Obesity and cardiovascular risk management is a critical way to reduce healthcare resource pressure

Obesity is associated with elevated risks of cardiovascular disease (CVD), diabetes, and cancers. Obesity and related diseases have become a major public problem worldwide. According to the report from the World Health Organization (WHO), at least 2.8 million deaths and more than 35 million (2.3%) global disability-adjusted life-years are linked to overweight or obesity.¹ An individual participant data meta-analysis including over 120,000 Europeans showed that compared with normal weight, both mild and severe obesity are associated with significant reductions in disease-free years.² In the UK, obesity costs US$34bn a year.³ However, since obesity and CVD risks are highly correlated to each other, the individual contributions to the increased healthcare resource utilization from obesity and CVD risk are not clear.

The article by le Roux et al.⁴ published in this issue of the European Journal of Preventive Cardiology offers a targeted approach to this question. The authors found a consistently increasing trend in healthcare resource utilization related to CVD risk in each body mass index (BMI) group, and also a consistently increasing trend in healthcare resource utilization related to BMI in each CVD risk group. Their findings demonstrate that both obesity and CVD risk are important contributors to healthcare resource utilization and interventions on either one of them may help to contain the healthcare costs.

The healthcare system is facing great pressure in the UK and globally. According to the statistics from the WHO,⁵ between 2000 and 2017, global health spending in real terms grew by 3.9% a year while the economy grew 3.0% a year. The global spending on health was US$7.8tn in 2017 or about 10% of gross domestic product and US$1080 per capita. In the UK, health expenditure increased to US$3859 per capita in 2017 from US$1674 in 2000. The major drivers of the growing spending on healthcare include the aging of the population, lifestyle changes, increased demand with income rising, and technological advances. In the near future, further advances in aging, economics, and technology will put even more pressure on the healthcare system. Evidence-based interventions aiming at healthcare cost containment are urgently needed. The present study by le Roux et al.⁴ is valuable as the authors identified obesity and CVD risk as two independent contributors to healthcare resource utilization and even provide accurate estimations of the additional costs resulted from obesity and CVD risk. The decision-makers will benefit from these findings when investing the limited resources to contain healthcare costs.

We are now under the pandemic of the Coronavirus Disease-2019 (COVID-19), which is pushing the limit of our healthcare system and shows how fragile it is when facing this outbreak. Shortages of human resources, medication, medical equipment, personal protective equipment, and hospital beds are happening in many countries, especially the ones in the epicenters. Healthcare resource availability has a great impact on COVID-19 mortality. High mortality rates in the epicenters show us the damage from the over-pressured healthcare system. Obesity and CVD are two of the major underlying conditions that would largely increase the risk and severity of COVID-19 and some other viruses.⁶ As such, obesity and CVD per se could introduce both direct and indirect costs to the healthcare system. Therefore, health management targeting obesity and CVD could reduce the costs for the known health conditions, as well as ease the pressure from the unforeseeable public health emergency.

The estimation of obesity or CVD related healthcare costs can serve as a criterion for financial investment in potential health promotion programs. However, an accurate estimation of the cost resulted from obesity or CVD is lacking. Le Roux et al.,⁴ for the first time, present the variations in healthcare costs associated with obesity and CVD risk in a large representative population of the UK. Moreover, this study sourced cost data directly from the Nation Health Service, which is much more accurate, as opposed to insurance claims databases that often underestimate medical costs. Le Roux et al.⁴ reported that among the population with low CVD risk, the ones with BMI ≥40 kg/m² would cost more than two times those with BMI between 18.5 and 25 kg/m² (£6047 vs. £2683). Similarly, among the population with BMI between 18.5 and 25 kg/m², the ones with established CVD would more than double the cost of the ones with low CVD risk (£7394 vs. £2683). These findings suggest that there is a critical role in obesity and cardiovascular risk management to ease healthcare costs.

Considering the growing burden from obesity and CVD,^7,8 urgent strategies should be implemented. Although there were several limitations in the study by le Roux et al.,⁴ including a large proportion of patients with missing BMI data and without considering some important factors in the analysis, such as socioeconomic status, the present study still adds to the evidence of obesity management being essential to reduce healthcare costs. Unhealthy lifestyle is a major modifiable risk factor in obesity and the CVD population.⁹ Numerous intervention programs (including country-wide and community-wide intervention programs) aiming at reducing obesity and CVD have been developed, such as sugar-sweetened beverage taxes, nutrition labeling, advertising bans on unhealthy food, and lifestyle interventions.¹⁰ The cost-effectiveness of these programs should be accurately calculated to better inform the decision-makers.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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