How do you solve a problem like obesity?

Making headlines this morning (Thursday 20^th November) has been the report by McKinsey Global Institute, an offshoot of the management consultancy McKinsey, on the global economic impact of obesity. This report estimates that $2.0 trillion is spent annually worldwide as a result of obesity, which it compares to the global burden of smoking and armed conflict; the quoted figure is comprised of various elements such as productivity losses and spending to mitigate obesity. Certainly, the magnitude of the burden is in part due to the fact that obesity is generally a developed nation problem, and these nations typically spend many orders of magnitude more on healthcare than their developing nation counterparts. The claim then that obesity represents a problem as serious as armed conflict and violence may therefore end up being somewhat spurious if global issues were measured on a scale other than total financial expenditure. Nonetheless, the report acknowledges such issues, and provides a comprehensive summary of obesity related statistics to demonstrate them.

One of the main aims of the report is to identify interventions that may be used to tackle obesity in order to reduce expenditure resulting from obesity. To credit the McKinsey report, it recognises the complex nature of obesity and reproduces the above figure, asking if it is possible to tackle obesity given its complex aetiology. The report even provides some evidence that various social and cultural factors are at play. However, the authors write that while the background may be complex, the proximal causes are well known, and that interventions that target these proximal causes are both more feasible and simpler to implement and ought to be the ones they consider. This expression of a certain public health ideology, I would argue, is an issue with many discussions about population and global health issues.

This is the notion that public health and healthcare should be focussed on targeting individuals and modifying their behaviour, through such things as technological innovation, divorced from social, economic, or political contexts. For example, the McKinsey report suggests calorie labelling, advertising restrictions, and public health campaigns. However, if we want to tackle health issues such as obesity at the aggregate level then we should probably consider asking aggregate level questions, such as why markets are producing inefficient outcomes in terms of the health of the labour force, and why there is an oversupply of calories in some countries and an undersupply elsewhere. Policies that result from such analyses are likely to be more complex but are also more likely to be efficacious.

Historically, public health progress has been the result of a convergence of a wide range of social, economic, and political projects. Countries have adopted various strategies, historically, to reduce mortality including: better income distribution; improved diet; public health; medicine; changes in household education – however, none of these policies have been universally successful on its own and real progress requires integration of various social, medical, political, and economic strategies (Brin, 2005; The Lancet—University of Oslo Commission on Global Governance for Health, 2014). The interventions in the report seem to me to be somewhat limp in the face of what they call a problem with a ‘global burden’.

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