Counting the cost of obesity in Scotland
The economic and social costs of obesity in Scotland and what is needed to improve our health
The key findings
- The annual cost of obesity in Scotland in 2022 was £5.3bn – a figure set to rise in the coming years
- Of that, £4.1bn is the value lost to people through reduced quality of life
- The NHS faces a £776m annual cost and there are £459m in wider social and economic costs
- Supporting a population calorie reduction of 230 kcal per day for adults living with some level of excess weight would be enough to halve obesity prevalence
- The right policies could help reduce childhood obesity in Scotland by half by 2030
In Scotland, 67% of adults live with excess weight – the highest figure of any UK nation and one that has grown dramatically over the last 30 years. Obesity is now the leading cause of death in Scotland and is linked to 23% of all deaths.
The need to act to tackle the obesity crisis in Scotland is urgent. There is a compelling case to be made for bold policies and preventive action across government, industry and society. A strong evidence base in support of this work is vital.
To bolster that evidence base, we’ve produced three reports looking at the economic and social cost of obesity in Scotland and how reductions in obesity prevalence can be achieved in both adults and children in less than 10 years. Together they paint a comprehensive picture of obesity in Scotland and some of the measures that can be taken to improve our food environment.
The costs of obesity in Scotland
Nesta commissioned Frontier Economics to explore the costs of obesity in Scotland, including costs to individuals, costs to public services and wider social costs.
The report looked at the costs associated with obesity today, how those costs could change between now and 2030, and the reduction in costs that could be achieved if rates of obesity are reduced.
The analysis puts the annual full cost of obesity in Scotland in 2022 at £5.3 billion – equivalent to 3% of Scotland’s 2022 GDP.
The biggest driver of the estimated cost of obesity in Scotland is the value lost to individuals through reduced quality of life, lost opportunity and years of life lost.
A total value of £4.1bn was lost to ill health by individual people in 2022, including a £109m cost to children.
The cost is calculated using quality-adjusted life years (QALYs) – a measure used in public health research to quantify the value of healthy years of life. The £4.1bn figure is the equivalent of more than 58,000 years of good health lost each year to obesity in Scotland – 56,494 for adults and 1,559 for children.
The breakdown of the remaining costs include £776m to the NHS, split between £772m for treating obesity-related conditions such as type-2 diabetes, heart disease, strokes and cancers and £4m for mental health issues related to obesity.
The research shows a further £217m cost to the family and carers of those living with obesity through time spent on informal care and a £29m annual cost to the formal social care sector.
Scotland’s wider economy and employers face an annual cost of £213m associated with reduced rates of employment and lower rates of productivity among people living with obesity due to higher rates of sickness absence.
The cost of inequality
The effects of the obesity crisis are felt across the Scottish population – but the costs of obesity do not fall equally across the population. The research shows that the two-fifths of the population who live in the most deprived communities bear nearly half (48%) of the cost.
This analysis is based on the Scottish Index of Multiple Deprivation (SIMD), which looks at the relative deprivation across small areas in Scotland. The population can be split into groups of 20% corresponding to a ‘deprivation quintile’.
The cost of obesity drops as the level of deprivation reduces. The middle quintile absorbs 20% of the costs, the second-least deprived quintile 18% and the least deprived quintile experiences a 14% share of costs.
Future costs and potential savings
Nesta forecasts that if growth in obesity prevalence continues, the percentage of people living with obesity in Scotland could go up 1 percentage point from 30% in 2021 to 31% for adults and for children from 16% in 2019 to 17% by 2030.
Based on that projection, the total cost of obesity will increase by 12% between 2022 and 2030, reaching £5.9bn in 2030. The cumulative costs of obesity over this period are estimated to be £50.5bn.
These costs are reported in 2022 prices and do not account for inflation or make any adjustments for potential changes in costs in real terms. Future costs associated with obesity will therefore, in cash terms, be higher than estimated here.
The research suggests the inequality gap for obesity in Scotland is likely to become more pronounced in future, with the differences in costs between SIMD quintiles becoming greater by 2030. It predicts that in 2030, the two most deprived quintiles together will experience 50% of the total costs associated with obesity, up from 48% in 2022. Both obesity and severe obesity are projected to grow at a higher rate for the more deprived SIMD quintiles.
Nesta’s goal is to halve the prevalence of obesity by 2030. The Scottish Government has a policy aim, first stated in 2018, of halving childhood obesity by 2030. Cutting the prevalence of obesity across the population would have a significant impact on the cost of obesity, eventually reducing it by half as well.
For this report, we asked Frontier Economics to model two scenarios where more modest impact on obesity prevalence has been achieved.
Scenario 1
The first scenario assumes that the obesity rate will be kept constant at 2022 levels until 2030. Under this scenario, obesity costs continue to grow as a result of population growth, but not due to increasing rates of obesity. In 2030 total obesity costs would be £5.4bn, equivalent to £509m (or 9%) in avoided costs compared with our base case in 2030 alone. Cumulative avoided costs over the period 2022 to 2030 would be £2.3bn.
Scenario 2
The second scenario assumes that the forecast growth in obesity rates from 2022 to 2030 will be reduced by a half – from 1 percentage point to half a percentage point growth. Under this scenario, total obesity costs in 2030 would be £5.7bn, equivalent to £255 million (or 4%) in avoided costs compared with the base case in 2030 alone. Cumulative avoided costs would be £1.1bn.
Population-level calorie reduction in adults
We also looked at how obesity levels in Scotland could be reduced by improving our food environments.
The analysis uses population-level calorie reduction as a gauge for how obesity prevalence could be reduced by varying degrees, including a 50% reduction in line with Nesta’s healthy life mission goal.
Weight levels across the population – categorised as normal, overweight, obese and severely obese – are calculated using body mass index (BMI) data from the Scottish Health Survey (SHS). SHS data goes back as far as 1995 when obesity prevalence was 36% lower than 2019 levels, which is the latest available SHS publication that objectively measured BMI data. In order to calculate the calorie reduction needed to halve the prevalence of obesity across the population and in the different weight categories, values were extrapolated from trends in the existing data.
Nesta’s research shows that if improvements to our food environment lead to an on average reduction of 188 kcal per day for all adults – less than a 500ml bottle of a regular carbonated drink – that would be enough to halve the prevalence of obesity over as little as three years and increase the number of healthy years lived. For people living with some level of excess weight, which is 67% of the population, it would be a little more at 230 kcal – the equivalent of a typical milk chocolate bar.
Looking at the obesity crisis through the lens of total population calorie reduction allows us to quantify the scale of the challenge when it comes to lowering obesity prevalence. It can also provide a gauge to benchmark the impact of policy interventions designed to improve our food environments and tackle obesity.
Tackling childhood obesity in Scotland
It is a stated goal of the Scottish government to halve rates of childhood obesity
by 2030, with reference to obesity levels in 2016 when childhood obesity stood at 14%. This means reducing levels of childhood obesity to 7% when the latest data from 2019 shows mean obesity levels for children aged 2 to15 stand at 16.4%.
Further analysis from the Behavioural Insights Team has calculated a figure for calorie reduction required to reach the Scottish Government’s stated goal and uses that measure to estimate the impact of five potential interventions aimed at reducing childhood obesity.
The study calculates that, on average across all children living with obesity within the 2 to 15 year age range, a sustained reduction of 65 kcal per day – the equivalent of one digestive biscuit – would achieve the desired reduction in obesity from 16.4% to 7%. This represents a reduction of 3.0% in the daily calorie consumption of the average child living with obesity in Scotland.
It is important to note that 65 kcal per day is the weighted average of a range of estimates that vary by children’s age and sex, from 19 kcal per day to 142 kcal per day. In practice, a 65 kcal-per-day reduction in excess calories would be excessive for a two-year-old child, but insufficient for a 15-year-old living with obesity.
This report looks at five policies and their potential impact on childhood obesity in Scotland by estimating the expected average kcal-per-day reduction they are likely to achieve, with variation depending on adherence to the policy.
The policies
Sugar reduction targets
Introducing sugar reduction targets based on the UK Government’s broad, structured sugar-reduction programme to remove sugar from everyday products. This approach was outlined in its 2016 paper Childhood obesity: a plan for action which challenged all sectors of the food and drinks industry to reduce overall sugar across a range of products that contribute most to children’s sugar intakes by at least 20% by 2020.
Calorie reduction targets
Introducing calorie reduction targets based on the UK Government’s Calorie reduction: the scope and ambition for action from 2018, which included challenges to retailers and manufacturers to reduce calories by up to 10%, and the eating out of home, takeaway and delivery sector to reduce calories by up to 20%, by 2024. The programme focuses on everyday savoury foods and meals, meaning that there is no overlap with the foods included in the sugar reduction programme.
The HENRY programme
Implementing the Health, Exercise and Nutrition for the Really Young programme, a childhood obesity prevention programme that supports families with young children to develop healthy lifestyles. The programme is a universal service available across the UK for families with children aged 0–5.
Restricting unhealthy promotions
Restricting unhealthy food and drink promotions based on the Scottish Government’s commitment in its Programme for Government 2022-23 to bring forward legislation to restrict "unhealthier food and drink promotions".
Poverty reduction
The analysis also considered the potential impact of a reduction in childhood poverty on childhood obesity rates in Scotland. For example, through an increase in the Scotland Child Payment.
Each policy or intervention is considered in turn and the potential effects on calorie intake reduction calculated for a range of adherence rates. With notable caveats, the cumulative potential impact of the policies and programmes we have considered is estimated to be between 30.6% and 91.5% of the reduction in calories required to reach the 2030 obesity target, to a cumulative value of between £475m and £980m in QALYs gained for children.
There is no silver bullet but reducing obesity is achievable
Taken together, these three reports highlight the extent of the cost – to the public purse and to individuals – of the obesity crisis, but also that reducing obesity across the population is achievable.
There is no single silver bullet measure that would achieve significant reduction in obesity prevalence rates, instead, impact will require coordinated action across government, industry and wider society to implement a raft of policies.
Delivering interventions in our food environments – from reformulation, and restricting promotion of unhealthy food to working with governments and industry to improve the availability, accessibility and affordability of healthier options – are all essential if we are to turn the tide on obesity in Scotland.
We need to secure public support and political commitment for ambitious and effective measures to improve our food environments. These should aim to make the healthier choice the easy, cheap and attractive choice, whether we are eating in or out of our homes and irrespective of where we live.
We need to reduce prices and increase promotions of healthier food, restrict the flood of junk food adverts we see on a daily basis and make the food we buy and eat day to day healthier. These layers of policies, implemented across a range of settings, are urgently required to drive obesity levels down for the benefit of us all now and in the future.
Built with Shorthand