Electronic Supplementary Material (ESM)

The following tables are supplemental material from the following publication:

Lehnert T, Streltchenia P, Konnopka A, Riedel-Heller SG, König HH. Health burden and costs of overweight and obesity in Germany: An update. European Journal of Health Economics (2015).

Table S1: Prevalence of BMI classes by 5-year age groups in the German adult population

Source / Age / BMI < 25 / BMI 25-29.9 / BMI 30-34.9 / BMI 35-39.9 / BMI ≥ 40
M / F / M / F / M / F / M / F / M / F
DEGS1a / 18-19 / 0.647 / 0.700 / 0.267 / 0.204 / 0.066 / 0.069 / 0.016 / 0.018 / 0.004 / 0.009
20-24 / 0.647 / 0.700 / 0.267 / 0.204 / 0.066 / 0.069 / 0.016 / 0.018 / 0.004 / 0.009
25-29 / 0.647 / 0.700 / 0.267 / 0.204 / 0.066 / 0.069 / 0.016 / 0.018 / 0.004 / 0.009
30-34 / 0.375 / 0.620 / 0.404 / 0.201 / 0.168 / 0.116 / 0.040 / 0.040 / 0.013 / 0.023
35-39 / 0.375 / 0.620 / 0.404 / 0.201 / 0.168 / 0.116 / 0.040 / 0.040 / 0.013 / 0.023
40-44 / 0.301 / 0.535 / 0.471 / 0.278 / 0.165 / 0.127 / 0.042 / 0.039 / 0.021 / 0.021
45-49 / 0.301 / 0.535 / 0.471 / 0.278 / 0.165 / 0.127 / 0.042 / 0.039 / 0.021 / 0.021
50-54 / 0.216 / 0.391 / 0.508 / 0.335 / 0.230 / 0.175 / 0.038 / 0.053 / 0.008 / 0.046
55-59 / 0.216 / 0.391 / 0.508 / 0.335 / 0.230 / 0.175 / 0.038 / 0.053 / 0.008 / 0.046
60-64 / 0.161 / 0.293 / 0.508 / 0.359 / 0.253 / 0.225 / 0.058 / 0.088 / 0.020 / 0.035
65-69 / 0.161 / 0.293 / 0.508 / 0.359 / 0.253 / 0.225 / 0.058 / 0.088 / 0.020 / 0.035
70-74 / 0.175 / 0.197 / 0.513 / 0.388 / 0.257 / 0.281 / 0.050 / 0.096 / 0.005 / 0.038
AgeCoDeb / 75-79 / 0.195 / 0.275 / 0.562 / 0.384 / 0.188 / 0.202 / 0.051 / 0.100 / 0.005 / 0.040
80-84 / 0.294 / 0.357 / 0.519 / 0.375 / 0.144 / 0.158 / 0.039 / 0.078 / 0.004 / 0.032
85-89 / 0.376 / 0.463 / 0.491 / 0.337 / 0.103 / 0.118 / 0.028 / 0.059 / 0.003 / 0.024
90-100 / 0.421 / 0.576 / 0.470 / 0.281 / 0.084 / 0.084 / 0.023 / 0.042 / 0.002 / 0.017

a Mensink, G.B., et al., [Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2013. 56(5-6): p. 786-94.

b Authors own calculations using data from the German Study on Ageing. Cognition and Dementia in Primary Care Patients (AgeCoDe) (Luck, T., Riedel-Heller, S.G., Luppa, M., Wiese, B., Wollny, A., Wagner, M., Bickel, H., Weyerer, S., Pentzek, M., Haller, F., Moesch, E., Werle, J., Eisele, M., Maier, W., van den Bussche, H., Kaduszkiewicz, H.: Risk factors for incident mild cognitive impairment - results from the German Study on Ageing, Cognition and Dementia in Primary Care Pati-ents (AgeCoDe). Acta Psychiatr. Scand. 121, 260-272 (2010). To provide smooth transitions from DEGS1 to AgeCoDe data, calculated AgeCoDe prevalences were fitted using DisMod II (Barendregt, J.J., et al., A generic model for the assessment of disease epidemiology: the computational basis of DisMod II. Popul Health Metr, 2003. 1(1): p. 4.).

Table S2a: Population attributable fractions (PAF) for women by age group (BMI≥25)

Age / C15 / C16 / C18 / C22 / C23 / C25 / C50 / C53 / C56 / C61 / C64 / C82-
85 / C90 / C91-
96 / E11 / E65-
68 / E78.5,
E78.9 / I10-
15 / I20-
25 / K80
18-19 / 0.00 / 0.00 / 0.05 / 0.05 / 0.12 / 0.06 / 0.00 / 0.13 / 0.05 / 0.00 / 0.14 / 0.08 / 0.06 / 0.00 / 0.49 / 1.00 / 0.20 / 0.27 / 0.12 / 0.28
20-24 / 0.00 / 0.00 / 0.05 / 0.05 / 0.12 / 0.06 / 0.00 / 0.13 / 0.05 / 0.00 / 0.14 / 0.08 / 0.06 / 0.00 / 0.49 / 1.00 / 0.20 / 0.27 / 0.12 / 0.28
25-29 / 0.00 / 0.00 / 0.05 / 0.05 / 0.12 / 0.06 / 0.00 / 0.13 / 0.05 / 0.00 / 0.14 / 0.08 / 0.06 / 0.00 / 0.49 / 1.00 / 0.20 / 0.27 / 0.12 / 0.28
30-34 / 0.00 / 0.00 / 0.08 / 0.09 / 0.18 / 0.10 / 0.00 / 0.19 / 0.07 / 0.00 / 0.20 / 0.11 / 0.10 / 0.00 / 0.58 / 1.00 / 0.23 / 0.38 / 0.17 / 0.37
35-39 / 0.00 / 0.00 / 0.08 / 0.09 / 0.18 / 0.10 / 0.00 / 0.19 / 0.07 / 0.00 / 0.20 / 0.11 / 0.10 / 0.00 / 0.58 / 1.00 / 0.23 / 0.38 / 0.17 / 0.37
40-44 / 0.00 / 0.00 / 0.09 / 0.09 / 0.20 / 0.11 / 0.00 / 0.21 / 0.08 / 0.00 / 0.22 / 0.13 / 0.11 / 0.00 / 0.62 / 1.00 / 0.27 / 0.40 / 0.18 / 0.40
45-49 / 0.00 / 0.00 / 0.09 / 0.09 / 0.20 / 0.11 / 0.00 / 0.21 / 0.08 / 0.00 / 0.22 / 0.13 / 0.11 / 0.00 / 0.62 / 1.00 / 0.27 / 0.40 / 0.18 / 0.40
50-54 / 0.00 / 0.00 / 0.12 / 0.13 / 0.26 / 0.16 / 0.00 / 0.28 / 0.11 / 0.00 / 0.30 / 0.17 / 0.14 / 0.00 / 0.69 / 1.00 / 0.33 / 0.49 / 0.25 / 0.49
55-59 / 0.00 / 0.00 / 0.12 / 0.13 / 0.26 / 0.16 / 0.24 / 0.28 / 0.11 / 0.00 / 0.30 / 0.17 / 0.14 / 0.00 / 0.45 / 1.00 / 0.09 / 0.12 / 0.25 / 0.31
60-64 / 0.00 / 0.00 / 0.14 / 0.15 / 0.30 / 0.17 / 0.27 / 0.31 / 0.13 / 0.00 / 0.31 / 0.19 / 0.17 / 0.00 / 0.48 / 1.00 / 0.11 / 0.14 / 0.27 / 0.35
65-69 / 0.00 / 0.00 / 0.14 / 0.15 / 0.30 / 0.17 / 0.27 / 0.31 / 0.13 / 0.00 / 0.31 / 0.19 / 0.17 / 0.00 / 0.48 / 1.00 / 0.11 / 0.14 / 0.27 / 0.35
70-74 / 0.00 / 0.00 / 0.16 / 0.17 / 0.34 / 0.19 / 0.30 / 0.34 / 0.15 / 0.00 / 0.34 / 0.21 / 0.19 / 0.00 / 0.51 / 1.00 / 0.12 / 0.16 / 0.30 / 0.38
75-79 / 0.00 / 0.00 / 0.14 / 0.14 / 0.28 / 0.17 / 0.27 / 0.29 / 0.12 / 0.00 / 0.32 / 0.18 / 0.16 / 0.00 / 0.49 / 1.00 / 0.11 / 0.14 / 0.28 / 0.35
80-84 / 0.00 / 0.00 / 0.12 / 0.11 / 0.24 / 0.15 / 0.24 / 0.26 / 0.11 / 0.00 / 0.29 / 0.16 / 0.13 / 0.00 / 0.45 / 1.00 / 0.10 / 0.13 / 0.24 / 0.31
85-89 / 0.00 / 0.00 / 0.09 / 0.09 / 0.19 / 0.12 / 0.20 / 0.22 / 0.09 / 0.00 / 0.24 / 0.13 / 0.11 / 0.00 / 0.40 / 1.00 / 0.09 / 0.10 / 0.21 / 0.26
90-94 / 0.00 / 0.00 / 0.07 / 0.06 / 0.15 / 0.09 / 0.16 / 0.18 / 0.07 / 0.00 / 0.19 / 0.11 / 0.08 / 0.00 / 0.33 / 1.00 / 0.07 / 0.08 / 0.16 / 0.21
95-100 / 0.00 / 0.00 / 0.06 / 0.05 / 0.12 / 0.07 / 0.13 / 0.15 / 0.06 / 0.00 / 0.16 / 0.09 / 0.07 / 0.00 / 0.28 / 1.00 / 0.06 / 0.07 / 0.13 / 0.17
Age / C15 / C16 / C18 / C22 / C23 / C25 / C50 / C53 / C56 / C61 / C64 / C82-
85 / C90 / C91-
96 / E11 / E65-
68 / E78.5,
E78.9 / I10-
15 / I20-
25 / K80
18-19 / 0.07 / 0.03 / 0.09 / 0.14 / 0.14 / 0.07 / 0.00 / 0.00 / 0.00 / 0.04 / 0.08 / 0.06 / 0.08 / 0.07 / 0.58 / 1.00 / 0.09 / 0.25 / 0.04 / 0.33
20-24 / 0.07 / 0.03 / 0.09 / 0.14 / 0.14 / 0.07 / 0.00 / 0.00 / 0.00 / 0.04 / 0.08 / 0.06 / 0.08 / 0.07 / 0.58 / 1.00 / 0.09 / 0.25 / 0.04 / 0.33
25-29 / 0.07 / 0.03 / 0.09 / 0.14 / 0.14 / 0.07 / 0.00 / 0.00 / 0.00 / 0.04 / 0.08 / 0.06 / 0.08 / 0.07 / 0.58 / 1.00 / 0.09 / 0.25 / 0.04 / 0.33
30-34 / 0.12 / 0.08 / 0.17 / 0.28 / 0.23 / 0.13 / 0.00 / 0.00 / 0.00 / 0.08 / 0.15 / 0.13 / 0.16 / 0.13 / 0.75 / 1.00 / 0.16 / 0.41 / 0.11 / 0.54
35-39 / 0.12 / 0.08 / 0.17 / 0.28 / 0.23 / 0.13 / 0.00 / 0.00 / 0.00 / 0.08 / 0.15 / 0.13 / 0.16 / 0.13 / 0.75 / 1.00 / 0.16 / 0.41 / 0.11 / 0.54
40-44 / 0.14 / 0.09 / 0.18 / 0.30 / 0.25 / 0.14 / 0.00 / 0.00 / 0.00 / 0.08 / 0.16 / 0.14 / 0.17 / 0.15 / 0.76 / 1.00 / 0.18 / 0.43 / 0.11 / 0.58
45-49 / 0.14 / 0.09 / 0.18 / 0.30 / 0.25 / 0.14 / 0.00 / 0.00 / 0.00 / 0.08 / 0.16 / 0.14 / 0.17 / 0.15 / 0.76 / 1.00 / 0.18 / 0.43 / 0.11 / 0.58
50-54 / 0.14 / 0.09 / 0.20 / 0.30 / 0.28 / 0.15 / 0.00 / 0.00 / 0.00 / 0.09 / 0.17 / 0.16 / 0.18 / 0.16 / 0.79 / 1.00 / 0.19 / 0.45 / 0.13 / 0.57
55-59 / 0.14 / 0.09 / 0.20 / 0.30 / 0.28 / 0.15 / 0.00 / 0.00 / 0.00 / 0.09 / 0.17 / 0.16 / 0.18 / 0.16 / 0.47 / 1.00 / 0.10 / 0.14 / 0.13 / 0.31
60-64 / 0.16 / 0.11 / 0.22 / 0.36 / 0.30 / 0.17 / 0.00 / 0.00 / 0.00 / 0.11 / 0.19 / 0.18 / 0.21 / 0.18 / 0.51 / 1.00 / 0.10 / 0.16 / 0.15 / 0.34
65-69 / 0.16 / 0.11 / 0.22 / 0.36 / 0.30 / 0.17 / 0.00 / 0.00 / 0.00 / 0.11 / 0.19 / 0.18 / 0.21 / 0.18 / 0.51 / 1.00 / 0.10 / 0.16 / 0.15 / 0.34
70-74 / 0.16 / 0.10 / 0.21 / 0.33 / 0.29 / 0.17 / 0.00 / 0.00 / 0.00 / 0.10 / 0.18 / 0.17 / 0.20 / 0.17 / 0.49 / 1.00 / 0.11 / 0.15 / 0.14 / 0.33
75-79 / 0.14 / 0.08 / 0.20 / 0.30 / 0.27 / 0.15 / 0.00 / 0.00 / 0.00 / 0.09 / 0.17 / 0.15 / 0.18 / 0.16 / 0.47 / 1.00 / 0.11 / 0.13 / 0.11 / 0.31
80-84 / 0.12 / 0.07 / 0.17 / 0.25 / 0.24 / 0.13 / 0.00 / 0.00 / 0.00 / 0.08 / 0.15 / 0.12 / 0.16 / 0.13 / 0.43 / 1.00 / 0.10 / 0.11 / 0.09 / 0.28
85-89 / 0.11 / 0.05 / 0.14 / 0.20 / 0.21 / 0.11 / 0.00 / 0.00 / 0.00 / 0.06 / 0.13 / 0.10 / 0.13 / 0.11 / 0.39 / 1.00 / 0.09 / 0.09 / 0.06 / 0.25
90-94 / 0.10 / 0.04 / 0.13 / 0.18 / 0.20 / 0.10 / 0.00 / 0.00 / 0.00 / 0.06 / 0.12 / 0.09 / 0.12 / 0.10 / 0.36 / 1.00 / 0.09 / 0.09 / 0.05 / 0.23
95-100 / 0.09 / 0.04 / 0.12 / 0.17 / 0.18 / 0.09 / 0.00 / 0.00 / 0.00 / 0.05 / 0.11 / 0.08 / 0.11 / 0.09 / 0.34 / 1.00 / 0.07 / 0.08 / 0.05 / 0.21

Table S2b: Population attributable fractions (PAF) for men by age group (BMI≥25)

Table S3: Mortality, Years of Potential Life Lost (YPLL) and Quality Adjusted Life Years (QALY) loss attributable to obesity (BMI≥30), by disease group

Deaths / YPLL / QALYs
Male / Female / Both genders / BMI≥30a / Male / Female / Both genders / BMI≥30a / Male / Female / Both genders / BMI≥30a
Neoplasms / 5,485 / 6,190 / 11,675 / 67.6% / 81,031 / 93,033 / 174,063 / 69.1% / 72,195 / 78,199 / 150,394 / 69.1%
Endocrinological diseases / 1,527 / 1,846 / 3,373 / 71.9% / 27,413 / 24,723 / 52,136 / 79.7% / 24,657 / 20,884 / 45,541 / 80.0%
Cardiovascular diseases / 7,880 / 11,016 / 18,896 / 73.2% / 105,785 / 104,180 / 209,966 / 78.0% / 94,136 / 86,229 / 180,465 / 78.5%
Digestive diseases / 28 / 80 / 108 / 61.1% / 327 / 747 / 1,074 / 64.0% / 290 / 618 / 908 / 63.7%
Sum / 14,920 / 19,132 / 34,052 / 71.0% / 214,555 / 222,683 / 437,239 / 74.3% / 191,277 / 185,931 / 377,208 / 74.6%
BMI≥30b / 79.0% / 65.8% / 71.0% / 80.8% / 69.0% / 74.3% / 80.9% / 69.1% / 74.6%

a Columns show the percentage share of total excess weight related (BMI≥25) costs attributable to obesity (BMI≥30) by disease group for both genders combined.

b Rows shows the gender specific percentage share of total excess weight related (BMI≥25) costs attributable to obesity (BMI≥30).

Table S4: Mortality, Years of Potential Life Lost (YPLL), and Quality Adjusted Life

Year (QALY) loss attributable to excess weight (BMI≥25), by gender and age group a

Age / Male / Female
Deaths / YPLL / QALYs / Deaths / YPLL / QALYs
18 – 19 / 4 / 245 / 231 / 0 / 26 / 24
20 – 24 / 6 / 352 / 330 / 2 / 152 / 139
25 – 29 / 13 / 667 / 623 / 7 / 378 / 345
30 – 34 / 32 / 1,467 / 1,365 / 13 / 649 / 590
35 – 39 / 75 / 3,135 / 2,902 / 43 / 1,989 / 1,796
40 – 44 / 205 / 7,560 / 6,953 / 110 / 4,557 / 4,081
45 – 49 / 441 / 14,242 / 13,015 / 205 / 7,551 / 6,699
50 – 54 / 780 / 21,758 / 19,780 / 381 / 12,249 / 10,747
55 – 59 / 1,118 / 26,524 / 23,962 / 831 / 22,981 / 19,909
60 – 64 / 1,642 / 32,532 / 29,172 / 1,139 / 26,551 / 22,682
65 – 69 / 2,972 / 47,963 / 42,638 / 2,147 / 41,008 / 34,484
70 – 74 / 3,675 / 46,927 / 41,349 / 3,460 / 52,251 / 43,277
75 – 79 / 3,316 / 32,679 / 28,541 / 4,292 / 49,334 / 40,270
80 – 84 / 2,553 / 19,132 / 16,709 / 6,048 / 51,231 / 41,819
85 – 89 / 1,430 / 8,263 / 7,216 / 6,079 / 37,699 / 30,773
90 - 100 / 623 / 2,038 / 1,780 / 4,322 / 14,146 / 11,547

a Corresponds to Table 1 in the ESM of the original study.

Table S4a: Direct and indirect costs attributable to excess weight (25≤BMI) in millions of Euro, by disease group, both genders combined

Neoplasms / Endocrinological / Cardiovascular / Digestive / ALL
OW / OB / Total / OW / OB / Total / OW / OB / Total / OW / OB / Total / OW / OB / Total
Direct costs
Inpatient / 136 / 288 / 424 / 192 / 331 / 523 / 199 / 594 / 793 / 77 / 158 / 235 / 604 / 1,371 / 1,975
Outpatient / 121 / 238 / 359 / 731 / 1,702 / 2,433 / 578 / 1,221 / 1,800 / 33 / 71 / 104 / 1,464 / 3,232 / 4,696
Rehabilitation / 31 / 63 / 94 / 13 / 66 / 79 / 9 / 68 / 77 / 0 / 0 / 0 / 53 / 197 / 250
Other a / 75 / 154 / 229 / 218 / 581 / 799 / 172 / 440 / 612 / 28 / 57 / 85 / 493 / 1,233 / 1,726
Total direct costs / 363 / 743 / 1,106 / 1,154 / 2,680 / 3,834 / 959 / 2,323 / 3,282 / 138 / 287 / 425 / 2,613 / 6,034 / 8,647
Indirect costs (paid and unpaid work)
Mortality / 776 / 1,752 / 2,528 / 117 / 610 / 727 / 450 / 1,949 / 2,399 / 5 / 9 / 14 / 1,348 / 4,321 / 5,669
Early retirement / 128 / 259 / 387 / 106 / 444 / 550 / 45 / 216 / 261 / 0 / 0 / 0 / 278 / 921 / 1,199
Sickness Absence / 99 / 200 / 299 / 53 / 192 / 245 / 140 / 500 / 640 / 28 / 68 / 97 / 321 / 959 / 1,281
Total indirect costs / 1,002 / 2,212 / 3,216 / 276 / 1,246 / 1,522 / 636 / 2,665 / 3,301 / 33 / 78 / 111 / 1,948 / 6,202 / 8,150
Direct and indirect costs / 1,366 / 2,955 / 4,321 / 1,430 / 3,927 / 5,356 / 1,595 / 4,989 / 6,583 / 170 / 365 / 536 / 4,561 / 12,235 / 16,796

OW = Overweight (25≤BMI<30), OB = Obesity (BMI≥30)

a Includes costs for health protection, ambulance, administration, research and education, investments, and other facilities.

Table S4b: Direct and indirect costs attributable to excess weight (25≤BMI) in millions of Euro, by disease group, males

Neoplasms / Endocrinological / Cardiovascular / Digestive / ALL
OW / OB / Total / OW / OB / Total / OW / OB / Total / OW / OB / Total / OW / Obese / Total
Direct costs
Inpatient / 69 / 136 / 205 / 118 / 190 / 308 / 15 / 188 / 203 / 35 / 57 / 92 / 236 / 572 / 808
Outpatient / 50 / 99 / 139 / 420 / 811 / 1,231 / 278 / 610 / 888 / 13 / 24 / 37 / 760 / 1,535 / 2,295
Rehabilitation / 11 / 22 / 33 / 8 / 40 / 48 / 2 / 53 / 56 / 0 / 0 / 0 / 22 / 116 / 138
Othera / 37 / 70 / 107 / 130 / 280 / 410 / 68 / 224 / 292 / 12 / 23 / 35 / 247 / 596 / 843
Total direct costs / 166 / 319 / 485 / 676 / 1,320 / 1,996 / 363 / 1,075 / 1,438 / 60 / 104 / 164 / 1,265 / 2,818 / 4,084
Indirect costs (paid and unpaid work)
Mortality / 413 / 899 / 1,312 / 67 / 374 / 441 / 63 / 1,154 / 1,218 / 3 / 3 / 6 / 546 / 2,430 / 2,976
Early retirement / 66 / 139 / 205 / 78 / 275 / 353 / 24 / 168 / 192 / 0 / 0 / 0 / 169 / 582 / 751
Sickness Absence / 32 / 71 / 103 / 40 / 127 / 167 / 81 / 349 / 430 / 8 / 32 / 40 / 162 / 579 / 741
Total indirect costs / 513 / 1,108 / 1,620 / 185 / 776 / 962 / 168 / 1,671 / 1,839 / 11 / 36 / 47 / 877 / 3,591 / 4,468
Direct and indirect costs / 679 / 1,427 / 2,106 / 862 / 2,096 / 2,958 / 531 / 2,747 / 3,278 / 71 / 140 / 211 / 2,143 / 6,410 / 8,552

OW = Overweight (25≤BMI<30), OB = Obesity (BMI≥30)