Obesity

Objectives:Obesity burdens families, governments, and companies with a variety of direct costs for healthcare, and also indirect costs in lower productivity and well-being. To measure these costs in a middle-income country with rapidly rising obesity rates, we conducted a systematic review of the literature on the direct and indirect costs of obesity in Brazil. Methods: We searched for English and Portuguese language publications from 2004 to 2017 in EconLit, SciELO, NBER, PubMed, and Scopus. We included all studies that calculated the direct and indirect costs of obesity, except those that exclusively measured costs associated with bariatric surgery. No studies included were based on interventions. When studies calculated costs of obesity for a subset of the population, we extrapolated to the whole of Brazil, and all values were adjusted for inflation and expressed in 2017 prices. Results: The initial search identified 811 abstracts, of which eight publications met our criteria and were included. Seven of them have direct costs, while only one assessed indirect costs of obesity. Total costs of obesity in Brazil ranged from USD 133.8 million to USD 6.3 billion per year. This wide variance was driven by the difference in methods employed as well as diseases considered. Medication and out-of-pocket expenses were higher in households with obese individuals. The studies included were assessed according to the Quality Assessment Tool for Observational Cohort andCross-Sectional Studies of theNational Institute of Health, complying from 40% to 60% of the applicable criteria. All studies included only a fraction of known costs.Most included only data frompublic health care facilities, omitting expenditures at private clinics and pharmacies, and they used different comorbidities and criteria for measurement. Studies are also cross-sectional, and cannot determine causality. Conclusions: Evidence of the cost of obesity in Brazil is limited. The wide variance in methods used to calculate direct costs in the country restricts our ability to summarize the available evidence. However, all studies resulted in high costs of obesity. Studies that measure the indirect costs of obesity in Brazil are needed. Funding Sources: Bloomberg Philanthropies through a subaward agreement (5,104,695) between the University of North Carolina at Chapel Hill and Fundação Faculdade de Medicina, Brazil.