The Clinical and Economic Burden of Obesity in Low- and Middle-Income Countries: A Systematic Review

Fatoye, Francis ORCID: https://orcid.org/0000-0002-3502-3953, Mbada, Chidozie ORCID: https://orcid.org/0000-0003-3666-7432, Niyi-Odumosu, Faatihah, Fatoye, Clara, Useh, Ushotanefe, Hakimi, Zalmai and Gebrye, Tadesse ORCID: https://orcid.org/0000-0001-7976-2013 (2025) The Clinical and Economic Burden of Obesity in Low- and Middle-Income Countries: A Systematic Review. International Journal of Obesity. ISSN 0307-0565 (In Press)

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Abstract

Obesity has emerged as a critical public health challenge globally, with substantial health and economic repercussions. This study aimed to evaluate the literature on the clinical and economic burdens associated with obesity, specifically in low- and middle-income countries (LMICs). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The CINAHL, MEDLINE, PubMed, Web of Science and Scopus databases were systematically searched for studies published from inception to March 28, 2025. The costs of illness for all included studies were converted to 2024 United States (US) dollars, using country-specific gross domestic product inflators. Conversion to US dollars was based on purchasing power parity (PPP). The quality of all included studies was assessed via the Newcastle‒Ottawa Scale (NOS). Of the total of 676 reports identified by the search strategy, six studies were prevalence-based, four studies were survey-based, and three model-based studies (n = 13) were eligible for inclusion on the basis of predefined inclusion criteria. These studies published data from Brazil, Ghana, China, Iran, South Africa, Mexico, and Thailand. Three of the 13 studies reported indirect costs. Two studies reported the clinical impact of obesity. Methodological quality was deemed moderate. The annual direct and indirect costs associated with obesity for a population in LMICs ranged from USD 0.2 billion to USD 12.56 billion and USD 223 million to USD 227.5 million, respectively. Hospitalisation was the main cost driver in five of the included studies. One study reported the total number of hospitalisations/number of person-years for men and women as 803/9207 and 2354/25,173, respectively. This is the first systematic review to summarise the clinical and economic burdens associated with obesity in LMICs. The clinical and economic burden of obesity on individuals and healthcare systems is significant, necessitating effective prevention and management strategies. To increase the accuracy and comparability of findings, future research should adopt a standardised cost-of-illness methodology. This approach will provide clearer insights into the economic impact of obesity and facilitate more effective public health interventions.