Obesogenic environment: origin and consequences

The economic and intangible burden of obesity in Germany

Unhealthy eating and resulting obesity are well-known and highly discussed threats to health that have increased to problematic extents in high income countries during the last decades. For years the WHO has pointed to the dangers of chronic non-communicable diseases that are caused by obesity1. To underpin the urgency for preventive action against obesity in Germany, Tobias Effertz and colleagues from the University of Hamburg and the “Techniker Krankenkasse”, Germany´s biggest health insurance company within the statutory health insurance system, calculated the costs and consequences of obesity in Germany with claims data from the German statutory health insurance in a recent new study2. For their study they analyzed a sample of 146,000 subjects including 31,032 obese persons being observed for 4.5 years with regard to health costs, employment and other economically relevant parameters.

Measuring and quantifying the cost and consequences of obesity in Germany

In Germany currently more than half of the adult population is overweight with 24% even being obese according to the Robert-Koch-Institute in Berlin. Effertz and colleagues´ cost assessment study has a threefold focus and is thus very comprehensive: first it aims to calculate the annual economic costs due to obesity, which comprise of costs in the German health sector and productivity losses for individuals and society. Second, the authors focused on intangible impairments due to obesity that were most often not considered in past studies, namely “pain and suffering” of obese subjects in addition to costs. Third, there is important information to be derived for policy makers and the public on whether obese subjects “pay their way” in the German social security system, i.e. whether paid social insurance premiums exceed the costs for obese people or not. To address this question, the total net costs of an obese individual were calculated from a lifecycle perspective. In the past industry advocates e.g. the tobacco industry claimed that persons with risky life-styles yield a death benefi t for society, since they receive fewer pension payments due to their higher mortality. The study aimed at critically verifying this claim.

Resulting tangible and intangible consequences of obesity

The results of the new German study are alarming: In total the annual costs of obesity in Germany sum up to 63 bn. € each year with 29.39 bn. € direct costs in the health sector and 33.65bn. € of productivity losses like unemployment and mortality. In relation to the total budget of Germany’s statutory health insurance, 13.65% of all costs could be avoided if obesity would be effectively reduced. But since obesity in Germany is on the rise and has a high latency period for several severe diseases, the authors expect the economic costs to increase substantially in the future. The study estimates that obese people on average lose up to four years of life expectation. 102,000 persons die prematurely due to obesity in Germany each year: a figure close to the 110,000 annual deaths due to smoking in Germany. Additionally, pain and suffering, assessed by the authors with the likelihood of being diagnosed with acute or chronic pain during the observation time and additional comorbidity burden is signifi cantly increased. For example, the likelihood of being diagnosed with pain is 6 to 12 percentage points higher among obese persons. More than half of the older obese women in Germany suffer from acute or chronic pain. This displays the loss in quality of life that an obese individual suffers on average. Concerning the third focus of the study: the decreased lifetime does not compensate the high costs that accumulate throughout the life-cycle. Every obese male adolescent aged 15 causes net costs of 166,911 € in present value terms throughout the life-cycle; women even cause 206,526 € due to lower wages and working-times.

A wake-up call for Germany: The need for effective prevention

The derived fi gures display a crucial truth often neglected by public health politicians especially in Germany: Behavior-orientated prevention instruments, e.g. informationcampaigns and education in school on nutrition, which have been widely promoted by the food industry in Germany, are mostly ineffective. Industry´s food-marketing has constantly generated an “adipogenic environment” with advertising being aimed at children and low prices for unhealthy foods. Obesity is the manifestation of an unhealthy lifestyle that due to the strong habituation of eating also calls for strong instruments of prevention. Higher taxes on unhealthy foods high in fat, salt and sugar seem to be a strong and promising instrument to curb and reduce the occurrence of obesity in Germany. Finally, more than half of the incident cases of obesity in Germany are documented among subjects younger than 20 years of age. Public health politicians should realize that the roots of unhealthy eating and the obesity pandemic lie in childhood and adolescence. An important step forward in prevention would thus be the ban of food advertising to children in mass media, since they do not understand the lures of advertising appropriately. Most of Germany´s parents would surely consent to this.

1. World Health Organization (2004) Global strategy on diet, physical activity
and health. World Health Organization, Genf
2. Effertz T, Engel S, Verheyen F, Linder R, (2015) The Costs and Consequences
of Obesity in Germany – A new approach from a prevalence and lifecycle
perspective, European Journal of Health Economics, DOI 10.1007/s10198-015-