Abstract Body: Introduction: The obesity epidemic is a growing public health challenge. Obesity-related morbidity and mortality rates in the US are rising, putting a substantial burden on the US healthcare system. This SLR identified publications reporting HCRU and costs associated with overweight and obesity in the US.
Methods: A systematic search was conducted in January 2024, using Medline, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Eligible studies reported HCRU or costs in adults living with obesity (body mass index [BMI] ≥30 kg/m²), or overweight (BMI ≥27 kg/m²) and ≥1 obesity-related complication (ORC; diabetes, cardiovascular disease [including stroke], renal, liver, pancreas, or gallbladder disorders, sleep apnea, musculoskeletal condition, or mental health condition), published in English from 2019–present. Studies reporting other comorbidities, surgery (bariatric or musculoskeletal), or in patients with COVID-19 were excluded.
Results: Of 6862 publications identified, 60 were included. Of these, 23 reported general costs and HCRU associated with obesity and 37 reported the impact of ORCs, including cardiovascular comorbidities (n=10; venous thromboembolism, atrial fibrillation, infective endocarditis, and acute myocardial infarction), diabetes-related comorbidities (n=7), stroke (n=5), metabolic dysfunction-associated steatotic liver disease (n=1), osteoarthritis (n=1), mental health disorders (n=1), or ≥2 comorbidities (n=7). Total medical costs per patient per year (PPPY) associated with obesity ranged from $4443–$45,683, which increased with higher BMI. Annual direct healthcare costs were higher for individuals with ORCs than those without and increased with the number of ORCs (no ORCs: $5149; ≥3 ORCs: $16,451). Among ORCs, the highest mean PPPY cost was in bipolar disorder-1 ($37,771) and the lowest was in type 2 diabetes ($8987). Job seekers with obesity experienced longer average spells of unemployment than those without obesity, and rates of absenteeism increased with BMI. People with BMI ≥25 kg/m² who lost weight had lower direct medical costs (excluding anti-obesity medications), with greater cost savings at 2 years.
Discussion: Obesity and ORCs are significant drivers of HCRU and costs, which are expected to rise in the future. These results highlight an unmet need for effective prevention and treatments for obesity and ORCs to mitigate the economic burden of this chronic, complex disease.