Academic journal article Applied Health Economics and Health Policy

Lifetime Productivity Losses Associated with Obesity Status in Early Adulthood

Academic journal article Applied Health Economics and Health Policy

Lifetime Productivity Losses Associated with Obesity Status in Early Adulthood

Article excerpt

Key points for decision makers

* Obesity is associated with twice as high lifetime productivity losses to society as for normal weight

* Using the friction cost method instead of the human capital approach decreased the estimated productivity losses substantially


Obesity has been described as the largest threat to public health in the Western world today, along with smoking.[1] The effectiveness of several kinds of prevention and interventions is currently being studied, and many of these will also be evaluated from a health economic perspective in order to investigate whether the achieved effect is worth the costs. To ensure an effective allocation of resources in society, these health economic evaluations should include the consequences not only on healthcare consumption, but also on non-healthcare consumption and on productivity losses.[2] Currently this is seldom done, partly due to lack of data.

Productivity losses (indirect costs) are the value of the production foregone as a result of an individual's inability to work due to health reasons, normally due to sick leave, disability pension and premature death.[2] These costs are primarily carried by the other individuals in society, who lose out on the produced goods or services, rather than by the individuals themselves (as long as they are economically compensated by some kind of insurance). There are two common ways to estimate the value of productivity losses, the human capital approach and the friction cost method. The human capital approach assumes the value of the lost production to be equal to what the employer would have paid, had the individual been working;[2] that is, the time of the absenteeism multiplied by the salary, including all social fees. Using the friction cost method, the value of lost production is estimated in the same way per unit of time, but it is assumed that the absent employee is replaced after a certain period (the friction period).[3] It has been argued that the human capital approach overestimates productivity losses,[3] while the friction cost method has been criticized for not being supported by neoclassical economic theory.[4] Also, the friction period is often not known, and therefore risks becoming arbitrary.

Previous studies of the productivity losses associated with obesity have used a cross-sectional design, expressing the losses as a total sum attributable to obesity for a specific year and country.[5-7] For health economic analyses, a longitudinal design with cost data over time is needed. So far, only one study has performed such an analysis with an adequate time horizon (15 years in middle age) in the field of obesity.[8] However, the study was limited to productivity losses originating from premature death only.

The aim of the present study was to estimate the lifetime productivity losses to society associated with obesity status, in total as well as for its components: sick leave, disability pension and premature death.


A dataset was created with information on individual characteristics and sick-leave episodes, granted disability pensions and mortality. Adjusted number of work days lost per year from age 19 years to 65 years stratified on obesity status were estimated. The value of the productivity foregone due to these work days lost was then estimated using the human capital approach in the primary analysis, and by the friction cost method in a secondary analysis. Ethical approval for the study was granted by the regional ethics committee at Karolinska Institutet, Stockholm, Sweden.


Swedish men performing military conscription in 1969 and 1970 constituted the study cohort of this investigation. This cohort has been described in greater detail elsewhere.[9] Military conscription normally took place during the last year of high school (age 18-19 years), and was at this time mandatory, with participation enforced by law. The duration of the military service was normally about 1 year. …

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