Stigma and Silos: How can understanding economic impact put people at the center of the global obesity crisis?

In one of my first jobs in global health, I was invited to qualify for company-sponsored benefits including life insurance and pensions.?I was given a 20-page form; remember that in the pre-digital world? Wading through page after page, I reached question 25 which asked if I had any of the following conditions, including diabetes, heart disease and multiple sclerosis.?I checked “yes” to MS and turned the page. Then it all came to a shuddering halt with the words millions of people like me know all too well:

“If you have checked yes to any of these conditions, we are unable to provide you with this benefit.”

I have lost count of the times I have read those words. I had to learn how to fight against it, with evidence about how manageable conditions can be and a strong understanding of my rights, but still, it stings. It taps into the part of me that secretly believes I am to blame.

Even when I have lived in places such as Sweden where the safety net is much stronger than in the US, the financial burden is always there when you live with a condition (even if you are in remission, as has been the case with my MS for most of two decades).?

For these reasons I am proud to have been part of recent discussions on financing health, with donors and policy experts all collaborating on how we can bring much needed resources and attention to noncommunicable diseases (NCDs) and obesity. This includes an important part of what my organization, the World Obesity Federation, and our members are focused on – prioritizing the needs of people living with obesity.?

There have been some deeply welcomed commitments for NCDs, including obesity, by donors like Bloomberg Philanthropies and governments including Norway. However, I have always been struck by how little recognition there is of the financial impact of NCDs on real people - like me - both directly in terms of cost of healthcare and indirectly in terms of subtle discriminatory policies, missed opportunities, and out of pocket costs of care.

Douglas Webb of United Nations Development Programme described the financial realities for patients as always at risk of “tipping over the edge”. As a head of household who pays far more out of pocket than I would if I did not have a disease, I can attest that even with the privileges I know I have, that sense of living at the edge will never go away.

Helping people to live a fuller life, away from the edge

If we want to help more people not live on the edge, I believe there are two urgent priorities that can fight against the continued political inaction on the root causes of overweight and obesity; a chronic, relapsing, and progressive disease that 800 million people are living with and is rising fastest in lower- and middle-income countries. It is driving many NCDs and associated with about 5 million NCD deaths each year.

To address this, we need to unpack weight stigma so we can ensure that it is no longer acceptable to discriminate against people with obesity, while also understanding and respecting that view of weight can vary based on culture.

Obesity has been misunderstood as a matter of personal blame, mismanaged as a matter of simply eating less and moving more while discounting the role of drivers such as genetics and influences such as the obesogenic environment that makes overweight and obesity the default response. This is exacerbated by mistreatment in health systems, where people with obesity often do not receive care until they present with a comorbidity.?

I don’t know what it’s like to live with obesity or many of the other NCDs, but I do know what it’s like to work in a system that does not understand my disease and extracts a price on me based on misaligned policies and incentives.?

The ongoing bias against people with obesity is part of the reason it has been so poorly resourced, with far less than one percent of global funding for health associated to obesity.?It seems clear that one of our goals in the global obesity community, should be to close the gap between the time when an individual begins to experience challenges associated with weight – often in childhood – and when the health system addresses this. We have to understand the financial impact all of this misalignment is having on people living with obesity – not to mention the human cost of premature disability and mortality on individuals and their families.?

Which is exactly why the second priority is so critical; we need to look collectively at indirect and direct economic impact of not addressing obesity at the national level, so we can hold governments more accountable and drive joined-up policy changes and systemic change for people living with obesity.

That’s why World Obesity Federation and our partners Research Triangle Institute (RTI) have launched our first study into the on the economic impact of obesity.

Published in BMJ Global Health, our pilot study of eight countries, which will be followed by a full global study of 140 countries in 2022, has told us that the economic impact of inaction on obesity in all eight countries is projected to double to an average of 3.6% of GDP by 2060. That’s an estimated cost of $61billion, $160billion, $28billion and $93billion in Spain, Mexico, South Africa and Thailand, respectively.?

However, the study has made us optimistic that reversing this trend is possible – if we act now. We found that maintaining or reducing the prevalence of overweight and obesity can diminish the economic impacts in the future. A 5% reduction in obesity prevalence from the projected levels would result in average annual savings of around 5.2% across all eight countries between 2020 and 2060. Alternatively, if prevalence remains at 2019 levels until 2060, this will result in average annual savings of 13%.

Don’t scapegoat, show leadership and take action

And that brings me back to how weight stigma and understanding economic impact interact. Our report should not be used to scapegoat or further stigmatize people living with obesity. It should instead place their needs at the center and be a catalyst for change.

Change such as the importance of a UN resolution on obesity and the delivery of joined up national policies which recognize and address the underlying root causes of obesity. By broadening the evidence base to look at national economic impact, we hope that true transformation will be possible.

Of course, progress will only happen when all sectors of society including patients, governments, health care providers, educators, food manufacturers and employers work together. I am proud to stand with colleagues from all over the world including World Obesity Federation members, allies like WHO and NCD Alliance, and individuals like Joe Nadglowski, who are working tirelessly to make people centered and comprehensive support for obesity not just a priority, but our new normal.?

Please do read the full report and story here

Our project has been funded by a grant from Novo Nordisk to the World Obesity Federation. Novo Nordisk has had no influence over any aspect of this project, and WOF retains full editorial control in conjunction with RTI International.

World Obesity and RTI International have put several safeguards in place to maintain transparency, reproducibility, and iterative critical review of the research process for this project

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