Trillions will be spent on treating obesity-related diseases

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The cost of treating ill health caused by obesity around the world will top $1.2tn every year from 2025 unless more is done to check the rapidly worsening epidemic, according to new expert estimates. The Guardian reports that this is according to new expert estimates – released on World Obesity Day on 11th October – that found that obesity and smoking are the two main drivers behind the soaring numbers of cancers, heart attacks, strokes and diabetes worldwide, grouped together officially as non-communicable diseases. They are the biggest killers of the modern world.

The report says the US faces by far the biggest treatment bill, with a rise from $325bn per year in 2014 to $555bn in just eight years’ time, partly because of the high cost of medical care in the US. But all countries are looking at a very steep rise in costs that will be unaffordable for most. In the UK, the bill is set to rise from $19bn to $31bn per year in 2025.

Over the next eight years, the experts say, the US will spend $4.2tn on treating obesity-related disease, Germany will spend $390bn, Brazil $251bn and the UK $237bn if these countries do not do more to try to prevent it.

The report says the new figures come from the World Obesity Federation (WOF), which says there will be 2.7bn overweight and obese adults by 2025, many of whom are likely to end up needing medical care. That means a third of the global population will be overweight or obese.

The WOF’s estimates show adult obesity continuing its steady climb. In 2014, a third of men and women in the US were obese (34%). By 2025 that is predicted to be 41%. In the UK, more than a quarter of adults (27%) were obese in 2014 and that will rise to 34% by 2025. Egypt is predicted to go up from 31% to 37% of adults in the same period, while Australia and Mexico will rise from 28% to 34% if nothing changes.

“The annual medical costs of treating the consequences of obesity, such as diabetes and heart disease, is truly alarming,” said Professor Ian Caterson, the president of the federation. “Continual surveillance by WOF has shown how obesity prevalence has risen dramatically over the past 10 years and with an estimated 177m adults suffering severe obesity by 2025, it is clear that governments need to act now to reduce this burden on their national economies.”

The report says for its new analysis, ahead of World Obesity Day, the federation has for the first time costed in not just cancer, diabetes and heart disease but other harms, including damage to joints which may result in hip and knee replacements and back pain. “That’s why the figures are pretty astonishingly high,” said Tim Lobstein, its policy director. “Some poor countries are already swamped.”

The report says low income countries have healthcare systems that barely manage to cope with childbirth and infectious diseases, and have neither the money nor staff to deal with the epidemic of chronic illness such as cancer and heart disease that is being fuelled by obesity.

“For middle income countries we are going to see an enormous impact,” said Lobstein. “Countries in the Middle East and Latin America where health services are stretched are going to become highly stretched.” These are the regions where obesity among children and adults has soared in recent years.

But, the report says, the increasing costs will be a problem for every country in the world. “This is going to be an enormous burden either on the state, the individual or the insurance services which simply won’t be able to cope. How high can an insurance premium go?” said Lobstein.

Sugary drink taxes are an important measure governments can take, said Johanna Ralston, the federation’s CEO. “Right now there is a big focus on sugar-sweetened beverages, which is fantastic. I think as with tobacco, you want to find something that is tangible that governments can do and is measurable. But it is not enough.”

According to the report, the experts say spending more on treating and preventing obesity will save countries many millions in the long term. Bariatric surgery to reduce the size of the stomach is very effective in reducing appetite, and studies have shown it can reverse type 2 diabetes, dramatically improving people’s chances of a healthy life. But there is not enough treatment available, said Ralston.

“One of the reasons is that the consensus that obesity is a disease is only really emerging now,” she said. “That will also help with the stigma. Bariatric surgery is a fantastic intervention but realistically it will only be for a smallish proportion of the population. It has to be offered in concert with other forms of weight management. Every single individual has to be offered multiple interventions.”

 

 

The number of obese children and adolescents (aged five to 19 years) worldwide has risen tenfold in the past four decades and, according to a study led by Imperial College of London and the World Health Organisation (WHO), if current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.

The study was published ahead of World Obesity Day (11 October). It analysed weight and height measurements from nearly 130m people aged over five years (31.5m people aged five to 19, and 97.4m aged 20 and older), making it the largest ever number of participants involved in an epidemiological study. More than 1,000 contributors participated in the study, which looked at body mass index (BMI) and how obesity has changed worldwide from 1975 to 2016.

Obesity rates in the world’s children and adolescents increased from less than 1% (equivalent to 5m girls and 6m boys) in 1975 to nearly 6% in girls (50m) and nearly 8% in boys (74m) in 2016. Combined, the number of obese five to 19-year-olds rose more than tenfold globally, from 11m in 1975 to 124m in 2016. An additional 213m were overweight in 2016 but fell below the threshold for obesity.

Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, says: “Over the past four decades, obesity rates in children and adolescents have soared globally, and continue to do so in low- and middle-income countries. More recently, they have plateaued in higher income countries, although obesity levels remain unacceptably high.”

Ezzati adds: “These worrying trends reflect the impact of food marketing and policies across the globe, with healthy nutritious foods too expensive for poor families and communities. The trend predicts a generation of children and adolescents growing up obese and at greater risk of diseases, like diabetes. We need ways to make healthy, nutritious food more available at home and school, especially in poor families and communities, and regulations and taxes to protect children from unhealthy foods.”

The authors say that if post-2000 trends continue, global levels of child and adolescent obesity will surpass those for moderately and severely underweight youth from the same age group by 2022. In 2016, the global number of moderately or severely underweight girls and boys was 75m and 117m respectively. Nevertheless, the large number of moderately or severely underweight children and adolescents in 2016 (75m girls and 117m boys) still represents a major public health challenge, especially in the poorest parts of the world. This reflects the threat posed by malnutrition in all its forms, with there being underweight and overweight young people living in the same communities.

Children and adolescents have rapidly transitioned from mostly underweight to mostly overweight in many middle-income countries, including in East Asia, Latin America and the Caribbean. The authors say this could reflect an increase in the consumption of energy-dense foods, especially highly processed carbohydrates, which lead to weight gain and poor lifelong health outcomes.

Dr Fiona Bull, programme co-ordinator for surveillance and population-based prevention of non-communicable diseases (NCDs) at WHO, says: “These data highlight, remind and reinforce that overweight and obesity is a global health crisis today, and threatens to worsen in coming years unless we start taking drastic action.”

In conjunction with the release on the new obesity estimates, the WHO is publishing a summary of the Ending Childhood Obesity (ECHO) Implementation Plan. The plan gives countries clear guidance on effective actions to curb childhood and adolescent obesity. WHO has also released guidelines calling on frontline healthcare workers to actively identify and manage children who are overweight or obese.

Bull adds: “WHO encourages countries to implement efforts to address the environments that today are increasing our children’s chance of obesity. Countries should aim particularly to reduce consumption of cheap, ultra-processed, calorie dense, nutrient poor foods. They should also reduce the time children spend on screen-based and sedentary leisure activities by promoting greater participation in physical activity through active recreation and sports.”

Summary
Background: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.
Methods: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).
Findings: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese.
Interpretation: The rising trends in children’s and adolescents’ BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

Authors
NCD Risk Factor Collaboration

The Guardian report
World Obesity Federation material
World Health Organisation material
The Lancet article summary


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