Obesity continues to be a growing public health concern worldwide and increases the risk for multiple noncommunicable diseases (NCDs), including diabetes, asthma, heart disease, stroke, Alzheimer’s disease, and cancer. According to the Global Burden of Disease Study, each year these obesity attributable diseases cause over 5 million deaths and 160 million disability-adjusted life years globally.
In addition to the immense toll on health, obesity also leads to economic impacts. The direct cost of healthcare for treating obesity-attributable diseases are the most evident, however, there are indirect costs resulting from obesity as well. These indirect costs include absenteeism (missing days of work), presenteeism (reduced productivity while at work), early retirement, the cost of premature mortality, and more. Just as with other diseases, studying the economic impacts of obesity does not mean that individuals living with obesity are creating costs. Instead, it is increasingly obesogenic environments and genetic susceptibility that has led to higher obesity prevalence and associated economic impacts.
Much of what we know about the burden of obesity comes from studies in high-income countries, where the nutrition transition towards diets high in sugar, fats, animal products, and processed foods began several decades ago. Only a few studies have been conducted in low- and middle-income countries (LMICs), many of which are experiencing rapidly escalating rates of obesity. There is an urgent need to quantify the economic and social impacts of obesity using a modeling framework that can be replicated so that results are impactful, easily interpreted, and comparable across heterogeneous contexts around the world.
Developing the First Global and Country-Specific Estimate of the Economic Impact of Obesity
To achieve this, RTI is partnering with the World Obesity Federation (WOF), a global community of organizations dedicated to addressing obesity, to develop a modeling framework to estimate the economic costs of obesity by country on a global level.
RTI has extensive experience with economic and disease modeling approaches to measure costs of illness and the costs and cost-effectiveness of intervention programs for NCDs and NCD risk factors, including diabetes, hypertension, hyperlipidemia, kidney disease, and tobacco use. To apply our expertise to obesity, we first conducted a literature review of published cost estimates to understand the breadth of existing methodologies and results. We discovered that there were only studies published about five LMICs, and they varied tremendously in the types of direct and indirect costs included, the diseases included, and the methodologies employed, making comparison of results difficult.
Based on our literature review and consultations with an advisory group of experts, which we convened for this project, we have employed a cost-of-illness approach to estimate the economic impacts of obesity, including both direct and indirect costs from a societal perspective. Our analysis includes projections of costs to 2030 to coincide with the Sustainable Development Goals (SDGs) and to 2060 to account for current children who will experience the impacts of obesity over their lifetime.
Over the past year, RTI has produced estimates for eight pilot countries – Brazil, Mexico, Spain, Saudi Arabia, South Africa, India, Thailand, and Australia. These results will be shared in a forthcoming manuscript and published on WOF's Global Obesity Observatory.
In 2021, RTI and WOF are embarking on the second phase of the project, which will see the expansion of the modeling framework we have developed to produce estimates for all remaining countries. These results will be reported academically and on the World Obesity Observatory, which will include an interactive map of results and which can be updated as new data become available. This will be an important milestone as the first global and country-specific estimate of the economic impact of obesity and will serve as a crucial tool for local, national, and international advocacy efforts.
Obesity and the COVID-19 Pandemic
The COVID-19 pandemic is straining health systems worldwide, and the socio-economic impact of the outbreak is immense, particularly on already vulnerable individuals – especially those with underlying chronic conditions. Overweight and obesity have emerged behind only old age as the leading predictor of poorer COVID-19 outcomes, including hospitalization, admission to intensive care, mechanical ventilation, and death. This year’s edition of WOF’s World Obesity Atlas reviews the evidence of the relationship between overweight, obesity, and COVID-19 and finds that in countries where overweight and obesity prevalence is less than 50 percent, the mortality rate from COVID-19 is one-tenth of the level observed in countries with an overweight and obesity prevalence above 50 percent. The report finds that this is independent of a country’s age structure, national income level, and COVID-19 reporting capacity. This result clearly demonstrates the outsized role obesity has played in the health and economic damage caused by COVID-19.
To better quantify the economic impacts of COVID-19 on individuals living with obesity and countries with high prevalence of obesity, the second phase of the project also includes an analysis of the projected economic impacts of obesity, including assumptions around associations with COVID-19, up to 2025. After reviewing the evidence base, we are currently developing an epidemiological model of obesity-attributable deaths due to COVID-19, which we will then use to re-run our economic model. Our analysis will include different scenarios to account for vaccine access and quality of care.
It is our hope that the evidence generated will help bring about the changes that are needed at the national level, especially in LMICs, to address the wide-ranging personal, societal, and economic impact of the global obesity epidemic. Given that no single country has been successful in reducing the prevalence of obesity, urgent action is needed to highlight the increasing cost of this global epidemic. The COVID-19 pandemic has exposed the links between obesity and infectious disease and acutely demonstrates the consequences of inaction. Quantifying the economic and social impact of obesity can help stakeholders understand the importance of addressing obesity through systemic solutions and provide a crucial tool to national and international advocates to push policy makers into action.
