While many countries watch their financial debts mount, there is another ticking timebomb walking the streets, says obesity expert Professor Tony Leeds.
In this week’s Scrubbing Up, he warns that obesity could cost countries trillions in ill health and corrective surgery, and that for many, the problem is already so large that it’s too late for focusing on prevention.
The UK’s obesity problem has grown so much now that nearly a million obese Britons may be eligible for weight-reduction surgery. But it will take a bold government to treat them all - because the cost will exceed a staggering £9.1bn.
And that’s just the down payment.
The one-off cost of surgery for 910,000 people is about £10,000 each for gastric banding which restricts the amount of food eaten, or gastric bypass surgery.
During bypass surgery the stomach size is reduced and some of the small gut, where food is absorbed, is bypassed so that the smaller meals eaten are absorbed less efficiently, resulting in weight loss.
Bypass surgery - the current UK preference - must be followed by life-long monitoring and daily vitamin supplements.
So an annual screening of health and nutritional status is also needed, which could total £700 per person annually - possibly totalling another £637m nationally.
Over 10 years, this will amount to another £1.6 bn and that’s before considering any cosmetic implications such as getting rid of the excess flaps of loose skin left after weight loss.
And with obesity rates rising, these sums would not provide for all the others who will qualify for surgery next year, and the year after that, and the year after that.
But if we don’t treat them, the cost - in money and lives - also mounts.
People who qualify for surgery often need care - over many years - for other conditions including diabetes, heart disease and arthritis. Untreated, their risk of premature death is high.
With surgery 60% to 90% get resolution of their diabetes, with an overall cost-saving on healthcare about three years after surgery.
But before anyone thinks that the problem stops here, think again.
To date, we have only been talking about little more than 2% of the UK population - the morbidly obese.
CALCULATE YOUR BODY MASS INDEX
Healthy weight range is based on a measurement known as the body mass index (BMI)
Calculated by dividing weight in kilograms by height in metres squared
A BMI of 18.5 - 24.9 is considered healthy
A BMI of 25 to 29.9 is considered overweight
A BMI of 30 or more is considered obese
In fact, 62% of Britons are already obese or overweight, so government can no longer treat this as an issue of obesity prevention.
Around 13m people fall into an intermediate category where, ineligible for surgery, they nevertheless may benefit from losing 10 to 30kg (20 to 60 pounds).
So what should be done?
For government, there is no clearly defined strategy - GPs can offer dietary advice at one end of the scale, or surgery at the other. They can urge people to turn to some of the commercial dietary plans, but there are few partnerships to achieve this.
Any incoming government must look at all the options, including a health economics analysis of costs and benefits of obesity surgery for the morbidly obese.
There could be refinement of criteria for eligibility for surgery. For example, limiting it to groups, such as those with diabetes, proven by clinical trials to benefit from it.
There could be shared costs between the patient and the state for some procedures - gastric band insertion, for example.
There should be more training of doctors and nurses in obesity management.
These and other questions need to be addressed as a matter of urgency by a national task-force or commission charged with giving both interim and longer-term answers.
If they don’t, the problem will - quite literally - keep expanding.
Professor Tony Leeds
Obesity management specialist, Central Middlesex Hospital