Combined associations of body mass index and metabolic health status on medical and dental care days and costs in Japanese male employees: A 4-year follow-up study.

BACKGROUND: The combined associations of body mass index (BMI) levels and metabolic dysfunction on medical and dental care utilizations is unclear.

METHODS: A 4-year follow-up study was performed in 16,386 Japanese male employees (mean age, 48.2±11.0 years) without a history of cardiovascular disease (CVD), cancer, or renal failure. They were classified into 8 phenotypes based on 4 BMI levels (underweight <18.5, normal-weight 18.5-24.9, overweight 25.0-29.9, and obesity ≥30.0 kg/m2 ) and the presence or absence of ≥2 of 4 metabolic abnormalities: high blood pressure, high triglycerides, low HDL cholesterol, and high blood sugar. Based on their health insurance claims data, we compared medical and dental care days and costs among the 8 different BMI/metabolic phenotypes during 2010-2013.

RESULTS: The combinations of BMI levels and metabolic status were significantly associated with the adjusted mean and median medical outpatient days and costs, and the median dental outpatient days and costs. The obesity/unhealthy subjects had the highest medical outpatient days and costs, and the underweight/unhealthy subjects had the highest dental outpatient days and costs. The underweight/unhealthy subjects also had the highest medical inpatient days and hospitalization rates of CVD, and had higher medical costs compared with the obesity/healthy subjects. The differences in median medical costs between healthy and unhealthy phenotypes were larger year by year across all BMI levels.

CONCLUSIONS: Identification of obesity phenotypes using both BMI levels (including the underweight level) and metabolic status may more precisely predict healthcare days and costs compared with either BMI or metabolic status alone.