The economic burden of obesity in Europe: up to 1.4% of GDP

The economic burden of obesity in Europe runs from 0.7% of GDP in Romania to 1.4% in the UK and Greece, according to a contract research report published this week by the Office of Health Economics (OHE). Across the eight countries the authors studied, elevated body mass index (BMI) is linked to 278,000 deaths and almost 8 million disability-adjusted life years (DALYs) every year.

OHE puts the total annual cost of elevated BMI at 2.5 billion euros in Romania and 55.2 billion euros in Germany. Germany also carries the highest cost per resident, at 662 euros, while Romania carries the lowest at 131 euros. Indirect costs, which cover lost productivity and unpaid care, make up between 18% and 58% of the total depending on the country.

The study covers the UK, Germany, France, Italy, Spain, Ireland, Greece and Romania, a group chosen to reflect different demographics, health systems and economic capacities. Direct costs were estimated by applying population attributable fractions to national disease spending. Indirect costs drew on published estimates of obesity’s effect on premature mortality, economic inactivity, absenteeism, presenteeism and informal care.

The economic burden of obesity by country

Germany’s 55.2 billion euros is the largest total in the study, more than twenty times Romania’s 2.5 billion euros (11 billion RON). The UK sits at 43.2 billion euros, which OHE reports separately as 33.8 billion pounds, or 488 pounds per resident. France, Spain and Italy cluster near the 20 billion euro mark, at 23.3 billion, 19.6 billion and 20.3 billion euros respectively.

Ireland’s 3.2 billion euros is expressed as 1.1% of modified gross national income rather than GDP. The authors prefer that measure because multinational activity inflates Irish GDP and a GDP-based figure would understate the country’s relative burden.

Cost component (euros, billions)	UK	Germany	France	Spain	Italy	Ireland	Greece	Romania
Direct healthcare costs	18.2	30.3	19.2	14.9	12.9	1.5	2.3	1.1
Indirect costs	25.1	24.9	4.1	4.7	7.5	1.7	1.1	1.4
Economic inactivity	10.0	6.8	1.1	1.3	1.2	0.7	0.1	0.2
Absenteeism	3.0	8.7	0.6	1.3	2.4	0.2	0.3	0.4
Presenteeism	7.0	4.3	0.9	0.9	1.7	0.4	0.3	0.5
Informal care	3.3	3.4	1.0	0.9	1.4	0.3	0.2	0.1
Premature mortality	1.8	1.7	0.6	0.3	0.7	0.1	0.1	0.2
Total annual cost	43.2	55.2	23.3	19.6	20.3	3.2	3.4	2.5
Total cost per resident (euros)	625	662	343	401	345	598	328	131
Total as share of GDP	1.4%	1.3%	0.8%	1.2%	0.9%	1.1%*	1.4%	0.7%

Source: OHE, Table 3. *Ireland is measured against modified gross national income (mGNI) rather than GDP.

278,000 deaths and almost 8 million lost years

The health burden comes from the Global Burden of Disease study, using 2023 estimates. Cardiovascular disease contributes the largest number of deaths linked to elevated BMI, closely followed by diabetes mellitus type 2 on the DALY side. Elevated BMI feeds the risks that health systems already spend heavily on. It is implicated in more than half of all diabetes mellitus type 2 deaths across the study countries, 44% of digestive disease deaths and 31% of chronic kidney disease deaths. The share of DALYs is similar, at almost 60% for diabetes mellitus type 2, 45% for digestive diseases and 32% for chronic kidney disease.

Where the direct costs fall

The condition carrying the largest direct cost differs from country to country. The authors read this variation as an argument against a single European template. Diabetes mellitus type 2 leads in Italy at 3.8 billion euros, Ireland at 0.5 billion euros and Greece at 0.9 billion euros. Musculoskeletal diseases lead in France at 6.9 billion euros and Spain at 4.3 billion euros. Cardiovascular disease takes the top spot in Germany at 8.7 billion euros and Romania at 0.5 billion euros, while digestive diseases take it in the UK at 4.0 billion euros, just ahead of diabetes mellitus type 2 at 3.9 billion euros. Chronic kidney disease accounts for 2.9 billion euros in the UK and 8.3 billion euros in Germany, the second largest item in the German list.

Condition (euros, billions)	UK	Germany	France	Spain	Italy	Ireland	Greece	Romania
Diabetes mellitus type 2	3.9	3.8	4.9	3.0	3.8	0.5	0.9	0.1
Musculoskeletal diseases	1.6	6.1	6.9	4.3	2.5	0.4	0.4	0.2
Cardiovascular diseases	3.3	8.7	3.2	2.7	2.5	0.1	0.2	0.5
Chronic kidney disease	2.9	8.3	0.8	1.7	1.1	0.1	0.1	<0.1
Digestive diseases	4.0	1.7	1.0	1.5	1.5	0.2	0.2	<0.1
Cancers	0.6	0.5	0.8	0.0	0.1	0.1	0.0	<0.1
Others	1.9	1.2	1.6	1.6	1.4	0.2	0.4	0.2
Total direct costs	18.2	30.3	19.2	14.9	12.9	1.5	2.3	1.1

Source: OHE, Table 2. Musculoskeletal diseases include osteoarthritis and low back pain. Cardiovascular diseases include hypertensive heart disease, ischaemic heart disease, ischaemic stroke, intracerebral haemorrhage, ischaemic heart disease with diabetes mellitus type 2, and ischaemic heart disease and asthma. Cancers include breast cancer, colon and rectum cancer and liver cancer. Others include Alzheimer’s disease and other dementias, asthma, liver disease and tuberculosis.

Productivity losses reach 58% of the total in the UK

Indirect costs range from 18% of the total in France to 58% in the UK. The authors link that split to employment patterns. Countries with high employment rates across the working ages, including the UK, Germany and Ireland, have more people in work at the ages when overweight and obesity are most common, so there is more productivity to lose. France, Greece and Spain have lower employment rates at older ages and lower indirect shares as a result.

No single productivity component dominates everywhere. Absenteeism is the largest indirect item in Germany at 8.7 billion euros and Italy at 2.4 billion euros, and ties with presenteeism in Greece at 0.3 billion euros each. Economic inactivity leads in the UK at 10.0 billion euros and Ireland at 0.7 billion euros, and presenteeism leads in Romania at 0.5 billion euros. Informal care, the unpaid time provided by families, accounts for 13% to 14% of all indirect costs. Premature mortality is the smallest component, largely because many of the deaths linked to elevated BMI occur at or near retirement age.

Recommendations

The report closes with recommendations aimed at governments and EU institutions. Obesity should be recognised as a disease in its own right rather than only as a risk factor, because that recognition affects surveillance, funding and care pathways. Weight stigma needs to be tackled directly, since stigma keeps policy fixed on individual behaviour. Access should cover the whole continuum from prevention through early detection to behavioural, pharmacological and surgical treatment, with long-term management built in, because obesity relapses. Evidence should be generated in terms that matter to finance and labour ministries, not just health ministries, to justify funding across sectors. Finally, the EU Safe Hearts Plan should carry an obesity target and address obesity under its treatment and care pillar, where it is currently absent.

The report also warns that thinking stays siloed. Economic policymakers treat obesity as a health problem, health policymakers do not count its effect on workforce productivity, and the authors argue that this fragmented care of the wider burden is what keeps investment short of the evidence.

On treatment, the report puts weight loss at around 3% to 9% of body weight for older pharmacotherapies and around 6% to 22% for newer ones, with metabolic and bariatric surgery at 24% to 37%. Long-term management, the authors note, can hold a reduction of at least 10%.

Source: Office of Health Economics, The economic burden of overweight and obesity in Europe, September 2026. The full report is available as a PDF.