Ten-year progression of obesity-related complications in a population with overweight and obesity in the UK

High body mass index (BMI), defined as overweight (BMI 25-< 30) and obesity (BMI ≥ 30), is associated with a range of other chronic conditions. For example, individuals living with obesity are more than seven times more probable to develop type 2 diabetes and almost twice as probable to develop Cardiovascular Disease (CVD) than people with healthy weight. Accordingly, reducing the risk of co-morbidity development is a focus of obesity-management strategies and treatment decision-making, including in the UK National Institute for Health and Care Excellence (NICE) guidelines.

This retrospective open cohort study aimed to assess the prevalence of individual obesity-related complications (ORCs) and multimorbidity (≥ 1, ≥ 2 and ≥ 3 ORCs), and multimorbidity-associated healthcare costs, over 10 years.

This study used the Discover dataset. Adults were stratified by BMI: overweight: 25-< 30 , obesity class I: 30-< 35, obesity class II: 35-< 40, obesity class III: ≥ 40 . Outcomes by year since baseline were assessed for serial cross sections across the study period (1 January 2004 to 31 December 2019; the index date was the date of first eligible BMI measurement).

Across 1,410,146 individuals (overweight: 1,008 101; obesity class I: 278,782; obesity class II: 80,621; obesity class III: 42,642), ORC prevalence was higher in successive BMI groups, and increases over time were generally greater for obesity relative to overweight.

In those with ORC multimorbidity, both higher BMI and the presence of more ORCs were associated with higher annual per-person healthcare costs. Costs increased over time in those individuals with obesity and one or more ORC, as well as in those with obesity and two or more ORCs.

Higher BMI was associated with higher baseline ORC prevalence and a greater increase in ORC prevalence over time, and with higher healthcare costs in those with multimorbidity. To reduce the burden of overweight and obesity on patients and healthcare systems, the presence, number and type of ORCs should be considered in developing effective, targeted prevention and management care pathways.

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