Public Health 237 (2024) 184–192

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Public Health
journal homepage: www.elsevier.com/locate/puhe

Original Research

The cost of obesity and related NCDs in Brazil: An analysis of hospital

admissions, disability retirement benefits, and statutory sick pay
Eduardo Botti Abbade
Department of Administrative Sciences, Federal University of Santa Maria, Roraima Ave., n. 1000, Zip Code: 97105-900, Santa Maria, RS, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: This study analyses the prevalence of overweight/obesity in Brazil, and its costs regarding hospital
Obesity admissions (HA), disability retirement benefits (DRB), and statutory sick pay (SSP) associated with obesity-
Public health related non-communicable diseases (NCDs).
Economic assessment in health
Study design: Time-series study.
Environmental health
Methods: This study analyses data from the VIGITEL system (2010–2019) to calculate the body-mass index (BMI)
Public policy
Cost of illness of adult residents in Brazil’s state capitals. Data on HA, DRB, and SSP were obtained from Brazil’s SIH/SUS and
AEPS Infologo systems. Pearson’s correlation and linear regression models were applied. The study selected 23
diseases of the International Classification of Disease (ICDs) belonging to chapters C; E; I; and K. Cost values in
BRL were deflated using IPCA.
Results: The results showed a significant increase in overweight and obesity rates in Brazil, with BMI rising by
0.09 kg/m2 annually. Regression analysis revealed that each 1-point increase in the average BMI of the popu­
lation is associated with an increase of 81,772 (BRL 237.51 million/year) new HA per year, 5541 (BRL 18.8
million/year) new DRB granted per year, and 42,360 (BRL 131 million/year) new SSP per year. Also, every 1 %
increase in the share of the Brazilian population with obesity is associated with an increase of 16,973 (BRL 48.8
million/year) new HA per year, 1202 (BRL 3.97 million/year) new DRB granted per year, and 8686 (BRL 26.8
million/year) new SSP per year. Regressions for deflated values showed lower significance, suggesting a strong
impact of inflation on health costs in Brazil.
Conclusions: Obesity prevalence in Brazil implies high direct and indirect costs for the Brazilian government,
especially considering circulatory system diseases.

Introduction Previous studies have shown an association between obesity and

noncommunicable diseases (NCDs) such as diabetes, cardiovascular
Obesity has escalated into a global pandemic, affecting millions of disease, and some types of cancer.10–13 Considering the risk of cardio­
people across all age groups, cultures, and socioeconomic backgrounds. vascular disease, previous studies revealed that for each unit increase in
The prevalence of obesity has risen dramatically over the past few de­ body mass index (BMI), the risk of heart failure increases by 5 % and 7 %
cades, with nearly every region of the world experiencing significant in men and women, respectively.14,15
increases in rates.1–3 The obesity pandemic that plagues humanity, The prevalence of obesity implies high direct and indirect costs for
affecting both developed and developing countries, represents a risk society.16,17 Previous studies have addressed the relationship between
factor not only for the health of affected individuals but also for social, the prevalence of overweight and obesity and health expenditures.18,19
economic, and environmental issues.4–7 The World Health Organization The main direct costs associated with obesity are hospitalization and
(WHO) reported that in 2016, 39 % of the world’s population of adults outpatient care costs, as well as costs with tests, medical procedures,
over the age of 18 were overweight, and 13 % were obese.8 In Brazil, medications, and other forms of clinical treatment. The main indirect
2021 data from VIGITEL—a broad surveillance study of risk and pro­ costs related to obesity are the costs of premature retirement, loss of
tective factors for chronic diseases conducted by the Ministry of productivity, absenteeism at work due to hospitalizations and sick
Health—revealed that approximately 57.25 % of the adult population leaves, and costs associated with premature mortality.20–24
self-reported as overweight, and 22.35 % self-reported as obese.9 Furthermore, previous studies have shown a significant association

E-mail address: [email protected].

https://doi.org/10.1016/j.puhe.2024.10.006
Received 3 May 2024; Received in revised form 16 September 2024; Accepted 4 October 2024
Available online 18 October 2024
0033-3506/© 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training,
and similar technologies.
E.B. Abbade Public Health 237 (2024) 184–192

between the prevalence of overweight and obesity and disability pen­ of the interview conducted by VIGITEL were disregarded since pregnant
sions, as well as production loss. An expansive study evaluating the women have their BMI altered due to pregnancy and not due to over­
hazard ratio (HR)/risk ratio (RR), a risk indicator for people with normal weight and obesity. Subsequently, the BMI values obtained were clas­
BMI, showed that obesity is associated with an increased risk of sified according to the following categories: (1) normal [BMI <25]; (2)
disability retirement due to (1) musculoskeletal disorders (HR/RR = overweight [BMI ≥25]; (3) obesity I [BMI ≥30]; (4) obesity II [BMI
1.66, 95 % CI 1.42 to 1.94), (2) mental disorders (HR/RR = 1.29, 95 % ≥35]; and (5) obesity III [BMI ≥40]. After preliminary treatments of the
CI 1.04 to 1.61), and (3) cardiovascular disease (HR/RR = 2.80, 95 % CI database including the removal of records of pregnant women and
1.85 to 4.24).25 Another study showed that total and abdominal obesity incomplete records, the final database totaled 463,504 valid records
were responsible for increased costs, with a loss of productivity due to from 2010 to 2019.
early retirement in adults aged 50 years or older.26 Data on HA were obtained from Brazil’s Hospital Information System
Specifically in Brazil, some important studies have investigated the (SIH/SUS), extracted using TABWIN software. This system compiles
relationship between economic costs and obesity prevalence at the na­ data from Hospital Admission Authorizations, mandatory documents for
tional level. These studies contribute valuable insights by examining the HA in the Brazilian Public Health System. Variables extracted included
financial burden that obesity imposes on the healthcare system and the patients’ residence (limited to state capitals), main ICD diagnosis, total
economy. A study estimated that overweight and obesity contribute to HA cost, and year (2010–2019). Data were filtered to reflect the popu­
approximately US$ 654 million in annual direct healthcare costs related lation monitored by the VIGITEL study, focusing on state capitals.
to non-communicable diseases (NCDs) within the Brazilian Unified Data on DRB and SSP were obtained from Brazil’s Social Security
Health System (SUS), with cardiovascular diseases accounting for the AEPS Infologo system. This system provides annual data on pension and
highest costs.27 Additionally, a study found that obesity in Brazil is social benefit concessions, allowing diagnostic filtering to identify rea­
associated with a significantly higher utilization of health services, sons for DRB and SSP.32 These data cover the entire Brazilian
particularly for hypertension and diabetes, with obese individuals population.
making nearly double the use of these services compared to those of Regarding the main terms, HA refer to instances where individuals
normal weight. The results highlight the increased burden obesity places are admitted to healthcare facilities for treatment., DRB encompass
on the national health system, particularly in terms of human resources payments granted to individuals who are permanently unable to work
and material demand.28 Also, a systematic review found that the direct due to health conditions, and SSP refers to short-term financial
and indirect costs of obesity in Brazil range widely from USD 133.8 compensation provided to employees who are temporarily unable to
million to USD 6.3 billion annually, with significant variability due to work due to illness. These definitions are applied uniformly throughout
differing methods and diseases considered. The review highlights the the analysis.
need for more comprehensive studies, particularly on indirect costs, to The use of official data from the VIGITEL, SIH/SUS, and AEPS
better understand the full economic impact of obesity in Brazil.29 Infologo provides a robust foundation for this study, as these databases
Nevertheless, another study modeled the impact of implementing a 20 % are widely recognized for their comprehensive coverage and reliability.
and 30 % excise tax on sugar-sweetened beverages (SSBs) in Brazil, VIGITEL employs a systematic approach for collecting data through
finding that such taxes could reduce obesity prevalence by 6.7 % and telephone surveys, ensuring representation across Brazil’s capital cities
9.1 % respectively, and save up to $17.9 billion in obesity-related costs while utilizing post-stratification adjustments to correct for potential
over 10 years. The findings suggest that increasing SSB taxes could sampling biases. SIH/SUS follows strict protocols for data reporting and
significantly reduce consumption of ultra-processed beverages and verification, contributing to its reliability in tracking health outcomes
associated health costs.30 across the public healthcare system. Similarly, the AEPS Infologo data­
The objective of this study is to analyze the historical evolution of the base is subject to rigorous data entry, validation processes, and regular
prevalence of overweight and obesity in Brazil and assess its economic audits to maintain accuracy. Despite these quality controls, it is
impact. This paper examines spending granted by the Brazilian gov­ important to acknowledge that limitations may still exist, such as po­
ernment on hospital admissions (HA), disability retirement benefits tential underreporting in certain regions or discrepancies in coding
(DRB), and statutory sick pay (SSP) associated with (1) neoplasm di­ practices. Nonetheless, the use of these systems ensures that the data
agnoses; (2) endocrine, nutritional, and metabolic diseases; (3) diseases employed in this study meet high standards of accuracy and are suitable
of the circulatory system; and (4) diseases of the digestive system. for policy analysis.
The study focused on specific diagnoses from chapters C (neo­
Methods plasms), E (endocrine, nutritional, and metabolic diseases), I (circula­
tory system diseases), and K (digestive system diseases). Pearson’s
This study uses official data regarding the height and weight of correlation was calculated between selected diagnoses and average
people residing in the capitals of Brazil obtained from the Risk Factor Brazilian BMI from 2010 to 2019. Diagnoses strongly correlated with
Surveillance system for chronic NCDs of the Ministry of Health (VIG­ average BMI were selected, considering medical evidence. A total of 23
ITEL) to calculate individual BMI. This systematic survey conducted by priority diagnoses were identified. Despite the fact that Population
the Ministry of Health is carried out annually by the Brazilian govern­ Attributable Risk (PAR) as a more conventional approach in the litera­
ment, generating annual data on adult populations (≥18 years old) ture when assessing the impact of obesity on specific diseases,33–35 this
residing in the 26 Brazilian state capitals and the Federal District. A study uses Pearson’s correlation to provide a preliminary, direct
minimum of 2000 telephone interviews are carried out per capital of the assessment of the strength and direction of the relationship between
country to obtain a confidence level of at least 95 % and a sampling error overall population BMI trends and disease incidence. However, we
of a maximum of 2 %.31 This study used data from surveys carried out recognize the limitation that this approach does not differentiate the
from 2010 to 2019. This period was defined to keep reliable data proportion of disease cases specifically attributable to obesity, as would
available for all analyzed data systems and exclude any interference be the case with PAR.
from the COVID-19 pandemic. To examine the relationship between obesity and its economic and
The database compiled from VIGITEL data consisted of a base of health impacts, this study conducted a series of regression analyses. The
512,969 respondent records from 2010 to 2019. Note that the re­ dependent variables in these models were the annual number of new
spondents to the VIGITEL survey are only residents of the capitals of HA, new DRB granted, and new SSP, as well as their estimated cost. The
Brazil. The study proceeded with the calculation of BMI for each of the independent variables included the average body-mass index (BMI) of
records using the standard formula of BMI = [weight]/[height].2 Note the population and the percentage of the population classified as obese.
that the records of women who declared they were pregnant at the time The study employed linear regression models to estimate the impact of

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E.B. Abbade Public Health 237 (2024) 184–192

increases in BMI and obesity prevalence on the dependent variables. averaging: BRL1.7603/USD (2010), BRL1.6750/USD (2011),
The primary models were specified as follows: BRL1.9546/USD (2012), BRL2.1576/USD (2013), BRL2.3534/USD
(2014), BRL3.3315/USD (2015), BRL3.4901/USD (2016), BRL3.1920/
Model 1 : Y1 = α1 + β1 × BMI + ε1
USD (2017), BRL3.6542/USD (2018), and BRL3.9451/USD (2019).36
Additionally, to account for inflation during the analyzed period, this
Model 2 : Y2 = α2 + β2 × Obesity Prevalence + ε2
study used the official price index published by IBGE (IPCA),37 adjusting
Where: cost estimates to reflect prices as of December 2023. The following
Y1 represents the number or cost for new HA, DRB, or SSP; annual correction indices, based on the IPCA, were applied to adjust the
α1, α2 are the intercepts of the models; cost estimates for the years 2010–2019, bringing them to December
β1, β2 are the coefficients for BMI and obesity prevalence, 2023 values: 2.1327182 (2010), 1.9999069 (2011), 1.8950349 (2012),
respectively; 1.791582 (2013), 1.6813614 (2014), 1.5219221 (2015), 1.4225239
ε1, ε2 are the error terms. (2016), 1.3837262 (2017), 1.3299191 (2018), and 1.2877474 (2019).
The regression coefficients were interpreted to quantify the impact of These indices ensure that historical costs are properly adjusted for
obesity on the health system and social security costs. The models were inflation, reflecting their real value in 2023.
evaluated for statistical significance and goodness-of-fit measures. P-
values were calculated for each coefficient to assess their significance, Results
with a threshold of p < 0.05 indicating statistical significance. Adjusted
R-squared values were reported to measure the proportion of variance Table 1 outlines Brazilian trends in overweight/obesity prevalence,
explained by the models, ensuring the robustness of the findings. It is HA via the SUS system, DRB, and SSP for 2010, 2013, 2016, and 2019,
important to highlight that the regression model does not incorporate including linear trends and R2 values.
confounding variables (covariates), mainly due to the unavailability of The results indicate a significant increase in overweight/obesity
specific demographic or other relevant variables in the consulted prevalence, with an annual average BMI increase of 0.09 kg/m2. Over­
databases. weight and obesity rates rise by approximately 0.9 % and 0.45 % per
Diagnostic tests and residual plots confirmed that the relationships year, respectively. HA increased from approximately 11.3 million (BRL
between the variables met the linearity assumption, while tests for ho­ 10.7 billion) in 2010 to around 12.2 million (BRL 15.7 billion) in 2019,
moscedasticity and independence showed no significant violations. with an average annual growth of 84.7 thousand admissions and BRL
Also, the normality of residuals was verified through appropriate sta­ 544.9 million. New DRB granted rose from about 183 thousand (BRL
tistical tests, ensuring satisfactory robustness of the regression models 163.5 million) in 2010 to 244.5 thousand (BRL 369.4 million) in 2019,
used in this study. with an average annual increase of 6.4 thousand. Similarly, SSP grants
Monetary data were converted from Brazilian Real (BRL) to USD increased from 1.9 million (BRL 1.5 billion) in 2010 to 2.1 million (BRL
using annual exchange rates provided by the Central Bank of Brazil, 3.1 billion) in 2019, with an average annual increase of 11.7 thousand.

Table 1
Evolution of prevalence of overweigh and obesity, HA, granted DRB, and SSP in Brazil associated with the 23 selected diseases.
YEAR TREND (slope)d R2

2010 2013 2016 2019

Overweight/Obesity Prevalence
BMI (kg/m2) 25.6 26.0 26.3 26.5 0.0908 0.9410
Overweight (%) 49.1 % 52.6 % 56.2 % 57.4 % 0.902 % 0.9359
Obese. I (%) 15.6 % 17.8 % 19.0 % 20.3 % 0.453 % 0.9536
Obese. II (%) 4.0 % 4.5 % 4.8 % 5.3 % 0.129 % 0.9367
Obese. III (%) 1.0 % 1.3 % 1.2 % 1.4 % 0.032 % 0.7205
Hospital Admissions (HA)
No HA ( × 1000) 11,347 11,179 11,256 12,185 84.72 0.5856
$ HA (in BRL million) 10,753 12,655 13,868 15,730 544.95 0.9870
$ HA (in BRL million) deflateda 22,933 22,672 19,728 20,256 − 372.39 0.7771
$ HA (in USD million) 6108.62 5865.31 3973.53 3987.22 − 311.63 0.8003
Pension/Health Benefits | GRANTED
No DRBb 183,678 193,561 174,112 244,489 6412 0.4398
No SSP [LOPS] 1,900,728 2,273,074 2,197,054 2,075,240 11,783 0.0461
$ DRBb (in BRL million) 163.5 210 234.9 369.4 22.8 0.8387
$ DRBb (in BRL million) deflateda 348.7 376.2 334.1 475.7 13 0.4371
$ DRBb (in USD million) 92.88 97.33 67.30 93.64 − 1.01 0.0453
$ SSP (in BRL million) 1572.6 2358.5 2903.4 3087.2 173.8 0.8933
$ SSP (in BRL million) deflateda 3353.9 4225.4 4130.1 3975.5 55.6 0.2084
$ SSP (in USD million) 893.37 1093.11 831.90 782.54 − 26.67 0.2927
Pension/Health Benefits | ACTIVE
No DRBc 2,913,381 3,077,463 3,188,661 3,366,292 49,292 0.9921
No SSP [LOPS] 1,192,005 1,394,833 1,486,505 952,854 − 19,775 0.1118
$ DRBc (in BRL million) 2197.7 3041 4070.2 4920.8 316.4 0.9951
$ DRBc (in BRL million) deflateda 4687.1 5448.2 5789.9 6336.7 183.5 0.9654
$ DRBc (in USD million) 1248.48 1409.44 1166.21 1247.32 − 13.61 0.1152
$ SSP (in BRL million) 1011.8 1416.2 1862.3 1362.5 56.3 0.4117
$ SSP (in BRL million) deflateda 2157.9 2537.2 2649.2 1754.6 32.1 0.1066
$ SSP (in USD million) 574.79 656.38 533.60 345.37 − 29.87 0.6657

Note.
a
Monetary values Deflated to dez/2023 using IPCA (IBGE).
b
[(Disability Benefits | Determinant Ignored) + (Disability Benefits | LOPS].
c
[(Disability Benefits | Determinant Ignored) + (Other Disability Benefits) + (Disability Benefits | LOPS)].
d
Trend (slope) calculated using data from 2010 to 2019; LOPS = Organic Social Security Law Social.

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E.B. Abbade Public Health 237 (2024) 184–192

Active benefits also rose, with DRB increasing from around 2.9 million increase of around 1200 new DRB grants under these ICDs, notably in
(BRL 2.2 billion) in 2010 to 3.4 million (BRL 4.9 billion) in 2019, Chapters C (neoplasms) and I (circulatory system diseases).
averaging 49.3 thousand more per year. SSP increased from 1.2 million Moreover, using nominal values, each 1-point increase in the average
(BRL 1 billion) in 2010 to 952 thousand (BRL 1.4 billion) in 2019. population BMI corresponds to an average annual increase of BRL 18.8
The deflated values presented in Table 1 reveal important trends in million in new DRB expenses under the selected ICDs, while a 1 % in­
HA, DRB, and SSP. Although the nominal costs for HA, DRB, and SSP crease in obesity prevalence results in an average annual spending in­
have shown a significant upward trend over the years, the deflated crease of approximately BRL 3.97 million. However, when using
values suggests diferente trends. Deflated hospital admissions costs have deflated BRL values, the average BMI (independent variable) is not
decreased indicating a declining trend when adjusted for inflation. statistically significant, and a 1 % increase in obesity prevalence leads to
Similarly, the deflated values for DRB reveal a more modest increase. an average annual spending increase of around BRL 2.9 million. These
Also, deflated SSP values have shown some inconsistent trends. These results reinforce the strong effect inflation has on social security costs in
deflated trends highlight the complex impact of inflation on healthcare Brazil. USD estimates were not statistically significant.
and social security expenditures in Brazil. Table 5 displays regression results for SSP granted under the selected
Table 2 presents Pearson’s correlation values between average ICD diagnoses, with average population BMI and obesity prevalence as
population BMI and HA, DRB, and SSP for selected ICD diagnoses from independent variables. Coefficient β indicates the change in SSP per year
2010 to 2019, alongside the annual average amounts and monetary for each 1-point increase in BMI or 1 % increase in obesity prevalence in
values (in BRL and USD) for the 23 selected ICDs. Brazil from 2010 to 2019.
The 23 selected ICD diagnoses lead to approximately 183 thousand With rising overweight and obesity rates in Brazil, each 1-point in­
HA annually, about 13 thousand new DRB grants, and roughly 117 crease in average population BMI corresponds to an average annual
thousand SSP per year. HA and social security benefits are notably increase of 42.4 thousand new grants of SSP across the 23 selected ICDs
higher for cardiovascular diseases (Chapter I) like I21 and I64, and in the public health system. Additionally, for every 1 % increase in
certain digestive system diseases (K80 and K92). These diagnoses obesity prevalence (BMI >30), there’s an average annual increase of
contribute around BRL 388 million (USD 147 million) to annual HA around 8.7 thousand new SSP grants, notably in ICDs E66 and K80.
costs, approximately BRL 17.8 million (USD 6.5 million) to new DRB Moreover, considering nominal values, each 1-point increase in
grants, and about BRL 140.6 million (USD 51.9 million) to new SSP average population BMI is associated with an average annual increase of
annually. Most of this financial burden is linked to cardiovascular dis­ BRL 131 million in new SSP expenses under the selected ICDs, while a 1
eases (Chapter I). While ICD I20 shows high HA and SSP costs, its cor­ % increase in obesity prevalence leads to an average annual spending
relation with obesity prevalence (measured by average BMI) and the increase of around BRL 26.8 million. Also, considering deflated values,
number of HA and social security benefits is weak. each 1-point increase in average population BMI is associated with an
Table 3 displays regression results estimating the impact of popula­ average annual increase of BRL 87 million in new SSP expenses under
tion BMI and obesity prevalence on the number of HA under the selected the selected ICDs, while a 1 % increase in obesity prevalence leads to an
ICD diagnoses. The coefficient β indicates the change in HA for each 1- average annual spending increase of around BRL 17.9 million. However,
point increase in BMI or each 1 % rise in obesity prevalence in Brazil USD estimates were not statistically significant.
from 2010 to 2019. The table also presents regression considering the
total monetary value (in BRL and USD) associated with the 23 diagnoses Discussion
to estimate potential spending increases in Brazil due to worsening
overweight and obesity prevalence. This study shows that the prevalence of overweight and obesity in
The results indicate that with every 1-point increase in average Brazil has increased sharply in recent years, which justifies the need to
population BMI, there would be an average annual increase of 81.8 design more efficient public policies to combat this aggravation. The
thousand HA under the 23 selected ICD diagnoses in the Brazilian public study also points out that public spending on HA, DRB and SSP represent
health system. Similarly, for every 1 % increase in the prevalence of a considerable and growing amount of public financial resources spent
obesity (BMI >30), there would be an average annual increase of 16.97 each year, which greatly compromises the Brazilian public budget, as
thousand HA under these diagnoses. Notable increases are observed in previously seen in other countries.38–40
ICDs I21, I64, K80, and K92. This study reveals varying correlations between diseases and over­
Furthermore, when considering nominal values, each 1-point in­ weight/obesity prevalence. Highlighting diseases of the circulatory
crease in average population BMI would result in an average annual system, neoplasms, endocrine-metabolic, and digestive systems as hav­
increase of BRL 237.51 million in HA expenses under these ICD di­ ing significant cost impacts, it suggests a substantial increase in obesity-
agnoses, while a 1 % increase in obesity prevalence would lead to an related healthcare costs in Brazil in the coming years. While specific
average annual increase of BRL 48.82 million. However, the USD esti­ costs for each ICD were not estimated, evidence suggests an annual in­
mates did not show the same significance, indicating a weaker associ­ crease of approximately BRL 387.3 million for every 1-point rise in
ation between spending in dollars and worsening obesity prevalence, average population BMI and around BRL 79.6 million for every 1 %
suggesting a lag in public health expenditures in Brazil compared to increase in the obese population.
international currency values. Thus, when considering deflated BRL As a result, the worsening prevalence of overweight and obesity will
values, the regression presents no significance, suggesting that inflation trigger the need to promote an expansion in the healthcare capacity of
has an complex and strong effect on the dynamic of healthcare costs in the public health system in Brazil, increasing the number of hospital
Brazil. beds and outpatient clinics, hiring more health professionals, in addition
Table 4 presents regression results for DRB granted under the to requiring that the government allocate more funds and reorganize the
selected ICD diagnoses, with average population BMI and obesity public health and social security budget. It is also pertinent to consider
prevalence as independent variables. Coefficient β indicates the change the increase in social and indirect costs resulting from obesity, such as
in DRB granted per year for each 1-point increase in BMI or 1 % increase early retirement, reduced quality of life, difficulties in social adjust­
in obesity prevalence in Brazil from 2010 to 2019. ments and loss of productivity.41 Thus, this sharp increase in public
With the rising prevalence of overweight and obesity in Brazil, each health and social system costs in Brazil, aggravated by the obesity
1-point increase in average population BMI is associated with an average pandemic, will compromise the sustainability of the government’s social
annual increase of 5.5 thousand new grants of DRB across the 23 assistance system, which already receives diagnoses of economic and
selected ICDs in the public health system. Additionally, for every 1 % fiscal unsustainability.42,43
increase in obesity prevalence (BMI >30), there’s an average annual On the other hand, the economic fragility of great part of Brazilian

187
 E.B. Abbade
Table 2
Pearson’s correlations (between number of HA | DRB | SSP and average BMI), average annual amounts and average annual monetary values (BRL and USD) for HA (via SUS), DRB and SSP related to the 23 ICDs selected for
the period from 2010 to 2019 in Brazil.
Diagnose Pearson’s Correlation Quantity (annual average) [2010–2019] Monetary Value (annual average) in 1000 BRL Monetary Value (annual average) in 1000 USD
[2010–2019] [2010–2019]

Qt. of Hospital DRB Granted SSP Granted Hospital DRB SSP Hospital DRB SSP Granted Hospital DRB SSP
Admissions (HA) x BMI (Qt.) x BMI (Qt.) x BMI Admissions (HA) Granted Granted Admissions (HA) Granted Admissions (HA) Granted Granted

C16 0.981 *** 0.234 0.644 * 5566 640 2778 13,394.02 808.93 3357.24 5102.12 303.54 1261.39
C18 0.898 *** 0.880 *** 0.916 *** 7890 917 4208 18,845.33 1356.47 5779.22 7041.46 477.91 2096.86
C20 0.974 *** 0.837 ** 0.909 *** 4294 741 2401 11,470.37 1031.95 3127.72 4224.94 366.48 1142.42
C22 0.985 *** 0.891 *** 0.842 ** 2349 222 686 4075.76 325.28 919.45 1470.59 119.55 339.17
C25 0.948 *** 0.783 ** 0.880 *** 2160 272 936 4271.85 416.47 1334.29 1536.33 149.32 481.59
C61 0.961 *** 0.692 * 0.829 ** 7470 953 5920 19,797.46 1405.52 8431.35 7238.14 517.18 3161.15
E11 0.549 0.149 − 0.818 ** 2097 750 3169 1801.36 955.36 3605.36 673.57 359.05 1398.66
E16 0.799 ** 0.653 * 0.673 * 125 1 50 34.28 2.08 69.48 10.62 0.60 24.38
E34 0.639 * − 0.546 − 0.813 ** 61 4 140 32.89 5.34 146.40 12.75 2.13 76.80
E66 0.778 ** 0.933 *** 0.892 *** 2731 88 11,985 10,820.91 117.06 16,220.40 4219.42 37.54 5749.11
I20 0.600 − 0.441 − 0.700 * 22,635 1695 9092 97,391.53 2247.65 11,332.95 38,327.30 861.84 4426.13
188

I21 0.841 ** 0.769 ** 0.826 ** 22,887 1646 10,405 88,731.28 2324.23 14,242.52 33,286.67 855.60 5303.13
I26 0.942 *** 0.842 ** 0.928 *** 1725 48 1021 3324.24 66.84 1510.78 1243.82 23.07 531.17
I46 0.830 ** 0.953 *** 0.870 ** 1397 28 95 4020.23 43.32 131.78 1525.80 14.27 47.57
I63 0.714 * 0.798 ** 0.740 * 4499 915 2422 7639.64 1198.61 2951.41 2839.87 438.75 1100.49
I64 0.988 *** 0.817 ** 0.836 ** 25,822 3802 9821 37,134.71 4953.68 11,800.97 13,778.46 1787.81 4344.04
I74 0.965 *** 0.734 * 0.799 ** 4911 228 1026 12,489.60 288.78 1246.95 4871.62 104.09 459.64
I82 0.842 ** 0.663 * 0.920 *** 667 138 3811 1589.38 177.25 4700.83 591.19 62.50 1658.26
K52 0.966 *** 0.773 ** 0.365 1089 2 162 500.77 3.25 206.55 183.07 1.02 77.02
K80 0.887 *** 0.711 * 0.704 * 40,344 32 44,469 32,332.88 44.02 45,742.65 12,387.14 15.61 16,831.68
K83 0.955 *** 0.485 0.670 * 2844 20 601 3247.08 28.24 701.35 1210.69 10.30 258.69
K85 0.988 *** 0.360 0.448 3964 22 1769 3066.55 34.24 2224.35 1040.66 12.48 835.15
K92 0.912 *** 0.673 * − 0.454 15,674 27 680 12,790.82 37.95 815.28 4720.45 13.18 312.00
TOTAL - - - 183,201 13,191 117,647 388,802.91 17,872.55 140,599.27 147,536.67 6533.83 51,916.51
(Σ)

Note: *p < 0.05; **p < 0.01; ***p < 0.001; C16 = Malignant neoplasm of stomach; C18 = Malignant neoplasm of colon; C20 = Malignant neoplasm of rectum; C22 = Malignant neoplasm of liver and intrahepatic bile
ducts; C25 = Malignant neoplasm of pancreas; C61 = Malignant neoplasm of prostate; E11 = Type 2 diabetes mellitus; E16 = Other disorders of pancreatic internal secretion; E34 = Other endocrine disorders; E66 =
Obesity; I20 = Angina pectoris; I21 = Acute myocardial infarction; I26 = Pulmonary embolism; I46 = Cardiac arrest; I63 = Cerebral infarction; I64 = Stroke, not specified as hemorrhage or infarction; I74 = Arterial
embolism and thrombosis; I82 = Other venous embolism and thrombosis; K52 = Other non-infective gastroenteritis and colitis; K80 = Cholelithiasis; K83 = Other diseases of biliary tract; K85 = Acute pancreatitis; K92 =
Other diseases of digestive system.

Public Health 237 (2024) 184–192

E.B. Abbade Public Health 237 (2024) 184–192

Table 3
Regression results considering the Number of Hospital Admissions (HA) due to specific diagnoses as the dependent variable, and the average BMI and prevalence of
obesity as Independent variables.
Diagnose Average BMI Obesity Prevalence (BMI >30) [%]

Coefficient Std. Error Coefficient Std. Error R2 Coefficient Std. Error Coefficient Std. Error R2
Intercept (Intercept) β (β) Intercept (Intercept) β (β)

C16 − 43,749.64d 3439.9 1886.38d 131.57 0.9625d − 1513.23 ** 422.24 387.72d 23.07 0.9725d
C18 − 68,928.75d 13,284.65 2938.43d 508.13 0.8070d − 3261.50 1764.72 610.79d 96.40 0.8338d
C20 − 51,018.35d 4539.85 2115.78d 173.65 0.9489d − 3556.68c 719.99 429.99d 39.33 0.9373d
C22 − 35,867.30d 2368.69 1461.83d 90.60 0.9702d − 3095.32d 364.95 298.2d 19.94 0.9655d
C25 − 47,786.65d 5907.03 1910.53d 225.94 0.8994d − 5078.02d 724.85 396.44d 39.60 0.9261d
C61 − 63,004.90d 7124.58 2695.75d 272.51 0.9244d − 2689.19b 894.82 556.41d 48.88 0.9418d
E11 − 9785.53 6396.03 454.51 244.64 0.3014 464.36 930.44 89.40 50.83 0.2789
E16 − 3253.52c 900.40 129.21c 34.44 0.6376c − 365.03b 125.50 26.81c 6.86 0.6566c
E34 − 442.37 214.27 19.25b 8.20 0.4082b − 8.42 31.41 3.80 1.72 0.3797
E66 − 9499.47b 3488.77 467.82c 133.44 0.6057c 890.67 455.41 100.78c 24.88 0.6723c
I20 − 45,860.44 32,314.54 2620.06 1236.01 0.3597 12,985.94b 4661.59 528.51 254.65 0.3500
I21 − 259,698.28c 64,266.34 10,809.32c 2458.15 0.7074c − 19,102.81b 8231.32 2299.88d 449.65 0.7658d
I26 − 33,269.97 *** 4403.01 1338.61d 168.41 0.8876d − 3378.26d 513.19 279.51d 28.03 0.9255d
I46 − 45,025.98c 11,033.98 1775.75c 422.04 0.6888c − 5530.40c 1410.13 379.43c 77.03 0.7520
**
I63 − 56,476.04b 21,149.02 2332.39b 808.94 0.5096b − 4615.02 2873.85 499.21b 156.99 0.5583 *
I64 − 320,551.89d 19,290.62 13,249.32d 737.85 0.9758d − 23,276.16d 3488.68 2689.21d 190.58 0.9614d
I74 − 32,182.56d 3580.14 1418.89d 136.94 0.9307d − 400.36 493.68 290.93d 26.97 0.9357d
I82 − 30,292.49c 7001.03 1184.24c 267.79 0.7097c − 3909.56c 910.71 250.66c 49.75 0.7604c
K52 − 19,187.14d 1917.12 775.57d 73.33 0.9333 − 1801.95d 281.12 158.32d 15.36 0.9300d
K80 − 310,240.00c 64,637.72 13,410.34d 2472.36 0.7862d − 10,985.74 8340.00 2811.41d 455.59 0.8264d
K83 − 38,435.20d 4547.36 1579.00d 173.93 0.9115d − 2996.34c 710.11 319.90d 38.79 0.8947d
K85 − 178,842.93d 10,075.12 6992.63d 385.37 0.9763d − 21,892.13d 1927.66 1416.18d 105.30 0.9576d
K92 − 251,150.87d 42,297.87 10,206.43d 1617.87 0.8326d − 23,585.89c 5044.84 2150.32d 275.59 0.8839d
TOTAL (Σ) ¡1,954,550.24d 228,379.79 81,772.04d 8735.39 0.9163d ¡126,701.06c 26,697.19 16,973.81d 1458.39 0.9442d
BRL (x ¡5,820,367.64d 451,163.90 237,510.05d 17,256.76 0,9595d ¡502,552.37d 56,005,47 48,821.47 d 3059.42 0.9695d
1000) (Σ)
Def.BRL (x 168,647.78 953,069.77 17,309.76 36,454.37 0,0274 546,902.58c 135,841.44 4067.94 7420.63 0,0362
1000) (Σ)
a

USD (x 1,768,090.87c 525,340.29 ¡61,988.62b 20,093.96 0.5433b 372,034.83c 77,812.20 ¡12,296.25b 4250.66 0.5115b
1000) (Σ)

Note.
a
Regression calculated using deflated data to Dec/2023, considering the IPCA (IBGE).
b
p < 0.05.
c
p < 0.01.
d
p < 0.001.

population has potential to aggravate the obesogenic problem, and the malnutrition, such as obesity and other chronic diseases, are part of the
healthcare and pension systems costs. An inadequate minimum income list of impacts of the COVID-19 pandemic on food and nutrition security.
and/or insufficient family income represent a situation that limits access Both the fear of food shortages due to income or access issues, and
to healthy food.44 In this sense, previous studies show that overweight concerns about their health safety generate insecurity among
and obesity may affect economically more vulnerable populations more consumers.54,55
severely,45 possibly due to factors associated with dietary patterns, The results obtained in this study are partially aligned with recent
educational level and access to information, home conditions and life­ findings from both national and international studies that have exam­
style.46,47 Therefore, it is reasonable to suggest that the most economi­ ined the same theme.27,29,33 However, a direct comparison of the esti­
cally disadvantaged populations affected by obesity are subject to the mated coefficients with those of previous research is not entirely feasible
need for hospital and outpatient care, possibly via the Unified Health due to significant methodological differences and variations in the
System (SUS), due to the development of comorbidities associated with analytical scope. These studies often employ distinct data sources,
obesity. population samples, and econometric models, which limits the extent to
Nevertheless, the inconsistency verified in the comparative analysis which findings can be directly juxtaposed. Therefore, while the general
between monetary values in BRL and USD suggests that the values trends observed in this analysis resonate with broader research, the
defined by SUS for financial transfers to be carried out to public hospi­ specific outcomes are inherently shaped by these divergent approaches.
tals in Brazil, as well as the values of social benefits (DRB and SSP), are Strategies adopted in other countries may be relevant to be analyzed
out of date. Earlier studies has already pointed out this fragility of the to help the adoption of public policies in Brazil regarding the fight
Brazilian public health system and public budget,48–50 requiring an against the worsening prevalence of obesity and its consequences. In this
update and monetary correction. Also, the results presented here, regard, to combat the obesity epidemic, France has implemented a series
considering the difference between nominal and deflated values in the of policies, including voluntary front-of-pack labeling of foods and re­
regressions estimated for BRL amounts, reinforce that the reimburse­ strictions on advertising and taxes on sugary drinks.56 In fact, in a
ment values allocated to the Unified Health System (SUS) for hospital document that presents the government’s strategy to combat obesity in
admissions in Brazil are likely not adjusted in line with the country’s the country for the period 2010–2013, the following priorities were
inflation, leading to underfunding in several healthcare services.51–53 formalized: (1) Improve the provision of health care and promote
It is also pertinent to consider that the COVID-19 pandemic caused screening among children and adults; (2) Mobilize prevention partners,
economic impacts on the most vulnerable populations, affecting the act on the environment and promote physical activity; (3) Consider
conditions of access to healthy food. In fact, different forms of situations of vulnerability and combat discrimination; and (4) Invest in

189
E.B. Abbade Public Health 237 (2024) 184–192

Table 4
Regression results considering the number of DRB due to specific diagnoses as the dependent variable, and the average BMI and prevalence of obesity as independent
variables.
Diagnose Average BMI Obesity Prevlence (BMI > 30) [%]

Coefficient Std. Error Coefficient Std. Error R2 Coefficient Std. Error Coefficient Std. Error R2
Intercept (Intercept) β (β) Intercept (Intercept) β (β)

C16 − 332.08 1208.32 36.94 46.22 0.0740 466.53b 169.73 9.16 9.27 0.1087
C18 − 19,621.65c 3907.71 785.55d 149.47 0.7754d − 2133.42c 475.67 166.96d 25.98 0.8377d
C20 − 13,215.72c 3221.23 533.80c 123.21 0.7012c − 1350.63b 403.59 114.48d 22.05 0.7712d
C22 − 2141.34d 422.45 90.33d 16.16 0.7962d − 122.93 56.17 18.79d 3.07 0.8242d
C25 − 3701.56c 1061.61 151.89c 40.61 0.6362c − 325.09b 138.31 32.55c 7.56 0.6988c
C61 − 8174.73b 3405.49 348.97b 130.26 0.4729b − 440.45 456.79 76.07b 24.95 0.5374b
E11 − 914.78 3544.39 63.35 135.57 0.0266 428.47 502.26 17.13 27.44 0.0465
E16 − 91.87b 38.24 3.56b 1.46 0.4259b − 12.85b 5.20 0.78b 0.28 0.4819b
E34 105.88 57.73 − 3.89 2.21 0.2790 17.53 8.53 − 0.72 0.47 0.2319
E66 − 4660.03d 652.22 181.58d 24.95 0.8688d − 603.92d 80.52 37.84d 4.40 0.9025d
I20 8691.30 5277.76 − 268.04 201.87 0.1806 2528.74b 779.22 − 46.27 42.57 0.1287
I21 − 16,330.02b 5057.67 686.31c 193.45 0.6114c − 1058.52 673.25 146.26c 36.78 0.6641c
I26 − 1562.30c 364.84 61.57c 13.95 0.7088c − 189.34c 48.23 12.97c 2.63 0.7517c
I46 − 1253.93d 139.98 49.04d 5.35 0.9129d − 151.16d 24.07 9.81d 1.32 0.8744d
I63 − 8706.68c 2458.18 367.69c 94.02 0.6565c − 537.03 314.76 79.03c 17.19 0.7253c
I64 − 51,735.65c 13,648.02 2122.90c 522.03 0.6740c − 4548.64b 1741.06 455.24c 95.11 0.7412c
I74 − 3166.41b 1097.42 129.80b 41.98 0.5445b − 290.25 143.49 28.33c 7.84 0.6201c
I82 − 2945.07b 1212.68 117.83b 46.38 0.4465b − 341.79 160.78 26.14b 8.78 0.5254b
K52 − 157.44c 46.42 6.11c 1.78 0.5971c − 20.57b 6.59 1.26c 0.36 0.6044c
K80 − 718.24b 255.49 28.69b 9.77 0.5186b − 79.47 35.02 6.09b 1.91 0.5588b
K83 − 288.25 189.34 11.79 7.24 0.2489 − 29.54 25.89 2.71 1.41 0.3152
K85 − 259.48 268.64 10.78 10.28 0.1209 − 20.70 38.09 2.36 2.08 0.1380
K92 − 624.15b 252.89 24.90b 9.67 0.4530b − 72.43 34.08 5.43b 1.86 0.5153b
TOTAL (Σ) ¡131,804.22b 44,555.04 5541.46b 1704.20 0.5693b ¡8887.48 5824.42 1202.37c 318.17 0.6409c
BRL (x 1000) (Σ) ¡474,320.18c 94,562.60 18,819.81d 3616.96 0.7719d 54,798.19c 11,980.27 3969.88d 654.45 0.8214d
Def.BRL (x ¡323,823.44b 104,946.68 13,442.10 4014.15 0.5836b ¡25,557.94 13,685.86 2911.04c 747.62 0.6546c
1000) (Σ) a
USD (x 1000) (Σ) 713.52 29,718.16 219.72 1136.70 0.0046 4,885,66 4228.39 86.10 230.98 0.0171

Note.
a
Regression calculated using deflated data to Dec/2023, considering the IPCA (IBGE).
b
p < 0.05.
c
p < 0.01.
d
p < 0.001.

research.57 component costs are necessary and can be carried out in future in­
Another study that carried out a survey of the main actions to combat vestigations, providing a more complete picture of all care and costs
childhood obesity in the main nations of the world showed that gov­ related to Obesity and its associated NCDs.
ernments have adopted similar approaches, which include: (1) Higher Also, it is important to recognize that the reliance on data from the
taxes on HFSS (High fat sugar salt) foods and beverages to seek to reduce 27 capital cities in Brazil introduces potential biases that should be
consumption and/or encourage the reformulation of food companies; acknowledged. Capitals tend to have more urbanized environments,
(2) Restrictions on marketing HFSS food and beverages to children; (3) higher socioeconomic diversity, and better access to healthcare services,
Better food and menu labeling to help consumers make informed which may influence the prevalence and detection rates of overweight
choices; (4) School feeding regulations, to improve nutrition; (5) Na­ and obesity compared to smaller municipalities. On the Other hand,
tional diet and physical activity guidelines; and (6) Social marketing smaller municipalities, especially in rural or less developed regions, may
campaigns to encourage healthier eating and physical activity.58 It is exhibit different patterns of food availability, physical activity, and
possible to verify that these actions could be implemented in the Bra­ healthcare access, which could result in varying prevalence rates.
zilian context to reduce the high levels of overweight and obesity in the Therefore, caution is needed when generalizing findings to the entire
population. country, as the data from capitals may not fully capture the heteroge­
From a policy perspective, these findings underscore the urgent need neity of obesity prevalence across all Brazilian municipalities.
for more comprehensive public health interventions focused on obesity Regarding future studies, a more granular analysis of obesity-related
prevention and management. Policymakers should prioritize strategies costs could be conducted at the regional or municipal level in Brazil,
such as promoting healthier lifestyles, increasing access to nutritious considering socioeconomic and environmental factors that may influ­
food, and improving workplace wellness programs to mitigate the long- ence obesity prevalence and its economic burden. Also, longitudinal
term financial impact of obesity on public resources. Further research studies could assess the long-term impact of public health interventions
should explore targeted interventions in urban areas, where obesity aimed at reducing obesity rates, evaluating both their effectiveness and
rates are particularly high, to reduce both the prevalence and associated cost-efficiency in alleviating healthcare and social security expendi­
economic costs. tures. Nevertheless, future research could explore the indirect costs of
A significant limitation of this study is that only VIGITEL data were obesity, such as lost productivity and workforce participation, to pro­
used to calculate the variables related to the prevalence of overweight vide a more comprehensive understanding of its broader economic
and obesity. Another important aspect to be considered is related to the implications.
fact that there are flaws in the data feed of the SIH/SUS, the repository
where data on HA of the selected ICD diagnoses were obtained.59 Also, Conclusions
since this study was not able to evaluate the health costs associated with
outpatient care and medication costs, further studies with these This study contributes to a better understanding of the consequences

190
E.B. Abbade Public Health 237 (2024) 184–192

Table 5
Regression results considering the number of SSP benefits due to specific diagnoses as the dependent variable, and average BMI and prevalence of obesity as inde­
pendent variables.
Diagnose Average BMI Obesity Prevalence (BMI > 30) [%]

Coefficient Std. Error Coefficient Std. Error R2 Coefficient Std. Error Coefficient Std. Error R2
Intercept (Intercept) β (β) Intercept (Intercept) β (β)

C16 − 9447.36 4789.64 466.72b 183.20 0.4479b 973.42 673.33 97.53b 36.78 0.4678b
C18 − 63,308.63d 10,455.01 2582.57d 399.90 0.8391d − 5486.72c 1454.23 530.94d 79.44 0.8481d
C20 − 28,390.18d 4980.27 1177.76d 190.49 0.8269d − 2044.47b 675.36 243.42d 36.89 0.8448d
C22 − 5804.89c 1460.56 248.27c 55.87 0.7117c − 243.33 208.03 50.87c 11.36 0.7147c
C25 − 13,889.13c 2786.24 566.68d 106.57 0.7795d − 1226.57b 373.71 117.87d 20.41 0.8065d
C61 − 41,459.08c 11,339.35 1812.18c 433.72 0.6857c − 919.61 1586.15 374.41c 86.65 0.7001c
E11 29,795.45c 6733.55 − 1019.68c 257.55 0.6621c 6869.46d 1000.52 − 204.37c 54.66 0.6361c
E16 − 1016.14b 420.14 40.76b 16.07 0.4457b − 112.66 56.82 8.88b 3.10 0.5055b
E34 18,691.76c 4692.62 − 709.63c 179.49 0.6615c 2754.99c 688.59 − 143.23c 37.62 0.6444c
E66 − 308,673.66d 57,536.63 12,265.55d 2200.74 0.7952d − 33,375.38c 8535.05 2484.31d 466.25 0.7802d
I20 77,249.26b 24,901.57 − 2608.68b 952.47 0.4839b 18,663.82d 3608.30 − 526.5b 197.11 0.4714b
I21 − 85,777.31c 22,045.61 3672.78c 843.23 0.7034c − 3562.33 3106.90 755.95c 169.72 0.7126c
I26 − 25,307.12d 3732.11 1006.98d 142.75 0.8615d − 2807.05d 472.15 209.51d 25.79 0.8919d
I46 − 2018.30d 378.63 80.70d 14.48 0.7951d − 204.50c 57.76 16.21d 3.16 0.7675d
I63 − 13,869.29b 5129.67 622.41b 196.21 0.5571b 49.78 722.91 128.84b 39.49 0.5709b
I64 − 85,611.92c 21,579.62 3647.23c 825.41 0.7094c − 3926.02 3063.97 748.34c 167.38 0.7142c
I74 − 8958.30c 2667.57 381.64c 102.03 0.6362c − 410.08 379.98 78.27c 20.76 0.6399c
I82 − 79,232.45d 12,320.72 3173.07d 471.26 0.8500d − 8351.65d 1560.03 661.21d 85.22 0.8827d
K52 − 1138.62 1070.00 49.65 40.93 0.1554 − 41.47 150.71 11.01 8.23 0.1826
K80 − 335,772.46b 135,623.57 14,544.46b 5187.52 0.4956b − 9666.59 19,479.30 2964.63b 1064.10 0.4925b
K83 − 4543.63 2012.22 196.75b 76.97 0.4496b − 165.27 277.88 41.92b 15.18 0.4880b
K85 − 5243.43 4921.57 268.16 188.25 0.2023 773.78 706.07 54.4 38.57 0.1991
K92 3433.16 2007.66 − 105.41 76.79 0.1906 0.1011.53c 296.75 − 18.3 16.21 0.1374
TOTAL (Σ) ¡990,292.27b 296,408.09 42,360.91c 11,337.44 0.6357c ¡41,446.91 42,234.38 8686.11c 2307.14 0.6392c
BRL (x 1000) ¡3,285,048.31d 410,077.23 131,009.22d 15,685.22 0.8971d ¡350,302.71d 57,561.38 26,849.22d 3144.41 0.9011d
(Σ)
Def.BRL (x ¡2,057,261.75c 602,653.36 87,102.03c 23,051.14 0.6409c ¡107,183.52 85,416.67 17,911.06c 4666.07 0.6481c
1000) (Σ) a
USD (x 1000) 94,998.06 237,856.45 ¡1658.69 9097.87 0.0041 56,019.37 34,091.36 ¡240.12 1862.31 0,0021
(Σ)

Note.
a
Regression calculated using deflated data to Dec/2023, considering the IPCA (IBGE).
b
p < 0.05.
c
p < 0.01
d
p < 0.001.

of obesity on the Unified Health and Social Security System in Brazil. Acknowledgements
Since Brazil is currently facing problems of budgets and distribution of
health expenditures, it is necessary to adopt strategies and public pol­ This research is part of the project " Historical and projection of the
icies with the potential to reduce the impact of obesity on the public economic impact of obesity and its consequent Non-Communicable
budget, promoting a gain in the population’s quality of life. The results Chronic Diseases (NCDs) on the Unified Health System" funded by
found suggest that better planning aimed at early prevention in the care CNPQ (National Council for Scientific and Technological Development)
of some obesity-related diseases can bring about a reduction in HA ex­ (Process number 442619/2019-7). The author would like to thank
penses, and the granting of new DRB and SSP. There is a need for in­ CNPQ for the financial support provided.
tegrated actions that mitigate the increase in the BMI of Brazilian people
given the economic impact generated by obesity in the country. References

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