On determining how much obesity is costing society
Objectives: The objectives of this narrative review are to examine techniques used in determining the health costs accrued by obese individuals, and to estimate the overall costs of the current obesity epidemic to society. Methods: Information obtained from Ovid/Medline and Google Scholar through to August 2018 was supplemented by a search of the author's personal files. Results: Reasons for undertaking an economic analysis of obesity include the generation of favourable publicity, reviewing the efficacy of current treatment programmes, considering the effects of expanding or compressing therapeutic options, and assessing the need for alternative treatments. Technical difficulties in making such estimates include both differences in the relative impacts of overweight, moderate and gross obesity and the more general issues faced by all health economists: differential rates of inflation, varying international exchange rates, an appropriate choice of discount rate, and regional differences in medical costs, treatment patterns, job participation rates, and employee benefits. Allowance must also be made for secular shifts in population profile, opportunity costs of obesity and its treatment, losses due to the premature death of workers, and the value of services contributed by volunteers. In most developed countries, an excessive accumulation of body fat accounts for 2-5% of total medical expenditures, and in the U.S. costs are as high as 5-9%, with even larger indirect costs. Problems arise when obese individuals travel by plane or car. Per capita greenhouse gas emissions are also greater for the obese, and they experience a significant loss of potential human capital. Discussion and Conclusions: The validity of current estimates of the economic costs of obesity remains vulnerable to a substantial interaction and overlap between charges attributable to obesity and those due to physical inactivity. The respective magnitude of these 2 effects remains to be clarified by careful multivariate analyses, using samples with reliable and valid objective measures of habitual physical activity. Such an analysis is important, because it should influence the allocation of resources for both prevention and treatment.
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