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

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).