obese live longerand are more diseased than people being of normal
weight? A potential explanation is that obesity experts tend to focus on
the bads and not the goods of obesity. In line with this hypothesis it is
interesting to focus on the phrase “obesity paradox.” This refers to the
research finding that among the obese population the prevalence of certain
diseases is higher, but so are the chances of survival: “To date, scientists
have documented these findings in patients with heart failure, heart disease,
stroke, kidney disease, high blood pressureand now diabetes” (Brown,
2012 ).^10
If overweight people live longer, are at higher risk of chronic disease,
and have a higher chance of surviving those diseases then, of course, it
must be the case that they place a relatively high burden on the health-care
system. For the United States the CDC states: “The medical care costs of
obesity in the United States are staggering. In 2008 dollars, these costs
totaled about $147 billion.”^11 Already in 2003BMJreported: “The direct
cost of obesity to the NHS is£0.5bn ($0.9bn;h0.7bn), while the indirect
cost to the UK economy is at least£2bn, Liam Donaldson, England’s chief
medical officer, told a conference in London last week.”^12 The counter-
claim to this depends on the acceptance of the mortality claim. As long as
that claim was dominant one could argue that preventing overweight would
lead to more people living longer. And that would imply increasing health
costs of its own, which raises the question whether overweight prevention
is cost effective. However, as the mortality claim is weakened and to
some extent even reversed, this makes the morbidity claim all the more
convincing.
The dominant explanation obesity experts give for the epidemic involves
animbalance of “energy inversusenergy out” at the individual level and
the existence of an “obesogenic environment” in modern, industrialized,
and prosperous nations. Therefore, as industrialization and prosperity
spread across the globe so will obesity. According to this explanation we
can extrapolate present growth rates in prevalence in order to make
prognoses about the future. In the United Kingdom the Foresight Report
on obesity, for instance, calculates:
The extrapolation of current trends, which underpins the microsimulation, indicates
that, by 2015, 36% of males and 28% of females will be obese. By 2025, these
figures are estimated to rise to 47% and 36% respectively. By 2050, 60% of males and
50% of females could be obese. The proportion of men having a healthy BMI declines
from about 30% at present to less than 10% by 2050. Similarly, the proportion of
women in this “healthy weight” category drops from just over 40% to about 15% by- (UK Government Office for Science, 2007, p. 34)
124 ROEL PIETERMAN