Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND9 Breakdown of the estimated cost of treating the major secondary diseases attributable to obesity in 1998Hypertension £135mCoronary Heart Disease £127mType 2 Diabetes £124mOsteoarthritis £35mCancers £19mStroke £17mCost (£ million)Source: National Audit Office estimates (Appendix 6)2.27 We have deliberately produced conservative estimatesto raise their credibility as the basis of further discussionof this report in the face of a number of uncertainties(Appendix 6). For example, the potentially high costsassociated with treating obesity related depression andhyper-lipidemia have been excluded because ofinadequate data on relative risk. Even a small proportionof the cost of anti-depressants (£279 million per year)and lipid-regulating drugs (£190 million per year) wouldsignificantly increase our estimate of direct costs. Theanalysis also excludes other public expenditure notborne directly by the NHS, such as the costs of socialcare for obesity related stroke patients.The indirect costs of obesity inEngland may be around £2 billiona year2.28 The indirect costs of obesity are defined in terms of lostoutput in the economy due to sickness absence or deathof workers. This involves making assumptions abouthow the economy responds when members of theworkforce become sick or die. If it is assumed that theeconomy adjusts quickly, for example if job vacanciesare filled rapidly following a death, ultimately fromamong the non-employed labour force, or if workforceproductivity increases, then the impact on the economyis 'frictional' and small, in direct proportion to the speedof adjustment.2.29 Modelling the macroeconomic impact on the economyof sickness and premature death among the obese in thenecessary detail is not feasible. We have therefore madeestimates on the basis of work time lost through sicknessand premature death resulting from obesity, togetherwith data on average incomes. This 'human capital'based approach is the standard one adopted in theliterature (Appendix 6), but it is subject to largeuncertainty and will give higher estimates than thefriction cost method. These cannot be modelled otherthan by using a range of arbitrary assumptions.2.30 Within these limitations, we estimate that the indirectcosts of obesity in England in 1998 were £2.1 billion, ofwhich £1.3 billion (61 per cent) was due to sicknessabsence attributable to obesity, and the remainder(£0.8 billion) due to premature mortality. Despite theuncertainties about the impact at the level of the wholeeconomy, the human costs to individuals in terms oftheir illness and premature death are very substantialindeed.On present trends, the costs of obesitycould increase by a further £1 billionby 20102.31 Combining the estimates of direct and indirect costs, thetotal estimated cost of obesity in England in 1998 was£2.6 billion. If the prevalence of obesity continues torise at the present rate until 2010, when it wouldapproach the levels of obesity now seen in the UnitedStates, these annual costs would increase by £1 billion,or over a third, to around £3.6 billion, by that year.part two17