Obesity Alert: Scientists Warn of Alarming Health Costs, Discuss Cures

By Editor, on August 26th, 2011

In a series of four scientific papers published today in The Lancet medical journal, noted scientists from several countries have examined in detail the worldwide obesity epidemic, its present and projected impact in the U.S. and the UK, and the causes of the problem, and they have suggested actions that are needed to reverse the epidemic.

All four scientific papers are published online in the August 27, 2011 issue of The Lancet medical journal.

In this article, we report on the first two of these scientific papers. We report on the other two papers in a sequel to this article: How Do People Lose Weight & What Can Be Done About the Obesity Epidemic?

Alarming Projections for the U.S. and the UK

In a paper entitled Health and economic burden of the projected obesity trends in the USA and the UK, Y Claire Wang of the Department of Health Policy and Management, Mailman School of Public Health, Columbia University in New York, and colleagues from there and from Oxford University, UK, the National Heart Forum in London, and the Harvard School of Public Health in Boston, present some alarming statistics and projections regarding obesity in the U.S. and the UK.

Based on current statistics and trends, the authors used a simulation model to project the probable health and economic consequences in the next two decades from a continued rise in obesity in the USA and the UK.

“These trends project 65 million more obese adults in the USA and 11 million more obese adults in the UK by 2030,” the authors reported. According to current statistics published by the CDC, this would mean that the number of obese adults in the U.S. would approximately double by 2030!

The researchers state that this will lead to an additional 6 million to 8.5 million cases of diabetes, 5.7 million to 7.3 million cases of heart disease and stroke, 492,000 to 669,000 additional cases of cancer, and 26 million to 55 million “quality-adjusted life years forgone for USA and UK combined.”

“The combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48—66 Billion/year in the USA and by £1·9—2 billion/year in the UK by 2030,” they projected.

“Hence, effective policies to promote healthier weight also have economic benefits,” the authors observed.

Describing the health risks from obesity, the authors state:

“The health burden from obesity is largely driven by an increased risk of type 2 diabetes, cardiovascular diseases, and several forms of cancer. For instance, every additional 5 kg/m2 in BMI increases a man’s risk of oesophageal cancer by 52% and for colon cancer by 24%, and in women, endometrial cancer by 59%, gall bladder cancer by 59%, and postmenopausal breast cancer by 12% (the association is strongest in women in the Asia—Pacific region). Excess bodyweight also contributes to non-fatal but costly or disabling disorders such as osteoarthritis. Moreover, rapidly expanding evidence suggests that excess bodyweight is linked to many additional disorders, including benign prostate hypertrophy, infertility, asthma, and sleep apnoea, further contributing to the cost burden….Some researchers have postulated a potential threat to the continued increase in life expectancy achieved by medical and public health advances during the past century.”

Explaining the economic costs of current obesity trends, if unchecked, for the U.S., and the implications for Medicare, the authors state:

“[E]xtrapolation of the historic trend in the USA would project an increase in annual medical cost from treating obesity-related disorders of US$28 billion per year by 2020 and $66 billion per year by 2030. The recent trend would project a lower, but still substantial increase in costs: $22 billion per year by 2020 and $48 billion per year by 2030. To put these numbers into context, a $22—66 billion increase in health-care spending represents a 0·8%—2·6% increase from the $2·5 trillion US health-care spending in 2009. The top contributors to this cost burden are arthritis, coronary heart disease, and diabetes, and about half these costs would be incurred by individuals 65 years and older (covered by the publicly funded Medicare programme).”

In addition to health care costs, the authors point out that obesity causes an enormous cost of lost productivity. Based on statistical analysis, the authors conclude “we would expect a loss of 1.7—3 million productive person-years in working US adults, representing an economic cost as high as $390—580 billion.”

The Global Obesity Pandemic

In a paper entitled The global obesity pandemic: shaped by global drivers and local environments, Prof Boyd A Swinburn, of the WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia, along with colleagues from there and the U.S. National Institutes of Health; University of Oxford, UK; Simon Fraser University, Vancouver, BC, Canada; and the Harvard School of Public Health in Boston, MA, have examined the history and causes of the global obesity epidemic.

They observe that, “The rise of the obesity epidemic seemed to begin almost concurrently in most high-income countries in the 1970s and 1980s; since then, most middle-income and many low-income countries have joined the global surge in obesity prevalence in adults and children. By 2008, an estimated 1.46 billion adults globally were overweight (body-mass index [BMI] >25 kg/m2) and 502 million adults were obese (BMI >30 kg/m2).”

“The global rise of obesity has serious health effects: Raised BMI is an established risk factor for diseases such as type 2 diabetes, cardiovascular diseases, and many cancers,” they state.

Moreover, “The disability attributable to obesity and its consequences was calculated in 2004 at more than 36 million disability-adjusted life-years, with obesity accounting for between 2% and 6% of total health-care costs in many countries,” according to the authors. In fact, obesity has become the principal cause of preventable diseases in many low-income countries, and has “overtaken tobacco as the largest preventable cause of disease burden in some regions,” they say.

“The increases in overweight and obesity in adults are widely projected to continue to heighten the burden of obesity-related morbidity and mortality in the coming decades,” the scientists warn.

What has caused this obesity pandemic? Prof. Swinburn and colleagues observe that the global rise in obesity has accompanied an increase in GDP, but based on obesity trends also found in some low-income countries, they conclude that “A degree of economic prosperity is thus an enabler for obesity, but the level of prosperity does not have to be high for obesity to manifest.”

They hypothesize that a number of environmental changes that typically accompany increasing wealth in a country may enable or encourage obesity. These changes include, “demographic (younger to older population distribution, rural to urban); epidemiological or health (infectious diseases to NCDs); technological (low to high mechanisation and motorisation); and nutritional (traditional foods and cuisines to more processed energy-dense foods).”

They focus primarily on changes in the food supply in countries with increasing GDP. “Several studies have tested the hypothesis that increases in the food supply are the dominant drivers of the weight gain in populations,” they write. “Results from these investigations show that the rise in food energy supply was more than sufficient to explain the rise in obesity in the USA from the 1970s, and most of the weight increase in the UK since the 1980s.”

“[H]igher levels of GDP do not bring greater happiness and wellbeing for their citizens but do bring greater consumption of all products. The technological changes that are creating cheaper and more available food calories and the strong economic forces driving consumption will inevitably lead to overconsumption and obesity,” the authors write.

What Can be Done? Professor Swinburn and colleagues argue that government action is needed to regulate the economic factors that have led to over consumption and obesity.

Examples they give of government policies that could help include “e.g, shifting agricultural polices to incorporate health outcomes, banning unhealthy food marketing to children, [and] healthy public sector food service policies.” Industry could also help, they suggest, through such actions as “e.g, moving product formulation towards healthier compositions, [and] self-regulation of marketing to children.”

The authors argue that such primarily government-led policies aimed at changing the environmental factors that have encouraged obesity will be more effective at a societal level than programs aimed primarily at influencing people’s behavior to change their diets and exercise. They point out that governments cannot enforce such healthy conduct, nor would we allow government to regulate such personal conduct.

The authors argue that effectively to reverse the obesity trends at a societal level will require more than just encouraging people to eat healthy and exercise. Rather, it will require government regulations, as well as industry self-regulation, attacking the actual societal and economic causes, primarily relating to the food chain, that have led to the obesity epidemic. This will involve primarily government and industry actions changing the composition of processed foods sold, and making healthier foods more affordable and more available, the authors advocate.

“Solutions to obesity and to improve health and development cannot be based on the existing framework (consumption-driven growth creating financially-defined prosperity) because this approach has helped to create the difficulties in the first place,” they state. “Governments and international organisations such as the UN need to provide global leadership on these issues and not abdicate them to the private sector,” the authors conclude.

Solutions

The two other scientific papers in the Obesity Series published in the August 27, 2011 issue of The Lancet focus on better understanding the process of losing weight and on examining further suggestions for solutions to the worldwide obesity pandemic.

HelpingYouCare™ will report on these last two scientific papers in a sequel to this article.

More Information

See the second article in this two-part series by HelpingYouCare™, entitled How Do People Lose Weight & What Can Be Done About the Obesity Epidemic?

See previous HelpingYouCare™ reporting on:

The Obesity Epidemic: What it Means for America & What Can Be Done About It

New Report Shows Americans Getting Fatter; Serious Health & Policy Concerns

Which Foods Are Linked to Highest Weight Gain Every 4 Years?

Diabetes Pandemic Linked to Obesity Epidemic; Study Finds Early Diet Intervention Helps and

MyPlate Icon Replaces Food Pyramid (with links to the new Dietary Guidelines for Americans issued by USDA and HHS).

See also the HelpingYouCare™ resource pages on Wellness/ Healthy Living for Seniors & Caregivers, including:

Diet & Nutrition: Physical Wellness and

Exercise: Physical Wellness