The European Journal of Health Economics

, Volume 16, Issue 9, pp 957–967 | Cite as

Health burden and costs of obesity and overweight in Germany: an update

  • Thomas LehnertEmail author
  • Pawel Streltchenia
  • Alexander Konnopka
  • Steffi G. Riedel-Heller
  • Hans-Helmut König
Original Paper


In 2011, Konnopka et al. (Eur J Health Econ 12:345–352, 2011) published a top-down cost of illness study on the health burden, and direct and indirect costs of morbidity and mortality attributable to excess weight (BMI ≥25 kg/m2) in Germany in 2002. The objective of the current study was to update the 2002 estimates to the year 2008. To simplify comparisons, we closely followed the methods and assumptions of the original study, using 2008 data for most input parameters (e.g. prevalence, mortality, resource use, costs). Excess weight related deaths increased by 31 % (from 36,653 to 47,964) and associated years of potential life lost (from 428,093 to 588,237) and quality adjusted life years lost (from 367,722 to 505,748) by about 37 %, respectively. Excess weight caused €16,797 million in total costs in 2008 (+70 %), of which €8,647 million were direct costs (corresponding to 3.27 % of total German health care expenditures in 2008). About 73 % (€12,235 million) of total excess weight related costs were attributable to obesity (BMI ≥30 kg/m2). The main drivers of direct costs were endocrinological (44 %) and cardiovascular (38 %) diseases. Indirect costs amounted to €8,150 million in 2008 (+62 %), of which about two-thirds were indirect costs from unpaid work. The great majority of indirect costs were due to premature mortality (€5,669 million). The variation of input parameters (univariate sensitivity analyses) resulted in attributable costs between €8,978 million (−47 % compared to base case) and €25,060 million (+49 %). The marked increase in excess weight related costs can largely be explained by increases in the prevalence of overweight and obesity, and to a lesser extent from increases in resource consumption, as well as increases in (unit) costs and wages (comprising 5.5 % inflation).


Overweight Obesity Population attributable fraction Cost analysis Germany 

JEL Classification

I00 I10 I19 H42 H51 



This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1001. The BMBF had no further role in the study design; in the collection, analyses and interpretation of data; in writing the report; and in the decision to submit the paper for publication. The publication of study results was not contingent on the sponsor’s approval.

Conflicts of interest

TL, PS, AK, SRH, and HHK have no conflicts of interest. This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1001.

Supplementary material

10198_2014_645_MOESM1_ESM.doc (434 kb)
Supplementary material 1 (DOC 433 kb)


  1. 1.
    Swinburn, B.A., Sacks, G., Hall, K.D., McPherson, K., Finegood, D.T., Moodie, M.L., Gortmaker, S.L.: The global obesity pandemic: shaped by global drivers and local environments. Lancet 378, 804–814 (2011)CrossRefPubMedGoogle Scholar
  2. 2.
    Hill, J.O., Wyatt, H.R., Peters, J.C.: Energy balance and obesity. Circulation 126, 126–132 (2012)PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Blüher, M.: The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 21, 38–43 (2010)CrossRefPubMedGoogle Scholar
  4. 4.
    SS Lim, T Vos, AD Flaxman, G Danaei, K Shibuya, HAdair-Rohani, M Amann, HR Anderson, KG Andrews, M Aryee, C Atkinson, LJ Bacchus, AN Bahalim, K Balakrishnan, J Balmes, S Barker-Collo, A Baxter, ML Bell JD Blore, FB lyth, C Bonner, G Borges, R Bourne, M Boussinesq, M Brauer, PB rooks, NG Bruce, B Brunekreef, C Bryan-Hancock, C Bucello, R Buchbinder, F Bull, RT Burnett, TE Byers, B Calabria, J Carapetis, E Carnahan, Z Chafe, F Charlson, H Chen, JS Chen, AT Cheng, JC Child, A Cohen, KE Colson, BC Cowie, S Darby, S Darling, A Davis, L Degenhardt, F Dentener, Des Jarlais, D.C., Devries, K., Dherani, M., Ding, E.L., Dorsey, E.R., Driscoll, T., Edmond, K., Ali, S.E., Engell, R.E., Erwin, P.J., Fahimi, S., Falder, G., Farzadfar, F., Ferrari, A., Finucane, M.M., Flaxman, S., Fowkes, F.G., Freedman, G., Freeman, M.K., Gakidou, E., Ghosh, S., Giovannucci, E., Gmel, G., Graham, K., Grainger, R., Grant, B., Gunnell, D., Gutierrez, H.R., Hall, W., Hoek, H.W., Hogan, A., Hosgood, H.D., 3rd, Hoy, D., Hu, H., Hubbell, B.J., Hutchings, S.J., Ibeanusi, S.E., Jacklyn, G.L., Jasrasaria, R., Jonas, J.B., Kan, H., Kanis, J.A., Kassebaum, N., Kawakami, N., Khang, Y.H., Khatibzadeh, S., Khoo, J.P., Kok, C., Laden, F., Lalloo, R., Lan, Q., Lathlean, T., Leasher, J.L., Leigh, J., Li, Y., Lin, J.K., Lipshultz, S.E., London, S., Lozano, R., Lu, Y., Mak, J., Malekzadeh, R., Mallinger, L., Marcenes, W., March, L., Marks, R., Martin, R., McGale, P., McGrath, J., Mehta, S., Mensah, G.A., Merriman, T.R., Micha, R., Michaud, C., Mishra, V., Hanafiah, K.M., Mokdad, A.A., Morawska, L., Mozaffarian, D., Murphy, T., Naghavi, M., Neal, B., Nelson, P.K., Nolla, J.M., Norman, R., Olives, C., Omer, S.B., Orchard, J., Osborne, R., Ostro, B., Page, A., Pandey, K.D., Parry, C.D., Passmore, E., Patra, J., Pearce, N., Pelizzari, P.M., Petzold, M., Phillips, M.R., Pope, D., Pope, C.A., 3rd, Powles, J., Rao, M., Razavi, H., Rehfuess, E.A., Rehm, J.T., Ritz, B., Rivara, F.P., Roberts, T., Robinson, C., Rodriguez-Portales, J.A., Romieu, I., Room, R., Rosenfeld, L.C., Roy, A., Rushton, L., Salomon, J.A., Sampson, U., Sanchez-Riera, L., Sanman, E., Sapkota, A., Seedat, S., Shi, P., Shield, K., Shivakoti, R., Singh, G.M., Sleet, D.A., Smith, E., Smith, K.R., Stapelberg, N.J., Steenland, K., Stockl, H., Stovner, L.J., Straif, K., Straney, L., Thurston, G.D., Tran, J.H., Van Dingenen, R., van Donkelaar, A., Veerman, J.L., Vijayakumar, L., Weintraub, R., Weissman, M.M., White, R.A., Whiteford, H., Wiersma, S.T., Wilkinson, J.D., Williams, H.C., Williams, W., Wilson, N., Woolf, A.D., Yip, P., Zielinski, J.M., Lopez, A.D., Murray, C.J., Ezzati, M.: A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 Lancet(380):2224–2260 (2012)Google Scholar
  5. 5.
    Finucane, M.M., Stevens, G.A., Cowan, M.J., Danaei, G., Lin, J.K., Paciorek, C.J., Singh, G.M., Gutierrez, H.R., Lu, Y.A., Bahalim, A.N., Farzadfar, F., Riley, L.M., Ezzati, M.: C, G.B.M.R.F.: National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet 377, 557–567 (2011)PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Malik, V.S., Willett, W.C., Hu, F.B.: Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol 9, 13–27 (2012)CrossRefPubMedGoogle Scholar
  7. 7.
    World Health Organization (WHO): Obesity and overweight. WHO Media Center (Fact Sheet N°311) (2013). Accessed 22 Oct 2013
  8. 8.
    Mensink, G.B., Schienkiewitz, A., Haftenberger, M., Lampert, T., Ziese, T., Scheidt-Nave, C.: Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 56, 786–794 (2013)CrossRefPubMedGoogle Scholar
  9. 9.
    Reynolds, S.L.: Recent developments in obesity research: linkages between obesity, disability, and physical functioning. Curr. Obes. Rep. 2, 267–274 (2013)CrossRefGoogle Scholar
  10. 10.
    Ul-Haq, Z., Mackay, D.F., Fenwick, E., Pell, J.P.: Meta-analysis of the association between body mass index and health-related quality of life among adults, assessed by the SF-36. Obesity 21, E322–E327 (2013)CrossRefPubMedGoogle Scholar
  11. 11.
    Flegal, K.M., Kit, B.K., Orpana, H., Graubard, B.I.: Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 309, 71–82 (2013)CrossRefPubMedGoogle Scholar
  12. 12.
    Whitlock, G., Lewington, S., Sherliker, P., Clarke, R., Emberson, J., Halsey, J., Qizilbash, N., Collins, R., Peto, R.: Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373, 1083–1096 (2009)CrossRefPubMedGoogle Scholar
  13. 13.
    Lehnert, T., Sonntag, D., Konnopka, A., Riedel-Heller, S., Konig, H.H.: Economic costs of overweight and obesity. Best. Pract. Res. Clin. Endocrinol. Metab. 27, 105–115 (2013)CrossRefPubMedGoogle Scholar
  14. 14.
    Raebel, M.A., Malone, D.C., Conner, D.A., Xu, S., Porter, J.A., Lanty, F.A.: Health services use and health care costs of obese and non-obese individuals. Arch. Intern. Med. 164, 2135–2140 (2004)CrossRefPubMedGoogle Scholar
  15. 15.
    Bierl, M., Marsh, T., Webber, L., Brown, M., McPherson, K., Rtveladze, K.: Apples and oranges: a comparison of costing methods for obesity. Obes. Rev. 14, 693–706 (2013)CrossRefPubMedGoogle Scholar
  16. 16.
    Konnopka, A., Bodemann, M., Konig, H.H.: Health burden and costs of obesity and overweight in Germany. Eur. J. Health. Econ. 12, 345–352 (2011)CrossRefPubMedGoogle Scholar
  17. 17.
    Rockhill, B., Newman, B., Weinberg, C.: Use and misuse of population attributable fractions. Am. J. Public Health 88, 15–19 (1998)PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Levine, B.: What does the population attributable fraction mean? Prev. Chronic Dis. 4, A14 (2007)PubMedCentralPubMedGoogle Scholar
  19. 19.
    Hanley, J.A.: A heuristic approach to the formulas for population attributable fraction. J. Epidemiol. Community Health 55, 508–514 (2001)PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Calle, E.E., Rodriguez, C., Walker-Thurmond, K., Thun, M.J.: Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N. Engl. J. Med. 348, 1625–1638 (2003)CrossRefPubMedGoogle Scholar
  21. 21.
    Must, A., Spadano, J., Coakley, E.H., Field, A.E., Colditz, G., Dietz, W.H.: The disease burden associated with overweight and obesity. JAMA 282, 1523–1529 (1999)CrossRefPubMedGoogle Scholar
  22. 22.
    Luck, T., Riedel-Heller, S.G., Luppa, M., Wiese, B., Wollny, A., Wagner, M., Bickel, H., Weyerer, S., Pentzek, M., Haller, F., Moesch, E., Werle, J., Eisele, M., Maier, W., van den Bussche, H., Kaduszkiewicz, H.: Risk factors for incident mild cognitive impairment–results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Acta Psychiatr. Scand. 121, 260–272 (2010)CrossRefPubMedGoogle Scholar
  23. 23.
    Statistisches Bundesamt [German Federal Statistical Office]: Todesursachenstatistik 2008. Fachserie 12, Reihe 4. Wiesbaden, Germany: Statistisches Bundesamt (2010)Google Scholar
  24. 24.
    Eisenmenger, M., Emmerling, D.: Amtliche Sterbetafeln und Entwicklung der Sterblichkeit. Statistisches Bundesamt, Wirtschaft und Statistik. Wiesbaden, Germany: Statistisches Bundesamt (2011)Google Scholar
  25. 25.
    Konig, H.H., Bernert, S., Angermeyer, M.C.: Gesundheitszustand der deutschen Bevölkerung: Ergebnisse einer repräsentativen Befragung mit dem EuroQol-Instrument. [Health status of the German population: results of a representative survey using the EuroQol questionnaire]. Gesundheitswesen 67, 173–182 (2005)CrossRefPubMedGoogle Scholar
  26. 26.
    Statistisches Bundesamt German Federal Statistical Office: Tiefgegliederte Diagnosedaten der Krankenhauspatientinnen und -patienten 2008. Wiesbaden, Germany: Statistisches Bundesamt (2010)Google Scholar
  27. 27.
    Statistisches Bundesamt German Federal Statistical Office: Kostennachweis der Krankenhäuser 2008. Fachserie 12, Reihe 6.3. Wiesbaden, Germany: Statistisches Bundesamt (2009)Google Scholar
  28. 28.
    Statistisches Bundesamt German Federal Statistical Office: Grunddaten der Krankenhäuser 2008. Fachserie 12, Reihe 6.1.1. Wiesbaden, Germany: Statistisches Bundesamt (2010)Google Scholar
  29. 29.
    Statistisches Bundesamt German Federal Statistical Office: Krankheitskostenrechnung 2002, 2004, 2006 und 2008. Fachserie 12, Reihe 7.2. Wiesbaden, Germany: Statistisches Bundesamt (2010)Google Scholar
  30. 30.
    Deutsche Rentenversicherung Bund German statutory pension insurance scheme: Abgeschlossene Leistungen zur medizinischen Rehabilitation im Berichtsjahr 2008. Berlin, Germany: Deutsche Rentenversicherung Bund, Sonderauswertung (2013)Google Scholar
  31. 31.
    Statistisches Bundesamt German Federal Statistical Office: Gesundheit. Ausgaben 1995-2010. Fachserie 12, Reihe 7.1.2. Wiesbaden, Germany: Statistisches Bundesamt (2012)Google Scholar
  32. 32.
    Statistisches Bundesamt [German Federal Statistical Office]: Verdienste und Arbeitskosten 2010. Verdienststrukturen 20110. Fachserie 16. Wiesbaden, Germany: Statistisches Bundesamt (2013)Google Scholar
  33. 33.
    Eurostat: Social security and other labour costs paid by employer. (2013). Accessed 5 September 2013
  34. 34.
    Statistisches Bundesamt German Federal Statistical Office: Statistisches Jahrbuch 2010. Wiesbaden, Statistisches Bundesamt (2010)Google Scholar
  35. 35.
    Statistisches Bundesamt German Federal Statistical Office: Bevölkerung und Erwerbstätigkeit. Fachserie 1, Reihe 4.2.1. Wiesbaden, Germany: Statistisches Bundesamt (2009)Google Scholar
  36. 36.
    Statistisches Bundesamt German Federal Statistical Office: Alltag in Deutschland, Analysen zur Zeitverwendung. Forum der Bundesstatistik, Band 43. Wiesbaden, Germany: Statistisches Bundesamt (2004)Google Scholar
  37. 37.
    BKK Bundesverband: BBK Gesundheitsreport 2009. Gesundheit in Zeiten der Krise. Sonderauswertung BKK-Bundesverband zu AU Tagen. Essen, Germany: BKK Bundesverband (2009)Google Scholar
  38. 38.
    Deutsche Rentenversicherung Bund [German statutory pension insurance scheme]: Rentenzugang 2008. Statistik der deutschen Rentenversicherung, Band 173. Berlin, Germany: Deutsche Rentenversicherung Bund (2009)Google Scholar
  39. 39.
    Connor Gorber, S., Tremblay, M., Moher, D., Gorber, B.: A comparison of direct vs. self-report measures for assessing height, weight and body mass index: a systematic review. Obes. Rev. 8, 307–326 (2007)CrossRefPubMedGoogle Scholar
  40. 40.
    Lehnert, T., Stuhldreher, N., Streltchenia, P., Riedel-Heller, S.G., Konig, H.H.: Sick leave days and costs associated with overweight and obesity in Germany. J. Occup. Environ. Med. 56, 20–27 (2014)CrossRefPubMedGoogle Scholar
  41. 41.
    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, 50–61 (2010)CrossRefGoogle Scholar
  42. 42.
    Muller-Riemenschneider, F., Reinhold, T., Berghofer, A., Willich, S.N.: Health-economic burden of obesity in Europe. Eur. J. Epidemiol. 23, 499–509 (2008)CrossRefPubMedGoogle Scholar
  43. 43.
    Withrow, D., Alter, D.A.: The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes. Rev. 12, 131–141 (2010)CrossRefGoogle Scholar
  44. 44.
    von Lengerke, T., Krauth, C.: Economic costs of adult obesity: a review of recent European studies with a focus on subgroup-specific costs. Maturitas 69, 220–229 (2011)CrossRefGoogle Scholar
  45. 45.
    Knoll, K., Hauner, H.: Kosten der Adipositas in der Bundesrepublik Deutschland. A health-economic analysis of the total cost burden caused by obesity and the diseases associated with obesity in the Federal Republic of Germany. Adipositas 2, 204–210 (2008)Google Scholar
  46. 46.
    Sander, B., Bergemann, R.: Economic burden of obesity and its complications in Germany. Eur. J. Health. Econ. 4, 248–253 (2003)CrossRefPubMedGoogle Scholar
  47. 47.
    Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L., Anis, A.H.: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9, 88 (2009)PubMedCentralCrossRefPubMedGoogle Scholar
  48. 48.
    Schultz, A.B., Edington, D.W.: Employee health and presenteeism: a systematic review. J. Occup. Rehabil. 17, 547–579 (2007)CrossRefPubMedGoogle Scholar
  49. 49.
    Finkelstein, E.A., DiBonaventura, M., Burgess, S.M., Hale, B.C.: The costs of obesity in the workplace. J. Occup. Environ. Med. 52, 971–976 (2010)CrossRefPubMedGoogle Scholar
  50. 50.
    Kesztyus, D., Schreiber, A., Wirt, T., Wiedom, M., Dreyhaupt, J., Brandstetter, S., Koch, B., Wartha, O., Muche, R., Wabitsch, M., Kilian, R., Steinacker, J.M.: Economic evaluation of URMEL-ICE, a school-based overweight prevention programme comprising metabolism, exercise and lifestyle intervention in children. Eur. J. Health. Econ. 14, 185–195 (2013)CrossRefPubMedGoogle Scholar
  51. 51.
    Lehnert, T., Sonntag, D., Konnopka, A., Riedel-Heller, S., Konig, H.H.: The long-term cost-effectiveness of obesity prevention interventions: systematic literature review. Obes. Rev. 13, 537–553 (2012)CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Thomas Lehnert
    • 1
    • 2
    Email author
  • Pawel Streltchenia
    • 1
  • Alexander Konnopka
    • 1
  • Steffi G. Riedel-Heller
    • 2
    • 3
  • Hans-Helmut König
    • 1
  1. 1.Department of Health Economics and Health Services Research, Hamburg Center for Health EconomicsUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.IFB AdiposityDiseases, University Medicine LeipzigUniversity of LeipzigLeipzigGermany
  3. 3.Department for Social Medicine, Occupational Medicine, and Public HealthUniversity of LeipzigLeipzigGermany

Personalised recommendations