Health care expenditure associated with overweight/obesity: a study among urban married women in Delhi, India

BACKGROUND Obesity is a multifaceted problem with wide-reaching medical, social and economic consequences. While health consequences are much known, but due to paucity of data, economic consequences are less known in India. The prevalence for excessive weight particularly among women population has been increasing dramatically in India in the last decades. We examined the economic burden on individual and households due to overweight and obesity among women in the national capital territory of India, Delhi. We particularly examined the health expenditure pattern in absolute amount as well as a proportion to their household expenditure among women according to their level of body mass index (BMI). METHODS A population based follow-up survey of 325 ever-married women aged 20-54 years residing in the national capital territory of Delhi in India, systematically selected from the second round of National Family Health Survey (NFHS-2, 1998-99) samples who were re-interviewed after four years in 2003. Women's expenditure on health has been seen as a gross and as a ratio of total household expenditure. Anthropometric measurements were obtained from women to compute their current body mass index. Multiple logistic regression analysis was used to estimate the odds ratios adjusting for various socio demographic confounders. RESULTS A significantly (p<0.0001) higher monthly gross health expenditure as well as proportion of total household expenditure was found according to the women's level of BMI. Average monthly health expenditure was Rs. 132 among overweight women, Rs 143 among obese women which further increased to Rs. 224 among morbidly obese women compared to only Rs 68 among normal weight women. Almost, 15% overweight, 16% obese and 21% morbidly obese women (p<0.0001) had economic burden which accounts for more than 5% of their total household expenditure on their health compared to only 10% normal weight women. Significantly, obese and morbidly obese women were more than two times more likely to spend higher amount on their health (OR 2.29 95% CI: 1.07-4.90; p=0.033) than normal weight women. Also overweight women were significantly two times more likely to spend high proportion on their health with respect to total household expenditure (OR 2.11; 95% CI: 1.03-4.35; p=0.042) than normal weight women. CONCLUSIONS There is substantial economic burden of obesity for individuals as well as for the households which calls for urgent intervention in the obesity awareness and health promotion among Indian women who faced the greatest burden of increasing body weight in the last decade. Prevention is obviously more cost effective than treatment, both in terms of healthcare and personal costs. Health care providers and policy makers need to critically understand the issue of obesity and develop effective policies and programs for its prevention among Indian women.