Increasing prevalence of obesity (BMI > 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1 billion people. Increasing trend in the prevalence of obesity in adults and children generates large social costs. The main aim of this study is to estimate both direct and indirect costs of obesity in the Czech Republic. Social costs of obesity are estimated using the cost-of-illness approach. Direct costs (healthcare utilization costs and costs of pharmacotherapy of 20 comorbidities) are estimated using the top-down approach, while indirect costs (absenteeism, presenteeism and premature mortality) are estimated using the human capital approach. In aggregate, the annual costs attributable to obesity in the Czech Republic in 2018 were 40.8 bn CZK (1.6 bn EUR, 0.8% GDP). Direct costs were 14.5 bn CZK (0.6 bn EUR) and accounted for 3.4% of Czech healthcare expenditures. The highest healthcare utilization costs were attributable to type II diabetes (20.6%), ischemic heart disease (18.8%) and osteoarthritis (16.7%). The largest indirect costs were attributable to premature mortality (10 bn CZK/0.39 bn EUR), absenteeism (9.2 bn CZK/0.36 bn EUR) and presenteeism (7.1 bn CZK/0.27 bn EUR). This article demonstrates that obesity is a serious problem with considerable costs. Several preventive interventions should be applied in order to decrease the prevalence of obesity and achieve cost savings.

Department of Public Health Faculty of Medicine Masaryk University Kamenice 5 625 00 Brno Czech Republic

Faculty of Social Sciences Charles University Opletalova 26 110 00 Prague Czech Republic

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Dobbs R, Sawers C, Thompson F, Manyika J, Woetzel J, Child P, McKenna S, Spatharou A. Overcoming obesity: An initial economic analysis. USA: McKinsey Global Institute; 2014.

OECD. The Heavy Burden of Obesity. OECD Publishing, 2019a. 10.1787/67450d67-en. https://www.oecd-ilibrary.org/content/publication/67450d67-en

Popkin, B.M., Du, S., Green, W.D., Beck, M.A., Algaith, T., Herbst, C.H., Alsukait, R.F., Alluhidan, M., Alazemi, N., Shekar, M.: Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes. Rev. 21(11), e13128 (2020). 10.1111/obr.13128 PubMed PMC

Bruthans, J.: Studie Czech post-MONICA a studie Czech EUROASPIRE: kardiovaskulární rizikové faktory a jejich kontrola v obecné populaci a u osob se stabilní ischemickou chorobou srdeční/Study Czech post-MONICA and study Czech EUROASPIRE: cardiovascular risc factors and their control in general population and in population with ischemic heart disease. http://www.szu.cz/uploads/documents/szu/akce/materialy/14.10.2019/BRUTHANS.pdf (2019). Accessed 17 May 2020

NIPH. Výskyt nadváhy a obezity (Prevalence of overweight and obesity). http://www.szu.cz/uploads/documents/chzp/info_listy/Vyskyt_nadvahy_a_obezity_2018.pdf (2018). Accessed 17 Oct 2020

Byford S, Torgerson DJ, Raftery J. Economic note: Cost of illness studies. BMJ. 2000;320(7245):1335. doi: 10.1136/bmj.320.7245.1335. PubMed DOI PMC

Guh, D.P., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C.L., Anis, A.H.: The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health 9(1), 88 (2009). 10.1186/1471-2458-9-88 PubMed PMC

Dobbins, M., Decorby, K., Choi, B.C.K.: The association between obesity and cancer risk: a meta-analysis of observational studies from 1985 to 2011. ISRN Prevent. Med. 2013, 680536 (1985). 10.5402/2013/680536 PubMed PMC

Effertz T, Engel S, Verheyen F, Linder R. The costs and consequences of obesity in germany: a new approach from a prevalence and life-cycle perspective. Eur. J. Health Econ. 2016;17(9):1141–1158. doi: 10.1007/s10198-015-0751-4. PubMed DOI

Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. J. Health Econ. 2012;31(1):219–230. doi: 10.1016/j.jhealeco.2011.10.003. PubMed DOI

Konnopka, A., Bödemann, M., König, H.H.: Health burden and costs of obesity and overweight in Germany. Eur. J. Health Econ. 12(4), 345–352 (2011). 10.1007/s10198-010-0242-6 PubMed

Arterburn, D.E., Maciejewski, M.L., Tsevat, J.: Impact of morbid obesity on medical expenditures in adults. Int. J. Obes. 29(3), 334–339 (2005). 10.1038/sj.ijo.0802896 PubMed

Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff. 2002;21(2):245–253. doi: 10.1377/hlthaff.21.2.245. PubMed DOI

Wang, F., McDonald, T., Bender, J., Reffitt, B., Miller, A., Edington, D.W.: Association of healthcare costs with per unit body mass index increase. J. Occup. Environ. Med. 48(7), 668–674 (2006). 10.1371/journal.pone.0247307 PubMed

Raebel, M.A, Malone, D.C, Conner, D.A., Xu, S., Porter, J.A., Lanty, F.A.: Health services use and health care costs of obese and nonobese individuals. Arch. Int. Med. 164(19), 2135–2140 (2004). 10.1001/archinte.164.19.2135 PubMed

Borg, S., Persson, U., Ödegaard, K., Berglund, G., Nilsson, J., Nilsson, P.M.: Obesity, survival, and hospital costs-findings from a screening project in Sweden. Value Health 8(5), 562–571 (2005). 10.1111/j.1524-4733.2005.00048.x PubMed

Krueger, H., Krueger, J., Koot, J.: Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can. J. Public Health 106(4), e171–e177 (2015). 10.17269/cjph.106.4994 PubMed PMC

Tuzarová, Kateřina: Společenské náklady obezity v České republice. Master’s thesis, Vysoká škola ekonomická v Praze, (2016)

Hodycová, T.: Ekonomické dopady rostoucí incidence obezity na zdravotnictví v ČR (diplomová práce)/Economic consequences of growing incidence of obesity on healthcare in the Czech Republic. Master’s thesis, Vysoká škola ekonomická, Institut managementu zdravotnických služeb (2009)

WHO. Absenteeism from work due to illness, days per employee per year. https://gateway.euro.who.int/en/indicators/hfa_411-2700-absenteeism-from-work-due-to-illness-days-per-employee-per-year/visualizations/#id=19398 &tab=table (2019). Accessed 27 Jan 2021

Dall TM, FulgoniIII VL, Zhang Y, Reimers KJ, Packard PT, Astwood JD. Predicted national productivity implications of calorie and sodium reductions in the american diet. Am. J. Health Promot. 2009;23(6):423–430. doi: 10.4278/ajhp.081010-QUAN-227. PubMed DOI

Finkelstein E, Fiebelkorn IC, Wang G. The costs of obesity among full-time employees. Am. J. Health Promot. 2005;20(1):45–51. doi: 10.4278/0890-1171-20.1.45. PubMed DOI

Dee, A., Callinan, A., Doherty, E., O’Neill, C., McVeigh, T., Sweeney, M.R., Staines, A., Kearns, K., Fitzgerald, S., Sharp, L. et al.: Overweight and obesity on the island of Ireland: an estimation of costs. BMJ Open 5(3) (2015). 10.1136/bmjopen-2014-006189corr1 PubMed PMC

Lehnert, T., Streltchenia, P., Konnopka, A., Riedel-Heller, S.G., König, H.H.: Health burden and costs of obesity and overweight in Germany: an update. Eur. J. Health Econ. 16(9), 957–967 (2015). 10.1007/s10198-014-0645-x PubMed

Kang JH, Jeong BG, Cho YG, Song HR, Kim KA. Socioeconomic costs of overweight and obesity in korean adults. J. Korean Med. Sci. 2011;26(12):1533–1540. doi: 10.3346/jkms.2011.26.12.1533. PubMed DOI PMC

Andreyeva, T., Luedicke, J., Wang, Y.C.: State-level estimates of obesity-attributable costs of absenteeism. J. Occup. Environ. Med. Am. Coll. Occup. Environ. Med. 56(11), 1120 (2014). 10.1097/JOM.0000000000000298 PubMed PMC

Johns G. Presenteeism in the workplace: A review and research agenda. J. Organ. Behav. 2010;31(4):519–542. doi: 10.1002/job.630. DOI

Finkelstein, E.A., DiBonaventura, M.dC., Burgess, S.M., Hale, B.C., et al.: The costs of obesity in the workplace. J. Occup. Environ. Med. 52(10), 971–976 (2010). 10.1097/JOM.0b013e3181f274d2 PubMed

Collins JJ, Baase CM, Sharda CE, Ozminkowski RJ, Nicholson S, Billotti GM, Turpin RS, Olson M, Berger ML. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers. J. Occup. Environ. Med. 2005;47(6):547–557. doi: 10.1097/01.jom.0000166864.58664.29. PubMed DOI

Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W. Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting us employers. J. Occup. Environ. Med. 2004;46(4):398–412. doi: 10.1097/01.jom.0000121151.40413.bd. PubMed DOI

Goetzel RZ, Gibson TB, Short ME, Chu B-C, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson MG, et al. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity. J. Occup. Environ. Med. 2010;52(1S):S52–S58. doi: 10.1097/JOM.0b013e3181c95b84. PubMed DOI PMC

Boles M, Pelletier B, Lynch W. The relationship between health risks and work productivity. J. Occup. Environ. Med. 2004;46(7):737–745. doi: 10.1097/01.jom.0000131830.45744.97. PubMed DOI

Burton WN, Chen C-Y, Conti DJ, Schultz AB, Pransky G, Edington DW. The association of health risks with on-the-job productivity. J. Occup. Environ. Med. 2005;47(8):769–777. doi: 10.1097/01.jom.0000169088.03301.e4. PubMed DOI

Ricci JA, Chee E. Lost productive time associated with excess weight in the us workforce. J. Occup. Environ. Med. 2005;47(12):1227–1234. doi: 10.1097/01.jom.0000184871.20901.c3. PubMed DOI

Gupta S, Richard L, Forsythe A. The humanistic and economic burden associated with increasing body mass index in the eu5. Diabetes Metab. Syndr Obes. Targets Ther. 2015;8:327–338. doi: 10.2147/DMSO.S83696. PubMed DOI PMC

Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Mamun AA, Bonneux L. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann. Intern. Med. 2003;138(1):24–32. doi: 10.7326/0003-4819-138-1-200301070-00008. PubMed DOI

Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187–193. doi: 10.1001/jama.289.2.187. PubMed DOI

OECD. The Heavy Burden of Obesity, Technical country notes. OECD Publishing, 2019b. URL http://www.oecd.org/health/the-heavy-burden-of-obesity-67450d67-en.htm

Nejedlá M. Zdravotní a hospodářské důsledky epidemie obezity a možnosti její prevence ve školách/health and economic consequences of obesity epidemic and possibilities of its prevention in schools. Česká Antropologie. 2014;64:20–24.

GHIF. Healthcare costs of selected diseases, 2018. Data obtained upon author’s request

IHIS. Information system incapacity for work, 2018a. Data obtained upon author’s request

IHIS. Information system deaths, 2018b. Data obtained upon author’s request

Abarca-Gómez, L., Abdeen, Z.A., Abdul Hamid, Z., Abu-Rmeileh, N.M., Acosta-Cazares, B., Acuin, C., Adams, R.J., Aekplakorn, W., Afsana, K., Aguilar-Salinas, C.A. et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet, 390(10113), 2627–2642 (2017). 10.1016/S0140-6736(17)32129-3 PubMed PMC

CSO. Structure of Earnings Survey - 2018. https://www.czso.cz/csu/czso/structure-of-earnings-survey-2018 (2019). Accessed 20 Nov 2020

AVČR. Jak Češi tráví čas? Výsledky 1. ročníku výzkumu proměny české společnosti 2015 (How Czechs spend time? Results of first research of changes in Czech society) (2016). https://www.promenyceskespolecnosti.cz/aktuality/aktualita22/Jak_Cesi_travi_cas_TK_20-06-2016.pdf. Accessed 1 Mar 2021

ISPV. Informační systém o průměrném výdělku - Mzdová sféra ČR 2018 (Information system on average earnings). https://www.ispv.cz/cz/Vysledky-setreni/Archiv/2018.aspx (2020). Accessed 18 Dec 2020

CSO. Life tables for the Czech Republic, cohesion regions, and regions - 2017 - 2018. https://www.czso.cz/csu/czso/life-tables-for-the-czech-republic-cohesion-regions-and-regions-2017-2018 (2020a). Accessed 18 Dec 2020

Eurostat. Employment and activity by sex and age - annual data. https://ec.europa.eu/eurostat/data/database (2018). Accessed 19 Jan 2021

Bloom, D.E., Cafiero, E., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Hamandi, A., Mowafi, M., et al.: The global economic burden of noncommunicable diseases. Technical report, Program on the Global Demography of Aging, (2012)

WHO. WHO guide to identifying the economic consequences of disease and injury. Technical report, 2009

IHIS. Health interview surveys in the Czech Republic: European Health Interview Survey 2014. https://ehis.uzis.cz/index-en.php?pg=ehis-2014 (2014). Accessed 19 Sep 2020

NIPH. Evropský průzkum zdravotního stavu (European health examination survey)—EHES. http://www.szu.cz/ehes (2014). Accessed 19 Sep 2020

CSO. Key macroeconomic indicators. https://www.czso.cz/csu/czso/hmu_ts (2021). Accessed 01 Mar 2021

CSO. Výsledky zdravotnických účtů ČR 2010–2018 (Health accounts results). https://www.czso.cz/csu/czso/vysledky-zdravotnickych-uctu-cr-2010-2018 (2020). Accessed 1 Mar 2021

Segel JE. Cost-of-illness studies - a primer. RTI-UNC Center Excell. Health Promot. Econ. 2006;1:39.

NIPH. Vybrané výsledky studie EHES 2019 (Selected results of EHES 2019). http://www.szu.cz/ehes/vybrane-vysledky-studie-ehes-2019 (2019). Accessed 5 Nov 2020

Ross H. Critique of the philip morris study of the cost of smoking in the Czech Republic. Nicot. Tob. Res. 2004;6(1):181–189. doi: 10.1080/14622200310001657000. PubMed DOI

Chadimova K, Mlcoch T, Dolejsi D, Hajickova B, Mazalova M, Lamblova K, Dolezal T. The economic burden of alcohol consumption in the Czech Republic. Value Health. 2019;22:S686. doi: 10.1016/j.jval.2019.09.1506. DOI

Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young adulthood from childhood and parental obesity. N. Engl. J. Med. 1997;337(13):869–873. doi: 10.1056/NEJM199709253371301. PubMed DOI

Schmid A, Schneider H, Golay A, Keller U. Economic burden of obesity and its comorbidities in Switzerland. Soc. Prevent. Med. 2005;50(2):87–94. doi: 10.1007/s00038-004-4067-x. PubMed DOI

Kleinman N, Abouzaid S, Andersen L, Wang Z, Powers A. Cohort analysis assessing medical and nonmedical cost associated with obesity in the workplace. J. Occup. Environ. Med. 2014;56(2):161–170. doi: 10.1097/JOM.0000000000000099. PubMed DOI

An R. Health care expenses in relation to obesity and smoking among us adults by gender, race/ethnicity, and age group: 1998–2011. Public Health. 2015;129(1):29–36. doi: 10.1016/j.puhe.2014.11.003. PubMed DOI

Sander B, Bergemann R. Economic burden of obesity and its complications in Germany. Eur. J. Health Econ. 2003;4(4):248–253. doi: 10.1007/s10198-003-0178-1. PubMed DOI

Lehnert T, Stuhldreher N, Streltchenia P, Riedel-Heller SG, König H-H. Sick leave days and costs associated with overweight and obesity in Germany. J. Occup. Environ. Med. 2014;56(1):20–27. doi: 10.1097/JOM.0000000000000065. PubMed DOI

Neovius K, Rehnberg C, Rasmussen F, Neovius M. Lifetime productivity losses associated with obesity status in early adulthood. Appl. Health Econ. Health Policy. 2012;10(5):309–317. doi: 10.1007/BF03261865. PubMed DOI

Pelletier B, Boles M, Lynch W. Change in health risks and work productivity over time. J. Occup. Environ. Med. 2004;46(7):746–754. doi: 10.1097/01.jom.0000131920.74668.e1. PubMed DOI

Gates DM, Succop P, Brehm BJ, Gillespie GL, Sommers BD. Obesity and presenteeism: The impact of body mass index on workplace productivity. J. Occup. Environ. Med. 2008;50(1):39–45. doi: 10.1097/JOM.0b013e31815d8db2. PubMed DOI

Kirkham HS, Clark BL, Bolas CA, Lewis GH, Jackson AS, Fisher D, Duncan I. Which modifiable health risks are associated with changes in productivity costs? Popul. Health Manag. 2015;18(1):30–38. doi: 10.1089/pop.2014.0033. PubMed DOI

OECD. Ageing and employment policies—statistics on average effective age of retirement. https://www.oecd.org/els/emp/average-effective-age-of-retirement.htm (2018). Accessed 18 Dec 2020

Hodgson, T. A., Meiners, M.R.: Cost-of-illness methodology: a guide to current practices and procedures. Milbank Mem. Fund Q. Health Soc. 429–462 (1982). 10.2307/3349801 PubMed

Lobstein, T., Leach, R.J.: DYNAMO-HIA: Report on data collection for overweight and obesity prevalence and related relative risks. https://webgate.ec.europa.eu/chafea_pdb/assets/files/pdb/2006116/2006116_d4_dynamo_hia.pdf, 2010. Accessed: 10 (May 2022)

de Oliveira, M.L., Pacheco Santos, L.M., da Silva, E.N.: Direct healthcare cost of obesity in Brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011. PLOS One 10(4), e0121160 (2015). 10.1371/journal.pone.0121160 PubMed PMC

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Comparing the Efficacy of Digital and In-Person Weight Loss Interventions for Patients with Obesity and Glycemic Disorders: Evidence from a Randomized Non-Inferiority Trial

The economic burden of obesity in 4 south-eastern European countries associated with obesity-related co-morbidities