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Background: Obesity is a well-known risk factor for sick leave, disability pension and premature death. Obesity is therefore presumably related to increased productivity losses., Objective: The aim of this study was to estimate the lifetime productivity losses to society associated with obesity status., Methods: This study was based on a 38-year follow-up of a nationwide cohort of 45 920 Swedish men performing mandatory military conscription tests at age 18.7 ± 0.5 years. Body mass index (BMI) based on measured height and weight at the time of military conscription tests was used to define underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obesity (≥30.0 kg/m(2)). Data on sick leave, disability pension and premature death were retrieved from national registers. The calculations were adjusted for socioeconomic index, smoking and muscular strength., Results: Using the human capital approach, the lifetime productivity losses were calculated as 55.6 (95% CI 50.7, 62.0) × €1000 and 55.6 (95% CI 50.9, 61.4) × €1000 for underweight and normal weight, respectively, and 72.6 (95% CI 66.3, 80.7) × €1000 and 95.4 (95% CI 89.0, 102.9) × €1000 for overweight and obesity, respectively. If using the friction cost method instead, the estimated productivity losses were reduced by about 80%., Conclusion: Obesity is associated with almost twice as high productivity losses to society as for normal weight over a lifetime. These costs are important to include in health economic analyses of obesity intervention programmes in order to ensure an effective allocation of resources from a societal perspective.

Background: Sick-leave is an important source of productivity losses to society. The objective of this study was to investigate the association between body mass index (BMI) status in young adulthood and future sick-leave., Methods: A nation-wide cohort of 43,989 Swedish men (18.7 ± 0.5 years) performing military conscription tests in 1969-70 were followed between 1986 and 2005 regarding sick-leave. BMI was used to define underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9) and obesity (≥ 30.0). Relative risks of sick-leave were estimated with Cox proportional hazards models adjusted for smoking, socio-economic index and muscular strength, using normal weight as the reference., Results: During 803,684 person-years of follow-up, 488,570 sick-leave episodes were recorded. On average, one short-term (≤ 7 days) episode occurred every eight person-months, one intermediate-term (8-30 days) every five person-years and one long-term (>30 days) episode every 15 person-years. Overweight was associated with 20% and obesity with >30% risk elevation for episodes ranging from 8 to 30 days [hazard ratio (HR) 1.20; 95% CI 1.15-1.24 and HR 1.35; 95% CI 1.24-1.47, respectively] as well as for episodes >30 days (HR 1.19; 95% CI 1.15-1.23 and HR 1.34; 95% CI 1.24-1.47, respectively) compared to normal weight. Obesity was also associated with an increased risk of sick-leave episodes ≤ 7 days (HR 1.13; 95% CI 1.09-1.16), but the corresponding risk increase for overweight was very small (HR 1.02; 95% CI 1.00-1.03). Underweight showed increased risk only for short-term episodes (HR 1.05; 95% CI 1.04-1.07)., Discussion: Overweight and obesity are associated with increased risk for sick-leave compared to normal weight, especially for sick-leave episodes of longer duration.

This review identified 36 studies on the relation between obesity status and sick leave. Pooling of effect estimates was not possible due to great heterogeneity between studies regarding definition of sick leave (short-term/long-term), measure of obesity (body mass index/waist circumference/percentage body fat), definition of obesity status (World Health Organization standards/other), study population (sex/age/occupation/country) and exposure and outcome ascertainment (self-reported/objectively assessed). Nevertheless, a clear trend towards greater sick leave among obese compared with normal weight workers could be discerned, especially for spells of longer duration. In studies from the USA, which consistently reported about five times lower number of sick leave days per person-year than European, obese workers had about 1-3 extra days of absence per person-year compared with their normal weight counterparts. In European studies, the corresponding difference was about 10 d. For overweight workers the data were conflicting, indicating either increased or neutral level of sick leave compared with normal weight. Regarding underweight, the studies were very few and concerns regarding direction of causality were greater. Finally, in all four interventional studies identified substantial weight loss in obese subjects resulted in reduced sick leave, at least temporarily. In conclusion, increasing obesity in children and adults is likely to negatively affect future productivity as obesity increases the risk of sick leave, disability pension and death.