The European Journal of Health Economics

, Volume 16, Issue 9, pp 951–956 | Cite as

An examination of the relationships between service use and alternative measures of obesity among community-dwelling adults in Ireland

  • Edel Doherty
  • Michelle Queally
  • Ciaran O’NeillEmail author
Original Paper


Obesity has received increased attention arising from its increasing prevalence and the implications of obesity-related problems for society and the wider economy. To estimate healthcare and non-healthcare obesity impacts, many studies rely on body mass index (BMI) as a measure of obesity. However BMI is considered to be a noisy measure of total body fat that unlike some other measures does not capture fat distribution. This study uses one such measure, the waist-to-hip ratio, as both an alternative and in conjunction with BMI in the estimation of the relationship between adiposity and health service use. The article uses data from a large-scale study of older adults living in Ireland (the Tilda data set). The findings indicate that studies that include both measures of general and central adiposity may provide a more comprehensive characterisation of the relationship between healthcare service use and adiposity.


Adiposity BMI Waist to hip Health service use 

JEL Classification

C31 I12 


  1. 1.
    Flegal, K.M., et al.: Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303(3), 235–241 (2010)CrossRefPubMedGoogle Scholar
  2. 2.
    National Centre for Health Statistics: Health US 2004: with chartbook on trends in the health of Americans. Centre for Disease Control, Atlanta (2004)Google Scholar
  3. 3.
    Dee, A., Staines, A., McVeigh, T., Sweeney, M.R., O'Neill, C., Callan, A., Doherty, E., O’Dwyer, V., Kearns, K., Sharp, L., Kee, F., Hughes, J., Balanda, K., Perry, I.J.: The cost of overweight and obesity on the island of Ireland (Executive summary) Safefood November (2012)Google Scholar
  4. 4.
    Guh, D.P., et al.: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC public health 9(1), 88 (2009)PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Allender, S., Rayner, M.: The burden of overweight and obesity-related ill health in the UK. Obes. Rev. 8(5), 467–473 (2007)CrossRefPubMedGoogle Scholar
  6. 6.
    Butland, B.G. Britain, tackling obesities: future choices: Project Report. 2007: Department of Innovation Universities and SkillsGoogle Scholar
  7. 7.
    Anis, A.H., et al.: Obesity and overweight in Canada: an updated cost-of-illness study. Obes. Rev. 11(1), 31–40 (2010)CrossRefPubMedGoogle Scholar
  8. 8.
    Finkelstein, E.A., et al.: The costs of obesity in the workplace. J. Occup. Environ. Med. 52(10), 971–976 (2010)CrossRefPubMedGoogle Scholar
  9. 9.
    Konnopka, A., Bödemann, M., König, H.-H.: Health burden and costs of obesity and overweight in Germany. Eur. J. Health Econ. 12(4), 345–352 (2011)CrossRefPubMedGoogle Scholar
  10. 10.
    Doherty, E., Dee, A., O’Neill, C.: Estimating the amount of overweight and obesity related health-care use in the Republic of Ireland using SLÁN data. Econ. Soc. Rev. 43(2), 227–250 (2012)Google Scholar
  11. 11.
    National Obesity Obervatory, Measures of central adiposity as an indicator of obesity (2009). Accessed June 2014
  12. 12.
    Panel, N.O.E.I.E., Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (1998)Google Scholar
  13. 13.
    Lean, M., Han, T., Morrison, C.: Waist circumference as a measure for indicating need for weight management. BMJ 311(6998), 158–161 (1995)PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Ho-Pham, L.T., Campbell,L.V., Nguyen T.V. More on body fat cutoff points. In Mayo Clinic Proceedings, Elsevier (2011)Google Scholar
  15. 15.
    Pischon, T., et al.: General and abdominal adiposity and risk of death in Europe. N. Engl. J. Med. 359(20), 2105–2120 (2008)CrossRefPubMedGoogle Scholar
  16. 16.
    Wang, Y., et al.: Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am. J. Clin. Nutr. 81(3), 555–563 (2005)PubMedGoogle Scholar
  17. 17.
    Schneider, H.J., et al.: Accuracy of anthropometric indicators of obesity to predict cardiovascular risk. J. Clin. Endocrinol. Metab. 92(2), 589–594 (2007)CrossRefPubMedGoogle Scholar
  18. 18.
    Lee, C.M.Y., et al.: Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J. Clin. Epidemiol. 61(7), 646–653 (2008)CrossRefPubMedGoogle Scholar
  19. 19.
    Finkelstein, E.A., et al.: Obesity and severe obesity forecasts through 2030. Am. J. Prev. Med. 42(6), 563–570 (2012)CrossRefPubMedGoogle Scholar
  20. 20.
    Tsai, A.G., Williamson, D.F., Glick, H.A.: Direct medical cost of overweight and obesity in the USA: a quantitative systematic review. Obes. Rev. 12(1), 50–61 (2011)PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Cornier, M.A., et al.: Relationship between waist circumference, body mass index, and medical care costs. Obes. Res. 10(11), 1167–1172 (2002)CrossRefPubMedGoogle Scholar
  22. 22.
    Colagiuri, S., et al.: The cost of overweight and obesity in Australia. Med. J. Aust. 192(5), 260–264 (2010)PubMedGoogle Scholar
  23. 23.
    Burkhauser, R.V., Cawley, J.: Beyond BMI: the value of more accurate measures of fatness and obesity in social science research. J. Health Econ. 27(2), 519–529 (2008)CrossRefPubMedGoogle Scholar
  24. 24.
    Johansson, E., et al.: Obesity and labour market success in Finland: The difference between having a high BMI and being fat. Econ. Human Biol. 7(1), 36–45 (2009)CrossRefGoogle Scholar
  25. 25.
    Mosca, I., Obesity and employment in Ireland: moving beyond BMI (2012). Accessed June 2014
  26. 26.
    Kenny, R.A., Nolan, A., T.C.D., The over 50 s in a changing Ireland: economic circumstances, health and well-being (2014). Accessed June 2014
  27. 27.
    Berkman, L.F., Syme, S.L.: Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am. J. Epidemiol. 109(2), 186–204 (1979)PubMedGoogle Scholar
  28. 28.
    McGregor, P., McKee, P., O’Neill, C.: GP utilisation in Northern Ireland: exploiting the gatekeeper function. Econ. Soc. Rev. 37(1), 71 (2006)Google Scholar
  29. 29.
    Bertakis, K.D., Azari, R.: Obesity and the use of health care services. Obes. Res. 13(2), 372–379 (2005)CrossRefPubMedGoogle Scholar
  30. 30.
    Heithoff, K.A., et al.: The association between body mass and health care expenditures. Clin. Ther. 19(4), 811–820 (1997)CrossRefPubMedGoogle Scholar
  31. 31.
    Quesenberry, C.P., Caan, B., Jacobson, A.: Obesity, health services use, and health care costs among members of a health maintenance organization. Arch. Intern. Med. 158(5), 466–472 (1998)CrossRefPubMedGoogle Scholar
  32. 32.
    Raebel, M.A., et al.: Health services use and health care costs of obese and nonobese individuals. Arch. Intern. Med. 164(19), 2135–2140 (2004)CrossRefPubMedGoogle Scholar
  33. 33.
    Wolf, A.M.: Economic outcomes of the obese patient. Obes. Res. 10(S1), 58S–62S (2012)Google Scholar
  34. 34.
    Højgaard, B., et al.: Waist circumference and body mass index as predictors of health care costs. PLoS One 3(7), e2619 (2008)PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Edel Doherty
    • 1
  • Michelle Queally
    • 1
  • Ciaran O’Neill
    • 1
    Email author
  1. 1.Discipline of EconomicsJ.E. Cairnes School of Business and EconomicsGalwayIreland

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