economic and health implications of obesity, recent analyses suggest that interventions aimed at reducing BMI could yield substantial benefits. For instance, projections indicate that reducing BMI from severe obesity (BMI ≥35 kg/m²) to a healthier range (BMI ≤25 kg/m²) could result in a gain of 3.48 quality-adjusted life years (QALYs) and substantial cost savings.
In light of these findings, this study endeavors to achieve three primary objectives. Firstly, it seeks to comprehensively assess the long-term economic costs of obesity across different age and sex groups in England.
Secondly, it aims to evaluate the potential health economic benefits of reducing BMI. Lastly, the study endeavors to delineate the distribution of health burdens associated with BMI across various regions in the UK.
By addressing these objectives, the study endeavors to provide critical insights essential for informing evidence-based strategies aimed at mitigating the escalating health and economic impacts of obesity across England.
Methods
Inclusion Criteria
– Studies or data sets pertaining to obesity prevalence, mortality rates, and healthcare resource utilization (HCRU) in England, specifically at the regional level.
– Data sources from national organizations such as NHS England, Office for National Statistics (ONS), and other reputable sources.
– Research papers or reports published in peer-reviewed journals or official government publications.
– Data covering the period from 2019 to avoid potential influences of the COVID-19 pandemic on obesity prevalence, mortality rates, and HCRU.
– Studies or models that provide detailed information on population demographics (age, sex, deprivation quintile), obesity prevalence by BMI class, mortality rates by age, sex, and socioeconomic status, and HCRU by age, sex, and socioeconomic level.
– Models or analyses that integrate multiple data sources to assess the impact of obesity on mortality rates and HCRU across different demographic groups and regions in England.
Exclusion Criteria
– Studies or data sets that focus solely on global or national-level data without regional breakdowns.
– Data sources that are not from reputable organizations or lack transparency in methodology.
– Studies or reports published before 2019 or after 2021, as they may not align with the specified timeframe.
– Research lacking detailed information on population demographics, obesity prevalence, mortality rates, and HCRU at the regional level in England.
– Models or analyses that do not integrate multiple data sources to provide comprehensive insights into the impact of obesity on mortality rates and HCRU across different demographic groups and regions.
Analysis
The statistical analysis involved amalgamating various datasets and odds ratios at the level of local integrated care boards (ICBs). This process aimed to develop a straightforward model illustrating population prevalence and the consequent effects on mortality and healthcare resource utilization (HCRU) across different demographic parameters such as age, sex, deprivation, and BMI class.
By breaking down the population into different segments and comparing between BMI classes, different scenarios were considered, and their impacts were then extrapolated to encompass the entire population. This analytical approach was conducted using Power Pivot within Microsoft Excel, facilitating efficient computation and visualization of the data.
Results
The total English population aged over 16 years was 45.5 million, with males constituting 49% (22.3 million) and females 51% (23.2 million). Class III obesity (BMI≥40 kg/m2) affected 1.50 million individuals, representing 3.3% of the population (males 0.49 million, females 1.01 million). Stratifying by age, 0.86 million individuals (males 0.26 million, females 0.60 million) in the 16-49 age group were affected, 0.47 million (males 0.15 million, females 0.32 million) in the 50-69 age group, and 0.17 million (males 0.07 million, females 0.10 million) in those aged 70 or above. Class I and II obesity (BMI 30.0-39.9 kg/m2) affected 11.23 million individuals (males 5.50 million, females 5.73 million), while overweight (BMI 25.0-29.9 kg/m2) was observed in 16.54 million individuals (males 9.22 million, females 7.32 million).
Among those with class III obesity, 35.1% were in the highest quintile of social disadvantage, exceeding the expected 20%. Notably, 39.8% of women aged 16-50 years were affected by class III obesity, compared to 26.7% of the total population.
Regarding mortality, the estimated annual deaths for the entire English population were 518,000 (males 262,000, females 256,000). If the entire population had a BMI <25 kg/m2, the expected deaths would be 455,000. The excess deaths attributable to obesity were distributed across different BMI classes: 53.9% for class III, 25.4% for class I and II, and 4.7% for overweight individuals. Excess deaths were 14.7% higher in males compared to females.
Projected average age and future life years varied by BMI class, with class III obesity associated with a reduction of 6.7 years in future life years. Applying a value of £30,000 per Quality-Adjusted Life Year (QALY), the potential QALY value lost due to obesity-related future life years was estimated at £24 billion per year.
Healthcare resource utilization (HCRU) costs per person were analyzed across age groups, sex, and BMI classes. Transitioning from BMI≥40 kg/m2 to BMI 30-39.9 kg/m2 resulted in an annual HCRU decrease of £342 per person, while the transition from BMI 30-39.9 kg/m2 to BMI 25-29.9 kg/m2 led to a reduction of £316 per person.
Lifetime health resource utilization costs, factoring in mortality and future life years, were assessed, totaling £435.7 billion for the current set of adults. If all adults had BMI <25 kg/m2, the total lifetime HCRU per year would be £433.3 billion. Geographical variation in outcomes across integrated care boards was presented, highlighting differences in population size, age, sex, deprivation, and annual HCRU spending.
Conclusion
Our analysis reveals a concerning trend of high relative prevalence of class III obesity among younger women aged 16-49 years. The national lifetime costs associated with obesity amount to approximately 3.5% of the current annual total expenditure of the NHS. While reductions in ongoing healthcare resource utilization (HCRU) for morbidly obese patients through tier 3 weight management services could provide a significant offset to long-term health management costs, so too could advancements in weight-mitigating pharmacotherapy.
It’s noteworthy that lifetime HCRU is influenced by the increased mortality rates observed among obese individuals. Our findings suggest that simple short-term reductions in HCRU resulting from BMI reduction alone may not be adequate to finance additional specialist weight reduction interventions. However, for morbidly obese individuals, the potential Quality-Adjusted Life Year (QALY) value lost per person per year was estimated at £2864, suggesting that these funds could be redirected towards intensive weight management programs, including pharmacotherapy.
Furthermore, our data highlight that while younger individuals with obesity may not incur significantly higher costs at their current age, they are likely to incur substantially higher costs in the future in terms of HCRU. Effective weight reduction strategies thus hold the potential to not only reduce healthcare costs year on year but also enable individuals to achieve their full potential in terms of life years.
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