Obesity casts a big shadow

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This special report was researched with the support of Novo Nordisk

This three-part special report explores the roots of the obesity crises, why it evolved so rapidly and how its unchecked growth will become an even larger drain on the global economy.

Obesity is not just a rich world disease. It also exists in countries with high rates of undernutrition. Classifying it as a disease in its own right, not an avoidable lifestyle choice, could be a vital first step to slowing the growth of obesity. But not all experts agree reclassification would be beneficial for patients.

Obesity is arguably unique among non-communicable diseases (NCDs), with rates skyrocketing globally at the same time that it has become a leading risk factor for so many other chronic conditions, including diabetes, cardiovascular disease and cancer.

The associated cost to health budgets and to the broader economy from lost productivity is already accelerating. The number of people in OECD countries who are obese has risen to nearly one in four in 2019, from one in five in 2010. In 2019, the OECD estimated that 8.4% of the health budgets of member countries will be spent on treating the consequences of being overweight and obese over the next three decades.

Obesity is heavily stigmatised. Like smoking and alcohol-related illnesses, obesity is one of a small group of conditions for which those who suffer from it often take the blame. Indeed, the 2019 study “Weight bias and health care utilization: a scoping review” found that stigma has been identified as a major barrier, hindering obesity suffers from engaging with primary health services. The Awareness, Care and Treatment in Obesity Management—an International Observation (ACTION IO) Study, published the same year, found that more than eight out of ten obese people believe that the need to lose weight is solely their responsibility.

Yet successive policies to combat obesity have often been piecemeal in approach and done little to reverse its current upward trajectory. Obesity is increasingly understood as a complex condition with a variety of physiological, behavioural, genetic and environmental causes. Combating it requires attention to the broad context in which obesity develops and the adoption of more ambitious, multi-faceted policies.

Mounting evidence that obesity has been an important risk factor for covid-19 is clearly focusing the minds of policymakers. A report on excess weight and covid-19 from Public Health England in July 2020 finds that excess weight is associated with an increased risk of a positive test, hospitalisation, advanced levels of treatment (including mechanical ventilation or admission to intensive or critical care) and death from the virus. These risks seem to increase progressively for people with body mass index measurements above the range for healthy weight, the report finds. Report data also indicate that excess weight may explain some of the ob- served differences in outcomes linked to covid-19 for older adults and some minority ethnic groups.

In the wake of the covid-19 pandemic, there is clearly renewed incentive to ramp up efforts to prevent and treat obesity. Policymakers will need to acknowledge the complex roots of the condition if they want to improve their chances for success.

TEXT Andrea Chipman

Read the full report below

Part 1: A ruinous epidemic

Part 2: Disease on disguise

Part 3: Double burden on the poor