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Sick Leave Days and Costs Associated With Overweight and Obesity in Germany

Lehnert, Thomas MSc; Stuhldreher, Nina MSc; Streltchenia, Pawel MSc; Riedel-Heller, Steffi G. MD, MPH; König, Hans-Helmut MD, MPH

Journal of Occupational and Environmental Medicine: January 2014 - Volume 56 - Issue 1 - p 20–27
doi: 10.1097/JOM.0000000000000065
Original Articles

Objective: To analyze the impact of body mass index on sick leave days and related costs in Germany.

Methods: Cross-sectional analysis of German Socio-Economic Panel data (n = 7990). The relationship between body mass index class and sick leave days was analyzed via analyses of variance (ANOVA) (bivariate) and zero-inflated negative binomial regression models (multivariate).

Results: Body mass index was positively associated with annual sick leave days in the bivariate analysis (P < 0.001). In the fully adjusted zero-inflated negative binomial, overweight women had 3.64, obese women 5.19, and obese men 3.48 excess sick leave days in 2009 (vs normal weight), while excess sick leave days of overweight men were not statistically significant. The extrapolated excess costs in the German working population amount to €2.18 billion (base case).

Conclusions: The absenteeism-related lost productivity costs associated with excess weight are formidable and emphasize the persistent need for health promotion efforts in Germany.

Supplemental Digital Content is Available in the Text.

From the Department of Health Economics and Health Services Research (Mr Lehnert, Ms Stuhldreher, Ms Streltchenia, and Dr König), Hamburg Center for Health Economics, University Medical Center Hamburg–Eppendorf, Hamburg, Germany; IFB Adiposity Diseases (Mr Lehnert and Dr Riedel-Heller), University Medicine Leipzig, and Department for Social Medicine, Occupational Medicine, and Public Health (Mr Riedel-Heller), University of Leipzig, Leipzig, Germany.

Address correspondence to: Thomas Lehnert, MSc, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg–Eppendorf, Martinistr 52, D-20246 Hamburg, Germany (

This work was supported by the Federal Ministry of Education and Research (BMBF), Germany, FKZ: 01EO1001.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Authors Lehnert, Stuhldreher, Streltchenia, Riedel-Heller, and Konig have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2014 by the American College of Occupational and Environmental Medicine