Disease Management and Health Outcomes

, Volume 5, Issue 1, pp 13–21 | Cite as

The Burden of Obesity and Its Sequelae

  • Jacob C. SeidellEmail author
Review Article


Obesity [body mass index (BMI) ≥30 kg/m2] is common in many parts of the world, especially in the established market economies, formerly socialist economies of Europe and Latin America and the Caribbean, as well as the Middle Eastern Crescent. Worldwide, as many as 250 million people may be obese (7% of the adult population) and 2 to 3 times as many may be considered overweight (BMI 25 to 30 kg/m2). The prevalence of obesity seems to be increasing in most parts of the world, even in areas where obesity used to be rare.

A waist circumference greater than 102cm in men and 88cm in women may be a more sensible classification than BMI to identify individuals who are at increased health risk because of obesity, but information on this point is still scarce.

Increased fatness measured by a high BMI, large waist circumference or high waist/hip circumference ratio is associated with many chronic diseases as well as poor physical functioning. These all contribute to the costs associated with excess bodyweight. The economic costs of obesity can be broken down into 3 levels

Direct costs: costs to the community related to the diversion of resources to the diagnosis and treatment of diseases directly related to obesity as well as the treatment of obesity itself. These costs have been estimated to account for 2 to 8% of total healthcare costs of various countries.

Indirect (or societal) costs: these costs are related to the loss of productivity caused by absenteeism and premature death and disability pensions. There is a lack of good economic analysis in this area, although research from Sweden, Finland and The Netherlands has clearly shown that obesity is associated with increased sick leave and the need for disability pensions.

Personal costs: obese individuals may earn less than their lean counterparts because of job discrimination (related to the stigma associated with obesity or because of diseases and disabilities caused by obesity). Many insurance companies (particularly life insurance) charge higher premiums with increasing degrees of overweight.

In conclusion, there is much indirect information that obesity and overweight are important and growing public health concerns that contribute substantially to healthcare-related costs. Effective strategies for the prevention and management of obesity are needed.


Obesity Waist Circumference Adis International Limited Disability Pension High Density Lipoprotein 
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  1. 1.
    World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization, 1998Google Scholar
  2. 2.
    Lean MEJ, Han TS, Seidell JC. Impairment of health and quality of life in men and women with a large waist. Lancet 1998; 351: 853–6PubMedCrossRefGoogle Scholar
  3. 3.
    National Institutes of Health, National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults–the evidence report. Bethesda (MD): National Institutes of Health, Jun 1998Google Scholar
  4. 4.
    Molarius A, Seidell JC. Selection of anthropometric indicators for classification of abdominal fatness–a critical review. Int J Obesity 1998; 22: 719–27CrossRefGoogle Scholar
  5. 5.
    Seidell JC. Time trends in obesity: an epidemiological perspective. Horm Metab Res 1997; 29: 155–8PubMedCrossRefGoogle Scholar
  6. 6.
    Seidell JC, Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull 1997; 53; 238–52PubMedCrossRefGoogle Scholar
  7. 7.
    Seidell JC, Rissanen A. World-wide prevalence of obesity and time-trends. In: Bray GA, Bouchard C, James WPT, editors. Handbook of obesity. New York: M. Dekker Inc., 1997: 79–91Google Scholar
  8. 8.
    Murray CJL, Lopez AD. The global burden of disease. Washington, DC: World Health Organization/World Bank, 1996Google Scholar
  9. 9.
    Allison DB, Faith MS, Heo M, et al. Hypothesis concerning the u-shaped relation between body mass index and mortality. Am J Epidemiol 1997; 146: 339–49PubMedCrossRefGoogle Scholar
  10. 10.
    Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995; 333: 677–85PubMedCrossRefGoogle Scholar
  11. 11.
    Seidell JC. Relationships of total and regional body composition to morbidity and mortality [chapter 18]. In: Heymsfield S, Lohman T, Roche AF, editors. Human body composition. Champaign (IL): Human Kinetics Publishers, 1996: 345–53Google Scholar
  12. 12.
    Stevens J, Cai J, Pamuk ER, et al. The effect of age on the association between body-mass index and mortality. N Engl J Med 1998; 338: 1–7PubMedCrossRefGoogle Scholar
  13. 13.
    Seidell JC. The impact of obesity on health status: some implications for health care costs. Int J Obesity 1995; 19 Suppl. 6: S13–S16Google Scholar
  14. 14.
    Wolf AM, Colditz GA. The Cost of obesity–the US perspective. Pharmacoeconomics 1994; 5 Suppl. 1: 34–7PubMedCrossRefGoogle Scholar
  15. 15.
    Segal L, Carter R, Zimmet P. The cost of obesity–the Australian perspective. Pharmacoeconomics 1994; 5 Suppl. 1: 45–52PubMedCrossRefGoogle Scholar
  16. 16.
    Levy E, Levy P, Le Pen C, et al. The economic costs of obesity: the French situation. Int J Obesity 1995; 19: 788–92Google Scholar
  17. 17.
    Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998; 6: 97–106PubMedGoogle Scholar
  18. 18.
    Sjöström L, Narbro K, Sjöström D. Costs and benefits when treating obesity. Int J Obesity 1995; 19 Suppl. 6: S9–S12Google Scholar
  19. 19.
    Rissanen A, Heliövaara M, Knekt P, et al. Risk of disability and mortality due to overweight in a Finnish population. BMJ 1990; 301: 835–7PubMedCrossRefGoogle Scholar
  20. 20.
    Van Deursen CGL, Linssen GGA. Quetelet Index en Ziekteverzuim. Voeding 1989; 50: 86–9Google Scholar
  21. 21.
    Gortmaker SL, Must A, Perrin JM, et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993: 1008-12Google Scholar
  22. 22.
    Sargent JD, Blanchflower DG. Obesity and stature in adolescence and earnings in young adulthood. Pediatr Adolesc 1994; 148: 681–7CrossRefGoogle Scholar
  23. 23.
    Sonne-Holm S, Sörensen TIA. Prospective study of attainment of social class of severely obese subjects in relation to parental social class, intelligence, and education. BMJ 1986; 292: 586–9PubMedCrossRefGoogle Scholar
  24. 24.
    Sörensen TIA. Socio-economic aspects of obesity: causes or effects? Int J Obesity 1995; 19 Suppl. 6: S6–S8Google Scholar
  25. 25.
    Lean MEJ, Han TS, Seidell JC. Impairment of health and quality of life using new US Federal guidelines for the identification of obesity. Arch Intern Med. In pressGoogle Scholar
  26. 26.
    Sarlio-Lähteenkorva S, Stunkard AJ, Rissanen A. Psychosocial factors and quality of life in obesity. Int J Obesity 1995; 19 Suppl. 6:S1–S5Google Scholar
  27. 27.
    Launer LJ, Harris T, Rumpel C, et al. Body mass index, weight change, and risk of mobility disability in middle-aged and older women. JAMA 1994; 271: 1093–8PubMedCrossRefGoogle Scholar
  28. 28.
    US Congress House. Cost of weight loss aids. Deception and fraud in the diet industry; part I: 101-50. Hearing before subcommittee on regulation, business opportunity and energy. Committee on Small Business. 101st Congress, 2nd session, Washington, DC: Government Printing Office, 1990Google Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  1. 1.National Institute of Public Health and Environmental Protection (RIVM)BA BilthovenThe Netherlands

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