The humanistic and economic burden associated with increasing body mass index in the EU5

Figures & data

Table 1 Respondent characteristics by BMI category

Characteristics	Normal weight (N=27,350)	Overweight (N=20,135)	Obese class I (N=7,268)	Obese class II (N=2,360)	Obese class III (N=1,251)	P-value
Country
France, n (%)	7,400 (27.06%)	4,588 (22.79%)	1,504 (20.69%)	453 (19.19%)	245 (19.58%)	<0.001
Germany, n (%)	6,213 (22.72%)	5,044 (25.05%)	1,990 (27.38%)	691 (29.28%)	386 (30.86%)
UK, n (%)	5,574 (20.38%)	4,698 (23.33%)	2,140 (29.44%)	779 (33.01%)	426 (34.05%)
Italy, n (%)	4,942 (18.07%)	3,303 (16.40%)	899 (12.37%)	218 (9.24%)	109 (8.71%)
Spain, n (%)	3,221 (11.78%)	2,502 (12.43%)	735 (10.11%)	219 (9.28%)	85 (6.79%)
Age (years)
Mean ± SD	43.64±15.93	50.76±15.19	51.05±14.64	49.93±14.41	46.98±13.86	<0.001
Sex
Female, n (%)	16,609 (60.73%)	8,415 (41.79%)	3,408 (46.89%)	1,303 (55.21%)	770 (61.55%)	<0.001*
Male, n (%)	10,741 (39.27%)	11,720 (58.21%)	3,860 (53.11%)	1,057 (44.79%)	481 (38.45%)
Marital status
Single, n (%)	11,312 (41.36%)	6,330 (31.44%)	2,347 (32.29%)	864 (36.61%)	550 (43.96%)	<0.001*
Married/living with partner, n (%)	16,038 (58.64%)	13,805 (68.56%)	4,921 (67.71%)	1,496 (63.39%)	701 (56.04%)
Education level
Less than college educated, n (%)	16,440 (60.11%)	13,093 (65.03%)	5,109 (70.29%)	1,728 (73.22%)	914 (73.06%)	<0.001*
College educated, n (%)	10,910 (39.89%)	7,042 (34.97%)	2,159 (29.71%)	632 (26.78%)	337 (26.94%)
Annual household income
<€20,000/<£20,000, n (%)	7,690 (28.12%)	5,123 (25.44%)	2,135 (29.38%)	832 (35.25%)	510 (40.77%)	<0.001
€20,000 to <€50,000/£20,000 to <£40,000, n (%)	11,528 (42.15%)	9,053 (44.96%)	3,189 (43.88%)	971 (41.14%)	467 (37.33%)
€50,000+/£40,000+, n (%)	4,228 (15.46%)	3,510 (17.43%)	1,179 (16.22%)	333 (14.11%)	167 (13.35%)
Decline to answer, n (%)	3,904 (14.27%)	2,449 (12.16%)	765 (10.53%)	224 (9.49%)	107 (8.55%)
Currently employed, n (%)	16,710 (61.10%)	11,329 (56.27%)	3,874 (53.30%)	1,178 (49.92%)	600 (47.96%)	<0.001*
Retired, n (%)	4,396 (16.07%)	5,541 (27.52%)	2,047 (28.16%)	592 (25.08%)	249 (19.90%)	<0.001*
Short-term disability, n (%)	85 (0.31%)	71 (0.35%)	41 (0.56%)	17 (0.72%)	12 (0.96%)	<0.001*
Long-term disability, n (%)	336 (1.23%)	364 (1.81%)	216 (2.97%)	129 (5.47%)	89 (7.11%)	<0.001*
Drink alcohol, n (%)	21,494 (78.59%)	15,974 (79.33%)	5,629 (77.45%)	1,708 (72.37%)	872 (69.70%)	<0.001*
Smoking behavior
Non-smoker, n (%)	12,565 (45.94%)	8,385 (41.64%)	2,909 (40.02%)	910 (38.56%)	483 (38.61%)	<0.001
Former smoker, n (%)	7,347 (26.86%)	7,028 (34.90%)	2,739 (37.69%)	929 (39.36%)	464 (37.09%)
Current smoker, n (%)	7,438 (27.20%)	4,722 (23.45%)	1,620 (22.29%)	521 (22.08%)	304 (24.30%)
Exercise behavior
Do not exercise, n (%)	9,517 (34.80%)	8,243 (40.94%)	3,460 (47.61%)	1,352 (57.29%)	767 (61.31%)	<0.001*
Exercise, n (%)	17,833 (65.20%)	11,892 (59.06%)	3,808 (52.39%)	1,008 (42.71%)	484 (38.69%)
Charlson Comorbidity Index
Mean ± SD	0.23±0.81	0.34±0.87	0.45±0.92	0.51±0.85	0.65±1.16	<0.001

Notes:

* P-value determined with chi-square tests, with the exception of P-values marked with, which were determined with Cochran–Armitage test for trend - which only applies to binary variables.

Abbreviations: BMI, body mass index; SD, standard deviation.

Figure 1 Prevalence of comorbidities by BMI category.

Note: *P<0.05 compared with normal weight.
Abbreviation: BMI, body mass index.

Table 2 Health outcomes by different BMI categories in the EU5

Health outcomes	Normal weight (N=27,350)	Overweight (N=20,135)	Obese class I (N=7,268)	Obese class II (N=2,360)	Obese class III (N=1,251)	P-value
SF-36v2: mental component summary	45.91±10.37	47.38±10.39	46.32±11.02	44.36±11.78	42.81±12.01	<0.001
SF-36v2: physical component summary	52.90±8.06	50.99±8.69	48.39±9.68	45.76±10.66	42.54±10.90	<0.001
Health state utility score	0.72±0.13	0.72±0.13	0.69±0.13	0.66±0.13	0.63±0.13	<0.001
Absenteeism % (n=32,303)*	4.83±17.05	5.53±18.87	6.07±20.04	8.27±23.66	11.24±25.61	<0.001
Presenteeism % (n=31,653)*	16.00±23.31	15.63±23.20	17.60±24.40	20.37±25.46	29.20±29.80	<0.001
Overall work impairment % (n=32,303)*	19.01±27.18	19.13±27.87	21.33±29.09	25.70±31.39	34.66±33.91	<0.001
Activity impairment %	22.18±27.03	23.66±28.11	29.04±30.05	36.40±31.89	44.31±32.63	<0.001
Health care provider visits in past 6 months	4.16±5.82	4.74±6.60	5.59±7.11	6.71±8.16	7.67±9.81	<0.001
Emergency room visits in the past 6 months	0.19±0.99	0.19±0.86	0.20±1.02	0.26±0.81	0.32±1.74	<0.001
Hospitalizations in the past 6 months	0.12±0.76	0.13±0.77	0.14±0.90	0.15±0.55	0.19±0.81	0.001

Notes:

* Includes employed respondents only. Data are shown as mean ± SD.

Abbreviations: BMI, body mass index; SD, standard deviation; SF, short form.

Figure 2 Health utilities as a function of different BMI categories, controlling for covariates.

Notes: Presented are adjusted means with 95% confidence intervals. Generalized linear regression models controlled for age, sex, diagnosed hypertension, diagnosed depression/anxiety, experiencing sleep apnea regularly, and the Charlson Comorbidity Index. *P<0.05 compared with normal weight and ^exceed minimally important difference compared with normal weight.
Abbreviations: BMI, body mass index; SF-6D, Short Form-six dimension health utilities.

Figure 3 Work and activity impairment as a function of different BMI categories, controlling for covariates.

Notes: Presented are adjusted means with 95% confidence intervals. Generalized linear regression models controlled for age, sex, diagnosed hypertension, diagnosed depression/anxiety, experiencing sleep apnea regularly, and the Charlson Comorbidity Index. *P<0.05 compared with normal weight.
Abbreviation: BMI, body mass index.

Figure 4 Resource utilization as a function of different BMI categories, controlling for covariates.

Notes: Presented are adjusted means with 95% confidence intervals. Generalized linear regression models controlled for age, sex, diagnosed hypertension, diagnosed depression/anxiety, experiencing sleep apnea regularly, and the Charlson Comorbidity Index. *P<0.05 compared with normal weight.
Abbreviation: BMI, body mass index.

Figure 5 Indirect costs as a function of different BMI categories, controlling for covariates.

Notes: Presented are adjusted means with 95% confidence intervals. Generalized linear regression models controlled for age, sex, diagnosed hypertension, diagnosed depression/anxiety, experiencing sleep apnea regularly, and the Charlson Comorbidity Index. *P<0.05 compared with normal weight.
Abbreviation: BMI, body mass index.

Figure 6 Direct costs as a function of different BMI categories, controlling for covariates.

Notes: Presented are adjusted means with 95% confidence intervals. Generalized linear regression models controlled for age, sex, diagnosed hypertension, diagnosed depression/anxiety, experiencing sleep apnea regularly, and the Charlson Comorbidity Index. *P<0.05 compared with normal weight.
Abbreviation: BMI, body mass index.