Out-of-pocket health expenditure among individuals with obesity

Furkan Alp Eren; Canser Boz

doi:10.20518/tjph.1796314

Out-of-pocket health expenditure among individuals with obesity

Abstract

Objective: Obesity imposes a growing economic burden on individuals and health systems, particularly in settings with limited public coverage for treatment. To evaluate the out-of-pocket health expenditure associated with obesity and identify factors influencing monthly costs among patients followed at a tertiary-level obesity clinic in Türkiye.

Methods: A cross-sectional study was conducted among adults attending an obesity outpatient clinic. Data on sociodemographic, clinical characteristics, and obesity-related expenditures were collected through structured interviews. Statistical analyses included descriptive statistics, t-tests, ANOVA, Mann-Whitney U, Kruskal-Wallis, chi-square tests, and multivariate linear regression. Results: The mean monthly obesity-related expenditure was USD 44.6 (±75.0), with pharmacological treatment-particularly liraglutide-representing the most significant cost. Liraglutide users reported an average monthly expenditure of over USD 350. The regression model identified liraglutide use as the only significant predictor of high monthly cost. Employment and education level were associated with increased spending, while individuals with chronic diseases reported lower costs, potentially due to partial drug reimbursement. Catastrophic health expenditure (CHE) thresholds were exceeded by 30.1% (5% threshold) and 20.7% (10% threshold) of participants.

Conclusion: Obesity-related costs can pose a substantial financial burden on individuals, especially when effective treatments are not covered by public insurance. Expanding insurance coverage and addressing disparities in access to treatment are critical to reducing the economic impact of obesity.

Keywords

Supporting Institution

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical Statement

Ethical approval was obtained from the İstanbul Medeniyet University Clinical Research Ethics Committee (date: 21/09/2022, approval no: 2022/0542).

Thanks

The authors would like to express their sincere gratitude to Prof. Dr. Mehmet SARGIN for his facilitative role in obtaining the necessary institutional permissions, and to Dr. Hasan Özcan DEMİR for his valuable assistance during the data collection process.

References

1. World Health Organization. Obesity and overweight. 2024. [cited 2025 July 24]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
2. World Obesity Federation. World Obesity Atlas 2023. London: WOF; 2023. [cited 2025 July 24]. Available from: https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2023.
3. Tremmel M, Gerdtham UG, Nilsson PM, Saha S. Economicburden of obesity: a systematic literature review. Int JEnviron Res Public Health. 2017;14(4):435.
4. Okunogbe A, Nugent R, Spencer G, et al. The economicburden of obesity: a systematic literature review. Obes Rev.2021;22(9):e13313.
5. Gogas Yavuz D, Akhtar O, Low K, et al. The economicimpact of obesity in Turkey: a micro-costing analysis.Clinicoecon Outcomes Res. 2024;16:123-32.
6. Vilsbøll T, Christensen M, Junker AE, Knop FK, GluudLL.Effects of glucagon-like peptide-1 receptor agonistson weight loss: systematic review and meta-analyses ofrandomised controlled trials. BMJ. 2012;344:d7771.
7. Getachew N, Shigut H, Edessa GJ, et al. Catastrophic health expenditure and associated factors among households of non-community-based health insurance districts, Ilubabor Zone, Oromia Regional State, southwest Ethiopia. Int J Equity Health. 2023;22:40.
8. Ministry of Health of the Republic of Türkiye. Turkey Nutrition and Health Survey (TNHS) 2019. Ankara: Halk Sağlığı Genel Müdürlüğü; 2020.

9. Sandalcı U, Tuncer G. An evaluation of direct and indirect costs of obesity. Aksaray Univ J Fac Econ Adm Sci. 2020;12(2):29-44.
10. Yiğit A, Yiğit V. Economic burden of obesity-related comorbidities in Turkey. Gümüşhane Univ J Health Sci. 2019;8(3):223-30.
11. Turkish Society of Endocrinology and Metabolism (TEMD). Obesity Diagnosis and Treatment Guideline - 2024. Ankara: TEMD Publications; 2024.
12. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. Geneva: World Health Organization; 2000. (WHO Technical Report Series, No. 894).
13. European Association for the Study of Obesity. The use of anti-obesity drugs: A position statement from the European Association for the Study of Obesity. 2015 [cited 2025 July 24]. Available from: https://easo.org/wp-content/ uploads/2018/12/The-use-of-anti-obesity-drugs.pdf
14. Vilsbøll T, Christensen M, Junker AE, Knop FK, Gluud LL. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ. 2012;344:d7771.
15. Dushay J, Gao C, Gopalakrishnan GS, et al. Short-term exenatide treatment leads to significant weight loss in a subset of obese women without diabetes. Diabetes Care. 2012;35(1):4-11.
16. Xu K, Evans DB, Carrin G, et al. Protecting households from catastrophic health spending. Health affairs (Project Hope). 2007;26(4):972-83.
17. Waters HR, Anderson GF, Mays J. Measuring financial protection in health in the United States. Health policy. 2004;69(3):339-49.
18. Wyszewianski L. Financially catastrophic and high-cost cases: definitions, distinctions, and their implications for policy formulation, Inquiry. 1986;23(4):382-94.
19. Köktaş AM, Eren AA. Katastrofik Sağlık Harcaması: Literatür Taraması, Fiscaoeconomia, Special Issiue 1: Catastrophic Health Expenditure. 2017;1-4.
20. Boz C, Mete AH, Aslan Ö. Determinants of Catastrophic Health Expenditure for Surgical Care: Panel Regression Model, Indian J Surg. 2020;83:1210-5.
21. Olivieri AV, Muratov S, Larsen S, et al. Cost-effectiveness of weight-management pharmacotherapies in Canada: a societal perspective. International journal of obesity. 2024;48(5):683-93.
22. Hu S, Zanwar PP, Jenkins T, Sevak RJ, Jasti BR. Comparing Out-of-Pocket Costs and Health-Related Quality of Life Between Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists in Patients with Type 2 Diabetes. Drug Healthc Patient Saf. 2025;17:121-34.
23. Liu BY, Rome BN. State Coverage and Reimbursement of Antiobesity Medications in Medicaid. JAMA. 2024;331(14):1230-2.
24. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health affairs (Project Hope). 2009;28(5): w822-31.
25. Lehnert T, Sonntag D, Konnopka A, Riedel-Heller S, König HH. Economic costs of overweight and obesity. Best Pract Res Clin Endocrinol Metab. 2013;27(2):105-15.
26. Dee A, Kearns K, O'Neill C, et al. The direct and indirect costs of both overweight and obesity: a systematic review. BMC Res Notes. 2014;7:242.
27. Dieleman JL, Baral R, Birger M, et al. US Spending on Personal Health Care and Public Health, 1996-2013. JAMA. 2016;316(24):2627-46.
28. Sørensen K, Van den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80.
29. Withrow D, Alter DA. The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev. 2011;12(2):131-41.
30. Peng Z, Zhu L. The impacts of health insurance on financial strain for people with chronic diseases. BMC Public Health. 2021;21:1012.
31. Lasota K, Holownia-Voloskova M, Casciano R, Walczak J. Is there an opportunity for reimbursement of anti-obesity drugs in Central and Eastern Europe? Value Health. 2024;27(12):S2.
32. Rezapour A, Vahedi S, Khiavi FF, Esmaeilzadeh F, Javan- Noughabi J, Rajabi A. Catastrophic Health Expenditure of Chronic Diseases: Evidence from Hamadan, Iran. Int J Prev Med. 2017;8:99.
33. Liu H, Zhu H, Wang J, et al. Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system. BMC Public Health. 2019;19:1761.
34. Annie Haakenstad, Matthew Coates, Gene Bukhman, Margaret McConnell, Stéphane Verguet, Comparative health systems analysis of differences in the catastrophic health expenditure associated with non-communicable vs communicable diseases among adults in six countries, Health Policy and Planning. 2022;37(9):1107-115.

Details

Primary Language

English

Subjects

Public Health (Other)

Journal Section

Research Article

Authors

Furkan Alp Eren ^*
0000-0002-8914-7302
Türkiye

Canser Boz
0000-0002-6136-4479
Türkiye

Publication Date

May 15, 2026

Submission Date

October 3, 2025

Acceptance Date

March 23, 2026

Published in Issue

Year 2026 Number: 1

DOI

https://doi.org/10.20518/tjph.1796314

IZ

https://izlik.org/JA87XT68NZ

Cite

RIS / Bibtex

APA

Eren, F. A., & Boz, C. (2026). Out-of-pocket health expenditure among individuals with obesity. Turkish Journal of Public Health, 1. https://doi.org/10.20518/tjph.1796314

AMA

1.Eren FA, Boz C. Out-of-pocket health expenditure among individuals with obesity. TJPH. 2026;(1). doi:10.20518/tjph.1796314

Chicago

Eren, Furkan Alp, and Canser Boz. 2026. “Out-of-Pocket Health Expenditure Among Individuals With Obesity”. Turkish Journal of Public Health, no. 1. https://doi.org/10.20518/tjph.1796314.

EndNote

Eren FA, Boz C (May 1, 2026) Out-of-pocket health expenditure among individuals with obesity. Turkish Journal of Public Health 1

IEEE

[1]F. A. Eren and C. Boz, “Out-of-pocket health expenditure among individuals with obesity”, TJPH, no. 1, May 2026, doi: 10.20518/tjph.1796314.

ISNAD

Eren, Furkan Alp - Boz, Canser. “Out-of-Pocket Health Expenditure Among Individuals With Obesity”. Turkish Journal of Public Health. 1 (May 1, 2026). https://doi.org/10.20518/tjph.1796314.

JAMA

1.Eren FA, Boz C. Out-of-pocket health expenditure among individuals with obesity. TJPH. 2026. doi:10.20518/tjph.1796314.

MLA

Eren, Furkan Alp, and Canser Boz. “Out-of-Pocket Health Expenditure Among Individuals With Obesity”. Turkish Journal of Public Health, no. 1, May 2026, doi:10.20518/tjph.1796314.

Vancouver

1.Furkan Alp Eren, Canser Boz. Out-of-pocket health expenditure among individuals with obesity. TJPH. 2026 May 1;(1). doi:10.20518/tjph.1796314