Obesity the Problem

Obesity has substantial costs and serious health consequences.  It has been estimated that the cost of obesity to the NHS is £1 billion a year, with an additional £2.3 to £2.6 billion per year to the UK economy as a whole.  If the current trend is not halted, by 2010 the detriment to the economy alone could be £3.6 billion a year, and by 2050 it is projected to approach £45 billion a year.

Illness associated with obesity generates NHS expenditure which arises, for example, from NHS consultations, drugs and treatments of diseases attributable to obesity. It was estimated by the National Audit Office (NAO) that in 1998 these costs amounted to approximately £480 million or about 1.5% of the NHS budget. Of this, the cost of treating obesity itself was £9.5 million while approximately £470 million was spent on treating the consequences. The most significant costs were related to treatment of hypertension, coronary heart disease and type 2 diabetes.

The NAO has predicted that if one million fewer people in the UK were obese, there would be around 15,000 fewer people with coronary heart disease, 34,000 fewer people developing type 2 diabetes, and 99,000 fewer people with high blood pressure.  Many kinds of cancer would also be prevented, in addition to other medical and social complications that impact on society today.

More recent figures, produced for a House of Commons Select Committee report, suggest the cost of treating obesity itself was between £46 million and £49 million in 2002, a large increase compared to the £9.5 million estimated in 1998.  This largely is due to the increase in drug costs and in particular the licensing of Orlistat. Costs of treating the consequences of obesity were estimated to be between £945 million and £1,075 million in 2002. The increase in the estimate is due to a number of reasons, including higher NHS and drugs costs, more detailed and accurate data becoming available, the inclusion of more co-morbidities in the estimation of costs, as well as the increased prevalence of obesity.

Combining these costs gives an estimate for treating obesity and its consequences of between £990 million and £1,225 million (between 2.3% and 2.6% of NHS expenditure in 2001/02), more than double the figure estimated in 1998. These figures are still considered to be an underestimate.

It is predicted that by 2025, the cost to the NHS of dealing with obesity could rise to £5.3 billion. This worrying projection of an obesity epidemic, and its impact on the UK economy, has led the Government to consider its approach to the issue.

In 2007/2008 there were more than 5,000 NHS admissions with a primary diagnosis of obesity, almost seven times greater than the number ten years earlier.  The number of admissions with either a primary or secondary diagnosis of obesity has increased four-fold in the same period. 

Table 1 Relative risks of health problems associated with obesity

Note: All relative risk estimates are approximate. The relative risk indicates the risk measured against that of a non-obese person of the same age

The main concern with obesity is that it leads to other illnesses as detailed in Table 1. Around 58% of type-2 diabetes, 21% of heart disease and up to 42% cancer (endometrial, breast, and colon) are attributable to excess body fat. Obesity is responsible for 9,000 premature deaths each year in England, and reduces life expectancy by, on average, 9 years. Additionally obese people can experience stigmatization and bullying, which can lead to depression and low self-esteem. 

There are three main components driving obesity: First and second, the ubiquitous availability of high energy food as well as a decline in everyday activity. The third is a controlling factor in that humans evolved in an environment prone to food shortages. In fact, our natural drivers are geared to consuming more than we need. Our natural checks serve to answer to hunger and much less to excess. Consequently the ready availability of energy dense foods and decline in metabolic activity both serve to drive obesity.