Multi-stakeholder Interventions Needed to Address Obesity  


Contributed by Corinne Sawers, Engagement Manager at McKinsey & Company

Obesity is now a critical global issue. More than 2.1 billion people—nearly 30 percent of the global population—are overweight or obese today. That’s nearly two and a half times the number of adults and children who are undernourished. Obesity is responsible for about 5 percent of deaths worldwide. The global economic impact from obesity is roughly $2.0 trillion, or 2.8 percent of global GDP, roughly equivalent to the global impact from smoking or armed violence, war, and terrorism.

This global epidemic may seem to be “someone else’s problem” for emerging economies, many of which—in relatively recent times—have worried more about malnutrition than obesity. However, the uncomfortable truth is that 62 percent of the world’s obese people are now in developing countries.

As rapid industrialisation and urbanisation boost incomes in developing economies, obesity-prevalence rates are rising quickly. In India and China, the prevalence of obesity in cities is three to four times the rate in rural areas, reflecting higher incomes in urban areas and therefore higher levels of nutrition and food consumption and often less active labour. The prevalence of obese and overweight people rose at 1.2 percent a year in Chinese adult males between 1985 and 2004 and 1 percent a year in adult females1.

Many emerging economies have experienced a rise in prevalence of one percentage point a year between 2000 and 2008. Today, many countries have prevalence rates of 20 percent or even 30 percent and now have well-entrenched rising trends. A report from the Overseas Development Institute found that obesity and overweight rates in North Africa, Latin America, and the Middle East were on a par with Europe at 10 to 30 percent obesity in adults and at 30 to 70 percent overweight. Other regions, including South Asia and East Asia, are catching up with advanced economies in obesity prevalence2.

Worryingly, there is evidence that obesity could entrench itself even more quickly in developing economies. In countries where food was scarce and is now more plentiful as incomes rise, obesity rates explode disproportionately compared to the rates in countries with no recent history of food scarcity. Until the mid-20th century, the Micronesian island of Nauru experienced repeated food shortages and starvation. Once food poverty was a thing of the past, the prevalence of obesity and type 2 diabetes soared to among the highest worldwide. In 2010, 94 percent of men and 93 percent of women were overweight, and approximately 71 percent of the population was obese3

Worldwide, if the prevalence of obesity continues on its current upward trajectory, almost half of the world’s adult population will be overweight or obese by 2030. So what needs to be done?

MGI has studied 74 interventions to address obesity in 18 areas that are being discussed or piloted somewhere around the world including, for instance, subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising of high-calorie food and drinks, and public-health campaigns. There were sufficient data on 44 of these. MGI’s research offers an initial economic analysis of obesity.

Education about the risks of obesity is important; so is taking personal responsibility for one’s health, fitness, and weight. But all the evidence shows that these are not enough to move the needle on rising obesity. People need help and that means a change in the environment in which they are making choices—change such as reduced standard portion sizes, changing marketing practices, and restructuring cities and educational establishments to make it easier for people to exercise.

Each single intervention is likely to have only a small impact on its own. Only a systemic, sustained portfolio of anti-obesity initiatives are needed, implemented on a large scale will be effective. Nor can any single group in society—government, retailers, consumer goods companies, restaurants, employers, media organisations, educators, health-care providers, or individuals—can address obesity on their own. Everyone needs to play a full part in tackling this issue, and they need to coordinate their efforts.

Drawing on an initial analysis of obesity in the United Kingdom, MGI concludes that almost all the interventions identified are cost-effective for society. Savings on health-care costs and higher productivity—people who are overweight or obese are less productive in the workplace—could outweigh the investment needed to deliver interventions over the long term. In the United Kingdom, an integrated program to reverse rising obesity could save the National Health Service such a program could reverse rising obesity, saving about $1.2 billion a year.

There is no room for complacency in a country like India where obesity is still a problem for a relatively small share of the population compared with malnutrition. First, obesity imposes a disproportionate burden on disadvantaged households because of the health penalty, entrenching inequality. In countries with limited public-health provision, the cost of health care falls directly on such households. Second, there is evidence that countries with a recent history of malnutrition risk disproportionately higher rates of obesity and diabetes as their economies grow and people become more prosperous. This is the phenomenon of the “thrifty phenotype”. Obesity rates explode in countries where food was scarce but is now more plentiful; fetuses that were malnourished in the womb are more likely to be obese in later life.

For such reasons, it is important not to wait to act until comprehensive evidence on how to tackle obesity is in place. For sure, the evidence on the clinical and behavioral interventions to reduce obesity is far from complete. More investment in research is needed. But we should experiment with solutions and try them out. The knowledge we already have justifies much more action against obesity than is currently typically taking place.

Obesity is a complex issue with many causes and no easy solution, but this should not act as a barrier to action given rising societal and economic costs. MGI hopes that its initial research on this topic will serve as a useful guide and starting point to build on in the years ahead in a collective effort to turn the tide.


Click here to access the McKinsey Global Institute (MGI) discussion paper, Overcoming obesity: An initial economic analysis


The McKinsey Global Institute (MGI), the business and economics research arm of McKinsey, was established in 1990 to develop a deeper understanding of the evolving global economy. Its goal is to provide leaders in the commercial, public, and social sectors with the facts and insights on which to base management and policy decisions.



Notes
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1 Barry M. Popkin, “Will China’s nutrition transition overwhelm its health care system and slow economic growth?” Health Affairs, volume 27, number 4, 2008.

2 Sharada Keats and Steve Wiggins, Future diets: Implications for agriculture and food prices, Overseas Development Institute, January 2014.

3 Nauru country health information profile 2011, statistical annex, World Health Organization.

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