Modeling the Cost of Inaction in Treating Obesity in Canada

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This study updates estimates of the societal cost of inaction in treating obesity, emphasizing the significant economic burden stemming from both direct healthcare costs and indirect productivity losses. Methods We combined data from national surveys and published literature to estimate the 2023 national economic implications of obesity. Comparing adults with obesity (BMI ≥ 30) to those with healthy weight (25 > BMI ≥ 18.5), we assessed healthcare costs, absenteeism, presenteeism, disability pensions, mortality-related costs, workforce participation, and earnings. Canadian data were used where possible, supplemented by U.S. data, standardized to 2023 CAD $ . Results The cost of inaction in treating obesity in Canada was $ 27.6 billion in 2023, including $ 5.9 billion in direct healthcare and $ 21.7 billion in indirect costs. Excess healthcare costs are driven by higher utilization of medical services. Indirect costs include approximately $ 8.2 billion from reduced workforce participation, $ 6.8 billion from presenteeism, $ 3.8 billion in lower earnings among employed with obesity, $ 2.0 billion from lost wages due to premature mortality, $ 682 million from absenteeism, and $ 268 million from disability pensions. Conclusions The economic implications of not addressing obesity effectively are substantial, emphasizing the urgent need for utilizing effective chronic disease management strategies. Our findings highlight the disproportionate impact on women and the broader economic consequences, underscoring the imperative for tailored policy interventions. Investing in comprehensive, evidence-based obesity management not only enhances individual well-being but also yields significant societal and economic benefits. obesity cost direct healthcare cost workforce productivity cost absenteeism presenteeism disability pension mortality-related costs lost wages Background In 2022, 30% of adult Canadians were reported to be living with obesity according to the Canadian Community Health Survey (CCHS) [ 1 ]. Obesity is defined as a progressive, relapsing, complex chronic disease characterized by abnormal or excessive adipose tissue that negatively impacts health [ 2 ]. This definition emphasizes that obesity is not merely about an individual's size or weight. Nevertheless, most prevalence data, including the CCHS, rely on body mass index (BMI) classification, reflecting a gap between evolving definitions and current research practices. Obesity is a significant risk factor for many chronic illnesses including type 2 diabetes, cardiovascular disease, respiratory disease, osteoarthritis, cancer and certain mental health conditions [ 3 ]. According to Statistics Canada, 13.4% of obese Canadians had type 2 diabetes, compared to 2.9% of Canadians with a normal weight [ 4 ]. The increase in the prevalence of obesity has led to the concomitant increase in the prevalence of type 2 diabetes further straining the healthcare system. Furthermore, due to its role in chronic inflammation and metabolic dysregulation, obesity can exacerbate the negative health outcomes and durations of acute illnesses such as a COVID-19 and influenza [ 5 ]. Obesity’s impact on population morbidity and mortality suggests that it plays a notable role in economic health and productivity. An increase in obesity-related complications can lead to more absenteeism and presenteeism in the workplace [ 6 ]. Furthermore, a higher risk of disability and early retirement from the workforce suggests that obesity can exact a long-term economic toll on workers and employers [ 7 ]. Higher use of healthcare resources incurs a direct cost for treatment on public payers and employers. One study estimated a fiscal burden of $ 23.0 billion on Canada’s economy in 2021 due to depressed employment and loss of direct tax revenues [ 8 ]. These factors, when paired with direct healthcare costs, were estimated to cost Canadians $ 752 per capita in taxes. The economic, social, and health costs of Canada’s growing obesity epidemic present a strong, multi-faceted incentive for its expanded treatment. This study provides updated estimates of the cost of inaction in treatment of obesity from a societal perspective and quantifies the components of this cost. Such information helps to underscore the importance of obesity prevention and treatment. Methods Overall model structure The model combined person-level survey data analysis and information from published studies to estimate the 2023 economic burden of obesity, covering direct medical costs and indirect costs related to productivity loss (Table 1 ). The model compares adults with obesity (BMI ≥ 30) to those with a healthy weight (25 > BMI ≥ 18.5) across various economic outcomes, including absenteeism (missed work due to illness), presenteeism (reduced productivity while at work due to illness), disability pension, mortality-related costs, reduced workforce participation, and lower earnings. Canadian-based data are used where available, supplemented by United States references. All economic inputs and outcomes are standardized to 2023 CAD $ . Table 1 Annual healthcare resource utilization and direct medical cost of obesity Age Group 18–34 35–49 50–64 65 and above All Healthy Weight Obesity Obesity Impact Healthy Weight Obesity Obesity Impact Healthy Weight Obesity Obesity Impact Healthy Weight Obesity Obesity Impact Obesity Impact Per capita healthcare utilization Generalist office visits a 3.7 5.0 1.3 3.8 5.8 2.1 4.7 6.5 1.8 5.5 7.0 1.5 1.7 Specialist office visits a 1.9 2.3 0.4 1.8 2.4 0.6 2.0 2.5 0.6 1.9 2.4 0.5 0.5 Hospital days a 0.5 0.7 0.2 0.5 0.6 0.1 0.6 0.9 0.3 1.5 1.8 0.3 0.2 Emergency visits b 0.3 0.5 0.2 0.3 0.5 0.2 0.3 0.5 0.2 0.6 0.7 0.1 0.2 Home health visits b 1.2 1.7 0.5 1.3 2.5 1.2 5.1 5 -0.1 21.2 20.3 -0.9 0.2 Prescription refills b 6.4 12.6 6.2 11.6 26.1 14.6 26.2 48.5 22.3 41.1 61.8 20.8 16.4 Per capita healthcare cost attributed to obesity Generalist office visits $ 57 $ 91 $ 80 $ 67 $ 75 Specialist office visits $ 35 $ 57 $ 48 $ 59 $ 50 Hospital days $ 138 $ 71 $ 192 $ 192 $ 147 Emergency visits $ 15 $ 36 $ 28 $ 17 $ 27 Home health visits $ 14 $ 35 $ 48 $ 0 $ 26 Prescription refills $ 94 $ 216 $ 332 $ 314 $ 245 Sum of per capita cost of obesity $366 $506 $728 $650 $572 Adults with obesity 1,969,900 2,555,500 2,605,100 2,117,900 9,248,400 LTC cost of obesity Admitted to LTC due to obesity-related cause 10,147 10,147 Aggregate LTC cost of obesity ( $ million) $ 639 $ 639 Total healthcare cost of obesity ($ million) $ 721 $ 1,293 $ 1,895 $ 1,377 $ 5,925 Data sources: a Derived from the Canadian Community Health Survey (2013–2018); b Derived from the Medical Expenditure Panel Survey (2015–2020). Study sample We analyzed pooled adult sample records from the CCHS and the Medical Expenditure Panel Survey (MEPS) [ 9 ], [ 10 ]. The CCHS provides comprehensive health status and some healthcare utilization data among Canadians, while MEPS provides healthcare service use data in the U.S. Direct medical costs were estimated from CCHS data on doctor visits and hospital stays, with additional data from MEPS for emergency visits, home health visits, and prescription refills. This approach assumes that obesity’s impact on emergency visits, home health visits, and prescription refills is similar in both countries [ 11 ]. Indirect costs were primarily derived from CCHS productivity-related variables, supplemented by data from peer-reviewed journals and published reports (see Appendix Tables 1–7). Direct medical cost estimation Direct medical costs of obesity were estimated using healthcare service utilization data from CCHS (2013–2018) and MEPS (2015–2020). Adults with obesity were 1:1 matched to those with healthy weight based on propensity scores calculated from factors including age group (18–34, 35–49, 50–64, 65 and over), gender, racial background, marital status, and year of data collection [ 12 ]. Excess service use attributed to obesity was multiplied by average spending to estimate per capita medical costs (see Appendix Table 2). Long-term care (LTC) costs due to obesity were estimated using data from Yang et al., applying a 19.5% increased probability of LTC entry for women with obesity and 11.5% for men with severe obesity [ 13 ]. We estimated the number of seniors with obesity admitted to LTC facilities in Canada and calculated the total excess cost using an average of $ 63,000 CAD per capita, representing the additional cost of living in a LTC facility compared to the community [ 14 ], [ 15 ]. Table 2 Estimated productivity and income-related indirect cost of obesity # Adults Per capita excess cost of obesity ( $ ) National Estimate ( $ million) Total indirect costs of obesity $ 21,664 Higher pension costs from obesity-related disability 43,000 $ 3,150 $ 268 Lost productivity from excess mortality 45,200 $ 43,780 $ 1,979 Absenteeism $ 682 From obesity-related chronic conditions 5,335,000 $ 567 $ 463 From obesity-related injuries 2,315,000 $ 95 $ 219 Presenteeism 5,335,000 $ 1,274 $ 6,798 Reduced work force participation 130,000 $ 62,584 $ 8,152 Lower personal income associated with obesity 4,529,000 $ 1,160 $ 3,785 Total federal and provincial tax implication of obesity $5,133 Income tax revenue loss from reduced work force participation 130,000 $ 8,905 $ 1,160 Income tax revenue loss from lower earnings 4,529,000 $ 178 $ 807 Sales and corporate tax revenue loss from reduced economic activity $ 3,166 Indirect cost estimation We used data from the CCHS (2013–2018) to estimate obesity-related absenteeism and presenteeism among employed workers. Absenteeism was analyzed using Poisson regression, with economic losses calculated by multiplying additional missed workdays due to obesity by the average daily wage of Canadian employees in 2023 (stratified by age and gender). It has been suggested the true value of productivity costs to employers is significantly higher than the cost of wages [ 16 ], [ 17 ], and indirect cost of absenteeism and presenteeism include diminished team productivity, lower service or product quality due to understaffing, along with work environment–related problems [ 18 ], [ 19 ]. Therefore, we applied a mean absenteeism wage multiplier of 1.97 to reflect the true costs of productivity loss for employers [ 17 ]. Predictive variables used in the model were age group, gender, racial background, marital status, and year of data collection. Presenteeism was estimated based on CCHS (2011–2014) responses about reduced work activity due to long-term physical or mental conditions. Responses “sometimes” and “often” were used as proxies for presenteeism and converted into model parameters, with productivity loss extrapolated from the literature. “Sometimes” indicated productivity reductions of 5%, 10%, and 15%; “often” indicated reductions of 15%, 23%, and 30% for a low, medium, and high range. A multivariate generalized logit model analyzed the impact of presenteeism for employees with obesity versus healthy weight. The cost was calculated by multiplying additional presenteeism days by the average wage of Canadian employees, stratified by age group and gender [ 20 ], with a wage multiplier of 1.54 to reflect true productivity loss [ 17 ]. Excess benefit payments for obesity-related disability were estimated by comparing CCHS records of adults with obesity to a matched healthy weight cohort. Our analysis found that 45% of adults with obesity and disability did not work in the prior 12 months, and 6% did not work in the prior week. Assuming these individuals received Canada Pension Plan (CPP) disability benefits, with an average monthly payment of $ 1,177 ( $ 583 post-retirement) [ 21 ], we calculated the additional disability pension cost as the total period unable to work due to obesity-related disability multiplied by the CPP payment. Premature mortality costs were estimated by applying population attributable fractions (PAFs) (Appendix Table 3) for leading causes of death to Canada's mortality data (by age group and gender) to estimate deaths attributed to obesity. We then calculated how many individuals who died prematurely in the past decade would have been in the workforce in 2023, based on labor force participation rates by demographic, and their expected earnings (Appendix Table 4). Table 3 Summary of direct and indirect costs of inaction in obesity Estimated cost Estimated cost (lower limit) Estimated cost (upper limit) Direct medical cost, $ billion $ 5.9 $ 3.7 $ 8.9 Person level estimate (office visit, inpatient, emergency department, Rx, home health), $ million $ 5,286 $ 3,132 $ 8,230 Long term care facility, $ million $ 639 $ 580 $ 699 Pension and productivity related cost, $ billion $21.7 $17.5 $26.1 Higher pension cost due to obesity-related disability, $ million $ 268 $ 233 $ 304 Lost productivity due to excess mortality, $ million $ 1,979 $ 1,951 $ 2,023 Absenteeism, $ million $ 682 $ 570 $ 809 Due to obesity-related chronic conditions, $ million $ 463 $ 392 $ 549 Due to obesity-related injuries, $ million $ 219 $ 178 $ 260 Presenteeism, $ million $ 6,798 $ 4,085 $ 9,804 Less income due to reduced work force participation, $ million $ 8,152 $ 7,948 $ 8,355 Less personal income associated with obesity, $ million $ 3,785 $ 2,663 $ 4,826 Grand total (direct + indirect cost), $ billion $27.6 $21.2 $35.1 Additional Files Additional file 1 (.txt) Income impacts were modeled using CCHS data (2013–2018) on self-reported annual income, categorized into six groups - no income, less than $ 20,000, $ 20,000 to $ 39,999, $ 40,000 to $ 59,999, $ 60,000 to $ 79,999, and $ 80,000 or more. For modelling, we used the medians within each income category ( $ 0, $ 10,000, $ 30,000, $ 50,000, $ 70,000) and $ 90,000 for the top category as proxies in the multivariate generalized regression model. We analyzed the impact of obesity on individual income among men and women, as well as tax implications (federal and provincial), using regression and published mean effective tax rates (Appendix Tables 5 and 6). Workforce participation rates were derived from CCHS responses about employment among adults over the past year. We compared participation rates between individuals with obesity and healthy weight, estimating incremental costs from reduced participation by applying the number of individuals who would otherwise be employed and average earnings by age group and gender, and associated tax implications based on average earnings when employed [ 20 ]. Sensitivity analysis To account for uncertainty in the study sample and model inputs derived from various sources, we conducted a deterministic sensitivity analysis to test the robustness of our findings. To calculate a high and low range, we varied key input variables within their 95% confidence intervals and adjusted key assumptions to their upper and lower ranges (Appendix Table 8). Results The total cost of inaction in treatment of obesity in Canada in 2023 is estimated at $ 27.6 billion. This includes $ 5.9 billion in direct healthcare costs (Table 1 ) and nearly $ 21.7 billion in indirect costs due to increased absenteeism and presenteeism, additional disability pension payments, reduced productivity, lower workforce participation, and premature death (Table 2 ). Additionally, federal, and provincial governments could gain nearly $ 5.1 billion in additional tax revenue in the absence of obesity. Table 1 presents the breakdown of healthcare resource utilization and associated medical costs attributed to obesity. Individuals with obesity showed higher rates of medical visits compared to those with healthy weight (matched based on demographic variables). Specifically, obesity is associated with 1.7 more visits to general practitioner offices, 0.5 more visits to specialist offices, 0.2 more visits to emergency departments, 0.2 more days of hospital stays, 0.2 more home health visits, and 16.4 more prescription drug refills annually. Consequently, the incremental annual costs due to obesity were $ 75, $ 50, $ 27, $ 147, $ 23, $ 26, and $ 245 for generalist office visits, specialist office visits, emergency department services, hospital stays, home health visits, and prescription drug refills, respectively. The total incremental annual medical costs per person with obesity sum to $ 572, totaling nearly $ 5.4 billion nation-wide. Additionally, obesity-related complications are estimated to result in an additional 10,150 admissions to long-term care (LTC) facilities in 2023, costing $ 639 million. Obesity leads to reduced economic output from absenteeism, presenteeism, disability, and premature mortality, and also raises worker compensation costs [ 22 ]. We estimate a 1% higher rate of disability among adults associated with obesity, resulting in 43,000 individuals unable to work due to obesity-related causes (Table 2 ) and $ 268 million in excess pension costs. Additionally, about 45,200 annual deaths attributable to obesity result in $ 2.0 billion in lost wages (Table 2 ). Obesity disproportionately impacts women's workforce participation. Women with obesity are 5.3% less likely to be employed than women with healthy weight, while for men obesity reduces the likelihood of employment by 0.3%. Applying these percentages to the workforce in 2023, we estimated that about 130,300 more adults (approximately 37,400 men and 92,900 women) with obesity would be employed if they were in the healthy weight category, resulting in nearly $ 8.2 billion in lost wages with $ 1.2 billion less in associated federal and provincial income taxes (Table 2 ). Additionally, women with obesity earned, on average, $ 1,160 (4%) less annually than women with healthy-weight, resulting in nearly $ 3.8 billion in lost income and $ 807 million less in tax revenues nationally. Obesity appears to have no impact on earnings for men. Furthermore, after adjusting for age, race, and marital status, we found that among female employees, those with obesity are 2.2% more likely to report missing workdays due to chronic conditions and 0.8% more likely to report missing workdays due to workplace injuries compared to their healthy-weight peers. In contrast, among male employees, obesity is associated with a 0.4% and 0.2% higher likelihood of missing workdays due to chronic conditions and injuries, respectively, compared to their healthy-weight peers. Obesity-related presenteeism was estimated based on the CCHS (2011–2014) question of whether a long-term physical condition or mental condition or health problem reduce the amount or the kind of activity of the person. Three answer options to the question are “sometimes”, “often” and “never” and we used sum of the first two answers as the proxy to indicate implication of presenteeism." Among female employees, obesity is associated with a 8.4% increase in people responding "sometimes" and 3.6% increase in people responding "often" compared to responses for women with healthy-weight. Among male employees, obesity is associated with a 4.3% increase in responding "sometimes" and a 2.3% increase in responding “often". We estimated the total cost of absenteeism due to obesity at $ 682 million and presenteeism at nearly $ 6.8 billion (Table 2 ). The federal and provincial governments reported nearly $ 202.8 billion in consumption/sales tax revenues and $ 116.8 billion in business tax revenues in 2022 [ 23 ]. Since our estimated total indirect cost of obesity is about 1.0% of Canada’s $ 2.2 trillion gross domestic product (GDP), we assume that sales and business activities would also be about 1.0% higher in the absence of obesity. This would result in approximately $ 2.0 billion more in consumption/sales tax revenues and $ 1.2 billion more in business tax revenues (Appendix Table 7). Combining this with the lost income tax revenue due to premature death, reduced labor force participation, and lower individual income, we estimate that obesity resulted in $ 5.1 billion in lost income, sales, and business tax revenues. Our sensitivity analysis suggests that the estimated total attributable cost of not treating obesity ranges from $ 21.2 billion to $ 35.1 billion, depending on variations in key model input variables (Table 3 ). The range for direct medical costs is $ 3.7 billion to $ 8.9 billion, and the range for productivity-related indirect costs is $ 17.5 billion to $ 26.1 billion. Discussion Our $ 27.6 billion estimate, including $ 5.9 billion in higher healthcare costs and $ 21.7 billion in reduced productivity, reveals a substantial economic burden of obesity in Canada, underscoring the critical need for effective chronic disease management and treatment strategies to address existing obesity. Our estimates align with other economic models of obesity disease in Canada. For instance, Kotsopolous et al. estimated the fiscal burden of obesity in Canada at $ 23 billion 2021 CAD ( $ 25.3 billion in 2023 $ ), with close to $ 8.0 billion in healthcare costs [ 8 ]. Another study from 2015 reported $ 23.3 billion ( $ 27.7 billion in 2023 $ ) in annual obesity-related costs [ 24 ]. These estimates align with the base case presented here, and fall within sensitivity analyses ranges, with differences reflecting the use of more recent data and multiple input sources in the current model. While the total economic costs are similar, there are differences in the value of the components of total cost. Given the strong link between obesity and related conditions like type 2 diabetes, the direct and indirect costs associated with obesity also highlight the economic burden of various comorbidities. This underscores the need for comprehensive prevention and management strategies that address both obesity and its related conditions. Study findings indicate that obesity affects women more significantly than men in terms of higher rates of absenteeism and presenteeism, lower workforce participation, and reduced income levels compared to their healthy-weight peers. These findings are consistent with published studies that obesity decreases the probability of employment and wages more for women than for men. For example, it was shown among young American workers women with obesity have longer unemployment duration than men [ 25 ]. Another study reported obesity class 2 and 3 increased the probability of taking an early retirement by 1.5% for men and by 2.5% for women among workers nearing retirement [ 26 ]. It was also reports that absenteeism rates are almost three times higher among women with obesity than their male counterparts, and the weight status of male workers is not associated with absenteeism [ 27 ]. These obesity-related gender disparities exacerbate other economic disparities such as increased hiring discrimination, pay gaps, higher healthcare costs, and limited access to professional development. The economic implications of obesity extend to government revenues, with an estimated $ 5.1 billion lost in income, sales, and business tax revenues. These estimates might be conservative, as they do not fully account for the economic multiplier effect. In addition, the $ 5.9 billion in higher healthcare costs, largely paid by public ministries of health, highlights the significant cost of obesity to government budgets. We calculated the cost of obesity-related mortality based on the demographics of people who died in the prior decade who likely would have been in the workforce in 2023 (45,200 adults), with a total cost valued at $ 2.0 billion based on expected earnings (average $ 43,780). The recommendation for valuing a statistical life for Canadian government studies is $ 6.5 million in 2007 $ ( $ 8.5 million in 2023 $ ) [ 28 ]. Applying this $ 8.5 million number to the estimated 39,200 adults with obesity-attributed deaths in 2023 would value their deaths at $ 333 billion. Our study has several limitations. While we utilized Canadian-based data where available, some estimates were derived from U.S. or other countries (e.g., comorbidity risk ratios, LTC utilization, and wage multipliers for absenteeism and presenteeism). The CCHS income data were grouped and converted to median income for modeling, possibly underestimating the economic impact of obesity. The percentage decrease in earnings due to obesity in our study is about half of what other countries report [ 29 ], [ 30 ]. Additionally, the CCHS did not ask explicitly about obesity's impact on work limitations, which may affect the accuracy of presenteeism cost estimates. We calculated national outcomes, but future research might use provincial data to capture regional variations and provide more targeted insights. We also did not include cost implications for children, suggesting actual economic costs are likely higher. Moreover, we lacked data on employer-provided services like short- or long-term disability benefits, likely exceeding our CPP-based estimates. Finally, we did not quantify humanistic costs, such as emotional well-being and family impacts, which are crucial for a holistic prevention and treatment strategy. Conclusion This study provides a comprehensive and updated estimate of the economic burden of obesity in Canada. In 2023, the total cost of inaction in the treatment of obesity among adults in Canada is estimated to be $ 27.6 billion, including $ 5.9 billion in higher healthcare costs and $ 21.7 billion in reduced productivity. These findings underscore the urgent need for effective public health strategies to manage obesity effectively, which could yield substantial economic benefits alongside improved health outcomes. Abbreviations BMI Body Mass Index CCHS Canadian Community Health Survey MEPS Medical Expenditure Panel Survey LTC Long Term Care CPP Canadian Pension Plan PAF Population Attributable Fractions GDP Gross Domestic Product Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials Data available at: https://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&Id=1531795 Competing interests None to declare Funding GlobalData Healthcare received funding from Eli Lilly Canada Inc. to conduct this study Authors' contributions FC designed the study, acquired, analysed, and interpreted the data, and drafted the manuscript. TS led the literature review, acquired, analysed and interpreted the data, and drafted the manuscript. ZN contributed to the literature review and drafting of the manuscript. TMD conceived and designed the study, drafted, and revised the manuscript. IP and SS critically revised the manuscript for important intellectual content. Acknowledgements Not applicable References Canada S. Health characteristics, annual estimates. Accessed: Apr. 19, 2024. [Online]. Available: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601 Wharton S et al. Aug., Obesity in adults: a clinical practice guideline, Can. Med. Assoc. J. , vol. 192, no. 31, p. E875, 2020, 10.1503/cmaj.191707 Public Health Agency of Canada. Obesity in Canada – Health and economic implications. Accessed: Jul. 11, 2024. [Online]. Available: https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesity-canada/health-economic-implications.html Canada S. Overweight and obese adults, 2018, Jun. 2019. Accessed: Jul. 29, 2024. [Online]. Available: https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00005-eng.htm Zhao X, et al. Obesity increases the severity and mortality of influenza and COVID-19: a systematic review and meta-analysis. Front Endocrinol. Dec. 2020;11:595109. 10.3389/fendo.2020.595109 . Sanchez Bustillos A, Vargas KG, Gomero-Cuadra R. Work productivity among adults with varied body mass index: results from a Canadian population-based survey. J Epidemiol Glob Health. 2014;5(2):191. 10.1016/j.jegh.2014.08.001 . Tran BX, Nair AV, Kuhle S, Ohinmaa A, Veugelers PJ. Cost analyses of obesity in Canada: scope, quality, and implications. Cost Eff Resour Alloc. 2013;11(1). 10.1186/1478-7547-11-3 . Kotsopoulos N, Connolly MP. Assessing the fiscal burden of obesity in Canada by applying a public economic framework. Adv Ther. Jan. 2024;41(1):379–90. 10.1007/s12325-023-02718-4 . Canada S. Canadian Community Health Survey - Annual Component (CCHS). Accessed: Apr. 19, 2024. [Online]. Available: https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=3226 Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey. 2023. Accessed: Apr. 19, 2024. [Online]. Available: https://meps.ahrq.gov/mepsweb/ Pylypchuk Y, Sarpong EM. Comparison of health care utilization: United States versus Canada, Health Serv. Res. , vol. 48, no. 2 Pt 1, pp. 560–581, Apr. 2013, 10.1111/j.1475-6773.2012.01466.x Ho D, Imai K, King G, Stuart EA. Nonparametric preprocessing for parametric causal inference, J. Stat. Softw. , vol. 42, no. 8, pp. 1–28, Jun. 2011, 10.18637/jss.v042.i08 Yang Z, Zhang N. The burden of overweight and obesity on long-term care and Medicaid financing, Med. Care , vol. 52, no. 7, pp. 658–663, Jul. 2014, 10.1097/MLR.0000000000000154 Guliani H, Hadjistavropoulos T, Jin S, Lix LM. Pain-related health care costs for long-term care residents. BMC Geriatr. Oct. 2021;21(1):552. 10.1186/s12877-021-02424-2 . Adamovic M. Summary of cost of living in Canada, Numbeo cost of living database. Accessed: Mar. 15, 2024. [Online]. Available: https://www.numbeo.com/cost-of-living/country_result.jsp?country=Canada Zhang W, Sun H, Woodcock S, Anis A. Illness related wage and productivity losses: Valuing ‘presenteeism,’ Soc. Sci. Med. 1982, vol. 147, pp. 62–71, Dec. 2015, 10.1016/j.socscimed.2015.10.056 Strömberg C, Aboagye E, Hagberg J, Bergström G, Lohela-Karlsson M. Estimating the effect and economic impact of absenteeism, presenteeism, and work environment-related problems on reductions in productivity from a managerial perspective. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2017;20(8):1058–64. 10.1016/j.jval.2017.05.008 . Nicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML. Measuring the effects of work loss on productivity with team production, Health Econ. , vol. 15, no. 2, pp. 111–123, Feb. 2006, 10.1002/hec.1052 Lohela-Karlsson M, Hagberg J, Bergström G. Production loss among employees perceiving work environment problems. Int Arch Occup Environ Health. Aug. 2015;88(6):769–77. 10.1007/s00420-014-1003-0 . Canada S. Income of individuals by age group, sex and income source, Canada, provinces and selected census metropolitan areas. Accessed: Apr. 19, 2024. [Online]. Available: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1110023901 Employment, Canada SD. Canada Pension Plan disability benefits: How much you could receive. Accessed: Mar. 13, 2024. [Online]. Available: https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit/benefit-amount.html Goettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open. Oct. 2017;7(10):e014632. 10.1136/bmjopen-2016-014632 . Organisation for Economic and Co-operation and, Development. Details of Tax Revenue - Canada. Accessed: Apr. 22, 2024. [Online]. Available: https://stats.oecd.org/Index.aspx?DataSetCode=REVCAN Krueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health Rev Can Sante Publique. Apr. 2015;106(4):e171–177. 10.17269/cjph.106.4994 . Groves J, Wilcox V. The impact of overweight and obesity on unemployment duration among young American workers. Econ Hum Biol. Dec. 2023;51:101280. 10.1016/j.ehb.2023.101280 . Renna F, Thakur N. Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults, Soc. Sci. Med. , vol. 71, no. 2, pp. 405–413, Jul. 2010, 10.1016/j.socscimed.2010.03.038 Keramat SA, Alam K, Gow J, Biddle SJH. Gender differences in the longitudinal association between obesity, and disability with workplace absenteeism in the Australian working population. PLoS ONE. May 2020;15(5):e0233512. 10.1371/journal.pone.0233512 . Chestnut L, De Civita P. Economic valuation of mortality risk reduction: review and recommendations for policy and regulatory analysis / [by] Lauraine G. Chestnut, Paul De Civita. : PH4-51/2009E-PDF - Government of Canada Publications - Canada.ca, Jul. 2002. Accessed: May 30, 2024. [Online]. Available: https://publications.gc.ca/site/eng/346309/publication.html Lee H, Ahn R, Kim TH, Han E. Impact of obesity on employment and wages among young adults: observational study with panel data. Int J Environ Res Public Health. Jan. 2019;16(1):139. 10.3390/ijerph16010139 . DeBeaumont R, Girtz R. The mediation effect of self-esteem on weight and earnings, Atl. Econ. J. , vol. 47, no. 4, pp. 415–427, Dec. 2019, 10.1007/s11293-019-09648-z Additional Declarations No competing interests reported. Supplementary Files ObesityCanadaappendix.docx Cite Share Download PDF Status: Published Journal Publication published 04 Mar, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 01 Oct, 2024 Reviews received at journal 20 Sep, 2024 Reviews received at journal 15 Sep, 2024 Reviews received at journal 28 Aug, 2024 Reviewers agreed at journal 26 Aug, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviewers agreed at journal 20 Aug, 2024 Reviewers invited by journal 20 Aug, 2024 Editor invited by journal 19 Aug, 2024 Editor assigned by journal 15 Aug, 2024 Submission checks completed at journal 15 Aug, 2024 First submitted to journal 15 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Obesity is defined as a progressive, relapsing, complex chronic disease characterized by abnormal or excessive adipose tissue that negatively impacts health [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This definition emphasizes that obesity is not merely about an individual's size or weight. Nevertheless, most prevalence data, including the CCHS, rely on body mass index (BMI) classification, reflecting a gap between evolving definitions and current research practices.\u003c/p\u003e \u003cp\u003eObesity is a significant risk factor for many chronic illnesses including type 2 diabetes, cardiovascular disease, respiratory disease, osteoarthritis, cancer and certain mental health conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to Statistics Canada, 13.4% of obese Canadians had type 2 diabetes, compared to 2.9% of Canadians with a normal weight [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The increase in the prevalence of obesity has led to the concomitant increase in the prevalence of type 2 diabetes further straining the healthcare system. Furthermore, due to its role in chronic inflammation and metabolic dysregulation, obesity can exacerbate the negative health outcomes and durations of acute illnesses such as a COVID-19 and influenza [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObesity\u0026rsquo;s impact on population morbidity and mortality suggests that it plays a notable role in economic health and productivity. An increase in obesity-related complications can lead to more absenteeism and presenteeism in the workplace [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, a higher risk of disability and early retirement from the workforce suggests that obesity can exact a long-term economic toll on workers and employers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHigher use of healthcare resources incurs a direct cost for treatment on public payers and employers. One study estimated a fiscal burden of \u003cspan\u003e$\u003c/span\u003e23.0\u0026nbsp;billion on Canada\u0026rsquo;s economy in 2021 due to depressed employment and loss of direct tax revenues [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These factors, when paired with direct healthcare costs, were estimated to cost Canadians \u003cspan\u003e$\u003c/span\u003e752 per capita in taxes. The economic, social, and health costs of Canada\u0026rsquo;s growing obesity epidemic present a strong, multi-faceted incentive for its expanded treatment.\u003c/p\u003e \u003cp\u003eThis study provides updated estimates of the cost of inaction in treatment of obesity from a societal perspective and quantifies the components of this cost. Such information helps to underscore the importance of obesity prevention and treatment.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eOverall model structure\u003c/h2\u003e \u003cp\u003eThe model combined person-level survey data analysis and information from published studies to estimate the 2023 economic burden of obesity, covering direct medical costs and indirect costs related to productivity loss (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The model compares adults with obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30) to those with a healthy weight (25\u0026thinsp;\u0026gt;\u0026thinsp;BMI\u0026thinsp;\u0026ge;\u0026thinsp;18.5) across various economic outcomes, including absenteeism (missed work due to illness), presenteeism (reduced productivity while at work due to illness), disability pension, mortality-related costs, reduced workforce participation, and lower earnings. Canadian-based data are used where available, supplemented by United States references. All economic inputs and outcomes are standardized to 2023 CAD\u003cspan\u003e$\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnnual healthcare resource utilization and direct medical cost of obesity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"13\" nameend=\"c14\" namest=\"c2\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e18\u0026ndash;34\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e35\u0026ndash;49\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e50\u0026ndash;64\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e65 and above\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy Weight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObesity Impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealthy Weight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eObesity Impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealthy Weight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eObesity Impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHealthy Weight\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eObesity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eObesity Impact\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003eObesity Impact\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePer capita healthcare utilization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralist office visits \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist office visits \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital days \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency visits \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome health visits \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescription refills \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e41.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c12\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePer capita healthcare cost attributed to obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralist office visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialist office visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmergency visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome health visits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescription refills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSum of per capita cost of obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$366\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$506\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e$728\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e$650\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cb\u003e$572\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdults with obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,969,900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2,555,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2,605,100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e2,117,900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e9,248,400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLTC cost of obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmitted to LTC due to obesity-related cause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e10,147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e10,147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAggregate LTC cost of obesity (\u003cspan\u003e$\u003c/span\u003e million)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal healthcare cost of obesity ($ million)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5,925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"14\"\u003eData sources: \u003csup\u003ea\u003c/sup\u003e Derived from the Canadian Community Health Survey (2013\u0026ndash;2018); \u003csup\u003eb\u003c/sup\u003e Derived from the Medical Expenditure Panel Survey (2015\u0026ndash;2020).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy sample\u003c/h2\u003e \u003cp\u003eWe analyzed pooled adult sample records from the CCHS and the Medical Expenditure Panel Survey (MEPS) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The CCHS provides comprehensive health status and some healthcare utilization data among Canadians, while MEPS provides healthcare service use data in the U.S. Direct medical costs were estimated from CCHS data on doctor visits and hospital stays, with additional data from MEPS for emergency visits, home health visits, and prescription refills. This approach assumes that obesity\u0026rsquo;s impact on emergency visits, home health visits, and prescription refills is similar in both countries [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Indirect costs were primarily derived from CCHS productivity-related variables, supplemented by data from peer-reviewed journals and published reports (see Appendix Tables\u0026nbsp;1\u0026ndash;7).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDirect medical cost estimation\u003c/h2\u003e \u003cp\u003e Direct medical costs of obesity were estimated using healthcare service utilization data from CCHS (2013\u0026ndash;2018) and MEPS (2015\u0026ndash;2020). Adults with obesity were 1:1 matched to those with healthy weight based on propensity scores calculated from factors including age group (18\u0026ndash;34, 35\u0026ndash;49, 50\u0026ndash;64, 65 and over), gender, racial background, marital status, and year of data collection [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Excess service use attributed to obesity was multiplied by average spending to estimate per capita medical costs (see Appendix Table\u0026nbsp;2). Long-term care (LTC) costs due to obesity were estimated using data from Yang et al., applying a 19.5% increased probability of LTC entry for women with obesity and 11.5% for men with severe obesity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. We estimated the number of seniors with obesity admitted to LTC facilities in Canada and calculated the total excess cost using an average of \u003cspan\u003e$\u003c/span\u003e63,000 CAD per capita, representing the additional cost of living in a LTC facility compared to the community [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEstimated productivity and income-related indirect cost of obesity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e# Adults\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePer capita excess cost of obesity (\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNational Estimate (\u003cspan\u003e$\u003c/span\u003e million)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal indirect costs of obesity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e21,664\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher pension costs from obesity-related disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost productivity from excess mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45,200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e43,780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e682\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom obesity-related chronic conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,335,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrom obesity-related injuries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,315,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresenteeism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,335,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e6,798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced work force participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e62,584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8,152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower personal income associated with obesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,529,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal federal and provincial tax implication of obesity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$5,133\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome tax revenue loss from reduced work force participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e130,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8,905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome tax revenue loss from lower earnings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4,529,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSales and corporate tax revenue loss from reduced economic activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eIndirect cost estimation\u003c/h2\u003e \u003cp\u003eWe used data from the CCHS (2013\u0026ndash;2018) to estimate obesity-related absenteeism and presenteeism among employed workers. Absenteeism was analyzed using Poisson regression, with economic losses calculated by multiplying additional missed workdays due to obesity by the average daily wage of Canadian employees in 2023 (stratified by age and gender). It has been suggested the true value of productivity costs to employers is significantly higher than the cost of wages [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and indirect cost of absenteeism and presenteeism include diminished team productivity, lower service or product quality due to understaffing, along with work environment\u0026ndash;related problems [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, we applied a mean absenteeism wage multiplier of 1.97 to reflect the true costs of productivity loss for employers [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Predictive variables used in the model were age group, gender, racial background, marital status, and year of data collection.\u003c/p\u003e \u003cp\u003ePresenteeism was estimated based on CCHS (2011\u0026ndash;2014) responses about reduced work activity due to long-term physical or mental conditions. Responses \u0026ldquo;sometimes\u0026rdquo; and \u0026ldquo;often\u0026rdquo; were used as proxies for presenteeism and converted into model parameters, with productivity loss extrapolated from the literature. \u0026ldquo;Sometimes\u0026rdquo; indicated productivity reductions of 5%, 10%, and 15%; \u0026ldquo;often\u0026rdquo; indicated reductions of 15%, 23%, and 30% for a low, medium, and high range. A multivariate generalized logit model analyzed the impact of presenteeism for employees with obesity versus healthy weight. The cost was calculated by multiplying additional presenteeism days by the average wage of Canadian employees, stratified by age group and gender [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], with a wage multiplier of 1.54 to reflect true productivity loss [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExcess benefit payments for obesity-related disability were estimated by comparing CCHS records of adults with obesity to a matched healthy weight cohort. Our analysis found that 45% of adults with obesity and disability did not work in the prior 12 months, and 6% did not work in the prior week. Assuming these individuals received Canada Pension Plan (CPP) disability benefits, with an average monthly payment of \u003cspan\u003e$\u003c/span\u003e1,177 (\u003cspan\u003e$\u003c/span\u003e583 post-retirement) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], we calculated the additional disability pension cost as the total period unable to work due to obesity-related disability multiplied by the CPP payment.\u003c/p\u003e \u003cp\u003ePremature mortality costs were estimated by applying population attributable fractions (PAFs) (Appendix Table\u0026nbsp;3) for leading causes of death to Canada's mortality data (by age group and gender) to estimate deaths attributed to obesity. We then calculated how many individuals who died prematurely in the past decade would have been in the workforce in 2023, based on labor force participation rates by demographic, and their expected earnings (Appendix Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of direct and indirect costs of inaction in obesity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimated cost\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEstimated cost (lower limit)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEstimated cost (upper limit)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect medical cost, \u003cspan\u003e$\u003c/span\u003e billion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5.9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3.7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8.9\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerson level estimate (office visit, inpatient, emergency department, Rx, home health), \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5,286\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8,230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLong term care facility, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePension and productivity related cost, $ billion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e$21.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e$17.5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$26.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher pension cost due to obesity-related disability, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLost productivity due to excess mortality, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e2,023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsenteeism, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDue to obesity-related chronic conditions, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDue to obesity-related injuries, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e260\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresenteeism, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e6,798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e4,085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e9,804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess income due to reduced work force participation, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8,152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e7,948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e8,355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess personal income associated with obesity, \u003cspan\u003e$\u003c/span\u003e million\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e2,663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e4,826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrand total (direct\u0026thinsp;+\u0026thinsp;indirect cost), $ billion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e$27.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e$21.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$35.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eAdditional Files\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAdditional file 1 (.txt)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIncome impacts were modeled using CCHS data (2013\u0026ndash;2018) on self-reported annual income, categorized into six groups - no income, less than \u003cspan\u003e$\u003c/span\u003e20,000, \u003cspan\u003e$\u003c/span\u003e20,000 to \u003cspan\u003e$\u003c/span\u003e39,999, \u003cspan\u003e$\u003c/span\u003e40,000 to \u003cspan\u003e$\u003c/span\u003e59,999, \u003cspan\u003e$\u003c/span\u003e60,000 to \u003cspan\u003e$\u003c/span\u003e79,999, and \u003cspan\u003e$\u003c/span\u003e80,000 or more. For modelling, we used the medians within each income category (\u003cspan\u003e$\u003c/span\u003e0, \u003cspan\u003e$\u003c/span\u003e10,000, \u003cspan\u003e$\u003c/span\u003e30,000, \u003cspan\u003e$\u003c/span\u003e50,000, \u003cspan\u003e$\u003c/span\u003e70,000) and \u003cspan\u003e$\u003c/span\u003e90,000 for the top category as proxies in the multivariate generalized regression model. We analyzed the impact of obesity on individual income among men and women, as well as tax implications (federal and provincial), using regression and published mean effective tax rates (Appendix Tables\u0026nbsp;5 and 6).\u003c/p\u003e \u003cp\u003eWorkforce participation rates were derived from CCHS responses about employment among adults over the past year. We compared participation rates between individuals with obesity and healthy weight, estimating incremental costs from reduced participation by applying the number of individuals who would otherwise be employed and average earnings by age group and gender, and associated tax implications based on average earnings when employed [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSensitivity analysis\u003c/h2\u003e \u003cp\u003eTo account for uncertainty in the study sample and model inputs derived from various sources, we conducted a deterministic sensitivity analysis to test the robustness of our findings. To calculate a high and low range, we varied key input variables within their 95% confidence intervals and adjusted key assumptions to their upper and lower ranges (Appendix Table\u0026nbsp;8).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe total cost of inaction in treatment of obesity in Canada in 2023 is estimated at \u003cspan\u003e$\u003c/span\u003e27.6\u0026nbsp;billion. This includes \u003cspan\u003e$\u003c/span\u003e5.9\u0026nbsp;billion in direct healthcare costs (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and nearly \u003cspan\u003e$\u003c/span\u003e21.7\u0026nbsp;billion in indirect costs due to increased absenteeism and presenteeism, additional disability pension payments, reduced productivity, lower workforce participation, and premature death (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, federal, and provincial governments could gain nearly \u003cspan\u003e$\u003c/span\u003e5.1\u0026nbsp;billion in additional tax revenue in the absence of obesity.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the breakdown of healthcare resource utilization and associated medical costs attributed to obesity. Individuals with obesity showed higher rates of medical visits compared to those with healthy weight (matched based on demographic variables). Specifically, obesity is associated with 1.7 more visits to general practitioner offices, 0.5 more visits to specialist offices, 0.2 more visits to emergency departments, 0.2 more days of hospital stays, 0.2 more home health visits, and 16.4 more prescription drug refills annually. Consequently, the incremental annual costs due to obesity were \u003cspan\u003e$\u003c/span\u003e75, \u003cspan\u003e$\u003c/span\u003e50, \u003cspan\u003e$\u003c/span\u003e27, \u003cspan\u003e$\u003c/span\u003e147, \u003cspan\u003e$\u003c/span\u003e23, \u003cspan\u003e$\u003c/span\u003e26, and \u003cspan\u003e$\u003c/span\u003e245 for generalist office visits, specialist office visits, emergency department services, hospital stays, home health visits, and prescription drug refills, respectively. The total incremental annual medical costs per person with obesity sum to \u003cspan\u003e$\u003c/span\u003e572, totaling nearly \u003cspan\u003e$\u003c/span\u003e5.4\u0026nbsp;billion nation-wide. Additionally, obesity-related complications are estimated to result in an additional 10,150 admissions to long-term care (LTC) facilities in 2023, costing \u003cspan\u003e$\u003c/span\u003e639\u0026nbsp;million.\u003c/p\u003e \u003cp\u003eObesity leads to reduced economic output from absenteeism, presenteeism, disability, and premature mortality, and also raises worker compensation costs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We estimate a 1% higher rate of disability among adults associated with obesity, resulting in 43,000 individuals unable to work due to obesity-related causes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and \u003cspan\u003e$\u003c/span\u003e268\u0026nbsp;million in excess pension costs. Additionally, about 45,200 annual deaths attributable to obesity result in \u003cspan\u003e$\u003c/span\u003e2.0\u0026nbsp;billion in lost wages (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eObesity disproportionately impacts women's workforce participation. Women with obesity are 5.3% less likely to be employed than women with healthy weight, while for men obesity reduces the likelihood of employment by 0.3%. Applying these percentages to the workforce in 2023, we estimated that about 130,300 more adults (approximately 37,400 men and 92,900 women) with obesity would be employed if they were in the healthy weight category, resulting in nearly \u003cspan\u003e$\u003c/span\u003e8.2\u0026nbsp;billion in lost wages with \u003cspan\u003e$\u003c/span\u003e1.2\u0026nbsp;billion less in associated federal and provincial income taxes (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, women with obesity earned, on average, \u003cspan\u003e$\u003c/span\u003e1,160 (4%) less annually than women with healthy-weight, resulting in nearly \u003cspan\u003e$\u003c/span\u003e3.8\u0026nbsp;billion in lost income and \u003cspan\u003e$\u003c/span\u003e807\u0026nbsp;million less in tax revenues nationally. Obesity appears to have no impact on earnings for men.\u003c/p\u003e \u003cp\u003eFurthermore, after adjusting for age, race, and marital status, we found that among female employees, those with obesity are 2.2% more likely to report missing workdays due to chronic conditions and 0.8% more likely to report missing workdays due to workplace injuries compared to their healthy-weight peers. In contrast, among male employees, obesity is associated with a 0.4% and 0.2% higher likelihood of missing workdays due to chronic conditions and injuries, respectively, compared to their healthy-weight peers.\u003c/p\u003e \u003cp\u003eObesity-related presenteeism was estimated based on the CCHS (2011\u0026ndash;2014) question of whether a long-term physical condition or mental condition or health problem reduce the amount or the kind of activity of the person. Three answer options to the question are \u0026ldquo;sometimes\u0026rdquo;, \u0026ldquo;often\u0026rdquo; and \u0026ldquo;never\u0026rdquo; and we used sum of the first two answers as the proxy to indicate implication of presenteeism.\" Among female employees, obesity is associated with a 8.4% increase in people responding \"sometimes\" and 3.6% increase in people responding \"often\" compared to responses for women with healthy-weight. Among male employees, obesity is associated with a 4.3% increase in responding \"sometimes\" and a 2.3% increase in responding \u0026ldquo;often\". We estimated the total cost of absenteeism due to obesity at \u003cspan\u003e$\u003c/span\u003e682\u0026nbsp;million and presenteeism at nearly \u003cspan\u003e$\u003c/span\u003e6.8\u0026nbsp;billion (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe federal and provincial governments reported nearly \u003cspan\u003e$\u003c/span\u003e202.8\u0026nbsp;billion in consumption/sales tax revenues and \u003cspan\u003e$\u003c/span\u003e116.8\u0026nbsp;billion in business tax revenues in 2022 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Since our estimated total indirect cost of obesity is about 1.0% of Canada\u0026rsquo;s \u003cspan\u003e$\u003c/span\u003e2.2 trillion gross domestic product (GDP), we assume that sales and business activities would also be about 1.0% higher in the absence of obesity. This would result in approximately \u003cspan\u003e$\u003c/span\u003e2.0\u0026nbsp;billion more in consumption/sales tax revenues and \u003cspan\u003e$\u003c/span\u003e1.2\u0026nbsp;billion more in business tax revenues (Appendix Table\u0026nbsp;7). Combining this with the lost income tax revenue due to premature death, reduced labor force participation, and lower individual income, we estimate that obesity resulted in \u003cspan\u003e$\u003c/span\u003e5.1\u0026nbsp;billion in lost income, sales, and business tax revenues.\u003c/p\u003e \u003cp\u003eOur sensitivity analysis suggests that the estimated total attributable cost of not treating obesity ranges from \u003cspan\u003e$\u003c/span\u003e21.2\u0026nbsp;billion to \u003cspan\u003e$\u003c/span\u003e35.1\u0026nbsp;billion, depending on variations in key model input variables (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The range for direct medical costs is \u003cspan\u003e$\u003c/span\u003e3.7\u0026nbsp;billion to \u003cspan\u003e$\u003c/span\u003e8.9\u0026nbsp;billion, and the range for productivity-related indirect costs is \u003cspan\u003e$\u003c/span\u003e17.5\u0026nbsp;billion to \u003cspan\u003e$\u003c/span\u003e26.1\u0026nbsp;billion.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur \u003cspan\u003e$\u003c/span\u003e27.6\u0026nbsp;billion estimate, including \u003cspan\u003e$\u003c/span\u003e5.9\u0026nbsp;billion in higher healthcare costs and \u003cspan\u003e$\u003c/span\u003e21.7\u0026nbsp;billion in reduced productivity, reveals a substantial economic burden of obesity in Canada, underscoring the critical need for effective chronic disease management and treatment strategies to address existing obesity. Our estimates align with other economic models of obesity disease in Canada. For instance, Kotsopolous et al. estimated the fiscal burden of obesity in Canada at \u003cspan\u003e$\u003c/span\u003e23\u0026nbsp;billion 2021 CAD (\u003cspan\u003e$\u003c/span\u003e25.3\u0026nbsp;billion in 2023\u003cspan\u003e$\u003c/span\u003e), with close to \u003cspan\u003e$\u003c/span\u003e8.0\u0026nbsp;billion in healthcare costs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study from 2015 reported \u003cspan\u003e$\u003c/span\u003e23.3\u0026nbsp;billion (\u003cspan\u003e$\u003c/span\u003e27.7\u0026nbsp;billion in 2023\u003cspan\u003e$\u003c/span\u003e) in annual obesity-related costs [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These estimates align with the base case presented here, and fall within sensitivity analyses ranges, with differences reflecting the use of more recent data and multiple input sources in the current model. While the total economic costs are similar, there are differences in the value of the components of total cost. Given the strong link between obesity and related conditions like type 2 diabetes, the direct and indirect costs associated with obesity also highlight the economic burden of various comorbidities. This underscores the need for comprehensive prevention and management strategies that address both obesity and its related conditions.\u003c/p\u003e \u003cp\u003eStudy findings indicate that obesity affects women more significantly than men in terms of higher rates of absenteeism and presenteeism, lower workforce participation, and reduced income levels compared to their healthy-weight peers. These findings are consistent with published studies that obesity decreases the probability of employment and wages more for women than for men. For example, it was shown among young American workers women with obesity have longer unemployment duration than men [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Another study reported obesity class 2 and 3 increased the probability of taking an early retirement by 1.5% for men and by 2.5% for women among workers nearing retirement [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. It was also reports that absenteeism rates are almost three times higher among women with obesity than their male counterparts, and the weight status of male workers is not associated with absenteeism [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These obesity-related gender disparities exacerbate other economic disparities such as increased hiring discrimination, pay gaps, higher healthcare costs, and limited access to professional development.\u003c/p\u003e \u003cp\u003eThe economic implications of obesity extend to government revenues, with an estimated \u003cspan\u003e$\u003c/span\u003e5.1\u0026nbsp;billion lost in income, sales, and business tax revenues. These estimates might be conservative, as they do not fully account for the economic multiplier effect. In addition, the \u003cspan\u003e$\u003c/span\u003e5.9\u0026nbsp;billion in higher healthcare costs, largely paid by public ministries of health, highlights the significant cost of obesity to government budgets.\u003c/p\u003e \u003cp\u003eWe calculated the cost of obesity-related mortality based on the demographics of people who died in the prior decade who likely would have been in the workforce in 2023 (45,200 adults), with a total cost valued at \u003cspan\u003e$\u003c/span\u003e2.0\u0026nbsp;billion based on expected earnings (average \u003cspan\u003e$\u003c/span\u003e43,780). The recommendation for valuing a statistical life for Canadian government studies is \u003cspan\u003e$\u003c/span\u003e6.5\u0026nbsp;million in 2007\u003cspan\u003e$\u003c/span\u003e (\u003cspan\u003e$\u003c/span\u003e8.5\u0026nbsp;million in 2023\u003cspan\u003e$\u003c/span\u003e) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Applying this \u003cspan\u003e$\u003c/span\u003e8.5\u0026nbsp;million number to the estimated 39,200 adults with obesity-attributed deaths in 2023 would value their deaths at \u003cspan\u003e$\u003c/span\u003e333\u0026nbsp;billion.\u003c/p\u003e \u003cp\u003eOur study has several limitations. While we utilized Canadian-based data where available, some estimates were derived from U.S. or other countries (e.g., comorbidity risk ratios, LTC utilization, and wage multipliers for absenteeism and presenteeism). The CCHS income data were grouped and converted to median income for modeling, possibly underestimating the economic impact of obesity. The percentage decrease in earnings due to obesity in our study is about half of what other countries report [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Additionally, the CCHS did not ask explicitly about obesity's impact on work limitations, which may affect the accuracy of presenteeism cost estimates. We calculated national outcomes, but future research might use provincial data to capture regional variations and provide more targeted insights. We also did not include cost implications for children, suggesting actual economic costs are likely higher. Moreover, we lacked data on employer-provided services like short- or long-term disability benefits, likely exceeding our CPP-based estimates. Finally, we did not quantify humanistic costs, such as emotional well-being and family impacts, which are crucial for a holistic prevention and treatment strategy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a comprehensive and updated estimate of the economic burden of obesity in Canada. In 2023, the total cost of inaction in the treatment of obesity among adults in Canada is estimated to be \u003cspan\u003e$\u003c/span\u003e27.6\u0026nbsp;billion, including \u003cspan\u003e$\u003c/span\u003e5.9\u0026nbsp;billion in higher healthcare costs and \u003cspan\u003e$\u003c/span\u003e21.7\u0026nbsp;billion in reduced productivity. These findings underscore the urgent need for effective public health strategies to manage obesity effectively, which could yield substantial economic benefits alongside improved health outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCanadian Community Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMEPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMedical Expenditure Panel Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLTC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLong Term Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCPP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCanadian Pension Plan\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePAF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePopulation Attributable Fractions\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGDP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGross Domestic Product\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData available at:\u003c/p\u003e\n\u003cp\u003ehttps://meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp\u003c/p\u003e\n\u003cp\u003ehttps://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey\u0026amp;Id=1531795\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobalData Healthcare received funding from Eli Lilly Canada Inc. to conduct this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFC designed the study, acquired, analysed, and interpreted the data, and drafted the manuscript. TS led the literature review, acquired, analysed and interpreted the data, and drafted the manuscript. ZN contributed to the literature review and drafting of the manuscript. TMD conceived and designed the study, drafted, and revised the manuscript. IP and SS critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCanada S. Health characteristics, annual estimates. Accessed: Apr. 19, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601\u003c/span\u003e\u003cspan address=\"https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310009601\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWharton S et al. Aug., Obesity in adults: a clinical practice guideline, \u003cem\u003eCan. Med. Assoc. J.\u003c/em\u003e, vol. 192, no. 31, p. E875, 2020, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1503/cmaj.191707\u003c/span\u003e\u003cspan address=\"10.1503/cmaj.191707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePublic Health Agency of Canada. Obesity in Canada \u0026ndash; Health and economic implications. Accessed: Jul. 11, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesity-canada/health-economic-implications.html\u003c/span\u003e\u003cspan address=\"https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesity-canada/health-economic-implications.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanada S. Overweight and obese adults, 2018, Jun. 2019. Accessed: Jul. 29, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00005-eng.htm\u003c/span\u003e\u003cspan address=\"https://www150.statcan.gc.ca/n1/pub/82-625-x/2019001/article/00005-eng.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao X, et al. Obesity increases the severity and mortality of influenza and COVID-19: a systematic review and meta-analysis. Front Endocrinol. Dec. 2020;11:595109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fendo.2020.595109\u003c/span\u003e\u003cspan address=\"10.3389/fendo.2020.595109\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanchez Bustillos A, Vargas KG, Gomero-Cuadra R. Work productivity among adults with varied body mass index: results from a Canadian population-based survey. J Epidemiol Glob Health. 2014;5(2):191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jegh.2014.08.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jegh.2014.08.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTran BX, Nair AV, Kuhle S, Ohinmaa A, Veugelers PJ. Cost analyses of obesity in Canada: scope, quality, and implications. Cost Eff Resour Alloc. 2013;11(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1478-7547-11-3\u003c/span\u003e\u003cspan address=\"10.1186/1478-7547-11-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotsopoulos N, Connolly MP. Assessing the fiscal burden of obesity in Canada by applying a public economic framework. Adv Ther. Jan. 2024;41(1):379\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12325-023-02718-4\u003c/span\u003e\u003cspan address=\"10.1007/s12325-023-02718-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanada S. Canadian Community Health Survey - Annual Component (CCHS). Accessed: Apr. 19, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey\u0026amp;SDDS=3226\u003c/span\u003e\u003cspan address=\"https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey\u0026amp;SDDS=3226\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgency for Healthcare Research and Quality. Medical Expenditure Panel Survey. 2023. Accessed: Apr. 19, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://meps.ahrq.gov/mepsweb/\u003c/span\u003e\u003cspan address=\"https://meps.ahrq.gov/mepsweb/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePylypchuk Y, Sarpong EM. Comparison of health care utilization: United States versus Canada, \u003cem\u003eHealth Serv. Res.\u003c/em\u003e, vol. 48, no. 2 Pt 1, pp. 560\u0026ndash;581, Apr. 2013, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1475-6773.2012.01466.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1475-6773.2012.01466.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHo D, Imai K, King G, Stuart EA. Nonparametric preprocessing for parametric causal inference, \u003cem\u003eJ. Stat. Softw.\u003c/em\u003e, vol. 42, no. 8, pp. 1\u0026ndash;28, Jun. 2011, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18637/jss.v042.i08\u003c/span\u003e\u003cspan address=\"10.18637/jss.v042.i08\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z, Zhang N. The burden of overweight and obesity on long-term care and Medicaid financing, \u003cem\u003eMed. Care\u003c/em\u003e, vol. 52, no. 7, pp. 658\u0026ndash;663, Jul. 2014, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MLR.0000000000000154\u003c/span\u003e\u003cspan address=\"10.1097/MLR.0000000000000154\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuliani H, Hadjistavropoulos T, Jin S, Lix LM. Pain-related health care costs for long-term care residents. BMC Geriatr. Oct. 2021;21(1):552. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12877-021-02424-2\u003c/span\u003e\u003cspan address=\"10.1186/s12877-021-02424-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdamovic M. Summary of cost of living in Canada, Numbeo cost of living database. Accessed: Mar. 15, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.numbeo.com/cost-of-living/country_result.jsp?country=Canada\u003c/span\u003e\u003cspan address=\"https://www.numbeo.com/cost-of-living/country_result.jsp?country=Canada\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang W, Sun H, Woodcock S, Anis A. Illness related wage and productivity losses: Valuing \u0026lsquo;presenteeism,\u0026rsquo; \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e 1982, vol. 147, pp. 62\u0026ndash;71, Dec. 2015, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2015.10.056\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2015.10.056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStr\u0026ouml;mberg C, Aboagye E, Hagberg J, Bergstr\u0026ouml;m G, Lohela-Karlsson M. Estimating the effect and economic impact of absenteeism, presenteeism, and work environment-related problems on reductions in productivity from a managerial perspective. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2017;20(8):1058\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jval.2017.05.008\u003c/span\u003e\u003cspan address=\"10.1016/j.jval.2017.05.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML. Measuring the effects of work loss on productivity with team production, \u003cem\u003eHealth Econ.\u003c/em\u003e, vol. 15, no. 2, pp. 111\u0026ndash;123, Feb. 2006, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/hec.1052\u003c/span\u003e\u003cspan address=\"10.1002/hec.1052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLohela-Karlsson M, Hagberg J, Bergstr\u0026ouml;m G. Production loss among employees perceiving work environment problems. Int Arch Occup Environ Health. Aug. 2015;88(6):769\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00420-014-1003-0\u003c/span\u003e\u003cspan address=\"10.1007/s00420-014-1003-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanada S. Income of individuals by age group, sex and income source, Canada, provinces and selected census metropolitan areas. Accessed: Apr. 19, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1110023901\u003c/span\u003e\u003cspan address=\"https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1110023901\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmployment, Canada SD. Canada Pension Plan disability benefits: How much you could receive. Accessed: Mar. 13, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit/benefit-amount.html\u003c/span\u003e\u003cspan address=\"https://www.canada.ca/en/services/benefits/publicpensions/cpp/cpp-disability-benefit/benefit-amount.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoettler A, Grosse A, Sonntag D. Productivity loss due to overweight and obesity: a systematic review of indirect costs. BMJ Open. Oct. 2017;7(10):e014632. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2016-014632\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2016-014632\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganisation for Economic and Co-operation and, Development. Details of Tax Revenue - Canada. Accessed: Apr. 22, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://stats.oecd.org/Index.aspx?DataSetCode=REVCAN\u003c/span\u003e\u003cspan address=\"https://stats.oecd.org/Index.aspx?DataSetCode=REVCAN\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health Rev Can Sante Publique. Apr. 2015;106(4):e171\u0026ndash;177. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17269/cjph.106.4994\u003c/span\u003e\u003cspan address=\"10.17269/cjph.106.4994\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroves J, Wilcox V. The impact of overweight and obesity on unemployment duration among young American workers. Econ Hum Biol. Dec. 2023;51:101280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ehb.2023.101280\u003c/span\u003e\u003cspan address=\"10.1016/j.ehb.2023.101280\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenna F, Thakur N. Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults, \u003cem\u003eSoc. Sci. Med.\u003c/em\u003e, vol. 71, no. 2, pp. 405\u0026ndash;413, Jul. 2010, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.socscimed.2010.03.038\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2010.03.038\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeramat SA, Alam K, Gow J, Biddle SJH. Gender differences in the longitudinal association between obesity, and disability with workplace absenteeism in the Australian working population. PLoS ONE. May 2020;15(5):e0233512. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0233512\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0233512\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChestnut L, De Civita P. Economic valuation of mortality risk reduction: review and recommendations for policy and regulatory analysis / [by] Lauraine G. Chestnut, Paul De Civita. : PH4-51/2009E-PDF - Government of Canada Publications - Canada.ca, Jul. 2002. Accessed: May 30, 2024. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.gc.ca/site/eng/346309/publication.html\u003c/span\u003e\u003cspan address=\"https://publications.gc.ca/site/eng/346309/publication.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Ahn R, Kim TH, Han E. Impact of obesity on employment and wages among young adults: observational study with panel data. Int J Environ Res Public Health. Jan. 2019;16(1):139. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph16010139\u003c/span\u003e\u003cspan address=\"10.3390/ijerph16010139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeBeaumont R, Girtz R. The mediation effect of self-esteem on weight and earnings, \u003cem\u003eAtl. Econ. J.\u003c/em\u003e, vol. 47, no. 4, pp. 415\u0026ndash;427, Dec. 2019, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11293-019-09648-z\u003c/span\u003e\u003cspan address=\"10.1007/s11293-019-09648-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"obesity cost, direct healthcare cost, workforce productivity cost, absenteeism, presenteeism, disability pension, mortality-related costs, lost wages","lastPublishedDoi":"10.21203/rs.3.rs-4921188/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4921188/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity prevalence continues to rise in Canada, highlighting a growing public health concern. This study updates estimates of the societal cost of inaction in treating obesity, emphasizing the significant economic burden stemming from both direct healthcare costs and indirect productivity losses.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe combined data from national surveys and published literature to estimate the 2023 national economic implications of obesity. Comparing adults with obesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30) to those with healthy weight (25\u0026thinsp;\u0026gt;\u0026thinsp;BMI\u0026thinsp;\u0026ge;\u0026thinsp;18.5), we assessed healthcare costs, absenteeism, presenteeism, disability pensions, mortality-related costs, workforce participation, and earnings. Canadian data were used where possible, supplemented by U.S. data, standardized to 2023 CAD\u003cspan\u003e$\u003c/span\u003e.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe cost of inaction in treating obesity in Canada was \u003cspan\u003e$\u003c/span\u003e27.6\u0026nbsp;billion in 2023, including \u003cspan\u003e$\u003c/span\u003e5.9\u0026nbsp;billion in direct healthcare and \u003cspan\u003e$\u003c/span\u003e21.7\u0026nbsp;billion in indirect costs. Excess healthcare costs are driven by higher utilization of medical services. Indirect costs include approximately \u003cspan\u003e$\u003c/span\u003e8.2\u0026nbsp;billion from reduced workforce participation, \u003cspan\u003e$\u003c/span\u003e6.8\u0026nbsp;billion from presenteeism, \u003cspan\u003e$\u003c/span\u003e3.8\u0026nbsp;billion in lower earnings among employed with obesity, \u003cspan\u003e$\u003c/span\u003e2.0\u0026nbsp;billion from lost wages due to premature mortality, \u003cspan\u003e$\u003c/span\u003e682\u0026nbsp;million from absenteeism, and \u003cspan\u003e$\u003c/span\u003e268\u0026nbsp;million from disability pensions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe economic implications of not addressing obesity effectively are substantial, emphasizing the urgent need for utilizing effective chronic disease management strategies. Our findings highlight the disproportionate impact on women and the broader economic consequences, underscoring the imperative for tailored policy interventions. Investing in comprehensive, evidence-based obesity management not only enhances individual well-being but also yields significant societal and economic benefits.\u003c/p\u003e","manuscriptTitle":"Modeling the Cost of Inaction in Treating Obesity in Canada","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-13 02:34:36","doi":"10.21203/rs.3.rs-4921188/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-01T15:22:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-20T12:24:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-15T23:09:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-28T11:02:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95470975909144142283156540133985003173","date":"2024-08-26T21:27:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14528174145964655001836461544022809580","date":"2024-08-20T15:45:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125613496369525376652236387110226603882","date":"2024-08-20T15:32:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-20T15:05:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-19T08:53:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-16T02:20:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-16T02:20:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-08-15T20:03:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf119164-24ad-45c1-93d6-e7276a28dadf","owner":[],"postedDate":"September 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-10T19:45:06+00:00","versionOfRecord":{"articleIdentity":"rs-4921188","link":"https://doi.org/10.1186/s12889-025-21905-2","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-03-04 15:57:59","publishedOnDateReadable":"March 4th, 2025"},"versionCreatedAt":"2024-09-13 02:34:36","video":"","vorDoi":"10.1186/s12889-025-21905-2","vorDoiUrl":"https://doi.org/10.1186/s12889-025-21905-2","workflowStages":[]},"version":"v1","identity":"rs-4921188","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4921188","identity":"rs-4921188","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}