OBJECTIVES: Obesity disease continues to represent a significant public health concern, with a broad impact from both a health and economic perspective. This analysis assesses the fiscal consequences of obesity disease in Japan through application of a government perspective to capture obesity-attributable lost tax revenues and increased government transfers.

METHODS: The fiscal burden of obesity disease was estimated using an age-specific prevalence model, which tracked the Japanese population across different body mass index (BMI) categories. The model was populated with fiscal data for Japan, including employment activity and government spending, to calculate tax revenue and transfer costs. A targeted literature review was conducted to identify data estimating the impact of obesity disease on employment, income, sick leave, retirement, and mortality. These modifiers were applied to Japanese epidemiological and fiscal projections to calculate government tax revenue and spending. The incremental impact of reducing obesity disease in the general population was subsequently calculated. Results were estimated based on the 2023 Japanese population.

RESULTS: The total fiscal burden of obesity disease in Japan, defined as BMI≥25, is estimated at $18.56 billion (¥2.66 trillion). This consists of a loss of $6.58 billion (¥944 billion) and $1.18 billion (¥169 billion) in direct and indirect tax revenue, respectively (due to lower employment and income combined with higher sick leave). Excess obesity-attributable healthcare costs were $8.96 billion (¥1.29 trillion), while additional pension payment spending of $1.84 billion (¥264 billion) was estimated, due to higher levels of early retirement.

CONCLUSIONS: While the health implications of obesity disease are well documented, this fiscal analysis demonstrates the significant economic burden of obesity disease both to the healthcare system and broader government accounts. As such, policies aimed at reducing population-level obesity have the potential to significantly benefit government accounts through increasing employment and reducing healthcare and transfer spending.