Skip to main content


Log in

Health burden and costs of obesity and overweight in Germany

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript


This study aimed to estimate the health burden and the direct as well as indirect costs of morbidity and mortality attributable to obesity and overweight in Germany for the year 2002. We used the concept of attributable fractions based on German prevalence data and relative risks from US studies as well as routine statistics. We estimated obesity- and overweight-attributable deaths, years of potential life lost (YPLL) and quality-adjusted life years lost (QALY) for various diseases associated with obesity and overweight. Direct costs were estimated for inpatient and outpatient treatment, rehabilitation and non-medical costs. Indirect costs were estimated for sickness absence, early retirement and mortality using the human capital approach. We estimated 36,653 obesity- and overweight-attributable deaths with 428,093 consecutive YPLL and 367,772 QALYs lost. Obesity caused 4,854 million EUR in direct costs corresponding to 2.1% of the overall German health expenditures in 2002 and 5,019 million EUR in indirect costs. Forty-three percent of direct costs resulted from endocrinological diseases like diabetes and obesity itself, followed by cardiovascular diseases (38%), neoplasms (14%) and digestive diseases (6%). Sixty percent of indirect costs resulted from unpaid work, and 67% of overall indirect costs were due to mortality. Obesity and overweight are connected to considerable morbidity and mortality as well as societal costs. Improvement and further development of effective strategies for preventing and dealing with obesity and overweight are necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Statistisches Bundesamt. Fragen zur Gesundheit—Mikrozensus 2003. Körpermaße der Bevölkerung im Mai 2003. Wiesbaden (2004)

  2. Visscher, T.L., Seidell, J.C.: The public health impact of obesity. Annu. Rev. Public Health 22, 355–375 (2001)

    Article  PubMed  CAS  Google Scholar 

  3. 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)

    Article  PubMed  CAS  Google Scholar 

  4. Calle, E.E., Rodriguez, C., Walker-Thurmond, K., Thun, M.J.: Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N. Engl. J. Med. 348, 1625–1638 (2003)

    Article  PubMed  Google Scholar 

  5. Hodgson, T.A.: The state of the art of cost-of-illness estimates. Adv. Health. Econ. Health. Serv. Res. 4, 129–164 (1983)

    PubMed  CAS  Google Scholar 

  6. Rice, D.P.: Estimating the cost of illness. Am. J. Public Health Nations. Health 57, 424–440 (1967)

    Article  PubMed  CAS  Google Scholar 

  7. Kohlmeier, L., Kroke, A., Pötzsch, J., Kohlmeier, M., Martin, K.: Ernährungsabhängige Krankheiten und ihre Kosten. Schriftenreihe Des Bundesministeriums Für Gesundheit, Band 27. Nomos Verlagsgesellschaft: Baden-Baden (1993)

  8. Sander, B., Bergemann, R.: Economic burden of obesity and its complications in Germany. Eur. J. Health Econ. 4, 248–253 (2003)

    Article  PubMed  Google Scholar 

  9. von Lengerke, T., Reitmeir, P., John, J.: Direct medical costs of (severe) obesity: a bottom-up assessment of over- vs. normal-weight adults in the KORA-study region (Augsburg, Germany). Gesundheitswesen 68, 110–115 (2006)

    Article  Google Scholar 

  10. Kleinbaum, D.G., Kupper, L.L., Morgenstern, H.: Epidemiologic research, principles and quantitative methods. Van Nostrand Reinold, New York (1982)

    Google Scholar 

  11. Deutsches Institut für Medizinische Dokumentation und Information DIMDI. ICD-10-GM Version 2005. Stuttgart: Kohlhammer (2004)

  12. Statistisches Bundesamt. Fachserie 12, Reihe 4, Todesursachen in Deutschland 2002. Wiesbaden (2004)

  13. Statistisches Bundesamt. Statistisches Jahrbuch 2004. Wiesbaden (2004)

  14. Dolan, P.: Modeling valuations for EuroQol health states. Med. Care 35, 1095–1108 (1997)

    Article  PubMed  CAS  Google Scholar 

  15. Konig, H.H., Bernert, S., Angermeyer, M.C.: Health Status of the German population: results of a representative survey using the EuroQol questionnaire. Gesundheitswesen 67, 173–182 (2005)

    Article  PubMed  CAS  Google Scholar 

  16. Greiner, W., Claes, C., Busschbach, J.J., von der Schulenburg, J.M.: Validating the EQ-5D with time trade off for the German population. Eur. J. Health Econ. 6, 124–130 (2005)

    Article  PubMed  CAS  Google Scholar 

  17. Statistisches Bundesamt. Tiefgegliederte Diagnosedaten der Krankenhauspatientinnen und -patienten 2002. Wiesbaden (2004)

  18. Verband deutscher Rentenversicherungsträger VDR. Stationäre Leistungen zur medizinischen Rehabilitation und sonstige Leistungen im Berichtsjahr 2002, Tabelle 900.01 M Verteilung nach Altersgruppen sowie Durchschnittsalter nach Diagnosen gemäss ICD-10, VDR Sonderauswertung, 2002

  19. Statistisches Bundesamt. Fachserie 12 Reihe 6.3, Kostennachweis der Krankenhäuser 2002. Wiesbaden (2005)

  20. Verband deutscher Rentenversicherungsträger VDR. Aufwendungen und Erträge für Leistungen zur Teilhabe und sonstige Leistungen zur Teilhabe der Rentenversicherung in Euro 2002. Tabelle 8.00A [Expenditures and proceeds from benefits in the pension fund in Euro 2002, Table 8.00A]. Frankfurt/Main: VDR, Sonderauswertung (2002)

  21. Statistisches Bundesamt. Krankheitskostenrechnung 2002. Wiesbaden (2006)

  22. Statistisches Bundesamt. Gesundheit, Ausgaben 2002. Wiesbaden (2004)

  23. Graf von der Schulenburg, J.M., Greiner, W., Jost, F., et al.: German recommendations on health economic evaluation: third and updated version of the Hanover Consensus. Value Health 11, 539–544 (2008)

    Article  PubMed  Google Scholar 

  24. Statistisches Bundesamt. Fachserie 16, Heft 1 Löhne und Gehälter, Lohn und Gehaltsstrukturerhebung 2001. Wiesbaden (2004)

  25. Statistisches Bundesamt. Löhne und Gehälter, Arbeitskostenerhebung, Ergebnisse der Arbeitskostenerhebung 2000 für Deutschland. Wiesbaden (2004)

  26. Statistisches Bundesamt. Statistisches Jahrbuch 2003. Wiesbaden (2003)

  27. Statistisches Bundesamt. Forum der Bundesstatistik, Band 43, Alltag Deutschland, Analysen zur Zeitverwendung. Wiesbaden (2004)

  28. BKK Bundesverband. Gesundheit und Arbeitswelt, BKK Gesundheitsreport 2003. Essen (2004)

  29. Verband deutscher Rentenversicherungsträger VDR. Rentenzugang des Jahres 2002, Band 145

  30. Ezzati, M., Lopez, A.D., Rodgers, A., Vander Hoorn, S., Murray, C.J.: Selected major risk factors and global and regional burden of disease. Lancet 360, 1347–1360 (2002)

    Article  PubMed  Google Scholar 

  31. Fontaine, K.R., Barofsky, I.: Obesity and health-related quality of life. Obes. Rev. 2, 173–182 (2001)

    Article  PubMed  CAS  Google Scholar 

  32. Neubauer, S., Welte, R., Beiche, A., Koenig, H.H., Buesch, K., Leidl, R.: Mortality, morbidity and costs attributable to smoking in Germany: update and a 10-year comparison. Tob. Control 15, 464–471 (2006)

    Article  PubMed  Google Scholar 

  33. Konnopka, A., Konig, H.H.: Direct and indirect costs attributable to alcohol consumption in Germany. Pharmacoeconomics 25, 605–618 (2007)

    Article  PubMed  Google Scholar 

  34. Thompson, D., Wolf, A.M.: The medical-care cost burden of obesity. Obes. Rev. 2, 189–197 (2001)

    Article  PubMed  CAS  Google Scholar 

  35. Worre-Jensen, A.L., Jensen, N.B., Heitmann, B.L., Sorensen, T.I.: The cost of obesity on the Danish health care system. Ugeskr. Laeger 169, 2634–2637 (2007)

    PubMed  Google Scholar 

  36. Schmid, A., Schneider, H., Golay, A., Keller, U.: Economic burden of obesity and its comorbidities in Switzerland. Soz. Praventivmed. 50, 87–94 (2005)

    Article  PubMed  Google Scholar 

  37. Rissanen, A.M.: The economic and psychosocial consequences of obesity. Ciba Found Symp. 201, 194–201 (1996). discussion 201–6

    PubMed  CAS  Google Scholar 

  38. Odegaard, K., Borg, S., Persson, U., Svensson, M.: The Swedish cost burden of overweight and obesity—evaluated with the PAR approach and a statistical modelling approach. Int. J. Pediatr. Obes. 3(Suppl 1), 51–57 (2008)

    Article  PubMed  Google Scholar 

  39. Long, D.A., Reed, R., Lehman, G.: The cost of lifestyle health risks: obesity. J. Occup. Environ. Med. 48, 244–251 (2006)

    Article  PubMed  Google Scholar 

  40. Kortt, M.A., Langley, P.C., Cox, E.R.: A review of cost-of-illness studies on obesity. Clin. Ther. 20, 772–779 (1998)

    Article  PubMed  CAS  Google Scholar 

  41. Knai, C., Suhrcke, M., Lobstein, T.: Obesity in Eastern Europe: an overview of its health and economic implications. Econ. Hum. Biol. 5, 392–408 (2007)

    Article  PubMed  Google Scholar 

  42. Katzmarzyk, P.T., Janssen, I.: The economic costs associated with physical inactivity and obesity in Canada: an update. Can. J. Appl. Physiol. 29, 90–115 (2004)

    Article  PubMed  Google Scholar 

  43. Emery, C., Dinet, J., Lafuma, A., Sermet, C., Khoshnood, B., Fagnani, F.: Cost of obesity in France. Presse Med. 36, 832–840 (2007)

    Article  PubMed  Google Scholar 

Download references


This study was supported by the IFB Adiposity Diseases Leipzig funded by the German Federal Ministry of Education and Research (BMBF). The authors have no conflicts of interest that are relevant to the contents of this article.

Author information

Authors and Affiliations


Corresponding author

Correspondence to A. Konnopka.

Additional information

A. Konnopka and M. Bödemann contributed equally to this manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 357 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Konnopka, A., Bödemann, M. & König, HH. Health burden and costs of obesity and overweight in Germany. Eur J Health Econ 12, 345–352 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: