2. THE CHALLENGE OF OBESITY
What is obesity?
2.1 Obesity occurs when energy intake from food and drink consumption, including alcohol, is greater than energy requirements of the body's metabolism over a prolonged period, resulting in the accumulation of excess body fat. The Body Mass Index 3 ( BMI) is commonly used as a measure of obesity and overweight, with BMI greater than 30 taken to indicate obesity and BMI between 25 and 30 as overweight in adults ( Appendix 1).
2.2 In 2007, the UK Government Office for Science published the Foresight Tackling Obesities Report. This represents the most comprehensive summary of the evidence of the causes of obesity in the UK population and demonstrates that there are many behavioural and societal factors that combine into a " complex web of societal and biological factors that have, in recent decades, exposed our inherent human vulnerability to weight gain". 4 As highlighted in the Foresight report an appetite which exceeds immediate need had huge evolutionary survival value when food supply was erratic, but is disadvantageous when food provision is excessive.
2.3 Being obese or overweight can increase the risk of developing a range of serious diseases, including type 2 diabetes, hypertension, heart disease, some cancers and premature death. The risks rise with weight levels and are greatest for obese individuals. Obesity has been shown to be associated with at least as much ill-health as poverty, smoking and problem drinking 5 and with as much premature mortality as smoking 6 ( Appendix 1).
The current challenge
2.4 Scotland has one of the highest levels of obesity in OECD7 countries; only the USA and Mexico having higher levels. Population-wide obesity levels in Scotland are measured by the Scottish Health Survey ( SHeS). The most recent SHeS showed that nearly 27% of adults and more than 15% of children were obese and more than 65% of adults and nearly 32% of children were overweight and obese combined. There is a clear linear pattern of increasing obesity with increasing deprivation in adult women in Scotland, and it is predicted that such a correlation between deprivation and obesity may soon become apparent for adult men and children. 8
2.5 We estimate that the total cost to Scottish society of obesity in 2007/8 was in excess of £457 million and it is likely that this is an underestimate 9 ( Appendix 2). Much of this cost is avoidable.
2.6 More than £175 million of the cost of obesity is direct NHS costs, equivalent to 2% of the NHSScotland's revenue budget. However, 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. 10 Obesity has been shown to adversely affect employment, production levels (via increased sickness absence from work or school and premature death) and mental wellbeing. Additionally, it is increasingly being cited as a cost burden in infrastructure planning. 11
People with extreme obesity eg BMI > 50 are increasing in numbers most rapidly and present much greater costs, to housing, transport, social support as well as healthcare. 12
The future challenge - 2030
2.7 Estimates from OECD13 show continued increase in obesity rates across the world. Extrapolating from trend data from the USA, we predict that by 2030 adult obesity in Scotland could reach over 40% even with current health improvement efforts, an increase of more than 50% over 2008 levels ( Appendix 3). Alongside the increase in these levels are significant increases in the health problems associated with obesity.
2.8 We estimate that by 2030 directly as a result of obesity:
- More than 860,000 people, an increase of 379,000 over 2003 levels, will have high blood pressure
- More than 150,000 people, an increase of 68,000 over 2003 levels, with type 2 diabetes (representing 75% of all cases)
- More than 48,000 heart attacks, an increase of 21,000 over 2003 levels
2.9 These consequences of obesity will reflect, perpetuate and potentially increase social inequalities in health in Scotland.
2.10 We estimate that the direct NHSScotland costs of obesity will almost double by 2030. Using assumptions made in previous estimates, the total cost to Scottish society of obesity, including both direct and indirect costs, range from £0.9 billion-£3 billion.
2.11 This Route Map sets out the further direction of national and local government decision-making in the short and medium term to avoid these predicted consequences becoming a reality.