What really is the cost of obesity to the NHS?

We live in a world where people who are overweight or obese are considered part of a ‘national health crisis’, which needs addressing through nanny-state measures such as the sugar tax - or, alternately, simply left to die an early death to benefit the rest of us, according to BBC presenter Michael Buerk. The logic behind these policies is that, especially in a nation with state-run healthcare, it is for the public good to have citizens who are healthier, and thus less of a drain on NHS resources due to preventable diseases or lifestyle choices, justifying an increased level of control over the lives of individuals. 

However, this is misleading for two reasons. Firstly, direct links between being overweight and catastrophic health problems are arguably overstated. In fact, “the available scientific data neither support alarmist claims about obesity nor justify diverting scarce resources away from far more pressing public health issues”, and instead place the focus on the real health dangers which lie in lifestyle and diet choices and where the most significant benefits can be gained. While obesity is not ideal health, there is a substantial difference between being overweight, and being unhealthy, and it is very possible to be one without the other. In fact, between one-third and three-quarters of ‘obese’ people are metabolically healthy. This is a fact it seems our healthcare system has not yet recognised. Because of this failure to separate weight and health, significantly lower effort is being put towards educating people about the dangers of other factors such as being underweight, even though studies have found that “obesity and [being] underweight, but not [being] overweight, was associated with higher all-cause mortality”. If the purpose is to create a healthier society, more focus should be put on educating people about healthy lifestyles and diet choices, and a distinct division between health and weight ought to be created, something which must be perpetuated through change in social norms at large, not just in the doctor’s office. 

Secondly, the costs of obesity on the NHS have been largely miscalculated, promoting an ineffective and heavy-handed response. Several government and independent estimates of costs to the NHS because of overweight and obesity range from £5.1 billion to £6.1 billion; however, these estimates are not balanced cost-benefit analyses. The costs saved on pensions, healthcare, and other benefits from the 7.1% of early deaths attributable to overly high BMIs are calculated at £3.6 billion per year, which brings the net costs on the state of overweight and obesity down to £2.47 billion — 2.3% of the 2016/17 budget of the NHS. In conclusion, though, callous, “obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.'' 

However, even if one believes that part of the state's role is to promote healthy lifestyles because of increased productivity and the overall wellbeing of its citizens, enforcement, ineffective promotion, and shaming are some of the least beneficial ways to do so. The current culture of fat-shaming and the acceptance of discrimination based on weight (in the legal definition) is actually counterproductive, as perceived weight discrimination is directly linked to increased levels of the stress hormone cortisol, which “may play a role in generating a vicious circle of weight gain and discrimination and contribute to obesity‐associated health conditions”. Instead of ineffective sugar taxes, the state should focus on education, especially about the importance of a healthy diet and exercise, while disconnecting it directly from weight. A review of 44 studies of school-based activity and health programmes found that while such programmes did not result in weight loss for children, they were correlated with improved athletic ability, a tripling in daily exercise, and a reduction of TV consumption of up to an hour. A much more effective approach would be a focus on education and ‘nudge policies’, metaphorical carrots which encourage - but don’t penalise or enforce - healthful behaviour. These policies include redesigning roads to make safe cycling lanes (cyclists now constitute up to 70% of traffic on some London roads during peak hours), providing free and/or easily accessible exercise classes, and healthier school meals. These policies actually do encourage healthier lifestyles, without an unsubstantiated focus on overweight or obesity. This is not a national health crisis burdening our healthcare system with billions more in preventable costs, and it is not easily solved by measures which infringe on individual freedom and are largely ineffective. 

Melissa Owens is a research intern at the Adam Smith Institute.