Diet, obesity and health economics I nsights from the Netherlands - - PowerPoint PPT Presentation

Diet, obesity and health economics

I nsights from the Netherlands

Tommy LS Visscher

I mpact of obesity

ZIEKTE

Musculoskeletal disorders

O B E S I T Y

Type 2 diabetes mellitus Cardiovascular diseases MORBI DI TY MORTALI TY DI SABI LI TI ES

Visscher TLS, Seidell JC. Annu Rev Publ Health 2001; 22:355-75

I mportant measures

• Prevalence rates
• Relative risks
• Population Attributable Fraction

Obesity prevalence around 2000

• USA:

28-33%

Flegal et al JAMA 2002

• England:

17-22%

Health survey for England 1998.

• Finland:

20-21%

Lahti-Koski et al Int J Obes 2001

• Germany:

19-21%

Bergmann et al. Gesundheidswesen 1999

• Netherlands:

10%

Visscher et al IJO 2002/2004

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Obesity in the Netherlands

Visscher, Seidell, Kromhout Int J Obes 2002;26:1218-24 4 5 6 7 8 9 10

%

1976-80 1987-91 1993-97 age 37-43 jaar Men Women

Obesity in the Netherlands

Statistics Netherlands

5 10 15 1 9 8 1 1 9 8 3 1 9 8 5 1 9 8 7 1 9 8 9 1 9 9 1 1 9 9 3 1 9 9 5 1 9 9 7 1 9 9 9 jaar % cbs-women cbs-men

Obesity and educational level

period: 1993/97, age: 20-59 years

5 10 15 20 low middle high % men women

Visscher, Seidell, Kromhout Int J Obes 2002

Obesity and age

period: 1993-1997

5 10 15 20 20-29 30-39 40-49 50-59 Age (years) % men w omen

Visscher, Seidell, Kromhout Int J Obes 2002

Overweight and obesity in Dutch girls

2 4 6 8 10 12 14 16 6 12 18 Age 1980 1997

Fredriks et al Arch Dis Child 2000, Hirasing NtvG 2001

%

Obesity and age

5 10 15 20 25 30 35 16-24 25-34 35-44 45-54 55-64 65-74 >75 Age (years)

prevalence of obesity (%)

men women

Health Survey for England 1997 Figure from: Seidell & Visscher. Eur J Clin Nutr 2000

Behavioural determinants Energy-intake Energy expenditure Body weight Energy-balance

Weight gain

Food intake (The Netherlands 1988-1998)

• Saturated fat

+ (favourable)

• Tans-fatty acids

+

• Fish

+

• Fruits
• (unfavourable)
• Vegetables
• VCP / Van Kreijl 2004 RIVM

Sugared softdrinks boys (13-18)

50 100 150 200 250 300 350 400 450 500 1987/ 88 1992 1997/ 98 g per day fruit juice soft-drinks

Source: VoedselConsumptiePeiling

Relative risks

US women from the Nurses’ Health Study

Figure from Visscher et al Annu Rev Publ Health 2001

Relative risks

• Higher for morbidity than for mortality

Visscher Annu Rev Publ Health 2001, Visscher Arch Int Med 2004

• Decrease with ageing Stevens NEJM 1999, Visscher Arch Int Med 2004

Population attributable fraction

• Prevalence rate
• Relative risks

Population attributable fraction - BMI ≥30 Men Women

• Diabetes

26.3 52.9

• Hypertension

12.0 23.5

• CHD

4.1 17.4

• Stroke

5.5 2.8

Dutch Health Council

Costs – obesity – The Netherlands

Men Women

• Calculated from PAF

0.8% 1.3

Source: Dutch Health Council and www.kostenvanziekten.nl; Calculated for Lipgene

Costs underestimated

• Not all consequences
• Not age-specific:

– prevalence rate – Relative risks – absolute risk

Costs – obesity – The Netherlands - 1989

Million Euro’s BMI ≥25

BMI ≥30

General practitioners 46 12 Medical specialists 37 14 Hospital admissions 225 81 Medication 250 67 Total attributable to obesity: 558 174 % Direct health care costs

4% 1%

Seidell IJO 1995

Costs – obesity – The Netherlands

Million Euro’s Overweight (BMI ≥25 ) 558 Obesity (BMI ≥30) 174

Seidell IJO 1995

Overweight (BMI ≥25 ) 505

Polder 1999 RIVM

Diabetes II 430 Hypertension 433 Stroke 1029 MI 929

www.kostenvanziekten.nl

Costs of obesity

Direct

• USA: 6%

Wolf AM, Colditz GA. Obes Res 1998

• Europe: 1-5%
• Netherlands: 1%

Seidell JC. Int J Obes;1995

Indirect

• Loss of productivity : 10%

Narbro K, et al. Int J Obes 1996

Obesity and work disabilty

0.5 1 1.5 2 2.5

<22.5 22.5-24.9 25.0-27.4 27.5-29.9 30.0-32.4 >32.5

body mass index (kg/m2) Relative risk women men

Rissanen, BMJ 1990

I mpact of obesity

ZIEKTE

Musculoskeletal disorders

O B E S I T Y

Type 2 diabetes mellitus Cardiovascular diseases MORBI DI TY MORTALI TY DI SABI LI TI ES

Visscher TLS, Seidell JC. Annu Rev Publ Health 2001; 22:355-75

Is health promotion cost-effective?

Outcome measures

Life-years lost

• Healthy life-years
• Quality of Life
• DALY’s - QUALY’s
• Compression of morbidity

Health promotion cost-effective?

Vita, NEJM 1998

– Less lifetime disability – Less disability at any given age Prevention: less lifetime disability

Lubitz, NEJM 2003

– Health promotion improves health and longevity of the elderly without increasing health expenditures

Health promotion cost-effective?

Vita, NEJM 1998

– Less lifetime disability – Less disability at any given age Prevention: less lifetime disability

Lubitz, NEJM 2003

– Health promotion improves health and longevity of the elderly without increasing health expenditures

Barendregt, NEJM 1997

– Smoking cessation: increased direct health care costs

Deaths attributable to obesity (USA)

• 112,000 (Year 2000) Flegal JAMA 2005
• 414,000 (Year 2000) Mokdad JAMA 2004/2005
• 280,000 (Year 1991) Allison JAMA 1991

Confidence interval around 112,000: 54,000 – 170,000

Mark JAMA 2005

Costs: mortality versus morbidity

Direct health care costs 25% reduced when obesity- mortality relation is taken into account

Allison: AJPH 1999

Lost life-years

• BMI ≥30 at age 40 years:

6-7 years

Peeters Ann Int Med 2002

• BMI >33 from age 40 years:

2-3 years

Fontaine JAMA 2003

• BMI ≥30 at age 40 years:

0.8 years

Van Kreijl 2004 RIVM

• BMI >30, age 37-43 years, 25 years: 0.2 years

Visscher ECO 2005 Athens

Obesity / nutrition

• BMI ≥30 at age 40 years:

0.8 years

Van Kreijl 2004 RIVM

• Unhealthy food pattern at age 40:

1.2 years

Van Kreijl 2004 RIVM

• BMI ≥30:

215,000 DALY’s per year

Van Kreijl 2004 RIVM

• Unhealthy food pattern:

245,000 DALY’s per year

Van Kreijl 2004 RIVM

Unhealthy life-years

HEALTHY UNHEALTHY BASELINE MORBIDTY MORTALITY

Relative risks

US women from the Nurses’ Health Study

Figure from Visscher et al Annu Rev Publ Health 2001

Unhealthy life-years

10% weight loss in those aged 35-64 years: – 1.2-2.9 fewer life-years with hypertension – 0.5-1.7 fewer life-years with diabetes II

Oster AJPH 1999

Unhealthy life-years: empirical approach

• Mortality
• Work disability
• Coronary Heart Disease
• Chronic medication

HEALTHY UNHEALTHY 15 BASELINE MORBIDTY MORTALITY

Unhealty life-years

Social Insurance Instution’s Mobile Clinic Study (Helsinki) An adult obese Finn during 15 years:

• Half a year longer

Work disability

• Half a year longer

Coronary heart disease

• One and a half year longer

Chronic medication

Visscher TLS et al Arch Int Med 2004

I mpact of obesity

ZIEKTE

Musculoskeletal disorders

O B E S I T Y

Type 2 diabetes mellitus Cardiovascular diseases MORBI DI TY mortality DI SABI LI TI ES

Visscher TLS, Seidell JC. Annu Rev Publ Health 2001; 22:355-75

Cost-effective?

• Prevention more efficient than treatment

Russell IJO 1995

• Which age-category?

Seidell 2005 Boyd Orr

Which age-category?

Children?

• Relative risks high Stevens NEJM 1999, Visscher Arch Int Med 2004
• Behaviour and habits are learnt at young age (?)
• If successful, long term effect

Which age-category?

Adults?

• Sharpest increase in incidence of obesity in adulthood
• Absolute risk and PAF increase with age
• Intervention at young and older adults affect more

age-categories

Cost-effective?

• Prevention more efficient than treatment

Russell IJO 1995

• Which age-category?

Seidell 2005 Boyd Orr

• Effective? Evidence needed

Swinburn Obesity Reviews 2005

Conclusions

• Obesity prevalence is increasing in the Netherlands
• PAF calculations are hard:
• prevalence estimations, - relative risks, - subgroups
• Cost calculations are hard:
• Morbidity, - mortality

Conclusions

• Direct costs moderate overweight higher than costs obesity
• Direct costs comparable to hypertension, diabetes II
• Direct costs in the Netherlands

4% (BMI ≥25) / 1% (BMI ≥30)

• Indirect costs: 10%

Conclusions

• Obesity more strongly related to morbidity and disability

than to mortality

• Obesity related to UNHEALTHY life-years

Conclusions

• Obesity more strongly related to morbidity and disability

than to mortality

• Obesity related to UNHEALTHY life-years
• Further increase obesity will clearly lead to increased

costs

• Weight gain prevention is essential in reducing health

care costs

Thank you for your attention!

Tommy.Visscher @ falw.vu.nl