The potential health and economic effect of a Body Mass Index decrease in the overweight and obese population in Belgium

Highlights

• Overweight and obesity are a global public health concern.

• Health economic evaluations provide governments with insights useful for more efficient health care budget allocation.

• A BMI reduction results in improved health outcomes and lower costs.

• The Markov model may serve as the basis for future health economic evaluations of weight management strategies.

Abstract

Objectives

The aim of the study was to examine the health and economic consequences of a Body Mass Index decrease in the Belgian overweight and obese population over a 20-year time period.

Study design

Health economic evaluation study.

Methods

A Markov decision-analytic model using a societal perspective was applied, projecting the one-year results of a one unit Body Mass Index decrease over a time horizon of 20 years. Scenario analysis was applied evaluating the effects on the results of an alternative modelling assumption. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the effects on the findings of varying key input parameters.

Results

A one unit Body Mass Index decrease resulted in improved health outcomes and cost savings/patient (overweight women: 785€, obese women: 1039€, overweight men: 613€, obese men: 864€). For the total overweight and obese population, a cost saving of 2.8 billion euros was estimated. Considering the economic value of the health impact would result in a total economic benefit of about 15.9 billion euros for the Belgian society over a 20 year time period.

Conclusions

A one unit Body Mass Index reduction in the overweight and obese population in Belgium was found to be associated with improved health outcomes and cost savings. The evidence of such research can assist regulatory bodies in the allocation of healthcare budgets in a more efficient way.

Introduction

The prevalence of overweight (Body Mass Index – BMI 25–29.9 kg/m²) and obesity (BMI ≥30 kg/m²) has increased in the last decades and has become a serious global public health concern.¹ According to the results of the US National Health and Nutrition Examination Survey from 2009 to 2010, 69% of a nationally representative sample of the adult population was overweight, including 36% of them classified as obese.² In Europe, the obesity prevalence has increased by about 10–40% in the majority of countries during the last ten years of the 20th century.³ In Belgium, the results of the 2008 Health Survey Interview identified that 33% of a nationally representative sample of the adult general population was classified as being overweight and 14% as obese. It was moreover found that the prevalence of overweight increased from 30% in 1997 to 33% in 2008, while for obesity an increase from 11% to 14% during the same period was observed.⁴ The burden of overweight and obesity is not only increasing in the developed world, but also in low- and middle-income countries.⁵ Whereas in the past obesity was mostly associated with the higher socio-economic groups in these countries, it now tends to shift towards the groups with lower socio-economic status. It is assumed that the two most important reasons for the obesity increase in low- and middle-income countries are urbanization and globalization of food production and marketing.6, 7 Obesity is together with a number of clinical and metabolic elements a risk factor for the development of several non-communicable diseases such as diabetes, coronary heart disease (CHD), stroke, colon cancer and breast cancer.⁸

The growing burden of obesity and its related comorbidities will likely result in rising direct and indirect healthcare expenditures. Direct costs include the costs of the diagnosis and treatment of overweight and obesity and especially their associated diseases and complications, while the indirect costs are those resulting from work absenteeism, early retirement, and the lost value of life due to premature mortality.⁹ Therefore strategies aimed at reducing this burden should be integrated into public health policies. Evidence on which strategies work best and are thus most ‘effective’ is yet insufficient for policy making. Healthcare budgets are limited, hence governments are facing the problem how to set priorities in the allocation of health care resources to medical or public health interventions. So, studies evaluating the impact of weight loss on health outcomes and costs are important because such research can provide payers and governments with better insights how to spend the available resources in the most efficient way. Indeed, weight management interventions require an investment and it is therefore important for policy makers to understand the potential savings and health benefits of such interventions. With this study, it was the aim to evaluate the potential health and economic consequences for the Belgian society if the BMI of the overweight and obese population would decrease with one unit and thereby to apply a framework and method that can also be applied in other countries.