Original article
Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health SystemExceso de peso en España: situación actual, proyecciones para 2030 y sobrecoste directo estimado para el Sistema Nacional de Salud

https://doi.org/10.1016/j.rec.2018.10.010Get rights and content

Abstract

Introduction and objectives

Excess weight promotes the development of several chronic diseases and decreases quality of life. Its prevalence is increasing globally. Our aim was to estimate the trend in excess weight between 1987 and 2014 in Spanish adults, calculate cases of excess weight and its direct extra costs in 2006 and 2016, and project its trend to 2030.

Methods

We selected 47 articles in a systematic literature search to determine the progression of the prevalence of overweight, nonmorbid obesity, and morbid obesity and average body mass index between 1987 and 2014. We projected the expected number of cases in 2006, 2016, and 2030 and the associated direct extra medical costs.

Results

Between 1987 and 2014, the prevalence of overweight, obesity, and morbid obesity increased by 0.28%/y (P = .004), 0.50%/y (P < .001) and 0.030%/y (P = .006) in men, and by 0.10%/y (P = .123), 0.25%/y (P = .078), and 0.042%/y (P = .251) in women. The mean body mass index increased by 0.10 kg/m2/y in men (P < .001) and 0.26 kg/m2/y in women (significantly only between 1987 and 2002, P < .001). We estimated 23 500 000 patients with excess weight in 2016, generating 1.95 billion €/y in direct extra medical costs. If the current trend continues, between 2016 and 2030, there will be 3 100 000 new cases of excess weight, leading to 3.0 billion €/y of direct extra medical costs in 2030.

Conclusions

Excess weight in Spanish adults has risen since the creation of population registries, generating direct extra medical costs that represent 2% of the 2016 health budget. If this trend continues, we expect 16% more cases in 2030 and 58% more direct extra medical costs.

Resumen

Introducción y objetivos

El exceso de peso potencia algunas enfermedades crónicas y reduce la calidad de vida, y su prevalencia crece en todo el mundo. El objetivo es estimar la evolución del exceso de peso entre 1987 y 2014 en población española adulta, calcular los casos de exceso de peso y sus sobrecostes médicos directos en 2006 y 2016, y proyectar su tendencia a 2030.

Métodos

Se seleccionaron 47 artículos en una búsqueda bibliográfica sistemática para determinar la progresión de las prevalencias de sobrepeso, obesidad y obesidad mórbida y del índice de masa corporal promedio entre 1987 y 2014. Con estos datos, se estimó el número de casos en adultos españoles en 2006, 2016 y 2030 y sus sobrecostes directos.

Resultados

Entre 1987 y 2014, las prevalencias de sobrepeso, obesidad y obesidad mórbida aumentaron el 0,28%/año (p = 0,004), el 0,50%/año (p < 0,001) y el 0,030%/año (p = 0,006) en los varones y el 0,10%/año (p = 0,123), el 0,25%/año (p = 0,078) y el 0,042%/año (p = 0,251) en las mujeres. El índice de masa corporal aumentó 0,10 puntos/año en varones (p < 0,001) y 0,26 en mujeres (significativamente solo entre 1987-2002, p < 0,001). Se estimaron 23.500.000 casos de exceso de peso en 2016, cuyo sobrecoste médico directo supuso 1.950.000.000 euros/año. De mantenerse la tendencia, entre 2016 y 2030 aparecerán 3.100.000 nuevos casos de exceso de peso, y se alcanzará en 2030 un sobrecoste médico directo de unos 3.000.000.000 euros/año.

Conclusiones

El exceso de peso en los adultos en España aumenta desde que existen registros, y en 2016 supuso un sobrecoste directo del 2% del presupuesto sanitario. Con esta tendencia, en 2030 se habrá incrementado un 16% el número de casos y un 58% su sobrecoste sanitario directo.

Section snippets

INTRODUCTION

Excess weight is a priority concern in public health because it raises mortality (increased 7% to 20%, 45% to 94%, and 176% by overweight, obesity, and morbid obesity, respectively)1 and is the fourth preventable factor that most impairs quality of life.2 The prevalence of excess weight has risen since data were first recorded: in 2014, obesity was present in 10.8% of men and 14.9% of women worldwide, and these figures are expected to jump to 18% and 21%, respectively, by 2025.3

In Spain, excess

Design

The study design consisted of a systematic review search and estimate of trends over time.

Search Criteria

We examined primary literature sources published since 1985 describing the prevalence of excess weight, obesity, or morbid obesity or average BMI (quotient between weight in kg and the square of height in meters) in representative samples of the general Spanish adult population. The study considered overweight to be BMI ≥ 25 and < 30, nonmorbid obesity to be BMI ≥ 30 and < 40, and morbid obesity to be BMI ≥

RESULTS

The articles considered provide data from 51 studies conducted between 1987 and 2014 (Table 1),4, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60 which included 149 955 men and 167 159 women. The prevalences of overweight, obesity, and morbid obesity and average BMI appeared in 36, 46, 11, and 29 studies, respectively. The studies were of variable quality (35%

DISCUSSION

Excess weight is increasingly prevalent among Spanish adults: the data collected indicate that overweight, obesity, and morbid obesity rose significantly in men between 1987 and 2014, whereas obesity increased only slightly in women. The average BMI increased linearly and significantly in men over this period and in women only until 2002. These data are consistent with the rise in overweight and obesity of 1.8% and 8.5% described in national health surveys between 1987 and 2012,4 although they

CONCLUSIONS

The prevalences of overweight, obesity, and morbid obesity have risen since records were first kept in Spain, although the incremental rise among women is not statistically significant. The result is a prevalence of more than 23 million persons with excess weight, with direct extra medical costs of almost 2% of the 2016 health budget. According to this trend, by 2030 there will be about 3.1 million new cases and extra costs of about €3.0 billion per year (more than 3% of the current health

FUNDING

This study was funded by AGAUR (University and Research Aid Management Agency) (2014-SGR-240), the Health Department of the Generalitat de Catalunya (SLT006/17/00029), the Carlos III Health Institute (CES12/025, CD17/00122), CIBEROBN (Biomedical Research Center for the Obesity and Nutrition Pathophysiology Network), CIBERCV (Biomedical Research Center for the Cardiovascular Disease Network), and the European Regional Development Fund, as well as Novo Nordisk, which provided an unconditional

CONFLICTS OF INTEREST

None declared.

WHAT IS KNOWN ABOUT THE TOPIC?

  • Excess weight is one of the factors most likely to increase the morbidity and mortality of chronic diseases, most likely to impair quality of life, and most likely to raise health costs.

  • The prevalence of excess weight has risen worldwide since the start of record-keeping.

WHAT DOES THIS STUDY ADD?

  • The prevalences of overweight, obesity, and morbid obesity in Spain increased 0.28% per year (P  =  .004), 0.50% per year (P <  .001), and 0.030% per year (P  =  .006) in men and 0.10% per year (P  =  .123), 0.25% per year (P  =  

Acknowledgments

We appreciate the collaboration of Dr. Francisco Poyato (Novo Nordisk Pharma Spain, Madrid) in the discussion of the results of this work.

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