Productivity loss due to overweight and obesity: a systematic review of indirect costs

Abstract

Objective: The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity.

Methods: A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality.

Results: Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies.

Conclusion: The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.

Keywords: absenteeism; indirect costs; obesity; overweight; presenteeism; productivity loss.

Figure 1

PRISMA flow diagram.

Figure 2

Microeconomic excess cost of overweight and obesity.⁺Adapted productivity losses per person, with no information on costs of normal weight. *Adapted indemnity claims cost per 100 full-time equivalents 1997–2004, with no information on costs of normal weight. Excess per capita costs are displayed for each cost category for overweight, obesity and excess weight. Mean costs were estimated for studies which only had sex or obesity-grade specific costs available. If not available, excess costs were calculated by subtracting the cost of normal weight from overweight or obesity costs. The figure shows that the costs of obesity are significantly higher than those of overweight alone and those of overweight and obesity combined. Interestingly, the cost of overweight is not necessarily higher than the cost of healthy weight. Absenteeism and presenteeism were considerably higher and more commonly assessed than disability and premature death.

Figure 3

Macroeconomic costs of overweight and obesity. Ricci and Chee, Lightwood et al and Chenoweth and Leutzinger are outliers (coloured in grey). *Costs of the three US states: California, North Carolina, Massachusetts. ⁺Costs of the province Alberta. **Costs of the state New Mexico. ⁺⁺Costs of South Plains of Texas. Almost analogous to country size and high prevalence rates, USA has the highest national costs. Its lower values are related to particular states. The lowest costs were found in 2006 in New Zealand. National costs seem to increase in future years.