Europe is confronted by an obesity challenge. Rates of obesity have climbed fast over the past decades and estimates suggest that obesity rates will continue to grow over the next decades. Obesity is a complex disease and a source for many other medical problems like diabetes type 2 and cardiovascular diseases. Therefore, the growing prevalence of obesity also affects healthcare expenditures and labour supply in the economy. On current trend, obesity will in future have a significant impact on healthcare spending and the productivity of Europe’s economies.
There is a strong case to be made for policy leaders to give greater attention to obesity. The growth of obesity needs to be addressed and European countries need better prevention policies for that to happen. Furthermore, there also has to better policies to treat people that already suffer from obesity and associated diseases. As the medical science has rapidly advanced its understanding of obesity, and now agreed on clinical guidelines for surgeries of obese patients with type-2 diabetes, it is time for political leaders to respond to the opportunities created by new innovation.
The EU does not take a leading role in devising healthcare policies in Europe. Still, it has increased its ambitions in helping governments to reduce the growth of obesity. However, the EU can do more – and there is a natural role for it in helping governments to learn from best practices and to evaluate how well, or bad, they are responding to the obesity challenge.
2. Obesity in Europe
Since the 1980s there has been a sharp increase in the prevalence of overweight and obesity around the world. In Europe, it is estimated that over 50% of all men and women were overweight in 2014, and on average around 24.5% of all women and 21.5% of men were obese, according to the World Health Organisation (WHO).
Charts 1 and 2 show the prevalence of overweight and obesity in different European countries. The charts are based on the latest data from Eurostat: it’s latest survey was done in 2008 and a revision of the data is planned to be released in March 2017. However, the recent Health Interview Survey from late 2016 gives update figures for 2014 that indicate an increase in the rates of obesity. The WHO also offers later data on rates for overweight and obesity, but WHO estimates are less precise than Eurostat data. The share of the population that is overweight is quite similar across Europe. The rates of overweight vary, but the variations are not as big as the differences in obesity when European countries are compared. For example, while Romania has the highest share of overweight people, it also has the lowest share of obesity. Countries in the southern rim of Europe appear to be more represented among countries with the highest share of overweight than countries from the northern parts of Europe.
Chart 1. Share of overweight population aged 18 or older (BMI25-30)
Chart 2. Share of obesity among the population aged 18 or older (BMI >30)
In the European Union, between 36.9% and 56.7% of all women were overweight or obese according to data from 2008-09 (which, at the time of researching this paper, was the latest year for which data is available). The figures for the male population vary between 51% and 69.3% in the countries for which data is available. Amongst women, the prevalence of overweight and obesity tends to be higher in the northern part of Europe, whereas countries in the southern part of Europe have higher rates of overweight and obesity among men.
Chart 3. Overweight and obesity among women in Europe, % of total population
Chart 4. Overweight and obesity among men in Europe, % of total population
Overweight and obesity often results from a variety of factors: physical inactivity and unhealthy diets, as well as alcohol use, are some of the known sources. But obesity is more complex than just to originate from patterns of unhealthy living. There is a genetic component to the disease and medical research has in recent years made significant breakthroughs in understanding the nature of the disease. Physical activity, nutrition and alcohol are generally the main risk factors that cause non-communicable diseases, notably cancer, diabetes, or cardiovascular and lung diseases. It is estimated that non-communicable diseases are the main cause behind almost 86% of deaths in Europe, and 77% of the disease burden. Cardiovascular diseases, including hypertension (high blood pressure), cause more than half of all deaths in Europe. At the same time, diseases such as cancer, diabetes, cardiovascular and respiratory diseases represent the bulk of diseases that can be partly prevented in Europe. Fighting obesity plays a central role in reducing the number of people with such diagnoses. Between 1990 and 2010, the so-called global burden of disease has continued to shift away from communicable to non-communicable diseases. The Global Burden of Disease Study 2010 concluded that dietary risk factors and sedentary lifestyles accounted for 10% of disability adjusted life years globally in 2010.
Moreover, obesity and overweight are estimated to be the principal causes of 44% of all cases of diabetes around the world, 23% of ischaemic heart diseases and between 7-41% of all cancer cases, according to WHO figures. As for the European Union, 80% of all type 2 diabetes cases among adults are related to obesity, 35% of ischaemic heart diseases and 55% of hypertensive diseases. All in all, the WHO considers obesity to be the 5th leading death risk.
Chart 5. Death due to diabetes in 2009, per 100 000 inhabitants
The proportion of obesity and overweight among adults tends to increase with age in all European countries. This pattern is particularly clear among women. As for men, there is a general increase in the prevalence of obesity up until the age of 65. Thereafter the prevalence of obesity is somewhat diminishing.
Chart 6. Overweight and obesity among women in Europe, by age group
Chart 7. Overweight and obesity among men in Europe, by age group
In recent decades, there has been a significant increase in the number of people who are obese in OECD countries. Before the 1980s, around 10% of the population was considered obese. In just 30 years, the rates of obesity in OECD countries have more than doubled, and it is predicted that the situation will deteriorate further. In half of the OECD countries, at least one in two people is today overweight or obese. While it is estimated that the rate of overweight people (BMI 25-30) within the age group of 15-74 will stabilise in most countries, the rate of obesity (BMI >30) is however likely to continue to increase. The OECD has provided estimates on growth of obesity in selected EU countries, and they are presented in Table 1 below.
Table 1. Projected obesity rates, baseline scenario
Source: Sassi et. al, 2009, National Statistics
Obesity among children is also a growing trend. If it remains unaddressed, it will most certainly have an impact on health and healthcare costs in the future. People who become obese at a young age usually develop diseases that require medical attention later in life. Among children up to 4 years old, the prevalence of overweight and obesity has increased globally over the last decade. In 1990, 4.2% of all preschool children were overweight or obese. In 2010, the figure had increased to 6.7%, and it is expected to increase to 9.1% in 2020. Looking at children between 5-17 years old, around 21.4% of all girls and 22.9% of all boys were overweight or obese in OECD countries in 2011.
Excess weight can entail health and medical complications even at a young age, including diabetes, hypertension, and cardiovascular problems. Children who are overweight or obese are more likely than non-obese children to be obese later in life. Even if the excess weight is lost, childhood obesity is one of the main causes behind health and medical complications later in life, according to a recent study.
Also, childhood obesity incurs healthcare costs at an early age. A recent German study showed, for instance, that overweight and obese children have higher healthcare costs than other children at the same age: costs are €62 higher for obese children per year, and €27 higher for overweight children, in comparison to a child with a healthy weight. In relation to this, a study from Ireland showed that the percentage of hospital days related to childhood obesity increased from 0.81% to 1.37% of total hospital days in 2004, involving an increased in expenditures from €0.9 to €2.7 million.
The economic burden of obesity is increasingly documented. The costs come from different sources. There are direct healthcare costs – costs that are represented by healthcare expenditures. With a growing share of the population that are obese, these costs are increasing – and will continue to increase in the future. Several studies point out that it is difficult to measure direct healthcare costs as obesity is a cause to several diseases like diabetes type 2, and that the total direct healthcare costs are likely higher than estimates show. The indirect costs of obesity are higher because they include the loss to productivity because of obesity; people that are obese have higher rates of work absence and lower rates of labour participation. Estimates for the UK, for instance, suggests that the direct healthcare costs of obesity stood at approximately 4.2 billion pound in the noughties, and that the indirect costs of obesity were 27 billion pound in 2015.
With growing rates of obesity, the burden of the disease is about to become a central issue for fiscal and economic policy in Europe. The fiscal effects will mainly arise because higher rates of obesity will push up healthcare expenditures. There is another dimension to it as well; people with diseases like obesity also need financial support from social security systems at a greater degree than the population average. The growing economic burden will be a consequence of changes in the labour market and how the economy broadly will reallocate resources because of how labour participation changes. And this type of burden will most likely grow rapidly over the next couple of decades unless obesity rates cannot be better managed.
 The data is from the WHO Global Health Observatory data repository.
 Eurostat, 2016.
 Tyrrell et. al., 2016; Choquet and Meyre, 2011.
 A good overview of the results from the Global Burden of Disease Study 2010 can be found at the Lancet’s special website, http://www.thelancet.com/themed/global-burden-of-disease
 WHO, 2016.
 Sassi et. al., 2009.
 Trasande & Elbel, 2012.
 Trasande & Elbel, 2012.
 For overview studies of the economic burden of obesity, see Müller-Riemenschneider et. al., 2008; Specchia et. al. 2014; Dee et. al., 2014.
 NOO, 2010.
 Neovius et. al., 2008.