Invest in obesity prevention and management, save trillions

This year’s theme for the NCD Global Week for Action, ‘invest to protect,’ could not have come at a better time for the obesity community. After years of calling for more to be done about obesity, people working and living with obesity from all countries were delighted to see the World Health Assembly adopt the WHO Acceleration Plan and recommendations. Obesity is associated with 5 million deaths per year, and without investment it’s almost impossible to see how other NCD targets will be reached.

The good news is, now that we have a global roadmap, we also have an important new way to show the cost of inaction on obesity, and the case for investment. World Obesity Federation and RTI International have been collaborating to find a simple and fair way to measure this. We looked at the medical costs of cancer, heart disease and other NCDs and at the impact of disability and early death, as COVID so painfully demonstrated. The new methodology, which is hosted on the World Obesity Global Obesity Observatory, shows that these combined costs diverted about 2.2 percent of GDP and will almost double by 2060 if a “business as usual” approach persists.

What’s behind the continued and growing global obesity epidemic

The steady rise in obesity across all countries is directly related to the low priority it has received. Obesity has often been dismissed as a matter of personal failing or oversimplified as requiring the individual to merely “eat less and move more.” These miss out on the main reasons obesity rates keep rising:

• The science is still unfolding. It was not until 2013 that the scientific consensus for obesity as a disease was reached. More and more is learned about the pathology of obesity as both a disease and a driver of other diseases, as well as how increased weight is a response to an obesogenic environment. Yet policy prescriptions often focus only on one or two areas, when multiple areas working together are key.
• Obesity is still overlooked. Though an estimated five million NCD deaths per year are attributable to obesity, many countries do not measure obesity consistently and there are few champions. This means the response, even from WHO, has been fragmented while main references on NCDs, such as the Lancet Countdown 2030 and Global Burden of Disease barely mention it or categorize it only as a risk factor. The ways we measure obesity must change.
• The economic impact has been underestimated, and is massive. The new World Obesity Federation-RTI study shows that the economic impact of overweight and obesity represents trillions of dollars as a percentage of GDP. By 2060 (if rates of childhood obesity continue to rise), China will divert $10 trillion per year in avoidable costs associated with overweight and obesity, with the US and India not far behind. Poorer countries will have the greatest rates of growth.
• Stigma and bias are impeding action. Stigma – the belief in words, images and attitudes that misrepresent obesity as a matter of personal failing – is a big barrier to people with higher weights and obesity getting help. Even health professionals and policy makers may bring their own biases to how they address or avoid obesity, leading to delayed care and poorer health.

Investing in solutions

So we know we need less bias, less inertia, less delay. What we need more of is working together in three main ways:

1. Invest in ROOTS. This framework, developed by the obesity community in 2020, acknowledges the complex roots of obesity, including genetics, sleep disruption, unhealthy processed foods, marketing, and mental health. We call for the ROOTS framework for solutions (Recognize obesity as disease and risk, Obesity in the lifecourse, Obesity surveillance, Treat and Train, Systems including food and health).
2. Invest in the WHO Acceleration Plan and obesity recommendations. These were adopted by the World Health Assembly in May 2022 with 24 frontrunner countries and many more focusing on the obesity recommendations. Civil society has a critical role to play in advocating for and helping to deliver on the recommendations and national plans.
3. Invest in obesity in its own right to invest in NCD prevention. For too long, obesity has been downplayed as a priority, even among NCDs. Yet we know that investing in obesity will save lives from cardiovascular diseases, cancer and other NCDs, and increase resources for better health. Investing in obesity prevention and management is an investment in overall NCD prevention.

Let’s all commit to investing in addressing obesity. We can’t afford another failed target and we know what works. Let’s act on this, together.