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

## TL;DR

This study finds that indirect costs, like lost work time, make up a large part of the economic burden of obesity in Finland.

## Contribution

The study provides nationally representative data on the total economic burden of obesity, including indirect costs in a working-age population.

## Key findings

- Indirect costs were higher than direct costs for all overweight and obesity categories.
- Overweight and obesity were associated with significantly higher total annual costs compared to normal weight.
- Adjusting for age and sex showed large predicted cost differences between weight categories.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1186/s12889-025-22978-9.