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. 2025 May 10;25(1):1739.
doi: 10.1186/s12889-025-22978-9.

Indirect costs constitute a major part of the total economic burden of obesity: a Finnish population-based cohort study

Aino Vesikansa  1 , Juha Mehtälä  2 , Susanna Aspholm  3 , Kirsi Kallio-Grönroos  3 , Katja Mutanen  3 , Annamari Lundqvist  4 , Tiina Laatikainen  4   5   6 , Tero Saukkonen  3 , Kirsi H Pietiläinen  7
Affiliations

Indirect costs constitute a major part of the total economic burden of obesity: a Finnish population-based cohort study

Aino Vesikansa et al. BMC Public Health. .

Abstract

Background: The growing prevalence of overweight and obesity (OB) poses a considerable economic burden worldwide. However, nationally representative, detailed analyses estimating the total burden of OB are few. We characterized direct, indirect, and total costs of overweight and obesity in a population-based cohort of Finnish adult individuals and evaluated the additional total costs attributed to overweight and obesity.

Methods: The study cohort included 5,587 randomly-selected individuals (≥18 years of age) who participated in the national FinHealth 2017 health examination survey. The main study group consisted of working-age individuals (18-64 years of age; n = 3,914). Individual-level data were collected from the nationwide registers by the Finnish Institute for Health and Welfare (healthcare resource utilization), Social Insurance Institution of Finland (prescription medications, sick leaves, disability pensions, rehabilitation periods), and Statistics Finland (deaths). Indirect costs were calculated using the Human Capital Approach, and direct costs were based on the medication purchases and healthcare resource use.

Results: The mean annual indirect costs were €1,683 (SD, €6,395) per person for the working-age individuals with normal-weight (NW), €2,957 (€8,797) for individuals with overweight (OW), €4,488 (€11,607) for individuals with class I obesity (OBI), and €4,654 (€11,383) for individuals with class II-III obesity (OBII-III). The mean annual total (direct + indirect) costs were €3,314 (SD, €8,358) per person in the NW, €4,902 (€10,747) in the OW, €7,129 (€14,313) in the OBI, and €7,372 (€14,423) in the OBII-III groups. Compared with individuals with NW, OW was associated with 31% (rate ratio, RR, 1.31; 95% CI, 1.09-1.58; p = 0.005), OBI with 83% (RR, 1.83; 95% CI, 1.46-2.28; p < 0.001), and OBII-III with 95% (RR, 1.95; 95% CI, 1.48-2.55; p < 0.001) higher total costs in working-age individuals. When adjusted for age and sex, the predicted total annual cost difference per person was €1,124 for OW, €3,002 for OBI, and €3,443 for OBII-III compared with a person with NW.

Conclusions: Indirect costs constitute a major part of the total costs of obesity in the working-age population. Compared with NW, the total costs are significantly higher not only for severe obesity, but also for OW and OBI.

Keywords: Body-mass index; Direct costs; Economic burden; Indirect costs; Obesity; Total costs.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The FinHealth 2017 Survey received approval from the Coordinating Ethics Committee at the Hospital District of Helsinki and Uusimaa (Ref 37/13/03/00/2016). All FinHealth 2017 study participants had filled informed consent for a biobank study. Permission to use the FinHealth 2017 data in present study was granted by the THL Biobank. Permission for the data collection and linkage from the Care Register for Health Care and the Register of Primary Health Care Visits was granted by the Finnish Institute for Health and Welfare. Permission for data collection and linkage from the Prescription Centre was approved by The Social Insurance Institution of Finland. All data were analyzed in a pseudonymized format. Consent for publication: No individual-level data are reported in this study. Not applicable. Competing interests: AV and JM are employees of MedEngine Oy. TS, KM, and SA are employees of Novo Nordisk. KKG was an employee of Novo Nordisk at the time of manuscript preparation. TS owns shares in Novo Nordisk. AL, TL, and KHP have no competing interests.

Figures

Fig. 1
Fig. 1
Mean annual indirect costs per person in different BMI groups in the working-age population over the whole follow-up period, stratified by cost component. BMI, body-mass index
Fig. 2
Fig. 2
Mean annual total costs per person in different BMI groups in the working-age population over the whole follow-up period, stratified by the cost type (direct and indirect). BMI, body-mass index
Fig. 3
Fig. 3
The association between the BMI groups, sex, and age group with indirect costs in the working-age population. A The odds ratio (95% confidence intervals) of having indirect cost estimated using the logistic regression model, and (B) the cost ratio (95% confidence intervals) of positive indirect costs estimated using overdispersed Poisson regression. BMI, body-mass index; CI, confidence interval
Fig. 4
Fig. 4
The association (cost ratios and 95% confidence intervals) between BMI groups, sex, and age group with total (direct + indirect) costs in the working-age population estimated using an overdispersed Poisson regression model. BMI, body-mass index; CI, confidence interval
Fig. 5
Fig. 5
Distribution of the Finnish working-age population and costs at the national level stratified by BMI group over the whole follow-up period. BMI, body-mass index
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