OBESITY UPDATE 2012
The obesity epidemic slowed down in several OECD countries during the
past three years. Rates grew less than previously projected, or did not
grow at all, according to new data from ten OECD countries. Child obesity
rates also stabilised in England, France, Korea and United States. However,
rates remain high and social disparities in obesity are unabated. Many
governments have stepped up efforts to tackle the root causes of obesity,
embracing increasingly comprehensive strategies and involving
communities and key stakeholders. There has been a new interest in the
use of taxes on foods rich in fat and sugar, with several governments (e.g.
Denmark, Finland, France, Hungary) passing new legislation in 2011. This
policy brief presents an update of analyses of trends and social disparities
in obesity originally presented in OECD’s report “Obesity and the
Economics of Prevention: Fit not Fat”, published in 2010.
Until 1980, fewer than one in ten people were
obese. Since then, rates doubled or tripled and
in 19 of 34 OECD countries the majority of the
population is now overweight or obese. OECD
projections suggest that more than two out of
three people will be overweight or obese in
some OECD countries by 2020.
Three years on from the publication of the OECD
report “Obesity and the economics of
prevention: Fit not fat”, rates have increased
less than, or in line with, projections in most
countries for which new data have become
available. The data provide strong evidence that
the progression of the epidemic has effectively
come to a halt for the past ten years in countries
such as Korea (where obesity rates have
stabilised at 3-4%), Switzerland (7-8%), Italy (89%), Hungary (17-18%) and England (22-23%).
There is, however, no sign of retrenchment of
the epidemic, in any country. Rates remain very
high in most of the OECD, and countries
continue to experience a large burden from
chronic diseases associated with obesity.
The latest data show modest increases in
obesity over the past decade in countries like
Spain and France, in the order of 2-3%, and
larger increases in Ireland, Canada and the
United States (4-5%), although an even larger
increase had been expected in the United
States, based on previous OECD projections.
These findings would seem to contradict the
argument that economic recession might fuel
obesity by making people’s diets less healthy.
Figures 1 and 2 illustrate the progression of
obesity and overweight rates, respectively, in
seven OECD countries, along with previous
OECD projections (dotted lines) for overweight.
The prevalence of obesity today varies nearly
tenfold among OECD countries, from a low of
4% in Japan and Korea, to 30% or more in the
United States and Mexico. Current obesity rates
in all OECD countries are shown in an appendix
to this document.
Height and weight have been increasing since
the 18th century, as income, education and
living conditions gradually improved over time.
While weight gains were largely beneficial to the
health and longevity of our ancestors, an
alarming number of people have now crossed
the line beyond which further gains are
dangerous. Severely obese people die 8-10 years
sooner than those of normal-weight, similar to
smokers, with every 15 extra kilograms
increasing risk of early death by approximately
30%. Obesity is estimated to be responsible for
1% to 3% of total health expenditure in most
countries (5% to 10% in the United States) and
costs will rise rapidly in coming years as obesityrelated diseases set in.
Figure 1. Obesity rates
Figure 2. Overweight rates
35%
75%
- - - Past projection
New data points
70%
30%
65%
60%
20%
Rate of overweight
Rate of obesity
25%
Hungary
Ireland
England
15%
Canada
USA
10%
Spain
Italy
France
5%
England
45%
Spain
40%
Italy
France
Korea
25%
1975
1980
1985
1990
1995
2000
2005
2010
1970
Year
40%
30%
20%
10%
2000
2005
2020
Obesity is more common among the poor and
the less educated. In several OECD countries,
women with little education are two to three
times more likely to be overweight than more
educated women, but smaller or no disparities
exist for men. These disparities remained
remarkably stable over the past decade. Even
the latest data show no meaningful change in
inequality indexes like the one reported in
Figure 4 in the past three years, reflecting the
failure of government policies aimed at
protecting vulnerable groups.
50%
2010
2015
2020
Social disparities are also present in children
(both boys and girls) in England, France and the
United States, but not in Korea.
Year
Girls obesity
2010
Women are more often obese than men, but
male obesity rates have been growing faster
than female rates in most OECD countries.
Past OECD 2010 projections and new survey data point for 2009
1995
2000
Social disparities in obesity
Figure 3. Child obesity, United States
Boys obesity
1990
for the Study of Obesity, are available in an
appendix to this document. One-in-five children
are affected by excess body weight across all
countries, and in Greece, the United States and
Italy the figure is closer to one third. Only in
China, Korea and Turkey are 10% or less of
children overweight. In most countries, boys
have higher rates of overweight and obesity
than do girls. Girls tend to have higher rates in
Nordic countries (Sweden, Norway, Denmark),
as well as in the United Kingdom, the
Netherlands and Australia.
New data on child obesity from four OECD
countries (England, France, Korea and United
States) confirm and possibly strengthen the
message emerging from analyses of adult
obesity. Rates evolved according to previous
OECD projections or, more often, below those
projections, in all four countries. Child obesity
rates have effectively remained stable (at 6-8%)
over the past 20 years in France. The same is
true in the other three countries during the past
ten years, although with some fluctuations in
the United States (Figure 3). However, for child
obesity as well as adult obesity, there is no clear
sign of retrenchment of the epidemic, despite
major policy efforts focused on children in some
of the countries concerned.
60%
1980
Year
Child obesity
Rate of obesity and overweight
USA
30%
Korea
0%
1990
Canada
50%
35%
Switzerland
0%
1970
55%
Boys overweight
Girls overweight
Estimates of the prevalence of overweight
(including obesity) in OECD and emerging
countries among school-aged children aged 5-17
years, collated by the International Association
Poor health goes hand in hand with poor job
prospects for many obese people. Employers
2
prefer normal-weight over obese candidates,
partly due to expectations of lower productivity.
This contributes to an employment and wage
gap – in the United States, more than 40% of
severely obese white women are out of work
compared to just over 30% for all women. Obese
people earn up to 18% less than people of
normal weight. They need to take more days off,
claim more disability benefits, and tend to be
less productive on the job than people of normal
weight. In northern European countries, obese
people are up to three times more likely than
others to receive a disability pension, and in the
United States they are 76% more likely to suffer
short-term disability. When production losses
are added to health care costs, obesity accounts
for over 1% of GDP in the United States.
of the 3% of their healthcare budgets that OECD
countries now spend on prevention.
Governments can help people change their
lifestyle by making new healthy options available
or by making existing ones more accessible and
affordable. Alternatively, they can use
persuasion, education and information to make
healthy options more attractive. This gentle
approach is more expensive, hard to deliver and
hard to monitor. A tougher approach, through
regulation and fiscal measures, is more
transparent but it hits all consumers
indiscriminately, so can have high political and
welfare costs. It may also be difficult to organise
and enforce and have regressive effects.
So far, governments in the OECD area have given
priority to initiatives aimed at school-age children,
such as changes in school meals and vending
machines, better facilities for physical activity, and
health education. Many also disseminate nutrition
guidelines and health promotion messages such as
encouraging “active transport” – cycling and
walking – and active leisure.
In the past three years, some, but not all,
governments stepped-up their actions to fight
obesity. Health promotion efforts were
intensified, particularly through local initiatives
and further measures at the school level (e.g. in
France, Spain, Italy, Mexico). Co-ordinated
national programmes were launched in countries
like United States (Let’s Move), United Kingdom
(Change4Life), Switzerland (Actionsanté), and
others. There has been an increasing reliance on
partnership with the food and beverage industry
(e.g. United Kingdom and Switzerland) in the
design and implementation of actions to fight
obesity, particularly in product reformulation to
avoid
particularly
unhealthy
ingredients
(e.g. saturated fats and too much salt), in
reducing excessive portion sizes and providing
healthy menu alternatives; in limiting advertising,
particularly to vulnerable groups like children;
and informing consumers about food contents.
But the real novelty of the last three years has
been a strong and increasing interest in the use of
fiscal measures to limit the consumption of foods
high in fat, sugar and salt. As explained in the box
below, legislation was passed by several OECD
countries and further countries are expected to
follow through in the near future.
Figure 4. Inequality index, overweight
by education
Relative inequality index for overweight by
education level
5
4
3
5.0
2
3.2
1
2.9
2.7
2.2
1.6 1.4
1.4 1.3 1.2
1.2 1.1 1.0 1.0
0.9
1.8 1.7 1.7
1.4 1.4 1.3
0.7
0
Men
Women
Note: The index shows how many times as likely to be overweight
is someone at the lowest end of the education spectrum in one
country, compared to someone at the highest end.
What can governments and markets do
to promote better health?
The OECD called for strong action against obesity
in 2010. Analyses of the health and economic
impacts of programmes to improve diet and
increase physical activity led to the conclusion
that comprehensive prevention strategies are
needed, targeting different age groups and
determinants of obesity. These would provide an
affordable and cost-effective solution, saving
hundreds of thousands of deaths from chronic
diseases every year in the OECD area (e.g.
155 000 in Japan, 75 000 in Italy, 70 000 in
England), at a cost ranging from USD 12 (Mexico)
to USD 32 (Canada) per capita, only a fraction of
total health expenditure, and a small proportion
3
“Fat taxes”: an answer to the obesity epidemic?
Several OECD countries introduced taxes on unhealthy foods and beverages in 2011 as part of their
efforts to counter obesity. Taxes, along with other measures, can improve health by changing eating
habits. At the same time, they may generate important revenues, which must have contributed to
governments’ attraction to these measures at a time of tight fiscal constraints.
Denmark introduced a tax on foods containing more than 2.3% saturated fats (meat, cheese, butter,
edible oils, margarine, spreads, snacks, etc.) in 2011. Consumers pay 16 kroner (EUR 2.15) per kilogram of
saturated fat on domestic and imported food, which is equivalent to up to 30% more for a pack of butter,
8% more for a bag of chips, and 7% more for a litre of olive oil. Tax revenues are expected to be over
EUR 200 million per year, and saturated fat consumption is expected to decrease by 4%. Denmark had
also increased its excise taxes on chocolate, ice cream, sugary drinks and confectionery by 25% in 2010.
Also in 2011, Hungary introduced a tax on selected manufactured foods with high sugar, salt or
caffeine content. Carbonated sugary drinks are among the products targeted by the new measures. The
tax does not concern basic food stuffs and only affects products that have healthier alternatives. The
Hungarian government is reportedly expecting to raise in excess of EUR 70 million per year from the tax.
2011 was also the year that Finland introduced a tax on confectionery products, while biscuits, buns
and pastries remained exempt. The tax, originally intended to be set at almost one euro per kilogram of
product, was subsequently dropped to EUR 0.75 per kilogram. At the same time, the existing excise tax
on soft drinks was raised from 4.5 cents to 7.5 cents per litre.
In France, a tax on soft drinks came into force in January 2012. The tax affects both drinks with added
sugars and drinks with artificial sweeteners. It is set at EUR 7.16 per hectolitre (i.e., EUR 0.072 per litre or
approximately EUR 0.024 for a 33cl can) for both categories. It is payable by manufacturers established in
France and importers. The tax is expected to generate revenues in the region of EUR 280 million per year.
Taxation of unhealthy foods or beverages is being discussed in a number of other countries.
Belgium, Ireland, Romania, and the United Kingdom are among the countries actively considering a levy
on unhealthy food and/or drinks. Debates are taking place in the United States and Italy.
Will taxes affect consumption, and eventually obesity?
The impact of imposing taxes on the consumption of certain foods is determined by the
responsiveness of consumers to price changes, i.e. price elasticity. However, it is difficult to predict how
consumers will react to price changes caused by taxation. Some may respond by reducing their
consumption of healthy goods in order to pay for the more expensive unhealthy goods, thus defeating the
purpose of the tax. Others may seek substitutes for the taxed products, which might be as unhealthy as
those originally consumed. Depending on the elasticity of the demand for the taxed products, consumers
will either end up bearing an extra financial burden, or changing the mix of products they consume in ways
that can be difficult to identify. The impact of the tax on government and supplier (e.g. food manufacturer)
revenues will also depend on the elasticity of consumers’ demand for the taxed product.
If a tax is well designed, i.e. if it covers all possible substitute foods, consumers will likely decrease
their consumption, and at the same time spend more on the taxed foods then they used to. This may
displace other forms of consumption, which requires close monitoring by governments.
Will manufacturers and retailers “absorb” the tax and leave prices unchanged?
This is unlikely to happen if the tax is well designed (again, to cover all immediate substitute
products). Manufacturers and retailers are more likely to pass on the tax to consumers, because they
would lose further revenues if they did not. It is even possible that consumer prices will increase more
than the amount of the tax, if manufacturers and retailers wish to limit their losses.
4
Are food taxes regressive?
Given that people with lower incomes spend more, in proportion, on food than do people with
higher incomes, the former will be hit more heavily by a tax. However, OECD work showed that those
with lower incomes will benefit disproportionately from the health gains deriving from a tax on
unhealthy foods.
How should governments use tax revenues?
Revenues from taxes on unhealthy foods can be substantial. These offer invaluable opportunities either
for attenuating any regressive impacts, or for magnifying the public health effects of the taxes, e.g. by
coupling them with subsidies on healthy foods or with targeted health education campaigns. In France
and Hungary, at least part of the revenues from the new taxes will contribute to financing health and
social security expenditures.
SUMMARY OF KEY FACTS ON OBESITY AND THE ECONOMICS OF PREVENTION






At least one in two people is now overweight or obese in over half of OECD countries. Rates
are projected to increase further and in some countries two out of three people will be obese
within ten years.
The latest data show a slowdown of the epidemic in several countries, with virtually stable
rates in Korea, Switzerland, Italy, Hungary and England over the past ten years, and mild
increases in France and Spain. However, larger increases were recorded in Ireland, Canada
and United States.
An obese person incurs 25% higher health expenditures than a person of normal weight in
any given year. Obesity is responsible for 1-3% of total health expenditures in most OECD
countries (5-10% in the United States). Obese people earn up to 18% less than non-obese
people.
Poorly educated women are two to three times more likely to be overweight than those with
high levels of education, but almost no disparities are found for men. OECD countries have
made no progress in tackling these disparities.
A comprehensive prevention strategy would avoid, every year, 155 000 deaths from chronic
diseases in Japan, 75 000 in Italy, 70 000 in England, 55 000 in Mexico and 40 000 in
Canada.
The annual cost of such strategy would be USD 12 per capita in Mexico, USD 19 in Japan
and England, USD 22 in Italy and USD 32 in Canada. The cost per life year gained through
prevention is less than USD 20 000 in these five countries.
5
Appendix: obesity rates in the OECD and beyond
Obesity rates among adults, 2009 (or nearest year)
Korea
Japan
Sw itzerland
Norw ay
Italy
Sw eden
France
Netherlands
Austria
Poland
Denmark
Israel
Belgium
Germany
Turkey
Portugal
Spain
Slovenia
OECD
Slovak Republic
Czech Republic
Estonia
Greece
Hungary
Iceland
Finland
Luxembourg
Ireland
United Kingdom
Canada
Australia
Chile
New Zealand
Mexico
United States
3.8
Self-reported data
3.9
Measured data
8.1
10.0
10.3
11.2
11.2
11.8
12.4
12.5
13.4
13.8
13.8
14.7
15.2
15.4
16.0
16.4
16.9
16.9
17.0
18.0
18.1
19.5
20.1
20.2
22.1
23.0
23.0
24.2
24.6
25.1
26.5
30.0
33.8
2.1
2.9
13.9
16.2
18.1
40
30
20
% of adult population
10
4.3
0
Females
3.5
Males
7.7
8.6
8.0
11.0
9.3
11.3
10.7
11.7
11.5
10.9
12.4
11.2
12.7
12.0
12.5
12.6
13.1
13.7
14.4
13.2
14.4
13.1
13.8
15.7
18.5
12.3
16.1
14.6
14.7
17.3
15.8
17.0
17.2
16.6
16.7
17.1
17.0
18.0
18.3
17.5
18.5
17.7
18.3
20.8
21.3
18.9
21.1
19.3
19.0
24.5
24.0
22.0
23.9
22.1
23.2
25.2
23.6
25.5
30.7
19.2
27.0
26.0
34.5
24.2
35.5
32.2
India
Indonesia
China
Brazil
Russian Fed.
South Africa
2.4
4.1
3.6
1.3
1.1
2.4
2.8
3.6
3.4
14.0
13.7
20.1
27.4
8.8
0
11.8
10
20
30
40
% of adult population
Source: OECD Health Data 2011; national sources for non-OECD countries.
Statlink: http://dx.doi.org/10.1787/888932523956
6
Children aged 5-17 years who are overweight (including obese), latest available estimates
Girls
Boys
Korea
Turkey
Poland
Sw itzerland
Japan
Norw ay
France
Denmark
Slovak Republic
Czech Republic
Germany
Netherlands
Finland
Sw eden
OECD
Portugal
Spain
Australia
Slovenia
Iceland
Hungary
Canada
United Kingdom
Chile
New Zealand
Mexico
Italy
United States
Greece
9.9
10.3
12.4
13.1
14.4
14.7
14.9
15.2
16.2
16.9
17.6
17.9
19.1
19.5
21.4
21.6
22.9
24.0
24.4
25.5
25.9
26.1
26.6
27.1
28.8
29.0
30.9
35.9
37.0
40
30
20
10
16.3
16.7
16.2
12.9
13.1
14.1
17.5
24.6
22.6
14.7
23.6
17.0
22.9
23.5
32.9
22.0
28.7
22.0
25.5
28.9
22.7
28.6
28.2
28.1
32.4
35.0
45.0
China
South Africa
India
Russian Fed.
Brazil
4.5
17.7
18.3
19.8
21.1
50
16.2
11.3
0
5.9
13.6
20.6
24.2
23.1
0
% of children aged 5-17 years
10
20
30
40
50
% of children aged 5-17 years
Source: International Association for the Study of Obesity (2011).
Statlink: http://dx.doi.org/10.1787/888932523994
Contacts
Useful links
OECD Media office
Helen Fisher
 +33-1-4524 8097
 [email protected]
OECD Obesity website:
www.oecd.org/health/fitnotfat
OECD Economics of prevention project:
www.oecd.org/health/prevention
OECD Health Division
Franco Sassi – Senior Health Economist and
main author of the report
 +33-1-4524 9239
 [email protected]
OECD work on Health:
www.oecd.org/health
Marion Devaux – Statistician and
co-author
 +33-1-4524 8261
 [email protected]
7