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Obesity, lifestyle risk-factors, and health service outcomes among healthy middle-aged adults in Canada

David A Alter1246*, Harindra C Wijeysundera136, Barry Franklin58, Peter C Austin16, Alice Chong16, Paul I Oh127, Jack V Tu136 and Therese A Stukel16

Author Affiliations

1 Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada

2 The Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, Toronto, Canada

3 The Schulich Heart Centre and the Clinical Epidemiology Unit of Sunnybrook Health Science Centre, Toronto, Canada

4 The Li Ka Shing Knowledge Institute of St. Michaels’ Hospital, Department of Medicine, Toronto, Canada

5 Cardiac Rehabilitation and Exercise Laboratories, William Beaumont Hospital, Royal Oak, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA

6 Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

7 Toronto Rehabilitation Institute, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada

8 William Beaumont Hospital, Royal Oak, 3601 W. 13 Mile Rd, Royal Oak, MI, 48073, USA

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BMC Health Services Research 2012, 12:238  doi:10.1186/1472-6963-12-238

Published: 4 August 2012



The extent to which uncomplicated obesity among an otherwise healthy middle-aged population is associated with higher longitudinal health-care expenditures remains unclear.


To examine the incremental long-term health service expenditures and outcomes associated with uncomplicated obesity, 9398 participants of the 1994–1996 National Population Health Survey were linked to administrative data and followed longitudinally forward for 11.5 years to track health service utilization costs and death. Patients with pre-existing heart disease, those who were 65 years of age and older, and those with self-reported body mass indexes of <18.5 kg/m2 at inception were excluded. Propensity-matching was used to compare obesity (+/− other baseline risk-factors and lifestyle behaviours) with normal-weight healthy controls. Cost-analyses were conducted from the perspective of Ontario’s publicly-funded health care system.


Obesity as an isolated risk-factor was not associated with significantly higher health-care costs as compared with normal weight matched controls (Canadian $8,294.67 vs. Canadian $7,323.59, P = 0.27). However, obesity in combination with other lifestyle factors was associated with significantly higher cumulative expenditures as compared with normal-weight healthy matched controls (CAD$14,186.81 for those with obesity + 3 additional risk-factors vs. CAD$7,029.87 for those with normal BMI and no other risk-factors, P < 0.001). The likelihood that obese individuals developed future diabetes and hypertension also rose markedly when other lifestyle factors, such as smoking, physical inactivity and/or psychosocial distress were present at baseline.


The incremental health-care costs associated with obesity was modest in isolation, but increased significantly when combined with other lifestyle risk-factors. Such findings have relevance to the selection, prioritization, and cost-effective targeting of therapeutic lifestyle interventions.

Obesity; Risk-factors; Health service utilization; Health care expenditures; Cohort study; Outcomes