UNMET MEDICAL NEED AND BURDEN OF OBESITY ON PATIENTS, PAYERS, AND HEALTH SYSTEMS IN CANADA, THE USA, AND ENGLAND
Author(s)
Julie Frappier, BS, MSc1, Stefan Walzer, MA, PhD2, Bjoern Schwander, BSc, MA, RN, PhD3, Sally Lewis, MD4, sabrina hanna, BSc5, Casandra Poitras, MPH (ongoing)6.
1President & Founder of the TOWWERS program, TOWWERS Institute (Data 4 Actions), Montreal, QC, Canada, 2MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 3AHEAD GmbH, Bietigheim-Bissingen, Germany, 4Kintsugi International, Wales, United Kingdom, 5the cancer collaborative, laval, QC, Canada, 6Conseils Zèbre Politique, Marieville, QC, Canada.
1President & Founder of the TOWWERS program, TOWWERS Institute (Data 4 Actions), Montreal, QC, Canada, 2MArS Market Access & Pricing Strategy GmbH, Weil am Rhein, Germany, 3AHEAD GmbH, Bietigheim-Bissingen, Germany, 4Kintsugi International, Wales, United Kingdom, 5the cancer collaborative, laval, QC, Canada, 6Conseils Zèbre Politique, Marieville, QC, Canada.
OBJECTIVES: To quantify the unmet medical need and burden of obesity on patients, payers, and health systems in Canada, the USA, and England. Despite rising prevalence and robust evidence supporting pharmacological treatment, access to effective anti-obesity therapies remains highly restricted across public and private payer systems. Understanding the magnitude of disease burden and access gaps is essential to inform sustainable treatment and reimbursement strategies.
METHODS: A targeted literature review was conducted using PubMed, EMBASE, government epidemiological databases (CDC, CIHI, NHS Digital), and OECD health expenditure statistics published between 2015 and 2024. Extracted data included obesity prevalence and severity, obesity-related comorbidities, quality-of-life impact, healthcare utilization, direct and indirect costs, and payer coverage of anti-obesity pharmacotherapies. National and regional payer documents, including Medicare policies, Canadian provincial formularies, and NHS England guidance, were reviewed to characterize reimbursement availability.
RESULTS: Obesity prevalence and associated burden are substantial across all settings. In the USA, approximately 42% of adults have obesity, including nearly 9% with severe obesity. Annual direct medical expenditures attributable to obesity exceed $173 billion, representing approximately 12% of healthcare spending, with high morbidity from diabetes and cardiovascular disease. In Canada, adult obesity prevalence is approximately 28%, with severe obesity more than tripling since 1985. Direct medical costs are estimated at $7-8 billion CAD annually, with total societal costs exceeding $15 billion when productivity losses are included. In England, approximately 26% of adults have obesity, contributing to NHS expenditures exceeding £6.5 billion annually and over one million obesity-related hospital admissions per year. Across all countries, fewer than 5-10% of eligible patients have reimbursed access to evidence-based pharmacotherapy.
CONCLUSIONS: Obesity represents a significant and growing unmet medical need. High prevalence, substantial comorbidity, and limited access to effective treatment highlight the need for more sustainable and equitable approaches to obesity management and reimbursement.
METHODS: A targeted literature review was conducted using PubMed, EMBASE, government epidemiological databases (CDC, CIHI, NHS Digital), and OECD health expenditure statistics published between 2015 and 2024. Extracted data included obesity prevalence and severity, obesity-related comorbidities, quality-of-life impact, healthcare utilization, direct and indirect costs, and payer coverage of anti-obesity pharmacotherapies. National and regional payer documents, including Medicare policies, Canadian provincial formularies, and NHS England guidance, were reviewed to characterize reimbursement availability.
RESULTS: Obesity prevalence and associated burden are substantial across all settings. In the USA, approximately 42% of adults have obesity, including nearly 9% with severe obesity. Annual direct medical expenditures attributable to obesity exceed $173 billion, representing approximately 12% of healthcare spending, with high morbidity from diabetes and cardiovascular disease. In Canada, adult obesity prevalence is approximately 28%, with severe obesity more than tripling since 1985. Direct medical costs are estimated at $7-8 billion CAD annually, with total societal costs exceeding $15 billion when productivity losses are included. In England, approximately 26% of adults have obesity, contributing to NHS expenditures exceeding £6.5 billion annually and over one million obesity-related hospital admissions per year. Across all countries, fewer than 5-10% of eligible patients have reimbursed access to evidence-based pharmacotherapy.
CONCLUSIONS: Obesity represents a significant and growing unmet medical need. High prevalence, substantial comorbidity, and limited access to effective treatment highlight the need for more sustainable and equitable approaches to obesity management and reimbursement.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR3
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)