Globally, it is widely acknowledged that obesity-related conditions and their complications add hugely to healthcare costs and productivity losses, adding a large burden to individuals, their families, and on governments, writes Micheal Boachie, a senior researcher at the University of the Witwatersrand for The Conversation, who says half of all adults in this country are either overweight or obese.
One estimate suggests that of the total health expenditure on the continent, 9% is attributed to dealing with people who are overweight and obese.
We conducted research to calculate the cost of obesity to South Africa’s health system. Our aim was to estimate the direct healthcare costs associated with the treatment of weight-related conditions based on public-sector tariffs.
Based on our calculations, overweight and obesity are costing South Africa’s health system R33bn a year. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is R2,769.
Among the most expensive conditions to manage were diabetes and cardiovascular diseases.
Our analysis shows that overweight and obesity impose a huge financial burden on the public healthcare system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.
Quantifying the financial costs of overweight and obesity also gives national policy-makers a sense of the scale of the cost to the state, those of managing their diseases, and the costs to the community.
Scale of the problem
Half of all adults in South Africa are overweight (23%) or obese (27%). And the World Obesity Federation anticipates an additional 10% increase (37%) in obesity among adults by 2030.
Overweight and obesity hugely increase the risk of non-communicable diseases. This burden contributes to the country’s high prevalence of diabetes, for example. An estimated 11% of people older than 15 had diabetes in 2021. This is much higher than Nigeria’s prevalence of 4%.
Around 12m people suffer from weight-related diseases for which they receive treatment in the public sector. These include diabetes, hypertension, cardiovascular disease, arthritis and some cancers.
This does not include the numerous undiagnosed people with diabetes and hypertension who are not on treatment. Nor does it include people being treated in the private sector.
These non-communicable diseases cause life-altering illness, disabilities and premature death.
What we found
Our research calculated the cost of obesity starting at age 15. In doing our calculations we looked at the following: cancers, cardiovascular diseases, diabetes, musculoskeletal disorders, respiratory diseases and digestive diseases.
We costed each in detail and used the prevalence of those to measure the cost to the system, taking account of healthcare use patterns.
In South Africa, the biggest share of the R33bn annual cost comes from treating diabetes (R19.86bn). Cardiovascular disease (R8.87bn) had the second biggest share. These costs are, in turn, mainly driven by the cost of medication and hospitalisation.
Diabetes and hypertension-related conditions are among South Africa’s top-10 causes of death. Digestive diseases, such as gallstones and diseases of the gallbladder, contribute the least (R395m).
Diabetes (95%) and arthritis (58%) are the diseases that are mostly caused by overweight and obesity.
Overall, 53% of total healthcare costs of managing and treating these diseases in the public sector was attributable to the overweight and obesity problem. South Africa shares this dubious distinction with other high- and middle-income countries such as Brazil, South Korea, Thailand and Colombia. Our results are similar to the World Obesity Federation’s estimate of R36bn.
We also warn that the R33bn is an underestimation of the economic cost. We used public-sector tariffs, which we calculated as 60% of private sector costs. We also excluded costs like clinical screening and the treatment of comorbidities, such as amputations as well as potential costs for the undiagnosed.
And our findings don’t include the indirect costs of productivity losses resulting from absenteeism. We also didn’t consider premature death as a result of overweight- and obesity-related diseases.
Next steps
Putting a health problem in monetary terms may create a sense of urgency to find ways to reduce future expenditure on the direct costs of healthcare, and to reduce future losses to the state from the consequences of illness and premature death, including the knock-on effects of worsening poverty as a result.
This is particularly problem in a setting such as South Africa, which already has a drastically under-resourced public-health system, shockingly high unemployment, and both under- and over-nutrition crises that are aggravated by obesogenic environments and poverty-driven food choices.
Until now, no detailed country-specific information on the economic cost of overweight and obesity in sub-Saharan Africa has existed. Based on our research, South Africa’s burden is even higher than the African or global averages: 15.38% of the overall government health budget, which equates to 0.67% of GDP.
Unless rapid steps are taken to decrease obesity and overweight, the health system will buckle under this strain, and the planned National Health Insurance scheme will not succeed in producing equity in health services.
The opportunity costs of overweight and obesity – and the diseases they often bring with them – are both personal and national. It is difficult to quantify the personal disability in monetary terms – the benefits of vastly improved quality of life are priceless.
Meanwhile, reports The Guardian, a team of researchers has found that watching videos on how to cook, eat less, and choose healthier foods, can help obese children lose weight, reduce their diabetes risk and become happier – proving, they said, that online healthcare can be just as effective as face-to-face consultations.
The team, led by Dr Felix Reschke of the children’s hospital in Hanover, Germany, studied 108 children who followed the video-based weight loss programme while the country was in its second COVID-19 lockdown in late 2020.
They found that many of the youngsters are far more fruit and vegetables and fewer sugary treat foods like sweets, snacks and soft drinks. They also reduced their number of daily meals, although they still averaged 4.1 meals, as a result of “video-based structured education”.
Overall, two-thirds lost weight and generally displayed better health.
The year-long programme consisted of the young people watching educational videos about good food choices, the amount they should be eating at mealtimes and the benefits of being physically active. Participants ranged from eight to 17 years old and their average age was 12.
All were already enrolled in the KiCK outpatient healthy living programme for under-18s who were overweight or obese. It was remodelled to become online only because of COVID.
It also included educational seminars and workshops, and online cooking sessions and discussions about difficult subjects such as “emotional eating” and the health consequences of obesity, which can include diabetes and a higher risk of heart, breathing and joint problems.
Participants displayed “significant improvements” in five key measures of their health. They had a lower body-mass index, reduced risk of developing diabetes, less cholesterol in their bloodstream, better results in a six-minute test of their walking speed, and improved mental welfare.
“Successful treatment of childhood obesity is challenging work, but we have demonstrated that adolescents with pre-existing obesity may be helped through video-based training,” Reschke said. “Participants showed improvements in their dietary choices, appetite control and portion sizes, which was reflected in better measures of their metabolic health and quality of life.”
The results proved that virtual care could help patients as much as in-person consultations, he added.
“Our results are hopeful that this approach may be a useful and cost-effective model for treating obesity in children. It eliminates the need for regular face-to-face contact, which may be of particular use for those who have difficulty attending appointments. However, we must take care not to unnecessarily increase the amount of screen time used by children. It may be a fine line, but our data suggest this approach is worthwhile.”
Study 1 details
Estimating the healthcare cost of overweight and obesity in South Africa
Micheal Kofi Boachie, Evelyn Thsehla, Mustapha Immurana, Ciaran Kohli-Lynch & Karen J Hofman.
Published in Global Health Action on 15 November 2021
Abstract
Background
Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity.
Objective
Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer.
Methods
Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease’s total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020.
Results
The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million.
Conclusion
This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.
Study 2 details
Significant improvement in dietary behaviours and quality of life among adolescents with obesity in the COVID-19 lockdown through telehealth
Nora Struckmeyer, Torben Biester, Chantal Weiner, Evelin Sadeghian, Cathrin Guntermann, Laura Galuschka, Kisa Reck, Jantje Weiskorn, Kerstin Kapitzke, Karin Lange, Thomas Dann, Felix Reschke.
Published in BioEngineeer on 15 September 2022
Background
COVID-19 lockdown resulted in an extreme change in daily lifestyle with a significant increase in weight and loss of quality of life, as well as an increase in the risk of secondary health conditions even in young people. One reason for this is a fatal change in the nutritional situation, especially among adolescents. Convincing models to counter this problem are missing so far. Multiprofessional training programmes could reveal an outstanding effect for secondary prevention of obesity in youth. Telehealth measures were successfully implemented several times during the pandemic.
Methods
Adolescents (8-17 years) with severe obesity referred through a large obesity consultation were interviewed using standardised dietary behaviour questionnaires (FEV-K, FFL-K, FFV-K) and quality of life questionnaires (WHO-5, KIND-L) and enrolled in a structured multimodal education programme for adolescents with overweight. The program content (sports, nutrition, medicine, psychology) was tought exclusively video-based. After the end of the program (12 months), the patients were interviewed again regarding eating behaviour and quality of life. In addition, a clinical examination including analysis of blood parameters was performed before and after the programme. The results were analysed and compared with results from the pre-pandemic period (2017 – 2019).
Results
108 children and adolescents (mean age 12.1 yrs; male 46.2%, BMI SDS 2.21) were studied and telemedicated. Based on a significantly increased intake of fatty and sugary foods and an increased amount of meals per day (7.2 meals per day), a significantly increased intake of vegetables and fruits as well as a massive decrease of sweets, snacks and soft drinks was observed after programme participation, which corresponds to a significant improvement in dietary behaviour also compared to the pre-pandemic period. The amount of meals per day decreased to 4.1 meals per day. The quality of life of the adolescents increased significantly. The BMI SDS and the blood parameters (cholesterol, triglycerides, HOMA index) showed a decreasing trend, which roughly corresponds to the effect of the pre-pandemic period.
Discussion & Conclusion
This study demonstrated a beneficial effect on dietary behaviours and quality of life of adolescents with obesity during lockdown through video-based structured education. Future research needs to show the extent to which this effect is replicable with respect to new periods of contact restriction. It is possible that telemedicine obesity education components can reach a large number of patients and especially families in rural areas, and thus can be a supraregional support for adolescents with obesity.
The Conversation – Obesity costs South Africa billions. We did the sums (Creative Commons Licence)
Bioengineer article –Video-based program successful in treating children with obesity (Open access)
See more from MedicalBrief archives:
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Doctors see benefits of telehealth — concerned some patients may get left behind
Almost three-quarters of US adults overweight or obese — up by half since 2000
Hours of screen time linked to diabetes risk in children