The Non-Linear Relationship between BMI and Health Care Costs and the Resulting Cost Fraction Attributable to Obesity

Abstract

This study aims to analyse the non-linear relationship between Body Mass Index (BMI) and direct health care costs, and to quantify the resulting cost fraction attributable to obesity in Germany. Five cross-sectional surveys of cohort studies in southern Germany were pooled, resulting in data of 6757 individuals (31–96 years old). Self-reported information on health care utilisation was used to estimate direct health care costs for the year 2011. The relationship between measured BMI and annual costs was analysed using generalised additive models, and the cost fraction attributable to obesity was calculated. We found a non-linear association of BMI and health care costs with a continuously increasing slope for increasing BMI without any clear threshold. Under the consideration of the non-linear BMI-cost relationship, a shift in the BMI distribution so that the BMI of each individual is lowered by one point is associated with a 2.1% reduction of mean direct costs in the population. If obesity was eliminated, and the BMI of all obese individuals were lowered to 29.9 kg/m2, this would reduce the mean direct costs by 4.0% in the population. Results show a non-linear relationship between BMI and health care costs, with very high costs for a few individuals with high BMI. This indicates that population-based interventions in combination with selective measures for very obese individuals might be the preferred strategy.

Disparities in Diffuse Cortical White Matter Integrity Between Socioeconomic Groups

“…We chose to examine these risk factors due to their well-documented associations with SES (Kaplan and Keil, 1993; Lorant et al, 2003) and white matter integrity (Burgmans et al, 2010; Gons et al, 2011; Korgaonkar et al, 2011; Stanek et al, 2011; Zhang et al, 2014; Walker et al, 2017). Given that BMI may have non-linear associations with health outcomes (e.g., Laxy et al, 2017), both linear and quadratic BMI were examined. To assess whether overall white matter vascular burden eliminated significant effects, we also ran sensitivity analyses adjusting for whole-brain white matter lesion volume.…”

Liquid Sucrose Consumption Promotes Obesity and Impairs Glucose Tolerance Without Altering Circulating Insulin Levels

“…Obesity is a continually increasing major public health problem worldwide (1) and is a major co-morbidity for other disorders, including cancer, diabetes, heart disease, and hypertension (2). Higher BMI values disproportionally contribute to rising healthcare costs (3). Multiple factors influence conditions of overweight and obesity, including genetic predisposition, sedentary lifestyles, reduced levels of physical activity, and food choices (4).…”

Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy

“…In this study, the authors calculated “valuation rates” for physician–patient contacts based on overall budgets paid to physicians by sickness funds and contact data, while also including PHI data. These valuation rates are used frequently in German health economic evaluations covering a range of disease areas due to their convenience and granularity [ 48 , 68 , 69 ]. Similar data, providing average remuneration per case, are provided by the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereiningung) in their yearly report.…”

“…In this study, the authors calculated "valuation rates" for physician-patient contacts based on overall budgets paid to physicians by sickness funds and contact data, while also including PHI data. These valuation rates are used frequently in German health economic evaluations covering a range of disease areas due to their convenience and granularity [48,68,69] Unlike in France and Italy, pharmacy cost data are not freely accessible in Germany. Instead, a paid subscription is required to access databases such as the Lauer-Taxe ® or the Rote Liste ® .…”