title: The humanistic and economic burden associated with increasing body mass index in the EU5.
abstract: OBJECTIVE
  This study evaluated the association of body mass index (BMI) with health-related quality of life (HRQoL), health utilities, health care resource utilization, productivity, activity impairment, and the associated costs.
  
  
  METHODS
  Results were from the 2013 EU5 (France, Germany, Italy, Spain, UK) National Health and Wellness Survey, a nationally representative, online survey of respondents aged ≥18 years. Analyses focused on normal weight (BMI ≥18.5 kg/m(2) and BMI <25 kg/m(2)), overweight (BMI ≥25 kg/m(2) and BMI <30 kg/m(2)), Obese Class (OC) I (BMI ≥30 kg/m(2) and BMI <35 kg/m(2)), OC II (BMI ≥35 kg/m(2) and BMI <40 kg/m(2)), and OC III (BMI ≥40 kg/m(2)) respondents. Outcomes included HRQoL (Short Form [SF]-36v2), health utilities (SF-six dimension [6D]), productivity loss (Work Productivity and Activity Impairment questionnaire), and resource utilization (provider visits, emergency room visits, and hospitalizations) in the past 6 months. Direct and indirect costs were estimated from the literature. Generalized linear regression models predicted outcomes as a function of BMI, adjusting for covariates (age, sex, comorbidities).
  
  
  RESULTS
  Among 58,364 respondents, 46.9% were normal weight, 34.5% were overweight, 12.5% were OC I, 4.0% were OC II, and 2.1% were OC III. Metabolic comorbidities increased as BMI increased. After adjustments, all three OC respondents exhibited significantly lower HRQoL than normal weight respondents. Health utilities (normal weight: 0.720; overweight: 0.718; OC I: 0.703; OC II: 0.683; OC III: 0.662) declined with an increase in BMI (all P<0.05 vs normal). Among employed respondents (57.7%), overall work impairment increased as BMI increased. Normal (vs all OCs) had lower activity impairment and fewer provider visits, lower indirect costs (normal weight: €7,974; overweight: €7,825; OC I: €8,465; OC II: €9,394; OC III: €10,437), and lower total direct costs (normal weight: €516; overweight: €553; OC I: €583; OC II: €605; OC III: €717), all P<0.05.
  
  
  CONCLUSIONS
  Increased BMI was associated with worse HRQoL, greater comorbidities, higher direct and indirect costs, and worse health utilities. Weight management may improve patient outcomes.
authors.affiliation: Kantar Health, Princeton, NJ, USA.
authors.forename: Shaloo
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Eisai Europe Ltd, Hatfield, UK.
authors.forename: Lance
authors.initials: L
authors.lastname: Richard
authors.affiliation: Eisai Inc., Woodcliff Lake, NJ, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Forsythe
keywords: Europe; direct and indirect costs; health utilities; health-related quality of life; metabolic comorbidities; obesity