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




Economic data

E-Newsletter

Stay up-to-date with the latest news from the OECD by signing up for our e-newsletter :

Twitter feed

Suscribe now

<b>Subscribe now!</b>

To receive your exclusive print editions delivered to you directly


Online edition
Previous editions

Don't miss

  • Low interest rates here to stay for half a century, says OECD director Adrian Blundell-Wignall.
  • OECD speak on support it will offer to Greek
  • 3.4 bn people or 56% of the world's population live only just above the global poverty line, on US$2-10 a day. The global middle class is both smaller and poorer than thought. Read more about the results of this Pew Research Centre's new study on the Financial Times.
  • Resale of charity shop rejects has destroyed Kenya's local textile industry but a proposed ban on the importation of used garments risks putting thousands out of work. Read more about this economic dilemma on The Guardian.
  • Bill Gates visited the OECD on 26 June. He met with the Secretary-General Angel Gurría to discuss areas of collaboration with his foundation and participated at a briefing session on official development assistance modernisation with OECD experts.
  • "Countries that are home to high proportions of immigrants tend to have better integration outcomes”, according to the OECD Indicators of Immigrant Integration 2015, released on 2 July 2015. Read more on The Guardian.
  • The People’s Republic of China decided to enhance longstanding collaboration with the OECD and to join the OECD Development Centre, in a historic visit by Chinese Premier Li Keqiang on 1 July to the OECD in Paris.
  • In order to face global warming, Asia needs at least $40 billion per year, derived from both the public and private sector. Read how to bridge the climate financing gap on the Asian Bank of Development's website.
  • One dollar in aid for trade generates eight dollars in extra trade for all developing countries and 20 dollars for low-income countries. Read OECD Secretary General's post on the newly released Aid for Trade at a glance 2015.
  • Catherine Mann, OECD Chief Economist, explains on Bloomberg why "too much bank lending can slow economic growth".
  • Interested in a career in Paris at the OECD? The OECD is a major international organisation, with a mission to build better policies for better lives. With our hub based in one of the world's global cities and offices across continents, find out more at www.oecd.org/careers .
  • Come va la vita in Italia? How's life in Italy? The OECD Better Life Index is an interactive online platform in seven languages that goes beyond GDP by offering important insights into measuring well-being and quality of life. Try it for yourself!
  • What does it mean to live on less than US$2 a day? Xavier Godinot, Delegate for International Affairs of ATD 4th World and René Locqueneux, a member of this NGO, gave an insightful presentation on the topic based on their field experience, at the 2015 OECD Forum.
  • How to jump-start slack investment to drive global growth and jobs dominated discussions at the annual OECD Ministerial Council Meeting, chaired by the Netherlands, which ended 4 June.
  • The IMF calls for a decisive energy subsidy reform in order to use the freed resources to meet critical public spending needs and to reduce pollution ahead of the Paris climate change summit.
  • More than 35 million young people, aged 16-29, across OECD countries are neither employed nor in education or training according to the newly released OECD Skills Outlook.
  • Have a look at these posters representing a world without fundamental rights at work – including child labour, forced labour and inequality. Read more about this ILO image competition here.
  • Rising inequality threatens social cohesion and growth. Income inequality has reached historical highs in most OECD countries and is still rising.
  • Time to vote! As the dust settles after the UK general election, let’s remember that voting at the ballot box is not an innate right enjoyed by everyone. Indeed, although the number of democracies across the world has spiked from 48 in 1989 up to 95 today, billions of people are still living in non-democratic, authoritarian regimes.
  • How can we achieve a zero-carbon future? A new World Bank report provides a few insights.
  • Today alcohol causes more deaths worldwide than HIV/AIDS, violence and tuberculosis combined. In order to reduce damages to health, the OECD recommends that regular drinkers reduce their consumption by one unit a week, that is, a small glass of wine for example. In addition, increasing prices, regulating advertising, effectively treating drinking problems together with stricter police enforcement would greatly contribute to reducing damages done to individuals and society.
  • video alcohol
  • Africa vs profit shifting African countries heavily rely on the income generated by multinationals’ taxation, which can represent as much as 88% of a country’s tax base. Little wonder Africa is involved in the OECD’s initiative to address tax base erosion caused by profit shifting, known as BEPS. The need to strengthen inter-governmental co-operation to curb cross-border tax losses was reaffirmed at the Africa Tax Administration Forum (ATAF) in Sandton on 21 April 2015.
  • Africa v. profit shifting
  • Rana Plaza
  • Wal-Mart, Other Retailers Sued over Bangladesh Factory Collapse Two years after the April 24, 2013, Bangladeshi factory collapse in the capital of Dhaka, the victims' families filed a lawsuit in U.S. federal court in Washington against Wal-Mart Stores Inc and other U.S.-based companies that sourced out their products from the Rana factory. Read more on Telesur's website.
  • #OECD360: Your country in figures.
  • How to ensure transparency in public procurement? Read Cobus de Swardt's article on OECD Insights.
  • After three decades of extraordinary economic development, China is shifting to a slower and more sustainable growth path, according to the OECD's latest Economic Survey of China.
  • In pursuit of the American Dream
  • Tim Harcourt Video
  • G20 and Australia: Bestselling economist Tim Harcourt speaks to the BBC about how Australia has gone from "Down Under to Down Wonder".

Most Popular Articles

Poll

What issue are you most concerned about in 2015?

Euro crisis
Unemployment
Global warming
International conflict
Other

OECD Insights Blog

NOTE: All signed articles in the OECD Observer express the opinions of the authors
and do not necessarily represent the official views of OECD member countries.

All rights reserved. OECD 2015