AREA DE LA COMPUERTA

Great advances were made in public health in the twentieth century; infectious diseases formerly responsible for the majority of premature deaths were nearly eradicated from industrialised nations. Today, however, chronic diseases affected by weight are the leading causes of premature death. A recent United States Surgeon General offered a stark warning to his population when he predicted that the increasing prevalence of serious diseases caused by obesity, unhealthy diets, and inactivity may result in the current generation of children having less healthy and shorter life spans than their parents (Carmona, 2004). As the rates of overweight and obesity in New Zealand and Australia are similar to those in the United States, Carmona’s warning is as relevant here as it was in his own jurisdiction.

Obesity Related Morbidity and Mortality

Obesity is now known to be the tenth highest risk factor for morbidity and mortality in developed countries (WHO, 2002b). The wide range of adverse health consequences arising from excess weight are well documented (Jung, 1997) (see Table 1 for

examples). As medical research further elucidates disease vectors, it is possible that more conditions will be attributed to excess weight.

Table 1 – Some physical diseases related to excess weight

Disease type Reference

Cardiovascular disease,

hypertension, stroke Wilkinson & Marmot (1998) Type 2 diabetes WHO (2003a)

Cancers (of many tissues) Callee, Rodriguez, Walker-Thurmond, & Thun (2003); _{Moller, Mellemgaard, Lindvig, & Olsen (1994)} Osteoarthritis of the knee Hart & Spector (1993); Sturmer, Gunther, & Brenner ₍₂₀₀₀₎ Fatty liver disease Wanless & Lentz (1990)

Renal disease Hall (2003)

Blindness Royal National Institute of the Blind (2006)

Much of the data regarding obesity and its health consequences comes from research on adult populations, as the diseases caused by overweight were formerly observed in older people. However, the growing incidence of ‘adult’ conditions afflicting overweight

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young people, such as impaired glucose tolerance and type 2 diabetes in children (Diabetes New Zealand, 2008; Fagot-Campagna, 2000) and increased rates of heart disease among young adults (Hayman, 2005), highlights the need for concern over the changing weight profile of the whole population.

Despite impressive advances in medical technology and increased access to these, premature death due to Non-Communicable Disease (NCD) is increasingly common. Globally, approximately 2.5 million people die prematurely each year from chronic diseases for which obesity is a major risk factor (WHO, 2002a). There is a near linear relationship between BMI and premature mortality (WHO, 2000), and the risk of death begins increasing with weight gain even within the healthy BMI range (van Dam, Willett, Manson, & Hu, 2006). Approximately 40 percent of all deaths in New Zealand each year are attributable to nutrition-related risk factors, particularly high saturated fat and salt intakes, being overweight and obese, or inadequate fruit and vegetable

consumption (MOH, 2004a).

Being overweight or obese often has detrimental effects upon psychological and social wellbeing. Mayer (1968) noted that historical literature has left a record of “…the low regard usually held for the obese by the thinner and clearly more virtuous observer” (p. 84); a stigma that persists today (e.g., Lane, 2006). It appears that many view obesity as a personal failure to manage diet and exercise levels adequately, the consequence of a weakness of resolve and character rather than of the environment within which people live and grow (Lee & Oliver, 2002; WHO, 2000). Overweight children are often stigmatised, teased and bullied (girls more so) (Tang-Péronard & Heitmann, 2008), and are more likely to have low self-esteem (French, Story, & Perry, 1995; Strauss, 2000; Wang & Veugelers, 2008). Overweight adolescents report higher levels of social isolation and are less likely to be nominated as friends by others, including those they think of as friends, than their healthy weight peers (Strauss & Pollack, 2003).

As adults, overweight people are more likely to experience discrimination by employers (Roehling, 1999), again particularly women (Pagan & Davila, 1997), as well as

discrimination in a variety of other interpersonal situations (Puhl & Brownell, 2001). Even health professionals display bias: physicians are significantly less likely to respect obese patients (Huizinga, Cooper, Bleich, Clark, & Beach, 2009). Consequently, overweight and obese people have weaker social support networks and lower social

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integration (Rugulies, Aust, & Syme, 2004), and are more likely to experience major depression and suicide ideation or attempts (Carpenter, Hasin, Allison, & Faith, 2000; Eaton, Lowry, Brener, Galuska, & Crosby, 2005; van Dam et al., 2006).

Economic and Societal Costs of Obesity

While modern medicine offers treatments to help manage illnesses caused by obesity, there are very high financial and social costs associated with this morbidity. The conditions stemming from obesity are often expensive and difficult to treat, lead to time away from work and a decrease in productivity (Neovius, Johansson, Kark, & Neovius, 2008), and create an economic burden borne by the whole of society (Centers for Disease Control, 2006; Finkelstein, Fiebelkorn, & Wang, 2003). In 2006, the then New Zealand Minister of Health said:

A lot of people have been looking for a crisis in health … This is it. One in five New Zealanders are obese and we can only begin to imagine what that will mean for the future of our health system (Hodgson, 2006b, ¶ 4)2_.

Data from Canada shows that obese adults incur greater health care costs than healthy weight adults (Janssen, Lam, & Katzmarzyk, 2008). The health budget is a limited resource, and successive governments are unlikely to want to increase taxes, instigate spending cuts in other areas, or increase national debt to cover the increasing cost of health care required by growing numbers of overweight and obese people.

A conservative estimate for the economic burden of obesity in New Zealand in 2005 was $303 million, based on WHO estimates of between two and five percent of the health budget (MOH, 2005), while a report on the economic impact of obesity in Australia in 2005 concluded the total cost was approximately AU$3.8 billion (Access Economics, 2006). Nearly ten percent of the United States’ health expenditure in 1998, around US$78.5 billion, related to conditions caused by obesity (Finkelstein et al., 2003). Now that the prevalence of obesity in New Zealand and Australia is similar to that of the United States, the proportion of the health budget spent on obesity related diseases may also have risen.

2 _{The number of obese adults increased to one in four after the former Minister of Health made this} comment.

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There are also indirect and opportunity costs associated with obesity (WHO, 2000), but these are harder to estimate and health economists debate which variables should be included in the calculations. Indirect costs include welfare and economic benefits lost to other members of society, such as diminished production capacity due to illness-related absenteeism and premature death, and use of central funds for health care that could be diverted to other projects if it were not for obesity. Opportunity costs to the individual include fewer years living without disability, reduced longevity, limitations to social class attainment, and increased probability of discrimination.

Summary

Excess weight increases the risk of developing many detrimental physical diseases or experiencing significant emotional distress. In turn, these health outcomes are reflected in morbidity and mortality statistics, which have substantial economic implications. Disparities in the prevalence of obesity between ethnic groups is one of the contributing factors to unequal health status experienced by Aboriginals, Māori and Pacific Islanders compared to people of European and Asian decent living in New Zealand and Australia. It is clear that the current situation of increasing weight gain is unsustainable, and that the factors associated with this trend need investigation so options that would reverse it may be identified and evaluated.