Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLANDthe data on relative risk and age- and sex-specificprevalence of obesity published in the Health Survey forEngland 1998 1 to give an estimate of the cost of treatingthe consequences of obesity.Indirect costs10 We approximated the indirect costs of obesity byestimating the earnings lost due to obesity and itsconsequences. These costs have two components:earnings lost due to premature mortality; and earningslost due to sickness.Results and discussionDirect costs of treating obesity15 We estimated the known, direct costs of treating obesityin England in 1998 to be £9.4 million at 1998 prices(Figure 32).32The cost of treating obesity in England in 1998 (£)Contact Total contacts Unit cost Total cost(£) 55 (£m)appendix sixEarnings lost due to premature mortality11 We estimated earnings lost due to premature mortalityby first identifying from the literature review the bestdata on the proportion of all deaths that are attributableto obesity. These data were then applied to the numberof age- and sex-specific deaths in England (taken from'Key Population and Vital Statistics for England', Officeof National Statistics) to estimate the number of deathsattributable to obesity in England in 1998.12 Data on residual life expectancy by age and sex weretaken from the Annual Abstract of Statistics 57 andapplied to the number of deaths to give an estimate ofthe years of life lost due to obesity. Assuming an end ofworking life of 65 for men and 60 for women, we thenadjusted these data by labour market participation andemployment rates to estimate the years of working lifelost due to obesity. Finally, these figures were multipliedby mean annual earnings data and discounted topresent values at the rate of six per cent to arrive at thediscounted earnings lost due to premature death causedby obesity in 1998.Earnings lost due to sickness absence13 Lost earnings due to sickness attributable to obesitywere estimated using days of certified incapacity from1 April 1997 to 31 March 1998. Figures for sicknessattributed to obesity and its associated diseases weresupplied by the Department of Social Security, detailingdays of certified incapacity benefit by cause where aclaim to benefit was made, drawn from a one per centsample of claims to benefit in Great Britain.14 We multiplied the days lost due to associated diseasesby the data on the proportion of each diseaseattributable to obesity to give an estimate of the numberof days off work attributable to obesity. This was thenmultiplied by mean daily earnings figures to calculatelost earnings due to sickness attributable to obesity.General practitioner 519,486 13 6.8consultationsOrdinary 1,220 1,066 1.3admissionsDay cases 127 403 0.1Outpatient 4,829 102 0.5attendancesPrescriptions 0.8Total 9.416 By far the largest component of this cost was generalpractitioner consultations: over half a million suchconsultations were recorded in 1998 at a cost of£6.8 million. This is probably an under-estimate for tworeasons.17 First, the number of consultations for obesity is likely tohave been underestimated. The most recent data was for1991-92 and since then the prevalence of obesity hasrisen. If the number of general practitioner consultationsfor obesity increased since 1992 at the same rate as theincrease in the number of obese people, then thenumber of consultations would rise to nearly 700,000,with a cost of over £9 million.18 Second, no data were available on consultations withpractice nurses and dietitians in primary care. Evidencefrom the National Audit Office's survey of generalpractitioners and practice nurses carried out for thisreport suggests that the amount of time spent by practicenurses in monitoring and advising obese patientsexceeds that spent by most general practitioners.Therefore, the cost of primary care interventions forobesity is likely to be significantly greater than thatindicated by general practitioner consultations alone.58