APPENDIX 2: THE COST OF OBESITY
The total cost to NHSScotland of obesity in 2007/8 was in excess of £175 million (approximately 2% of the budget allocated to NHS Boards), of which £4.5 million was associated with drugs for obesity. 38 The majority of costs were associated with the consequences of obesity, most notably type 2 diabetes (£48 million) and hypertension (£38 million). These costs relate to obesity alone - using the assumption made in the Foresight report that the costs per person of being overweight are half the costs per person of being obese could add a further £137 million, giving a total NHS cost of £312 million.
The effect of obesity is much wider than the costs directly related to health issues and it has been estimated that healthcare costs are a minority of costs to society of obesity. 39 Obesity has been shown to adversely affect employment, production levels (via increased sickness absence from school or work and premature death) and mental wellbeing. Additionally, it is increasingly being cited as a cost burden in infrastructure planning.
Obesity influences employment in a negative way both directly and indirectly via its effect on health status, with the probability of being in employment estimated to be up to 25% lower for those with BMI >30. 40 Furthermore, BMI has a negative effect on occupational attainment for women, although the results are mixed for males. 41
Obesity affects production though both increased sickness absence, but also as a result of premature death. Using incapacity benefit caseload figures for February 2008 by diagnostic group, it can be estimated that approximately 4% of claims result directly from the consequences of obesity. This equates to some 2.6 million days of work lost per year, or a potential cost of lost work days of around £195 million. This figure excluded those associated with short term sickness absence, although it has been shown that people with BMI greater than 30 have a 51% higher short and long-term sickness absences than those in the normal weight range. 42
Data on premature deaths in Scotland from conditions attributable to obesity are more difficult to obtain. A report from the House of Commons Health Committee 43 showed that 7% of total deaths in England in 2002 were attributable to the consequences of obesity, resulting in 45,000 years of working life lost. In 2002, 23.5% of the English population was obese; this is comparable with data from the 2003 Scottish Health Survey which gave obesity rates of 24% in women and 22% in men. Applying the 7% estimate to Scottish deaths in 2007 would give 3394 deaths and 4480 years of working life lost. Using the Scottish median gross weekly earnings for Scotland in 2007 44 gives an estimate of lost production for Scotland, associated with premature death, of £87 million. This figure is likely to be an underestimate as the prevalence of obesity has risen since 2002.
Obesity is affecting planning and infrastructure across many sectors - airlines, transport companies, hospitals - with the need to provide larger seats and fuel for airlines for example. 45 A survey of 150 hospital trusts in England in 2008 found that, on average, each spent £60,000 on specialist equipment per annum. Such equipment includes larger hospital beds, chairs, wheelchairs, surgical instruments, hoists and delivery beds. In Scotland, the Scottish Ambulance Service has recently adapted 63 vehicles to allow the anchoring of the trolley in the middle of the vehicle at a cost of £189,000 to manage obese patients. Morbidly obese patients in the West of Scotland have to be transported to Aberdeen to use the 'bariatric' MRI scanner.
The indirect costs of obesity calculated above suggest a ratio of direct to indirect costs of obesity of 1.6:1 (£282 million compared with £175 million). Literature estimates of the indirect costs of obesity range widely. The House of Commons report 46 estimates used a ratio of 2.4:1 for indirect to direct costs, the National Audit Office Report 47 used a ratio of 4.4:1 and some studies in the United States have suggested that direct costs may be lower than indirect costs. 48 These reports all suggest that the estimates are likely to be an underestimate of the true indirect costs to society of obesity, but these cannot be measured in an accurate way. The Foresight report uses a ratio of 7:1. This last figure includes the costs of welfare payments.
Applying literature estimates gives a range of indirect costs of obesity from £420 million to £1.225 billion. This would result in estimates of total cost to society of obesity in 2007/8 ranging from £0.6 billion to £1.4 billion.