# Obesity, Physical Activity and Occurrence of High Medical Expenditures at One-Year Follow-Up Among Japanese Beneficiaries of Employment-Based Health Insurances: An Analysis Based on a Nationwide Health Checkup Questionnaire

## TL;DR

This study found that physical activity can reduce high medical costs in overweight or obese Japanese employees, but effects vary by gender and age.

## Contribution

The study provides gender- and age-specific insights into how physical activity affects short-term medical expenditures among overweight or obese individuals.

## Key findings

- Inactive men and younger individuals with overweight or obesity had significantly higher odds of high medical expenditures.
- Physical activity reduced the risk of high medical costs in men and younger individuals with overweight or obesity.
- Women and older individuals with obesity showed mixed effects of physical activity on medical expenditures.

## Abstract

Objectives: This study aimed to prospectively investigate the associations among obesity, physical activity, and short-term high medical expenditures in Japanese employees and their dependents. Methods: Participants were 245,044 employees and their dependents aged 40–74 years who underwent the Specific Health Checkup in fiscal year 2008. Health checkup and medical expenditure data for 2008–2010 were provided by health insurers. They were divided into 12 groups according to the combination of body mass index categories (normal, overweight, and obesity) and engagement in exercise and/or daily physical activity (inactive, daily physical activity only, exercise only, and active). The multivariable-adjusted odds ratios of the groups for high total medical expenditures in the next year compared to the inactive normal body mass index group were estimated. High medical expenditures were defined as the top 5% of total annual expenditures, consistent with prior literature identifying high-cost users. Similar analyses were performed by sex and age (<65 years, ≥65 years). Results: Of the participants, 61.8% were men (mean age, 52.1 years). Multivariable-adjusted odds ratios were significantly high only in the inactive groups with overweight or obesity in men and younger individuals. In women and older individuals, the odds ratios were significantly high only in inactive women with obesity; however, the odds ratios were high in women who exercised only and in active older individuals, both with obesity. Conclusions: Exercise or daily physical activity might attenuate the possibility of incurring high short-term medical expenditures in men and younger individuals with overweight or obesity. These findings suggest that physical activity recommendations may need to be tailored for women and older individuals with obesity, and further longitudinal research is warranted.