Fighting down obesity

Health Division, OECD Employment, Labour and Social Affairs Directorate

“Obesity is one of the foremost public health emergencies of our time.”

Anyone who has difficulty believing this perhaps dramatic claim should consider a few facts. First, lifespan: a severely obese person can expect to live up to 8-10 years less than a normal-weight person. That is roughly the same life expectancy loss as smokers face.

But not only does mortality increase steeply once people cross the overweight threshold, healthcare costs do too. An obese person generates at least 25% higher healthcare expenditures than a normal weight person.

Clearly, obesity is a major and growing health concern which has many facets. It is associated with chronic diseases such as diabetes, heart disease, stroke and many cancers. Unhealthy lifestyles are also associated with obesity, with poor diet and lack of physical activity being among the best known causes. However, as obese people tend to live shorter lives, their health expenditures over a life-cycle are no higher, and possibly lower, than for normalweight people.

Obesity is estimated to be responsible for 1–3% of total health expenditure in most countries, though as high as 5% to 10% in the United States. When production losses are added to healthcare costs, obesity accounts for a fraction of a percentage point of GDP in most countries, and over 1% in the United States.

The rise in weight partly reflects an historical trend. Height and weight have been increasing since the 18th century in many developed countries, as income, education and living conditions gradually improved over time. But surveys began to record a sharp acceleration in the rate of increase in body mass index (BMI) in the 1980s, which in many countries grew two to three times more rapidly than in the previous century. BMI, which measures weight in relation to height, has its detractors, though is widely accepted as a useful indicator for monitoring weight.

Before 1980, obesity rates were generally well below 10% of the population. Since then, rates have doubled or tripled in many countries, and in over half of OECD countries 50% or more of the population is overweight.

If recent trends continue over the next ten years, projections suggest that obesity rates will continue to rise, even though the number of people overweight but not obese among adults–a BMI above the normal limit of 25 but below the obesity level of 30–will stabilise at about one third of the population.

There are patterns to watch out for that could inform policy action. For instance, obesity rates tend to be higher in women than in men, but male obesity rates have been growing faster than female rates in most OECD countries

Also, poorer people are more likely to be affected in rich countries. Poorly educated women are two or three times more likely to be overweight than women with the highest levels of education in several OECD countries. For men, the disparity is far narrower, if it exists at all.

Children who have at least one obese parent are three to four times more likely to be obese themselves. This is not just due to genes, but also to behavioural influences, which have played an important role in the spread of obesity.

Finding work can be a problem for obese people, who are often discriminated against, ostensibly because employers fear they will be less productive than people of normal weight. Also, research shows that wage penalties of up to 18% have been associated with obesity. Meanwhile, obese people tend to access disability benefits more than people of normal weight.

How did the obesity problem emerge? The reasons are several and complex, though with food and lifestyle changes being central. The supply and availability of food have changed remarkably since the latter half of the 20th century. There have been major changes in food production technologies, too, with more and more processed foods, which a backlash from more health-conscious sectors has not competed with, at least globally. There has also been an increasingly sophisticated use of advertising and peer pressure promoting speed and pleasure, often at the cost of healthier benefits.

The price of calories has fallen dramatically and convenience foods, often propelled by global brands, have become available virtually everywhere on the planet. Time devoted to traditional meal preparation from raw ingredients has shrunk, partly because of changing working and living conditions. Decreased physical activity at work, more women in the labour force, more stress and less job security, longer working hours for some jobs: these are all factors that, directly or indirectly, have contributed to the lifestyle changes behind the obesity epidemic.

By the same token, consumer and producer pressures and lifestyle can change again. We know that interventions to tackle obesity can improve health and life expectancy, and from a policy perspective, offer greater health benefits per dollar spent than many curative treatments currently provided by OECD healthcare systems. This is particularly true for health education and promotion, regulation and fiscal measures, and lifestyle counselling by family doctors.

 

Slimmer than you think

The cost of delivering a package of counterobesity interventions based on these three areas would be as low as $12 per capita per year in Mexico, $19 in Japan and England, $22 in Italy and $32 in Canada. That is a tiny fraction of health expenditure in those countries–think of it as equivalent to what a country like England spends just on cholesterol-lowering drugs. Moreover, this package would be a small proportion of what these countries already spend (somewhat ineffectively in most cases) on prevention. Most of the interventions examined have the potential to generate annual gains of at least 40,000 and up to 140,000 years of life, relatively free of disability in these five countries. One intervention, the counselling of individuals at risk by their family doctors, may lead to a gain of up to half a million life years free of disability.

The primary goal of prevention is to help people live longer, healthier lives. This applies to people who do not eat enough too–counter-obesity campaigns must always be mindful of the other side of the coin and not unwittingly encourage severe weight loss which can also damage health. Prevention should not be expected to reduce overall health expenditures either, since longer lives mean more care over time too. In the case of obesity, interventions will, at best, generate reductions in the order of 1% of total expenditure for major chronic diseases.

There is no magic bullet in the fight against obesity. A sensible and sensitive prevention strategy would combine health promotion campaigns, government regulation and other so-called population-wide approaches with approaches tailored to individuals, such as counselling.

Importantly, obese people themselves should be treated as players in their own right, and not discriminated against or feel persecuted in any way. But a wide range of food and health stakeholders should also be involved, from health providers and businesses, to government and consumer associations. While governments hold clear responsibility for the prevention of chronic diseases, it is not a burden they can afford to carry alone. Sustained action demands committed private sector involvement.

The current obesity epidemic is everyone’s problem. It must be tackled today to reduce health costs now, and prevent yet another burden of our time from being passed on to future generations.

Reference

Sassi, Franco (2010), Obesity and the Economics of Prevention: Fit not Fat, OECD Publishing, Paris, available from the OECD online bookshop.

©OECD Observer No 281, October 2010




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