There is growing evidence that, on top of the costs to healthcare systems, the productivity of employees is being undermined by obesity, compromising the competitiveness of companies. MGI assessed the productivity lost to obesity using the standard measurement of disability-adjusted life years, or DALYs, which measure the number of years that are lost or rendered economically unproductive due to disease. The number of DALYs lost to obesity today is three times as high in developed economies as it is in emerging markets. However, that gap is narrowing. The rise in the number of DALYs per 100,000 people lost because of obesity slowed in developed economies between 1990 and 2010 but soared by 90% in emerging economies.
Policies to tackle obesity
So what needs to be done? By reviewing around 500 obesity-reduction research trials around the world, MGI has identified 74 interventions to address obesity in 18 areas. These include subsidised school meals for all, calorie and nutrition labelling, restrictions on advertising of high-calorie food and drinks, and public health campaigns. There were sufficient data on 44 of these to be able to measure potential impact if scaled up to a national level. The systemic nature of the obesity challenge and the highly variable quality of the data that are available mean that this analysis is directional rather than perfect. Indeed, we see our analysis as analogous to a 16th century map that has islands missing and misshapen continents, rather than a perfect 21st century map of the full range of solutions.
If the UK, the country where MGI chose to pilot its initial assessment, were to deploy all 44 interventions that we were able to analyse, it could reverse rising obesity and bring roughly 20% of overweight and obese individuals back into the normal weight category within five to ten years. This would reduce the number of obese and overweight people by roughly the population of Austria.
Cost-effectiveness and the need for coordinated action
A comprehensive set of interventions needs to employ the full set of mechanisms for changing physical activity and nutritional behaviour. Education about the risks of obesity is important; so is taking personal responsibility for one’s health, fitness, and weight. But all the evidence shows that these are not sufficient on their own to offset the body’s desire to eat that has been honed over millennia of evolution. People need help and that means a change in the environment in which they are making choices – change such as reduced standard portion sizes, changing marketing practices, and restructuring cities and educational establishments to make it easier for people to exercise.
Our analysis for the UK suggests that almost all the interventions identified are cost-effective for society – savings on healthcare costs and higher productivity could outweigh the direct investment required to deliver the intervention when assessed over the full lifetime of the target population. An integrated program to reverse rising obesity could save the National Health Service about $1.2 billion a year. It is important to note that not all of the interventions are cost-effective for the specific stakeholder delivering them. Sometimes the return on investment lands elsewhere in the economy, the benefits going to households or to healthcare systems, for instance. This misalignment of economic incentives is one of the major challenges inhibiting concerted coordinated action on obesity.
Figure 2. Cost-effective interventions to reduce obesity in the United Kingdom include controlling portion sizes and reducing the availability of high-calorie foods.