{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T15:20:54Z","timestamp":1783783254310,"version":"3.55.0"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swiss National Science Foundation (SNSF), Switzerland","award":["204659"],"award-info":[{"award-number":["204659"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic low back pain (CLBP) imposes substantial societal costs, with comorbid overweight or obesity possibly further increasing them. This study assessed the cost of illness of individuals with CLBP and comorbid overweight or obesity in the Bern metropolitan area (Switzerland) from a societal perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following the Consolidated Health Economic Evaluation Reporting Standards 2022 and using preliminary baseline data from a randomised controlled trial, societal costs, including direct and indirect costs, over 3\u202fmonths were calculated for adults with overweight or obesity and CLBP. Self-reported data were monetised using a bottom-up, prevalence-based approach, and absenteeism and presenteeism were valued via the human capital approach. Mean costs with bootstrapped 95% confidence intervals (CI) were reported in 2025 Swiss Francs (CHF) per cost category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fifty-three individuals (19 male, 34 female) with a mean age of 47.8\u202fyears (SD: 10.1) were included, comprising 18 individuals with overweight and 35 with obesity. Mean direct medical costs were CHF 543.69 (95% CI\u202f=\u202f[382.80; 686.33]), and mean direct non-medical costs were CHF 19.39 (95% CI\u202f=\u202f[0.00; 38.63]) respectively. Indirect costs accounted for 80% of total societal costs, with costs attributable to absenteeism of CHF 1,000.39 (95% CI\u202f=\u202f[2.63; 1,681.40]), presenteeism costs of CHF 549.47 (95% CI\u202f=\u202f[281.67; 774.67]) and costs due to impaired unpaid work of CHF 745.56 (95% CI\u202f=\u202f[241.02; 1,436.80]). Total societal costs averaged CHF 2,850.44 (95% CI\u202f=\u202f[1,667.17; 3,829.17]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the exclusion of individuals with uncontrolled, untreated comorbidities and those receiving invalidity payments, this study demonstrates a substantial financial burden of individuals with overweight or obesity and CLBP. From societal perspective, this burden is primarily driven by productivity losses. These findings emphasise the need for targeted cost-effective clinical interventions, coordinated policy initiatives, and further research to mitigate the significant societal impact of this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      NCT05811624 (\n                      <jats:uri>Clinicaltrials.gov<\/jats:uri>\n                      ). Acronym: BO2WL trial.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1705891","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T06:33:53Z","timestamp":1768286033000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost of illness analysis in individuals with overweight or obesity and chronic low back pain in the Bern metropolitan area (the BO2WL trial)"],"prefix":"10.3389","volume":"13","author":[{"given":"Alexander P.","family":"Schurz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanael","family":"Lutz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Liechti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneleen","family":"Malfliet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Vanroose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb","family":"Maebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Nijs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Van Bogaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Clarys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Clijsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heiner","family":"Baur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Taeymans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Deliens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref1","year":"2022"},{"key":"ref2","year":"2022"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1186\/s12913-023-10124-3","article-title":"What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age","volume":"23","author":"Stucki","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"ref4","year":"2025"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1007\/s10198-010-0258-y","article-title":"Cost of low back pain in Switzerland in 2005","volume":"12","author":"Wieser","year":"2011","journal-title":"Eur J Health Econ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.spinee.2007.10.005","article-title":"A systematic review of low back pain cost of illness studies in the United States and internationally","volume":"8","author":"Dagenais","year":"2008","journal-title":"Spine J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/j.1472-8206.2009.00730.x","article-title":"Medical and non-medical direct costs of chronic low back pain in patients consulting primary care physicians in France","volume":"24","author":"Depont","year":"2010","journal-title":"Fundam Clin Pharmacol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1714","DOI":"10.1097\/BRS.0b013e3181cd656f","article-title":"Low back pain in primary care: costs of care and prediction of future health care utilization","volume":"35","author":"Becker","year":"2010","journal-title":"Spine"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1136\/oemed-2013-101571","article-title":"Absence from work and return to work in people with back pain: a systematic review and meta-analysis","volume":"71","author":"Wynne-Jones","year":"2014","journal-title":"Occup Environ Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2875","DOI":"10.1007\/s00586-018-5742-6","article-title":"Cost of low back pain: results from a national register study in Sweden","volume":"27","author":"Olafsson","year":"2018","journal-title":"Eur Spine J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"272","DOI":"10.20344\/amp.10910","article-title":"Pharmacoeconomic aspects of low Back pain treatment: cost of illness study in the republic of Serbia","volume":"32","author":"Radoi\u010di\u0107","year":"2019","journal-title":"Acta Medica Port"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"S136","DOI":"10.1007\/s00586-006-1070-3","article-title":"Chapter 2. European guidelines for prevention in low back pain: November 2004","volume":"15","author":"Burton","year":"2006","journal-title":"Eur Spine J"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1111\/papr.13093","article-title":"Burden of chronic low back pain: association with pain severity and prescription medication use in five large European countries","volume":"22","author":"Perrot","year":"2022","journal-title":"Pain Pract"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2618","DOI":"10.1186\/s12889-024-20011-z","article-title":"Overweight and obesity as risk factors for chronic low back pain: a new follow-up in the HUNT study","volume":"24","author":"Heuch","year":"2024","journal-title":"BMC Public Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1335115","DOI":"10.3389\/fpubh.2024.1335115","article-title":"Cost of overweight, obesity, and related complications in Switzerland 2021","volume":"12","author":"Steinl","year":"2024","journal-title":"Front Public Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1007\/s00038-004-4067-x","article-title":"Economic burden of obesity and its comorbidities in Switzerland","volume":"50","author":"Schmid","year":"2005","journal-title":"Soz-Pr\u00e4ventivmed"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1093\/aje\/kwp356","article-title":"The association between obesity and low back pain: a meta-analysis","volume":"171","author":"Shiri","year":"2010","journal-title":"Am J Epidemiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jval.2021.11.1351","article-title":"Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations","volume":"25","author":"Husereau","year":"2022","journal-title":"Value Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3350\/cmh.2014.20.4.327","article-title":"Cost-of-illness studies: concepts, scopes, and methods","volume":"20","author":"Jo","year":"2014","journal-title":"Clin Mol Hepatol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e098272","DOI":"10.1136\/bmjopen-2024-098272","article-title":"Economic evaluation of a lifestyle intervention for individuals with overweight or obesity suffering from chronic low back pain (the BO2WL trial): a protocol for a health economic analysis","volume":"15","author":"Schurz","year":"2025","journal-title":"BMJ Open"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"pzaf097","DOI":"10.1093\/ptj\/pzaf097","article-title":"Lifestyle intervention in people with overweight and obesity and chronic low back pain (BO2WL study): study protocol for an international multicenter randomized controlled trial","volume":"2025","author":"Liechti","year":"2025","journal-title":"Phys Ther"},{"key":"ref22","year":""},{"key":"ref23","doi-asserted-by":"publisher","first-page":"A550","DOI":"10.1016\/j.jval.2014.08.1791","article-title":"IMTA productivity cost questionnaire (IPCQ)","volume":"17","author":"Bouwmans","year":"2014","journal-title":"Value Health"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1016\/j.jval.2015.05.009","article-title":"The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses","volume":"18","author":"Bouwmans","year":"2015","journal-title":"Value Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1016\/j.jval.2013.02.009","article-title":"QALY and productivity loss: empirical evidence for \u2018double counting\u2019","volume":"16","author":"Shiroiwa","year":"2013","journal-title":"Value Health"},{"key":"ref26","author":"Soguel","year":"2004"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1080\/14737167.2016.1182865","article-title":"A further examination of the problem of double-counting in incremental cost-utility analyses","volume":"16","author":"Ungar","year":"2016","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s11136-012-0322-4","article-title":"Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study","volume":"22","author":"Janssen","year":"2013","journal-title":"Qual Life Res"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.jval.2012.02.008","article-title":"Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets","volume":"15","author":"van Hout","year":"2012","journal-title":"Value Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1007\/s40273-018-0615-8","article-title":"German value set for the EQ-5D-5L","volume":"36","author":"Ludwig","year":"2018","journal-title":"PharmacoEconomics"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"75","DOI":"10.2165\/00148365-200605020-00002","article-title":"How cost-of-illness studies can be made more useful for illicit drug policy analysis","volume":"5","author":"Moore","year":"2006","journal-title":"Appl Health Econ Health Policy"},{"key":"ref34","year":""},{"key":"ref35","doi-asserted-by":"publisher","first-page":"269","DOI":"10.2165\/00019053-200826040-00001","article-title":"An overview of methods and applications to value informal Care in Economic Evaluations of healthcare","volume":"26","author":"Koopmanschap","year":"2008","journal-title":"PharmacoEconomics"},{"key":"ref36","year":""},{"key":"ref37","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1332\/174426410X482999","article-title":"A web-based tool for adjusting costs to a specific target currency and price year","volume":"6","author":"Shemilt","year":"2010","journal-title":"Evid Policy"},{"key":"ref38","author":"Canty","year":"1999"},{"key":"ref39","year":"2023"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Softw"},{"key":"ref41","author":"Morton","year":"2019"},{"key":"ref42","author":"Wickham","year":"2025"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1007\/978-3-642-21700-5","volume-title":"Gesundheits\u00f6konomische Evaluationen","author":"Sch\u00f6ffski","year":"2012"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"e036638","DOI":"10.1136\/bmjopen-2019-036638","article-title":"Productivity losses among people with back pain and among population-based references: a register-based study in Sweden","volume":"10","author":"Gedin","year":"2020","journal-title":"BMJ Open"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1186\/s12891-022-05896-4","article-title":"Associations between social integration, participation and productivity loss among persons with chronic pain: a registry based cross sectional study","volume":"23","author":"Friedli","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e014632","DOI":"10.1136\/bmjopen-2016-014632","article-title":"Productivity loss due to overweight and obesity: a systematic review of indirect costs","volume":"7","author":"Goettler","year":"2017","journal-title":"BMJ Open"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s40273-014-0132-3","article-title":"How to estimate productivity costs in economic evaluations","volume":"32","author":"Krol","year":"2014","journal-title":"PharmacoEconomics"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/S0277-9536(99)00452-9","article-title":"Precision and accuracy in measuring absence from work as a basis for calculating productivity costs in the Netherlands","volume":"51","author":"Severens","year":"2000","journal-title":"Soc Sci Med"},{"key":"ref49","year":"2024"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1186\/1756-0500-7-242","article-title":"The direct and indirect costs of both overweight and obesity: a systematic review","volume":"7","author":"Dee","year":"2014","journal-title":"BMC Res Notes"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1007\/s10198-014-0645-x","article-title":"Health burden and costs of obesity and overweight in Germany: an update","volume":"16","author":"Lehnert","year":"2015","journal-title":"Eur J Health Econ"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1186\/s12889-022-14105-9","article-title":"Health care costs and lost productivity costs related to excess weight in Belgium","volume":"22","author":"Gorasso","year":"2022","journal-title":"BMC Public Health"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1038\/oby.2010.104","article-title":"Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort","volume":"19","author":"Bell","year":"2011","journal-title":"Obesity (Silver Spring)"},{"key":"ref54","first-page":"461","volume-title":"Methods for the economic evaluation of health care Programmes","author":"Drummond","year":"2015"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1177\/17407745231182010","article-title":"Chronic pain trials often exclude people with comorbid depressive symptoms: a secondary analysis of 346 randomized controlled trials","volume":"20","author":"Cheng","year":"2023","journal-title":"Clin Trials"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/1471-2474-7-72","article-title":"The association of comorbidities, utilization and costs for patients identified with low back pain","volume":"7","author":"Ritzwoller","year":"2006","journal-title":"BMC Musculoskelet Disord"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e2515592","DOI":"10.1001\/jamanetworkopen.2025.15592","article-title":"Volume and intensity of walking and risk of chronic low Back pain","volume":"8","author":"Haddadj","year":"2025","journal-title":"JAMA Netw Open"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1111\/obr.12532","article-title":"The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis","volume":"18","author":"Wewege","year":"2017","journal-title":"Obes Rev"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2024.05.033","article-title":"2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension","volume":"126","author":"Kreutz","year":"2024","journal-title":"Eur J Intern Med"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"e13700","DOI":"10.1111\/obr.13700","article-title":"Clinical practice guidelines for the management of overweight and obesity published internationally: a scoping review","volume":"25","author":"Gaskin","year":"2024","journal-title":"Obes Rev"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1111\/jan.13511","article-title":"Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review","volume":"74","author":"Wu","year":"2018","journal-title":"J Adv Nurs"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/obr.12266","article-title":"Impact of weight bias and stigma on quality of care and outcomes for patients with obesity","volume":"16","author":"Phelan","year":"2015","journal-title":"Obes Rev"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"101980","DOI":"10.1016\/j.copsyc.2024.101980","article-title":"The multi-dimensional stigma of chronic pain: a narrative review","volume":"62","author":"Scott","year":"2025","journal-title":"Curr Opin Psychol"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13561-023-00426-x","article-title":"The intangible costs of overweight and obesity in Germany","volume":"13","author":"Meng","year":"2023","journal-title":"Heal Econ Rev"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.2522\/ptj.2015.95.2.e1","article-title":"Report of the NIH task force on research standards for chronic low back pain","volume":"95","author":"Deyo","year":"2015","journal-title":"Phys Ther"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1705891\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T06:33:55Z","timestamp":1768286035000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1705891\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":65,"alternative-id":["10.3389\/fpubh.2025.1705891"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1705891","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"article-number":"1705891"}}