Economic burden of excess weight among older adults in Singapore: a cross-sectional study

Abstract

Objectives To estimate the incremental per capita and aggregate direct and indirect costs of excess weight among older adults (aged 40–80) in Singapore. Design Secondary data analysis of an existing cross-sectional survey Setting Residential districts in South-West Singapore Participants 5848 older adults (aged 40–80) from Singapore’s three dominant ethnic groups Primary and secondary outcome measures We used regression models to estimate per capita medical expenditures and absenteeism costs attributable to overweight and obesity based on WHO’s body-mass index (BMI) classification. Per capita estimates were multiplied by prevalence to obtain aggregate costs. Results The sample included 2467 Chinese, 2128 Indians and 1253 Malays. Indians and Malays are three to four times more likely to be obese (BMI≥30 kg/m 2 ) than Chinese. Among Chinese, compared with those who are normal weight, individuals who are overweight missed one additional workday per year more (p<0.05). Individuals in the obese category had S$720 per year greater medical expenditures (p<0.05) but missed workdays were not statistically different from those in the normal weight category. Among Indians, differences were not significant between normal and overweight categories. Indians in the obese category incurred an additional S$310 per year (p<0.10) more than those of normal weight. For Malays, no significant differences by BMI category were identified. Aggregate burden is estimated at S$261M (million) (95% CI: 57M to 465M) with 68% from medical expenditures. Chinese, Malays and Indians make up 79%, 12% and 9% of the population, respectively, but account for 76%, 19% and 4% of the costs of excess weight respectively. Conclusion Excess weight imposes a substantial health and economic burden among older Singaporeans. Successful efforts to prevent and reduce obesity prevalence may generate both health and economic improvements.

Weight bias and stigma in healthcare professionals: a narrative review with a Singapore lens

“…[ 4 ] Further, overweight and obesity appear to disproportionally affect Malay and Indian communities living in Singapore. [ 5 ] Estimated figures for Singapore are, at best, conservative and likely to underestimate the scale of the problem, given that people of Asian descent have a higher proportion of body fat detrimental to health and experience obesity-related complications at lower body mass index (BMI) values, relative to other populations. [ 3 ]…”

“…[ 9 ] In Singapore, the aggregate burden to the economy created by adults living with overweight or obesity is estimated to be SGD261 million. [ 5 ]…”

The impact of obesity: a narrative review

“…[ 120 ] As for Singapore, a recent study has attempted to quantify the economic burden of overweight and obesity. [ 121 ] Using econometric methods and cross-sectional data from the Singapore Epidemiology of Eye Diseases (SEED) cohort, which includes measured height and weight, self-reported healthcare utilisation and absenteeism/presenteeism (based on a modified version of the Work Productivity Activity Impairment questionnaire), the incremental per capita and aggregate direct and indirect costs of excess weight among a multiethnic population of older adults (aged 40–80) were estimated.…”

“…This figure is on the low end of published estimates, which range between 2.9% and 9.7% of the total healthcare spending. [ 121 ] Including absenteeism increases this estimate to SGD261 million, although this estimate is likely to be conservative because it does not include costs for presenteeism (reduced productivity while working), retraining, injuries or other costs resulting from excess weight in the workplace. [ 121 ] By ethnicity, Malays are responsible for 19% of the total costs of excess weight, even though they make up only 12% of the Singapore population.…”

“…[ 121 ] Including absenteeism increases this estimate to SGD261 million, although this estimate is likely to be conservative because it does not include costs for presenteeism (reduced productivity while working), retraining, injuries or other costs resulting from excess weight in the workplace. [ 121 ] By ethnicity, Malays are responsible for 19% of the total costs of excess weight, even though they make up only 12% of the Singapore population. [ 121 ] This disproportionate burden is consistent with the disproportionately higher rates of overweight and obesity among Malays.…”