The heavy burden of obesity : the economics of prevention

Foreword
Acknowledgements
Acronyms and abbreviations
Infographic 1. The heavy burden of obesity and the economics of prevention
Executive summary
	The challenge of growing obesity
	Higher rates of overweight and obesity fuel social inequalities
	Overweight damages population health, health budgets and the economy
	Tackling overweight is an excellent investment for OECD, EU28 and G20 countries
1 The heavy burden of obesity
	1.1. A growing obesity epidemic drives negative health and economic effects
	1.2. Unhealthy lifestyles are on the rise, and morbid obesity is growing
		1.2.1. Poor diet, lack of physical activity and sedentary behaviour have contributed to the obesity epidemic
		1.2.2. Individuals with a lower socio-economic status are more likely to be obese and to have unhealthy lifestyles
	1.3. Obesity and associated chronic diseases damage health and the economy
		1.3.1. Overweight and associated chronic diseases worsen health and decrease life expectancy…
		1.3.2. … and have a negative impact on health budgets
		1.3.3. Obesity negatively affects educational outcomes and human capital formation
		1.3.4. Obesity and associated chronic diseases damage labour force productivity, personal budgets and the economy
	1.4. The policy response to obesity has been insufficient
		1.4.1. Policies influencing lifestyles through information and education
		1.4.2. Policies widening the number of healthy choice options such as changing urban settings and school-based programmes
		1.4.3. Policies to modify the cost of health-related choices such as price policies
		1.4.4. Policies to regulate or restrict actions promoting unhealthy choice options such as the advertising of unhealthy products and regulating nutritional content
	1.5. Innovative public health actions have a positive impact on population health and are an excellent investment for OECD countries
		1.5.1. Population-wide actions targeting adults are generally most effective in the short and medium terms
		1.5.2. Combining policies into a coherent prevention strategy helps countries reach a critical mass with a greater impact
		1.5.3. Achieving a 20% reduction in calorie content in energy-dense food would have a significantly positive effect on the health and economy of countries
	1.6. Public health policies may affect industry revenues but countermeasures exist to minimise additional costs
		1.6.1. The main costs to industry include research and development costs, production and distribution costs, marketing and advertising costs and changes in sales
			Research and development of new or modified products.
			Production and distribution costs
			Marketing and advertising costs
			Changes in sales
		1.6.2. Solutions exist to mitigate implementation and compliance costs
	1.7. Conclusions: tackling obesity and its related unhealthy lifestyles is an excellent investment
	Notes
2 Overweight, poor diet and physical activity: Analysis of trends and patterns
	2.1. Why is obesity a public health concern?
		2.1.1. Obesity: how do countries compare?
			Rates of obesity among adults remain high while almost one in ten persons have morbid obesity
			Childhood obesity rates follow adult patterns
		2.1.2. Are obesity levels rising or falling?
			Morbid obesity is on the rise
			Childhood obesity continues to grow in some countries, slow in others
		2.1.3. What population groups are at highest risk for obesity?
			Overweight prevalence differs by sex
			Disparities in obesity rates exist between income groups
	2.2. Defining determinants of overweight: diet, physical activity, and sedentary behaviour
		2.2.1. Diet quantity or quality: do people eat too much, too unhealthily, or both?
			Demand for food and calories has been increasing over the past half century
			A better diet: Quality matters
			Who is at the highest risk of eating unhealthy foods?
		2.2.2. Low levels of physical activity and excess sedentary behaviour also contribute to the energy imbalance
			Do people spend their time on physical activities or in sedentary behaviour?
			The share of people meeting WHO physical activity thresholds and trends remains low
			What are the population groups at highest risk of insufficient physical activity and excessive sedentary behaviour?
		2.2.3 How are unhealthy lifestyles linked to obesity clusters?
	2.3. Conclusions
	References
		Annex 2.A. Additional analyses
		Note
3 The economic burden of obesity
	3.1. To make the economic case for investing in obesity prevention and treatment, its impact needs to be quantified
		3.1.1. Previous studies estimate the health care cost of overweight to be between 2% and 8% of total health expenditure
		3.1.2. Existing studies suggest that the impact of obesity on the wider economy is between 0.5% and 1.6% of GDP
		3.1.3. The OECD SPHeP-NCDs model estimates the health and economic burden of obesity
	3.2. Overweight and related diseases will reduce life expectancy in OECD countries by 2.7 years
	3.3. Overweight will account for over 8% of total health expenditure in OECD countries
	3.4. Overweight has a negative impact on the labour market, through absenteeism, presenteeism, unemployment and early retirement
	3.5. At a macroeconomic level, GDP in OECD countries will be 3.3% lower due to overweight
	3.6. Investment in the prevention and treatment of overweight is needed to reduce its impact on health and the economy
	References
		Annex 3.A. Additional analyses
		Disease incidence by age group and sex
		Life-years and disability-adjusted life-years lost
		Macro-economic impacts adjusted for changes in the retirement age
	Notes
4 The relationship between childhood obesity and educational outcomes
	4.1. The relationship between childhood obesity and educational outcomes is mediated by different factors
		4.1.1. The evidence points to a significant relationship between childhood obesity and educational outcomes
		4.1.2. The relationship between obesity and educational outcomes is mediated by biological, behavioural and emotional factors
			Biological factors may adversely affect both body weight and cognitive functions
			Behaviour may be associated with childhood obesity and lower concentration
			Emotional and mental health problems, related to bullying and stigma, can lead to poor academic performance
	4.2. There is a clear association between childhood obesity and school performance in OECD countries
		4.2.1. Children with obesity have lower performance at school than children with a healthy-weight
		4.2.2. Teenagers with obesity are more likely to miss school
	4.3. A potential causal effect of childhood obesity on educational outcomes is found in five countries
		4.3.1. The literature presents mixed evidence for the causal effect of obesity on education
		4.3.2. An OECD analysis points to a negative causal relationship between obesity and educational outcomes in five countries
			Childhood obesity is associated with lower educational performance later on
			Childhood obesity during school years is associated with lower educational attainment
	4.4. The short-term and long-term consequences of childhood obesity are of concern for individuals and societies
	4.5. Reducing childhood obesity will help build better future lives and stronger societies
	References
		Annex 4.A. Further analyses on inequality
		Notes
5 Promoting healthier diets and active lifestyles: Policies and best practices
	5.1. Introduction
	5.2. Multi-sectoral response is needed to target overweight determinants
		5.2.1. Population-level versus targeted approach: which one is preferable?
		5.2.2. Inter-sectoral collaboration is key to success and may help overcome barriers to overweight prevention and control
	5.3. Policy toolkit: what options work?
		5.3.1. Policies influencing lifestyles through information and education
			Food labelling
			Menu labelling
			Mass media campaigns
			New technologies
			Prescription of physical activity by primary care doctors
		5.3.2. Polices designed to widen choices
			School-based and other environmental policies that can influence children
			Workplace policies
			Policies promoting active transport and walking
		5.3.3. Policies to modify the costs of health-related choice
			Price policies
			Healthy food subsidies for health purposes
			Changes in nutritional community environment through economic incentives
		5.3.4. Policies to regulate or restrict actions promoting unhealthy choice options
			Regulation of advertising
			Other restrictions
	5.4. Conclusion
	References
	Notes
6 Impact of obesity policies on health and the economy
	6.1. Introduction
	6.2. Policies to tackle overweight and to promote healthy lifestyles: innovative policy options to upscale efforts
		6.2.1. Policies influencing lifestyles through information and education
			Food labelling
			Menu labelling
			Mass media campaigns
			Prescribing physical activity
			Mobile apps
		6.2.2. Policies widening the number of healthy choice options
			School-based programmes
			Workplace programmes targeting sedentary behaviour
			Workplace wellness programmes
			Expanding public transport
		6.2.3. Policies to regulate or restrict actions promoting unhealthy choice options
			Food advertising regulations
	6.3. Policies to tackle overweight and unhealthy lifestyles: what works?
		6.3.1. Obesity policies can contribute to significant health gains
		6.3.2. Obesity policies can reduce health expenditure
		6.3.3. The impact of obesity policies on the labour market and related costs
		6.3.4. Impact on the broader economy
	6.4. Combining policies into coherent prevention strategies has greater impact
	6.5. Conclusions
	References
		Annex 6.A.  Additional analyses
	Notes
7 Special focus: The health and economic impact of food reformulation
	7.1. Food reformulations present opportunities for effective public-private cooperation in overweight control
	7.2. What would be the effect of a global deal to scale up food reformulation worldwide?
		7.2.1. Impact on the population
		7.2.2. Impact on health expenditure
		7.2.3. Impact on labour market outputs and the broader economy
	7.3. Conclusion
	References
	Notes
8 The impact of obesity policies on the food and drink industry
	8.1. Introduction
		8.1.1. Obesity policies can have an economic impact on the food industry
	8.2. Product reformulation and its impact on the food industry
		8.2.1. Food producers can reformulate their products to improve the nutritional profile
		8.2.2. Reformulation carries R&D and implementation costs, and can have an impact on sales
			To develop and launch a reformulated product, producers may need to invest in R&D, new production processes and marketing
			Reformulation can result in a reduction or an increase in sales
			Reformulation may result in higher or lower production cost for producers
		8.2.3. The impact of reformulation on the industry is modulated by a number of factors
	8.3. Portion size changes and their impact on the food industry
		8.3.1. Portion size restrictions aim to reduce the volume of energy-dense products consumed
		8.3.2. Creating smaller portion sizes carries implementation costs, but the right marketing approach can benefit sales
			Some R&D and implementation costs may be associated with portion size changes
			The impact on sales for producers partially depends on the perception of value for money
			Marketing based on behavioural economics can help avoid a loss in sales for food vendors
	8.4. Food labelling and its impact on the food industry
		8.4.1. Food labels inform consumers about the nutritional value of products and encourage reformulation
		8.4.2. For producers, the introduction of front-of-pack food labels carries implementation costs, but may lead to an increase in sales
			There are direct costs associated with the design and printing of new labels
			Labels can be used in marketing campaigns to increase the sales of healthy products
		8.4.3. For food vendors, there are also implementation costs associated with menu labels, but the labels can be used to promote the sale of healthy products
			Implementation of menu labels may be associated with design, printing and nutritional analysis costs
	8.5. Food taxes and their impact on the food industry
		8.5.1. An increasing number of countries are implementing taxes which aim to reduce the consumption of energy-dense food and drinks
			Several OECD countries are introducing taxes on energy-dense food and drinks
		8.5.2. The impact of food taxes on the food industry depends on the pass-through rate and the sale of substitution products
			The direct cost related to tax depends on the pass-through rate
			Changes in sales due to taxes may be offset by sales of substitute products
			The impact of taxes on employment in the food and drink industry are likely to be offset by new employment in other industries
	8.6. Advertising restrictions and their impact on the food industry
		8.6.1. Many governments and companies have restricted the advertising of energy-dense products to children
		8.6.2. The impact of advertising restrictions on the industry depends on the type and extent of the ban
			There may be costs associated with the development of new advertising strategies
			The impact of advertising restrictions on overall sales is unclear when other advertising possibilities remain
		8.6.3. The impact of advertising regulations on the advertising and media industries is thought to be limited
	8.7. Healthy food subsidies and their impact on the food industry
		8.7.1. The US Healthy Incentives Pilot programme increased fruit and vegetable sales with limited burden on retailers
		8.7.2. The European Union School Fruit Scheme has created a new, stable market for the agriculture industry
	8.8. Conclusion
	References
	Notes