to be taken for granted, especially in developed economies.
However, economic prosperity has been accompanied by a rising
prevalence of obesity in many countries and with it an increase in
obesity-related disease that some experts warn could reverse rising
life expectancy.
Reinsurance group Swiss Re has termed obesity an “escalating
global epidemic” and one too significant for the life insurance
industry to ignore. The scale of the obesity problem is vividly
evident in the US and UK where, according to Swiss Re, obesity
increased two to threefold in the last 20 years. Other developed
countries and even some developing countries display similar
patterns of increase.
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A silent killer, obesity is measured in terms of the body mass
index (BMI) indicator developed by United Nation’s agency the World
Health Organisation. BMIs are calculated by dividing a person’s
weight in kilograms by the square of their height in metres. BMIs
are grouped into five groups:
• Healthy weight: BMI between 18.6 and 24.9
• Overweight: BMI between 25 and 29.9
• Obesity: BMI between 30 and 34.9
• Severe obesity: BMI between 35 and 39.9
• Morbid obesity: BMI over 40
So serious has the prevalence of obesity become in many countries
that some experts are warning that it could spell an end to rising
life expectancy. Among the most outspoken of these are Stuart J
Olshansky, professor of epidemiology at the University of
Illinois’s School of Public Health; Leonard Hayflick, professor at
the University of California’s (San Francisco) School of Medicine;
and Robert N Butler president and CEO of research body the
International Longevity Centre.
In a study conducted with the US Department of Health and Human
Services the academics warned the US could face a sustained drop in
life expectancy if urgent steps were not taken to reduce the
prevalence of obesity, particularly amongst children and young
adults.
For actuaries already battling with life expectancy projections the
authors sounded a special note, warning: “Forecasting life
expectancy by extrapolating from the past is like forecasting the
weather on the basis of its history. We see a threatening storm –
obesity – that will, if unchecked, have a negative effect on life
expectancy.”
According to international economic body the Organisation for
Economic Co-operation and Development (OECD) about one third of
Americans aged 15 and over are obese and a further one third are
overweight. However, while this is the highest level in the world
other countries are not far behind.
In the UK the University of Oxford’s Department of Primary Health
Care estimates that in England 17 percent of men and 21 percent of
women are obese and an additional 46 percent of men and 32 percent
of women are overweight. According to the OECD this puts the UK in
second position as the country with the highest prevalence of
obesity. Among OECD member countries, the UK is followed by
Australia, New Zealand and Canada, all within an adult obesity
prevalence range of 18 percent to 21 percent.
The lowest prevalence of obesity in an OECD country is in Japan at
about 3 percent. Notably, according to US Central Intelligence
Agency Japan ranked third in the world in 2007 in terms of life
expectancy at birth: 85.56 years for women and 78.67 years for men.
The US ranked 45th in terms of life expectancy at birth: 80.97
years for women and 75.15 years for men.
Health impairment as a result of obesity is significant. Among the
key areas highlighted by US federal agency the National Institutes
of Health are:
• Diabetes: For each additional unit of BMI over 22, the
relative risk of diabetes rises by about 25 percent. Of diabetics,
46 percent have a BMI of 30 or over.
• Coronary heart disease: Compared with BMIs of less than 21
risk of non-fatal myocardial infarction and coronary heart disease
death was double at BMIs of 25 to 28.9 and more than triple at BMIs
of 29 or greater.
• High blood pressure: Hypertension occurs among 38.4 percent
of men and 32.2 percent of women with BMIs of 30 or more compared
with 18.2 percent of men and 16.5 percent of women with BMIs of 25
or lower.
• Stroke: Risk is 137 percent higher in women with BMIs over
32, compared with women having BMIs under 21.
• Cancer: Mortality rates from all cancers combined in
individuals with a BMI of 40 or more are 52 percent higher for men
and 62 percent higher for women than the corresponding rates in
normal-weight men and women.
With higher levels of obesity also comes higher medical costs borne
by health insurers or the state. According to the Texas US-based
Baylor College of Medicine the estimated annual cost of obesity in
the US is about $125 billion of which half is for direct medical
costs. The other half is accounted for by the value of wages lost
by those unable to work because of obesity related illness or
disability.
The message is getting through to insurers, both in the health and
life sectors. Health insurers are placing their hope on programmes
aimed at encouraging and rewarding customers for leading healthier
lifestyles. Many life insurers are taking a harsher stance by
heavily penalising obese customers.
Action taken by UK life insurers in particular was the recipient of
recent intense media coverage headlined by comments such as “fat
tax on the obese.” Premium loading of obese customers was reported
to range from 50 percent for those with a BMI over 30 to 400
percent for particularly high risk obese customers such as
smokers.
