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Obesity costs

Obesity costs Ireland €1.64bn

Overweight and obesity accounted for 2.7% of total health expenditure in the Republic of Ireland

The annual cost of overweight and obesity in the Republic of Ireland is estimated to be €1.64 billion and a further €510 million in Northern Ireland, according to research by the University College Cork.

The study commissioned by Safefood, the public body responsible for food safety and healthy eating on the island of Ireland, has reported that in the Republic of Ireland, 35% of total costs (€398.6 million) represented direct healthcare costs (hospital in-patient; out-patient; GP and drug costs) and 65% of the economic costs were indirect costs in reduced or lost productivity and absenteeism and amounted to €728m. In Northern Ireland €127.4 million (25%) represented direct healthcare costs and €382.3 million (75%) were associated with indirect costs (Table 1).

Table 1: Direct and indirect costs

Costs

Republic of   Ireland (€)

Northern   Ireland (€) 2009

Northern   Ireland (£)

Direct   Costs

€398,615,581

€127,406,641

£92,323,652

Indirect   Costs

€728,968,662

€382,917,113

£277,476,168

Total Costs

€1,127,584,243

€510,323,754

£369,799,820

"The current findings on the cost of overweight and obesity highlight the extent of societal involvement in diet and health and the limitations of approaches which emphasise the role of personal choice, responsibility and market forces in relation to diet and health,” said research lead Professor Ivan Perry of University College Cork. "The current obesity epidemic in children and adults represents a clear example of market failure with external/third party costs defaulting to the taxpayers. The food sector is currently regulated to ensure food safety. Policy makers need to consider whether there is a need to extend this regulatory framework to address the effects of diet on health and wellbeing."

In total, 19 weight-related diseases (Table 2) were studied and the main drivers of direct healthcare costs are cardiac disease (44%), type 2 diabetes (9%), colorectal cancer (12%), stroke (6%) and cancers of the breast (2%), kidney (3%) oesophagus (2%) and gallbladder (3%). Low back pain has been found to be a major driver for work absenteeism and productivity loss.

Table 2: Conditions associated with overweight and obesity included in this project

Endocrine  

Type   2 diabetes

Cardiovascular  

Hypertension

 

Coronary   heart disease

 

Stroke

 

Congestive   cardiac failure

 

Pulmonary   embolus

 

Deep   vein thrombosis

Cancers  

Oesophagus

 

Post-menopausal   breast

 

Endometrial

 

Kidney

 

Colorectal

 

Gall   bladder

 

Pancreas

Other  

Asthma

 

Gallbladder   disease

 

Low   back pain

 

Osteoarthritis

 

Gout

The study said that overweight and obesity combined accounted for a similar burden of disease and cost in both jurisdictions, with an estimated 2.7% and 2.8% of total health expenditure in the Republic of Ireland and Northern Ireland, respectively, which is consistent with estimates from a number of European countries over the past decade. The findings also suggest that obesity as opposed to overweight is the major component of healthcare costs.

"Excess body weight is associated with a significant burden of chronic disease, with negative effects on overall life expectancy, disability free life expectancy, quality of life, health care costs and productivity,” said Dr Cliodhna Foley-Nolan, Director, Human Health & Nutrition of Safefood. “The findings from this research are critical for establishing priorities in health policy development and to guide and inform our response to the issue of excess weight in our society which is fundamentally preventable."

The report made 13 recommendations to reduce the levels of overweight and obesity, and their associated costs.

Recommendations

  • Urgent public health action is required to address the burden that overweight and obesity are placing on both the health services and the general economy.
  • A population-wide approach to reducing the problem of overweight is required.
  • Targeted action is required toreduce the burden being placed by the very obese on the health service.
  • Workplace interventions to reduce the burden of absenteeism related to back pain in the overweight and obese is required.
  • Given the overweight and obese-associated burden placed on the health service by colon cancer in particular, consideration should be given to targeting the overweight and obese specifically in the upcoming colorectal cancer screening programme.
  • They note and reiterate the recommendations from the National Taskforce on Obesity (NTO) whichreported in 2005 in ROI and the Fit Futures for All Framework published in 2012 in Northern Ireland. Both identify actions across a broad range of sectors, high level governmental support and cross departmental approaches.
  • The current findings on the cost of overweight and obesity highlight the extent of societal involvement in diet and health and the limitations of approaches which emphasise the role of personal choice, responsibility and market forces in relation to diet and health. The current obesity epidemic in children and adults represents a clear example of market failure with external/third party costs defaulting to the taxpayers. The food sector is currently regulated to ensure food safety. Policy makers need to consider whether there is a need to extend this regulatory framework to address the effects of diet on health and wellbeing.
  • The findings on the cost of  overweight and obesity highlight the need for significant investment in research to examine the influence of fiscal and other Government policies on consumer purchasing and their impact on overweight and obesity, including, for example, risk-benefits assessment of taxation that supportshealthy eating and active living and subsidies for healthy food such as fruit and vegetables.
  • There is also a need for work on modelling the future burden and costs of overweight and obesity over the next decade. This work will provide realistic estimates of the cost-benefit ratios and medium-term return on investment in societal level interventions designed to reduce calorie intakes and promote physical activity. For instance, based on the current estimates of the cost of overweight and obesity, significant investment in infrastructure to promote walking and cycling can be justified.
  • There is a need for on-going national health and lifestyle surveys at regular intervals to continue to monitor the progress of the epidemic of overweight/obesity and related chronic disease. Data, particularly relating to nutrition surveillance, has historically been collected at intervals through one-off studies, rather  than through a co-ordinated continuous fashion that would maximise surveillance resources. Weight status measurements should be resourced to collect data on measured, as opposed to self-reported height, weight and waist circumference.  There is also a need for on-going surveillance data on blood glucose status to monitor the parallel epidemic of type 2 diabetes.
  • The current study highlighted the dearth of reliable population-based (as opposed to service level) data onuptake of health services and illness-related productivity loss, including data on attendances at primary care, attendances at hospital emergency departments, referral to hospital outpatients and the costs associated with these services. Also unavailable are population-based data on admission to hospital, length of stay, drug prescribing and associated absenteeism fromwork. These data, which are vital to the conduct of cost of
  • The cost of overweight and obesity on the island of Ireland illness studies and related health economic analyses, should form a core element in on-going national health and lifestyle surveys in both the Republic of Ireland and Northern Ireland.
  • There is also a need for a primary care database which would serve as a longitudinal cohort, from which estimates of use and cost of health services would be based on patient level data, and which could be used in the evaluation of public health and other interventions to reduce population level BMI.
  • The availability of social welfare claims data was of critical importance in estimating the indirect costs of overweight and obesity in this study. However the range and quality of the data varied across the two jurisdictions. There is a need to consider how best to facilitate access by researchers to social welfare claims data in both the Republic of Ireland and Northern Ireland, working within existing data protection legislation.

Overweight and obesity levels

According to the IUNA National Adult Nutrition Survey 2011, 37% of 18-64 year olds are overweight (44% men/31% women) and 24% obese (26% men/21% women).

The prevalence of obesity in 18-64 year old adults has increased significantly since 1990 from 8% to 26% in men, and from 13% to 21% in women.

In the past twenty years men have gained an average of 8kg (nearly 18lbs) and women have gained an average of 5kg (over 11lbs).

The Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007) of adults aged 18+ in ROI found that 60% of respondents had an average waist circumference in the “at risk” zone for obesity (>37 inches for men and >32 inches for women).

In Northern Ireland, 61% of adults aged 16+ were overweight or obese (Health Survey Northern Ireland, 2012).

"We now have reliable contemporary and locally relevant figures for the annual, economic cost of weight-related ill health in Ireland,” said Martin Higgins, chief executive of Safefood. “While it is acknowledged that these are conservative figures and don't reflect the human and social costs, they show a compelling case for obesity prevention, based on changes in our food environment and physical activity levels."

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