Introduction to health economics and policy The Economics of Obesity

In recent years, there is widespread recognition that obesity is a major public health problem. Approximately onethird of all adults and 17 percent of children in the United States are obese and more are overweight. What explains increasing obesity? What are the costs of obesity? What are the justifications for public health intervention? Which policies might be implemented to tackle obesity?

EC386: Introduction to Health Economics and Policy

Topic 1: The economics of obesity

Task:

In recent years, there is widespread recognition that obesity is a major public health problem Approximately one-third of all adults and 17 percent of children in the United States are obese and more are overweight What explains increasing obesity? What are the costs of obesity? What are the justifications for public health intervention? Which policies might be implemented to tackle obesity?

Obesity used to be regarded as the disease of the wealthy (Hruby & B Hu, 2015) It can be true in the past, but obesity has been an increasing global concern in the world over the past two decades (Helble & Sato, 2018) The mass-media and political debate on the obesity raised people's higher awareness of its negative effects on both individuals and society, there are no signals of decrease in obesity rate annually (Templin et al., 2019) Obesity is not a physical health issue, it not only causes inconfidence for people or health strain on society, but importantly it affects dramatically their work efficiency and increased absenteeism contributing to the lower performance of a group, a company and an economy (D Ford et al., 2017) These days, people have a tendency to pay more attention to their health - they understand what obesity is and its tremendous impacts on both health and productivity; however, imbalanced diets and the work pressure leave them little time to prepare their own meals, so unhealthy food remained favored (Bhurosy & Jeewon, 2014) In this essay, obesity definition, why it does increases exponentially, its bad impacts in person and the whole economy, some justifications for public health intervention together with numerous proposed strategies to confront with the escalating obesity will be deliberated

Obesity refers to the abnormal or exorbitant fat aggregation, usually more than 20% of a person's average body weight that health may be deteriorated seriously to the larger extent (The WHO, 2000) Obesity indicates the overweight condition by consuming more calories than what the body requires to function properly, resulting in probable health complications including heart disease, diabetes, hypertension, a higher risk of cancer, and even death (Kim, 2016) According to the WHO (2000), by the Body Mass Index (BMI), a person could determine his obesity level based on the weight in kilograms against their height in metres squared For adults, those with over 30 BMI score are considered to be obese

Purnell (2018) acclaimed that obesity is a health paradox not only in developed countries, but the developing and even undeveloped nations as well (Figure 1) It is estimated that over 1 billion adults around the world are overweight, of which at least 300 million of them are obese (The WHO, 2003) This alarming trend has been roughly followed throughout the world with few exceptions and colossal variations in the levels of obesity across nations and continents Samoa ranked first with the highest obesity rate at 75%, while the lowest rate belonged to Japan at about 5% (OECD, 2017)

Figure 1: The prevalence of obesity in adults aged ≥20 years by the globe, from 1980 to

2008

Especially it has a tendency to be worse with "childhood obesity" (Sahoo et al., 2015) The flock of attractive fast foods, exciting PlayStation games, and smartphones, kids tend to be more inactive and become gradually obese as a result (The WHO, 2018) Obesity in children upsurge caused fierce concerns and debates (Figure 2) According to

a report by America's Children and the Environment in 2019, between 1976–1980 and

20152016, the children classified as obese demonstrates an upward trend, from just 5% in 1976

-1980 period to the peak at 18% between 2015 and 2016 Between 2001–2002 and 2015-2016, the percentage of children identified as obese remained between 15% and 18% And childhood obesity will likely cause some disorders and abnormal conditions in adolescents

later, diabetes or heart disease, for instance That is the reason why obesity has become an alarming issue as it even poses distressing impacts on the young generations of the world

Figure 2: Percentage of children ages 2 to 17 years who were obese, 1976-2016

(Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey, America's Children and the Environment,

Third Edition, updated in 2019)

Nowadays, not only developed countries, but the developing and underdeveloped nations are suffering from the high rate of obesity, especially in youngsters (Purnell, 2018) There are several factors contributing to this issue, but the sedentary lifestyle with unhealthy eating habits with junk foods and physical inactivity is the most prominent cause (Bora, 2016) One of the most obvious elements putting the rise to the higher obesity rate is the unhealthy diets involving junk foods due to the hectic life and abundant fast foods (Kuźbicka & Rachoń, 2013) They are convenient and affordable (Bora, 2016) The unhealthy diets including high levels of calories such as red meat, unhealthy fats, canned foods or sugary soft drinks lead to the overweight and then obesity (Cecchini et al., 2010) The convenient shops and food stalls are available everywhere, especially in big cities, which enables people to buy because of the accessibility, reasonable prices and time-saving (Swinburn et al., 2004) Especially, globalisation encourages FMCG multinationals to penetrate into new markets like developing countries, so fast food is considerably introduced and consumed (Hanus, 2018) Some people choose fast-food or canned food to ease the burden of food procession at home (Bora, 2016)

Additionally, heavily canned foods are refined ingredients mixed with additives in susceptible individuals (Garcia, 2012) They are cheap, last long, diversified and luscious at extremely eye-catching packings (Swinburn et al., 2004) Advertisements and marketing campaigns nowadays not only introduce the products, but importantly stimulate the overeating as well (Kim, 2016) Especially, the busy working life make parents leave their children with TV and the internet - thus, children have increasingly been the target audience

of FMCG companies (Roblin, 2007) As a result, children ask their parents to buy that food and their brand awareness has been gradually into their eating habit and affected their buying choices directly

The hectic life exhausts people to make their living (Hamasaki, 2017) According to Choi et

al (2017) at the office, people spend hours sitting in front of the computer without any physical activity for at least 8 hours Then when back home, they just wish to relax by spending time watching TV, surfing the internet or taking rest leisurely They are afraid of hanging out, doing exercises or going to the gyms Additionally, to save time, they prefer luring processed food as they are convenient and allow them to embrace more time to relax (West et al., 2018) Once the calories taken in can be burned through physical exercise or normal daily activities, it leads to the overweight as a consequence (Jakicic & Davis, 2011) For children, modern life keeps their parents engaged in various activities, thus leave them the freedom to waste hours playing computer games or watching Youtube videos rather than playing outdoor games with friends (Johnson, 2019) Many parents believe that snacks or fast food can keep their children safe at home without going out, so children are immersed in the fridge of unhealthy food (P Hills, 2011) Therefore, physical inactivity filled with unhealthy diets boots the obesity in both children and adults faster

A deskbound lifestyle keeps people stuck in a rush routine of stressful working day with little and even no room for physical exercises or gym, over unhealthy diets, stagnation, unattainable to healthy or organic food choices with owing to higher prices or over-advertising promoting high-calorie food or ailing junk food (Jakicic & Davis, 2011) That is why obesity surges extraordinarily

Many research has been carried out to figure out the exact costs of obesity; however, this discussion has turned into a great debate for both direct and indirect expenses to individuals and society (Mayor, 2017) Nevertheless, in general, obesity affects negatively in many aspects from lower salaries, higher risk of chronic diseases, decreased physical mobility and inactive function, social stigma vulnerability, increasing healthcare costs, and even shortened life expectancy (Sheets et al., 2019)

For individuals, obesity not only causes lack of confidence for individuals due to overweight appearance, but directly dismantles both physical and mental health, and results in serious diseases in the long term (Kopelman, 2007) Obesity leads to diabetes with some complications like hypertension, amputations, heart disease, stroke, kidney disease, higher blood pressure, or impotence (Afridi et al., 2003) It is reported that heart disease kills over 600,000 people in America every year (CDC, 2019) According to Uzogara (2017), people with obesity also deal with respiratory infections like asthma or respiratory disorders due to reduced lung capacity Those with obesity are shown to be three to four times more common

to get asthma compared to healthy people

Another health problem is obstructive sleep apnea when the oxygen amount in a person’s blood during sleep reduces (Pi-Sunyer, 1991) Over half of those suffering from the obesity faced this issue, which directly affected their health and working productivity Meanwhile, some people get less serious symptoms like Alzheimer’s disease, joint damage, disc herniation, back pain or visual impairment (Puhl & Suh, 2015) As a result, people have to pay for higher health expenditure At the same, their work efficiency will be decreased due to ailing physical and mental health, and then they will receive lower wages (Mayor, 2017) It can be seen that individuals have to suffer from serious symptoms of obesity, not only health but also the time and money, especially their live as BMI increases, so does your risk of cancer and death from cancer or septicemia Banegas et al (2003) reported that in the European Union (EU), over 175,000 deaths per year are caused by obesity

The severe effects of obesity in individuals are obvious, and the increase in obesity also carries tremendous costs to the economy as obesity, smoking and armed violence are top three social stigmas by humans (Hammond & Levine, 2010)

Obesity requires higher healthcare expenditure (Cecchini, 2019) The economic expense of obesity makes up for $2 trillion annually and approximately 2.8% of the global GDP (Tremmel et al., 2017) According to Hammond and Levine (2010) report, America's government calculated that obesity costed about $190 billion annually to the healthcare expense in 2017 The majority of healthcare fund is for diabetes, and 30% of overweight people have the disease while 85% of diabetics are obese The obesity in children costs $14.1 billion a year, with over $6,000 per obese child

Indirect costs by obesity are undeniable as it results in lower work efficiency, higher workers' compensation budget for medical claims, and insufficient earnings (Egger et al., 2012) It is true when those confronted with obesity will possess lower health - they will be less focused and less creative to work and contribute to the mutual work (Tremmel et al., 2017) Once they are sick, the company still compensates for their days off with anything completed, then the whole work performance or KPI will be affected (Cecchini, 2019) These extra costs of obesity are also reflected in the salary, as individuals with a BMI at over 40 are probably to earn 6% to 8% less than their colleagues at the normal weight (Cavaliere & Banterle, 2008)

As one of the top three most expensive burdens, obesity remains its negative impacts on the health of billions of people around the world and the global economy as well

The justification for public health intervention has been a controversial debate as the question

"Is obesity contagious?" has not been well-answered (Cohen-Cole & M Fletcher, 2007) Inadequate nutritional information, childhood obesity, and impatience and addiction are considered to be four main key justifications that raised some deliberation for obesity public health intervention, but even when they are well-discussed, they remain in a dilemma (Aranceta, 2013)

Some scientists believe that people could decide their ideal weight for themselves according

to their favorite taste, their eating habits, the food prices and their own budget as well as the assumption that people comprehend how their food choices intake or their body's demands (PAHO/WHO, 2004) However, consumers are found not well aware of the nutrition of the food they get in And respondents are inclined to underestimate calorie counts for the high-calorie dish severely Burton et al (2006) figured out that restaurant diners routinely underestimate the calorie amount of their ordered dishes - they guessed the calorie amount at

704 compared to 1,500 as the true amount measured, for example This lack of nutrition and healthy diets knowledge has required the justification for public health intervention like tags labelling nutrition facts Nevertheless, it positive effects seem to be controversial as not all the dinners respond or pay attention to this information - they have a tendency to prioritize the taste, the space, staff and prices (Daradkeh et al., 2018) Even then, the perfect nutrition base pushes consumers into confusion in translating into their own health outcomes (Aranceta, 2013)

Secondly, childhood obesity has been increasingly an alarming issue reflecting on the extraordinary surge recently (Karnik & Kanekar, 2012) According to the WHO (2012), children are not well informed of obesity's bad impacts, vulnerable to unhealthy food advertisements and escalating inactivity to prone to TV screen or smartphones, which gradually affect their both physical and mental health And the welfare and healthcare expenditure for obesity in children has been exponential That is also a clear justification for public health intervention for obese people, especially children

A notion called "behavioral economics" concentrating on over-FMCG scenarios has been raised - "what is people binge on snacks or chocolates but regret after that? or "what if people are hooked on french fries and cannot resist? (Abdukadirov & L Marlow, 2012) Some people strongly propose a ban on unhealthy fast foods to lessen obesity (R Just & Payne, 2009) This health intervention over obesity is stuck in a fierce debate on the individuals' liberty and the elementary hypothesis of welfare economics

It can be seen that a lot of justifications for public health arbitration over obesity, positive predictable effects are obvious, but their drawbacks especially individual liberty related problems are undeniable Therefore, obesity health intervention justifications are prevailingly controversial

Higher healthcare expenditures, decreased work efficiency, and premature deaths, together with higher risks of serious illness are typically bad consequences of obesity (Purnell, 2018)

As a preventable disease, it is time to sermonize obesity through education, fitness, media, and individuals (Aranceta, 2013) The alarming obesity increasing rate put higher pressure for both governments and citizens to confront this dreadful phenomenon soon rather than leave its costs to be formidable (Karnik & Kanekar, 2012) Prioritizing obesity education, as well

as changing to a healthier lifestyle with strict diets and adequate exercises can be the most effective solutions (R Just & Payne, 2009)

The first and foremost measure should be educating people about obesity including what it is, its risks to the health and the economy and childhood obesity in particular (Aranceta, 2013)

It is vital to promote the benefits of a healthy lifestyle with balanced diets, regular exercises and health-conscious minds in order to enrich both physical and mental health (Karnik & Kanekar, 2012) D Ford et al (2017) stated that parents should utmost importance of healthy eating habits to their children from the early age so that they follow the proper health guide till the end of their life Once people are well aware of obesity negative impacts, they will be more conscious of their health

Changing the lifestyle with a strict eating habit and regular physical activity are also prominent to obesity prevention and reduction

Many different diet plans for obesity are available, people should choose based on their favor, food types, budget and even accessibility and flexibility (Alsaleh & Alagrni, 2017) A

balanced diet can provide people with necessary nutrients, minerals, and vitamins for body and mind to healthily develop (Orringer et al., 2019) It is essential to list out what and what not to eat, and especially how much to eat daily and weekly (Kennedy et al., 2001)

According to Orringer et al (2019), a healthy diet keeps obese people away from fats, refined flours, fast food, snacks, and oily dishes or sugars People should include green vegetables as they are rich in vitamins and minerals and low calories in the diet such as beans, broccoli, cauliflower, asparagus, etc Fresh fruits to enhance the immune system like berries, grapes, pineapple, strawberries, or oranges are excellent as well To add a high protein diet, eggs, fish, and lean meats are great for obesity reduction, too (Nicklas et al., 2002) Finally, it is immensely vital to keep the body hydrated with at least 2 liters a day to stay focused, stay fresh and avoid overeating (Smethers & Rolls, 2018)

In addition to a strict diet, a regular physical activity, especially exercises play an indispensable role in keeping fit as exercises account for 70% of body fit while the diet makes up for 30% of the body shape (Philippou et al., 2019) They can be walking, taking stairs or doing exercises or taking up your favorite sports like swimming, football or cycling Instead of staring at your smartphones or TV screens after work, it is better to spend time on the parks to inhale the fresh air, to meet and communicate with people and especially to strengthen your physical health (Petridou et al., 2018) Like the diet, you can join some gym centers or choose a workout plan, cardio exercises or take part in a dance club Meditation and Yoga are also a robust treatment to relieve stress and obesity (Wiklund, 2016)

Obesity has been a distressing issue raging controversial discussions Its adverse impacts on both individuals and society require to confront soon The government should deliberate to tackle this discernible problem, mainly on education to raise people's awareness of obesity threats and its costs More importantly, individuals should enhance their recognition of obesity to enhance their knowledge, to improve their personal health, and then spread that awareness and educate the young generations

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