Citerank: (60) 340964Tackling obesity in the UKWith concern growing that the Foresight analysis—that 50% of the UK population could be obese by 2050, at an annual cost to the nation of around £50 billion per year [2]—substantially underestimates the scale of the unfolding obesity crisis, the College of Contemporary Health is working with the wider policy community to develop a whole systems map of the obesity crisis and the potential responses.7F1CEB7, 348675Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 348767A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 348770Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 348780Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 352311Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 352311Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 352373Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 352710Develop better pharmaceutical obesity therapiesObesity drug sales are forecast to $3.8bn globally in 2018 [2]—in comparison to $57bn for Diabetes drug sales[2]—with evidence suggesting that the modest average weight losses achieved with current anti-obesity agents may be of some clinical benefit [5]. However, the current generation of drugs, which act on the central nervous system to suppress appetite, have raised significant health concerns—including psychiatric disorders, such as suicidal behaviour, depression, and cardiovascular problems.565CA4D9, 352718Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 366161McKinsey Global InstituteThe MGI discussion paper, Overcoming obesity: An initial economic analysis studied studied 74 interventions (in 18 areas) that are being discussed or piloted somewhere around the world to address obesity, including subsidized school meals for all, calorie and nutrition labeling, restrictions on advertising high-calorie food and drinks, and public-health campaigns – with sufficient data found on 44 of the interventions in 16 areas. 58D3ABAB, 366169Obesity Interventions identified by MGI74 interventions – across 18 groups – to reduce obesity.565CA4D9, 366449Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 366450Understand how to align incentives and build cooperation109FDEF6, 366452No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 366453Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 366454Education and personal responsibility are necessary but not sufficientEducation and encouraging personal responsibility are necessary but not sufficient.1198CE71, 366456Co-ordinated multi-party actions are required to tackle obesityCapturing the full potential impact is likely to require commitment from government, employers, educators, retailers, restaurants, and food and beverage manufacturers, and a combination of top-down corporate and government interventions and bottom-up community-based ones. 1198CE71, 366457Government obesity efforts are too fragmented to be effectiveGovernment efforts to tackle the obesity issue seem too fragmented to be effective. In the United Kingdom, 15 central government departments; all local authorities with responsibility for health, education, and local planning; 16 EU directorates-general; and a wide range of nongovernmental organizations all have a significant impact on the major intervention areas. [1]118FF4888, 366458Current incentives are mis-aligned118FF4888, 366460Desire to prioritise options becomes a barrier to actionA search for the “best” interventions or a single solution could delay action and displace responsibility. Given the seriousness of the obesity issue, the aim should be to do as much as possible as soon as possible. [1]118FF4888, 366462Experiment with multiple interventionsSociety should be prepared to experiment with possible interventions. In many intervention areas, impact data from high-quality, randomized control trials are not possible to gather. So, rather than waiting for such data, the relevant sectors of society should be pragmatic with a bias toward action, especially where the risks of intervening are low, using trial and error to flesh out their understanding of potential solutions. 565CA4D9, 366463Paucity of investment in intervention measuresThe UK invests less than $1 billion a year in prevention activities such as weight-management programs and public health campaigns – i.e. around 1% of the social cost of obesity in the UK. More investment is required.555CD992, 366467Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 366479Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 366479Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 366481Improve surgical interventions for obesity565CA4D9, 366483Types of weight-management services565CA4D9, 366555Employers offer team challenge incentive schemes in the workplaceEmployers provide team challenge activities to encourage physical activity and improved key health indicators in the workplace.565CA4D9, 366557Employers give employees financial incentives to improve healthEmployers provide material incentives to individuals for improved key health indicators (e.g., discounts on insurance premiums, gym membership, prizes).565CA4D9, 371556Many obesity policy measures appear to be cost-effective for societyThe recent MGI study [1] reported that almost all of the obesity policy interventions included in its economic analysis appeared to be highly cost-effective at the societal level—i.e. the health-care costs and productivity savings that accrue from reducing obesity through a specific intervention outweighed the direct investment required to deliver that intervention when assessed over the full lifetime of the target population.1198CE71, 399546Tackling obesityMany policy interventions have been suggested to address the obesity crisis across multiple studies—and indeed many such measures have been implemented, and are being implemented, now. There's recognition too that these interventions need to be part of a coherent and comprehensive whole systems strategy [4]; with some grounds for optimism that such an approach has the potential to accomplish a significant reduction in the prevalence of obesity in the UK across the next decade. [2]565CA4D9, 399547Adopt a whole systems approach to obesityTackling obesity effectively—accomplishing a population wide-shift—requires a comprehensive and integrated whole systems approach, involving a range of measures focusing on individuals, social and other systems, including at the local and community level, and on the interrelated physical, physiological, social and cognitive factors that determine health outcomes.565CA4D9, 399548Invest in employee health and wellbeingEncourage organisations to invest employee health and wellbeing; including a health risk assessment and the provision of resources to help employees address the factors that pose the greatest risk to their health and wellness. [1], [2], [3], [4], [5]565CA4D9, 399552Develop a coherent fiscal, regulatory and governance frameworkTake every opportunity, iteratively over time, to bring the public fiscal, regulatory and governance framework into alignment with public health goals on obesity. Use taxes, subsidies, targets and pricing signals to incentivise change in behaviour, supply and consumption by aligning measures with the health properties of food and drink and behaviour—and seek, wherever practical, to amplify positive patterns that are aligned with the policy goals and damp those that pull against.565CA4D9, 399555Many obesity policy measures appear to be cost-effective for societyThe recent MGI study [1] reported that almost all of the obesity policy interventions included in its economic analysis appeared to be highly cost-effective at the societal level—i.e. the health-care costs and productivity savings that accrue from reducing obesity through a specific intervention outweighed the direct investment required to deliver that intervention when assessed over the full lifetime of the target population.1198CE71, 399561Deploy and integrate as many interventions as possible at scaleCommission and deploy as many interventions as possible at scale and delivered effectively, and integrated way, by the full range of sectors in society.565CA4D9, 399567Employers offer team challenge incentive schemes in the workplaceEmployers provide team challenge activities to encourage physical activity and improved key health indicators in the workplace.565CA4D9, 399568Employers give employees financial incentives to improve healthEmployers provide material incentives to individuals for improved key health indicators (e.g., discounts on insurance premiums, gym membership, prizes).565CA4D9, 399575Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 399575Align the school curriculum with obesity, nutrition and activity goals565CA4D9, 399586Develop better pharmaceutical obesity therapiesObesity drug sales are forecast to $3.8bn globally in 2018 [2]—in comparison to $57bn for Diabetes drug sales[2]—with evidence suggesting that the modest average weight losses achieved with current anti-obesity agents may be of some clinical benefit [5]. However, the current generation of drugs, which act on the central nervous system to suppress appetite, have raised significant health concerns—including psychiatric disorders, such as suicidal behaviour, depression, and cardiovascular problems.565CA4D9, 399588Improve surgical interventions for obesity565CA4D9, 399592Invest in weight management servicesThe departments of health in the four nations should extend and increase the provision of weight management services across the country, to mirror the provision of smoking cessation services.565CA4D9, 399599Encourage active transport (walking and cycling)Government authorities redesign urban planning to facilitate and encourage walking and cycling.565CA4D9, 399611Understand how to align incentives and build cooperation109FDEF6, 399612Co-ordinated multi-party actions are required to tackle obesityCapturing the full potential impact is likely to require commitment from government, employers, educators, retailers, restaurants, and food and beverage manufacturers, and a combination of top-down corporate and government interventions and bottom-up community-based ones. 1198CE71, 399613No single solution creates sufficient impact to reverse obesityNo single solution creates sufficient impact to reverse obesity: only a comprehensive, systemic program of multiple interventions is likely to be effective. 1198CE71, 399614Many interventions are highly cost-effectiveAlmost all of the interventions we analyzed are highly cost-effective from the viewpoint of society.1198CE71, 399615Education and personal responsibility are necessary but not sufficientEducation and encouraging personal responsibility are necessary but not sufficient.1198CE71, 399617Experiment with multiple interventionsSociety should be prepared to experiment with possible interventions. In many intervention areas, impact data from high-quality, randomized control trials are not possible to gather. So, rather than waiting for such data, the relevant sectors of society should be pragmatic with a bias toward action, especially where the risks of intervening are low, using trial and error to flesh out their understanding of potential solutions. 565CA4D9, 399715Types of weight-management services565CA4D9, 399887Causes of obesityUnderstanding the causes of obesity is critical to the success of prevention and treatment strategies. However, while (simply put) obesity occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period (resulting in the accumulation of excess body fat), in reality many complex behavioural and societal factors contribute systemically to the current crisis and no single influence dominates.555CD992, 399932Paucity of investment in intervention measuresThe UK invests less than $1 billion a year in prevention activities such as weight-management programs and public health campaigns – i.e. around 1% of the social cost of obesity in the UK. More investment is required.555CD992, 399973A potentially unsustainable financial burden on the health systemThe range of obesity's impacts makes accurate economic analysis challenging; however, a November 2014 study from the McKinsey Global Institute placed the annual economic impact on the UK at around $73bn (£46bn). Earlier analysis and modelling for the 2007 Foresight Report suggested a cost to the NHS of around £4.2bn annually to treat people with health problems related to elevated BMI and a total wider cost to the economy of around £15.8bn (rising to £27bn by 2015 and £49.9bn by 2050).57DE7179, 400018Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 400018Lost productivityObesity has as a serious impact on UK economic development –  constraining economic productivity and increasing business costs – affecting individuals’ ability to get and hold down work, their self-esteem and their underlying mental health.57DE7179, 400061Current incentives are mis-aligned118FF4888, 400083Government obesity efforts are too fragmented to be effectiveGovernment efforts to tackle the obesity issue seem too fragmented to be effective. In the United Kingdom, 15 central government departments; all local authorities with responsibility for health, education, and local planning; 16 EU directorates-general; and a wide range of nongovernmental organizations all have a significant impact on the major intervention areas.118FF4888, 400084Desire to priortise options becomes a barrier to actionA search for the “best” interventions or a single solution could delay action and displace responsibility. Given the seriousness of the obesity issue, the aim should be to do as much as possible as soon as possible.118FF4888

Key Findings

> 17 states tax candy at a higher rate than other groceries, and four states collect an excise tax on soda.

> In 2011, 14 states proposed new soda taxes (in some cases, raising product prices by as much as 264 percent). Two states proposed new candy taxes.
Between 1998 and 2010, soda consumption per capita fell by 16 percent.

> Soda and candy taxes do not necessarily decrease caloric intake. One recent study finds that when adolescents switch away from soda due to price increases, the drop in calories is offset by an increase in calories consumed in other food and drink.

> Definitional problems plague the enforcement of and compliance with special taxes on candy and soda. For example, under many tax laws, a product with flour would be treated as food while a similar product without flour would be considered candy.

> Excise taxes on candy and soda fall on all individuals who consume the products, even those who do so moderately.

The literature on fiscal food policies focuses on their effectiveness in altering diets and improving health, while this paper focuses on their welfare costs.Aformal welfare economics framework is developed to calculate the combined individualistic and distributional impacts of a tax-subsidy. Distributional characteristics of foods targeted by a tax tend to be concentrated in lower-income households. Further, consumption of fruit and vegetables tends to be concentrated in higher-income households; therefore, a subsidy on such foods increases regressivity. Aggregate welfare changes that result from a fiscal food policy are found to range from an increase of 1.41 per cent to a reduction of 2.06 per cent according to whether a subsidy is included, the degree of inequality aversion, and whether substitution among foods is allowed.