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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

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

BMC Health Services Research > Ausgabe 1/2012
David A Alter, Harindra C Wijeysundera, Barry Franklin, Peter C Austin, Alice Chong, Paul I Oh, Jack V Tu, Therese A Stukel
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-238) contains supplementary material, which is available to authorized users.

Competing interests

Dr. Alter is the Scientific Advisor of INTERxVENT Canada, which is a therapeutic lifestyle and disease management company. Dr. Alter has received consultation fees from INTERxVENT Canada in the past 5 years, but no longer does so. Dr. Alter has minimal shares in the organization. INTERxVENT Canada did not finance this article or the article processing charge. Dr. Alter has no other financial competing interests and has no non-financial competing interests to declare. None of the other authors have any financial or non-financial competing interests to declare.

Authors’ contributions

Dr. A conceived of the study and design, analyzed and drafted the manuscript; Drs. A and S participated in the design of the study and the statistical analysis. AC assisted with statistical analysis. All authors’ interpreted data, read and approved the final manuscript.



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.
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