The Cost Burden of Obesity

According to the World Health Organization (WHO), obesity is estimated as a body mass index (BMI) of 30.0 kg/m2 or greater and is divided into three classes: class I (30.0 = BMI = 34.9 kg/m2), class II (35.0 = BMI = 39.9 kg/m2), and class III (BMI = 40.0 kg/m2).1 The prevalence of obesity among adults in the United States (US) has been rising steadily since the 1980s, with the age-standardized prevalence reported to be 39.6% in 2015 to 2016. Notably, prevalence has been found to vary by occupation, suggesting that various employment factors, in addition to personal factors, may contribute to the high prevalence of obesity among the working population.Compared with normal BMI, obesity has been associated with higher direct healthcare costs and indirect work loss-related costs, including costs related to disability, absenteeism (absence from work, such as sick leave), and presenteeism (reduction in productivity while at work). The Milken Institute estimated a total cost of US$1.72 trillion associated with obesity/overweight and its related comorbidities in 2016. Consequently, the cost impact of obesity can be substantial for both affected employees and their employers.While trends in obesity-related costs were observed across industries, in-depth comparisons between industries were not analyzed. Therefore, this follow-up study was conducted to provide a deeper analysis of the industry-specific factors affecting the economic burden of obesity among the working population, with a specific focus on the incremental costs associated with the three classes of obesity among employees of the healthcare industry. Since healthcare workers are typically health-educated and may theoretically be more health-aware regarding the negative effects of chronic diseases like obesity, we hypothesized that the associated costs may be lower in this subpopulation. Therefore, we compared the economic burden of employees in the healthcare industry to that of other industries to identify specific subpopulations that may be at higher risk of obesity-related costs. Additionally, employment industry was explored as a predictor of high healthcare costs. Insights on at-risk employees are needed to implement targeted employer-based obesity interventions that can effectively promote weight management according to the goals and needs of each employee subpopulation.Briefly, employees were classified into one of the following study cohorts based on BMI: (1) obesity class I (employees with BMI between 30.0 and 34.9 kg/m2); (2) obesity class II (employees with BMI between 35.0 and 39.9 kg/m2); (3) obesity class III (employees with BMI of 40 kg/m2 or over); and (4) reference cohort, as a proxy of a normal-weight population, consisting of a randomly selected sample of employees without overweight, obesity, or underweight BMI codes and without overweight or obesity term International Classification of Diseases (ICD) diagnosis codes. Since normal BMI diagnosis codes are not generally used by healthcare providers except in conjunction with another underlying condition, selection of employees with normal BMI codes would have biased the reference cohort towards unhealthier individuals.Cohorts were further stratified by employees’ industries of employment as reported in the employer database: healthcare; transportation; manufacturing and energy; retail and consumer goods; government, education, and religious services (GERS); technology; finance and insurance; and other (ie, food services, entertainment, and other service industries).Study OutcomesStudy outcomes measured during the observation period included direct healthcare costs (among all employees) and medical-related absenteeism and short-term and long-term disability costs (among employees with work loss information). Direct healthcare costs were obtained from claims and included pharmacy costs and medical costs, including hospitalization, emergency department (ED), outpatient, home healthcare, and other (ie, ambulance, dentist, laboratory, and everything not previously identified) costs. Sick leave (absenteeism) costs were calculated from employees’ resource utilization multiplied by the workers’ recorded wages. Each hospitalization accounted for 8 hours of absenteeism from work (1 work day) and each ED, outpatient, and other visit accounted for 4 hours of absenteeism (1/2 a work day). Five-sevenths of the total sick leave hours were used in the calculation to account for weekend visits that did not result in work loss costs.16 Lastly, disability costs were calculated from short- and long-term disability data from claims.To explore the relationship between the type of industry and the incremental economic impact of obesity, direct, medical-related absenteeism, and disability costs were evaluated for each of the employment industries and compared with the costs of the healthcare industry. The healthcare industry was chosen as a focus and used as a reference because of the presumed propensity for its employees to be health-educated and potentially more health-conscious regarding the negative effects of obesity.Employees of specific industries, such as GERS, food/entertainment services, and technology, are at higher risk of incurring high obesity-related healthcare costs and may therefore benefit most from targeted, employer-led weight management approaches that encompass a comprehensive range of diet-, medication-, and surgery-based interventions. Finally, employees of the healthcare industry generally incurred lower obesity-related direct, absenteeism, and disability costs compared with other industries.Information regarding the industry-specific trends in obesity-related spending gained from this study will contribute towards the implementation and tailoring of employer-based weight management programs according to the specific needs of each industry subpopulation in order to achieve effective and sustained improvements in employee health.Source: Journal of Occupational and Environmental Medicine

The Cost Burden of Obesity

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Republikein 2025-09-18

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The Cost Burden of Obesity

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