Pound for pound: the economic case for weight loss

Guest Blog by Matt James, Senior Researcher at 2020health

Name calling is not pleasant but sometimes behind the hurt and the pain there is a degree of truth. In 2013 the World Health Organization (WHO) called Britain the ‘Fat man of Europe’. Whilst various initiatives have sought to reduce the nation’s waistband, it is true: people are generally still consuming too much of everything.

• A third of us eat junk food once a day
• Those of us with a normal Body Mass Index (BMI) has decreased over the past 20 years from 41.0 per cent to 32.1 per cent among men and from 49.5 per cent to 40.6 per cent among women
• Children on average eat 42 packets of biscuits a year

The previous blog posts in this series clearly indicate that the challenge of obesity is something that simply cannot be ignored. To adapt a familiar wartime slogan, “Careless eating cost lives”, the title of 2020health’s latest report.

To try and claim that this is something that has crept up on us is farcical. Back in 2007 Labour’s ‘Foresight Report’ set out to begin the process of finding a sustainable response to obesity over the next 40 years. The almost weekly press coverage of an obesity related story and associated rising costs mean that no one can claim ignorance, but the lack of action for what is a national crisis (as opposed to global terrorism and ebola) is astonishing. It is, according to some, the greatest threat to the nation’s health and possibly economic security

Public Health England report that in 2007 estimates of the direct NHS costs of treating overweight and obesity, and related morbidity in England were £4.2 billion and estimated to be £6.3 billion in 2015. Projections suggest that indirect costs of obesity could be as much as £27 billion by 2015. The same experts estimated that by 2050 the NHS cost attributable to obesity and overweight would be £9.7 billion and the total costs would be £49.9 billion (at 2007 prices)

Alongside the financial impact on the NHS, there are also the wider economic implications to consider: working days lost through ill health, increased benefit payments and social care costs. Towards the end of 2014, the European Court of Justice was asked to consider the case of a male child minder in Denmark who claimed he was sacked for being too fat. The court ruled that if obesity could hinder “full and effective participation” at work then it could count as a disability, given that it is covered by anti-discrimination legislation. This not only increases the pressure on health and social care, but upon employers as well. On a case by case basis, it is likely that employers will have to make reasonable adjustments to the working environment, such as providing larger chairs or special car parking spaces, for obese employees. Providers of goods and services including shops, cinemas and restaurants may also have to make reasonable adjustments for their customers.

US studies looking at the impact of obesity and lost productivity at work found that obese or overweight workers lost productive time at work to a value of over $42 billion (compared with less than $12 billion among workers of normal weight). Employees who have medical conditions such as heart disease, hypertension, diabetes and some cancers, were found to be more likely to have higher absenteeism and greater ‘presenteeism’.

Further research needs to be undertaken to better understand the saving which could be incurred by teaching and training children and parents about living healthy lives. Overlooking this means that we end up treating and spending money ‘downstream’ on outcomes, as opposed to addressing the heart of the problem (prevention) ‘upstream’.

As highlighted by this series of blog posts, there are many questions surrounding obesity with few, ready answers available. Obesity is more than just a physical issue to be addressed by the latest recommended diet. It is much more complex because it underpins how we live our daily lives, the environment in which we live and work and how we feel about ourselves.

A culture of blame, of some people telling others to take responsibility, of demonizing business, of singling out ingredients does not lead to sustainable solutions. It is only when the bigger picture is taken into consideration and a wide range of organisations and individuals become involved, that we will really begin to address the obesity challenge. The Foresight Report recognized this and asked for a portfolio of policies to lead the charge.

Increasing interest is being paid to how taxes and spending power can be harnessed to help promote healthier eating and drinking. Highly calorific food is often cheaper and more readily available while fresh fruit and vegetables are considered to be more expensive. This does not help to encourage any of us to pursue a healthy diet, particularly as we all look to make savings on the weekly shopping bill.

Whilst we need to ensure that freedom of choice and consumer sovereignty are not disregarded, serious consideration needs to be given to taxing foods that cause disease. There is merit in evaluating the impact of ‘soda’ taxes in countries and states that have recently introduced them, as well as reviewing whether any of these taxes have actually been hypothecated to improve public health. There is no evidence yet to show that we can simply tax our way out of public health problems, but there is a need for practical consideration around funding and a philosophical imperative to change behaviour proportionately through the tax system.

Over all this we need to invoke an obesity test on all new legislation, asking all government departments to consider the impact of proposed policy on eating behaviour and public health to ensure it does not compound the obesity crisis. Because it is a crisis, and to do nothing, or too little, will further undermine our NHS, our economy and betray those who are not highly resourced to make it through the day past the tidal wave of empty calories.

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You can read 2020health’s full report, Careless Eating costs lives, here.