The year is 26 BC. The city is Rome. Few people are obese, but those who are command respect and admiration from their peers. Obesity was a revered luxury of the rich and powerful, a status symbol of those with an army of servants to carry out their labour, those who could afford to overfeed themselves when many could barely scrape together a meal.
Fast-forward to 2023. Obesity is no longer rare, nor exclusive to the wealthy. In fact, for the first time ever, the amount of people with obesity worldwide surpassed those underweight earlier this century. While this was touted as a positive sign of growth and surplus provisions, a new report emphasises the health and social concerns of our increasing mass. Describing obesity as an “epidemic”, the report predicts more people in the world will be overweight by 2035 than not, with lower income countries, like their citizen’s belt straps, disproportionately feeling the strain of increasing obesity rates.
The Obesity Forecast
Earlier this month, the World Obesity Federation released the ‘World Obesity Atlas 2023’ that outlines the prevalence and costs of the global obesity crisis. It predicts that by 2035, 51% of the global population, over 4 billion people, will be medically described as ‘overweight’, of which 1.9 billion, almost a quarter of the predicted population, will be classified as ‘obese’. In 2020, the figure was around 2.6 billion, or 38% of the global population, thus forecasting a meteoric 54% increase over fifteen years.
Low and middle income countries are likely to experience increases in overweight and obesity that vastly eclipse those of high income countries. Predictions for low income countries show the proportion of those with obesity more than triple for both men and women, reaching a total of 90 million people, and over double for their middle income counterparts.
While in high income countries the rise has petered off, it has by no means ceased altogether. Almost 40% of the adult population in high income countries will be obese by 2035 compared to under one third in 2020. For the UK, a frightening 46% of the population is predicted to be obese in just twelve years’ time.
Though wealthier countries have been predicted less-explosive increases, they will maintain a much higher proportion of the global obese population, around four times as much as those with obesity in low income countries.
A Double-Edged Sword
Even more disheartening, however, is that undernutrition, though declining, is far from an issue resigned to the past. Around 663 million people worldwide, or 8.9% of the population, are undernourished, concentrated predominantly in low income countries. This challenges poorer countries with alleviating the paradoxical burdens of prevalent undernourishment and increasing obesity rates simultaneously.
For instance, Somalia or Yemen, both war torn and impoverished, have alarmingly high increases in Obesity predicted while also battling active famines. The report grades each country on their ‘Obesity Preparedness Ranking’, analysing their existing healthcare infrastructure and political commitment to the risk. It is no surprise then, that the countries on the lower end of these rankings are also the ones facing severe hunger crises.
An Ever-Increasing Waist of Money
The epidemic is predicted to cost the world economy an exorbitant sum of $4.3 trillion, which will lower the entire global GDP by 2.9%, an estimate that takes into account healthcare costs, comorbid afflictions, increased disability expenditure and reduced productivity. To contextualise this sum, COVID-19 shrunk the world economy by 3%, suggesting obesity as a health problem is comparable with a world-stopping pandemic.
Yet it is not just the future that is expensive. Obesity is estimated to have shrunk the global economy by 2.4% in 2020, so the obesity problem is already incredibly costly as well as unhealthy.
So what can we do?
Obesity is a complex health risk, with no discernible, well-defined, catchall intervention proven to be effective; the fact that no country has ever reduced its obesity rate since records began demonstrates this convincingly.
The causes of obesity, however, are relatively intuitive. Fundamentally, obesity is caused by an imbalance between energy consumption, especially in unhealthy foods, and energy expenditure, but there are certain risk factors that exacerbate the problem. Psychological disorders, increased access to unhealthy foods, exposure to advertisements, automation of labour, and lifestyle choices from increased wealth, such as car dependency, all contribute to the rapid growth of obesity. But addressing these without impeding too heavily on people’s freedoms proves an insurmountable task.
Despite calling for National Actions Plans to tackle the crisis, the recent report offers a few flimsy and vague proposals with little value to be unearthed. These include more political commitment, investment in healthcare, strengthening of existing health systems, and policies that may be effective but will be tough to convince an electorate to vote for, such as “Better surveillance and data collection”. What the report offers then are policies that could be applied to any health risk and most you hope would already be Government aims. It’s analogous to a sailor asking his captain how to navigate through an uncharted and hazardous strait during a fog storm and the captain replying, “Let’s just be better sailors in general!”
Other institutes have at least offered some evidence-based, fiscal interventions, such as higher taxation on unhealthy food and drink while subsidising items that enhance a healthy diet. Debates around these policies are commonplace in many countries at the moment, and one report by the World Health Organization champions these policies highlighting their various successes around the world to back up their support.
Overall though, scant concrete or specific interventions of the obesity epidemic have been outlined. Like now, the onus is almost entirely placed on the individual, with education on the risks as well as promotion of a healthy lifestyle being the leading approaches to tackling obesity, both now and most probably in the future.