Society and culture : Obesity

Economic impact

In addition to its health impacts, obesity leads to many problems including disadvantages in employment^[184][185] and increased business costs. These effects are felt by all levels of society from individuals, to corporations, to governments.

In 2005, the medical costs attributable to obesity in the US were an estimated $190.2 billion or 20.6% of all medical expenditures,^{[186][187][188]} while the cost of obesity in Canada was estimated at CA$2 billion in 1997 (2.4% of total health costs).^[68] The total annual direct cost of overweight and obesity in Australia in 2005 was A$21 billion. Overweight and obese Australians also received A$35.6 billion in government subsidies.^[189] The estimate range for annual expenditures on diet products is $40 billion to $100 billion in the US alone.^[190]

Obesity prevention programs have been found to reduce the cost of treating obesity-related disease. However, the longer people live, the more medical costs they incur. Researchers therefore conclude that reducing obesity may improve the public's health, but it is unlikely to reduce overall health spending.^[191]

Services must accommodate obese people with specialist equipment such as much wider chairs.^[192]

Obesity can lead to social stigmatization and disadvantages in employment.^[184] When compared to their normal weight counterparts, obese workers on average have higher rates of absenteeism from work and take more disability leave, thus increasing costs for employers and decreasing productivity.^[193] A study examining Duke University employees found that people with a BMI over 40 kg/m² filed twice as many workers' compensation claims as those whose BMI was 18.5–24.9 kg/m². They also had more than 12 times as many lost work days. The most common injuries in this group were due to falls and lifting, thus affecting the lower extremities, wrists or hands, and backs.^[194] The Alabama State Employees' Insurance Board approved a controversial plan to charge obese workers $25 a month for health insurance that would otherwise be free unless they take steps to lose weight and improve their health. These measures started in January 2010 and apply to those state workers whose BMI exceeds 35 kg/m² and who fail to make improvements in their health after one year.^[195]

Some research shows that obese people are less likely to be hired for a job and are less likely to be promoted.^[180] Obese people are also paid less than their non-obese counterparts for an equivalent job; obese women on average make 6% less and obese men make 3% less.^[196]

Specific industries, such as the airline, healthcare and food industries, have special concerns. Due to rising rates of obesity, airlines face higher fuel costs and pressures to increase seating width.^[197] In 2000, the extra weight of obese passengers cost airlines US$275 million.^[198] The healthcare industry has had to invest in special facilities for handling severely obese patients, including special lifting equipment and bariatric ambulances.^[199] Costs for restaurants are increased by litigation accusing them of causing obesity.^[200] In 2005 the US Congress discussed legislation to prevent civil lawsuits against the food industry in relation to obesity; however, it did not become law.^[200]

With the American Medical Association's 2013 classification of obesity as a chronic disease,^[10] it is thought that health insurance companies will more likely pay for obesity treatment, counseling and surgery, and the cost of research and development of fat treatment pills or gene therapy treatments should be more affordable if insurers help to subsidize their cost.^[201] The AMA classification is not legally binding, however, so health insurers still have the right to reject coverage for a treatment or procedure.^[201]

In 2014, The European Court of Justice ruled that morbid obesity is a disability. The Court argued that if an employee's obesity prevents him from "full and effective participation of that person in professional life on an equal basis with other workers", then it shall be considered a disability and that firing someone on such grounds is discriminatory.^[202]

Size acceptance

United States President William Howard Taft was often ridiculed for being overweight

The principal goal of the fat acceptance movement is to decrease discrimination against people who are overweight and obese.^[203][204]However, some in the movement are also attempting to challenge the established relationship between obesity and negative health outcomes.^[205]

A number of organizations exist that promote the acceptance of obesity. They have increased in prominence in the latter half of the 20th century.^[206] The US-based National Association to Advance Fat Acceptance (NAAFA) was formed in 1969 and describes itself as a civil rights organization dedicated to ending size discrimination.^[207]

The International Size Acceptance Association (ISAA) is a non-governmental organization (NGO) which was founded in 1997. It has more of a global orientation and describes its mission as promoting size acceptance and helping to end weight-based discrimination.^[208] These groups often argue for the recognition of obesity as a disability under the US Americans With Disabilities Act (ADA). The American legal system, however, has decided that the potential public health costs exceed the benefits of extending this anti-discrimination law to cover obesity.^[205]

Childhood obesity

The healthy BMI range varies with the age and sex of the child. Obesity in children and adolescents is defined as a BMI greater than the 95th percentile.^[15] The reference data that these percentiles are based on is from 1963 to 1994 and thus has not been affected by the recent increases in rates of obesity.^[16] Childhood obesity has reached epidemic proportions in the 21st century, with rising rates in both the developed and developing world. Rates of obesity in Canadian boys have increased from 11% in the 1980s to over 30% in the 1990s, while during this same time period rates increased from 4 to 14% in Brazilian children.^[209]

As with obesity in adults, many factors contribute to the rising rates of childhood obesity. Changing diet and decreasing physical activity are believed to be the two most important causes for the recent increase in the incidence of child obesity.^[210] Because childhood obesity often persists into adulthood and is associated with numerous chronic illnesses, children who are obese are often tested for hypertension, diabetes, hyperlipidemia, and fatty liver.^[68] Treatments used in children are primarily lifestyle interventions and behavioral techniques, although efforts to increase activity in children have had little success.^[211] In the United States, medications are not FDA approved for use in this age group.^[209]