Cecchini and Sassi Israel Journal of Health Policy Research 2012, 1:18

http://www.ijhpr.org/content/1/1/18 Israel Journal of

Health Policy Research

COMMENTARY Open Access

Tackling obesity requires efficient government

policies
Michele Cecchini and Franco Sassi*

Abstract
Changes in food supply and eating habits, combined with a dramatic fall in physical activity, have made obesity a
global epidemic. Across OECD countries, one in two adults is currently overweight and one in six is obese.
Children have not been spared, with up to one in three currently overweight. Obese people are more likely to
develop diseases such as diabetes, cardiovascular disease, and cancer, and have a shorter life expectancy than
people of normal weight. A prevention strategy combining health promotion campaigns, government regulation,
counseling of individuals at risk in primary care, and paying special attention to the most vulnerable, would
enhance population health at an affordable cost, with likely beneficial effects on health inequalities. Failure to
implement such a strategy would impose heavy burdens on future generations. The new IJHPR paper by Ginsberg
and Rosenberg illustrates how particular countries can assess alternative strategies for tackling obesity in a rigorous
fashion.
This is a commentary on http://www.ijhpr.org/content/1/1/17/

Commentary recession and severe public finance restrictions, govern-

Obesity is one of the main drivers of the global epi- ments ought to ensure greater priority is given to inter-
demic of chronic diseases. As such, it has risen to the ventions that provide the largest health returns for the
top of the public health policy agenda worldwide. In the money spent. Ginsberg and Rosenberg conclude that a
last 30 years obesity rates have doubled or tripled in combination of prevention policies could increase popu-
many countries; currently, half of the OECD population lation health by 32,671 QALYs (quality-adjusted life
qualifies as overweight. Although the prevalence of obe- years) at a favorable cost-effectiveness ratio (US$12,800/
sity in Israel is below the OECD average (14% vs. almost QALY). These results are consistent with those of ana-
17% in the OECD, according to the latest data [1]), rates lyses jointly undertaken by OECD and WHO to assess
are increasing as rapidly as in other countries. Women the impacts of strategies to improve diets and increase
in disadvantaged socio-economic conditions are more physical activity [4]. The latter showed that the imple-
likely than others to be or become obese, and children mentation and running costs of most prevention inter-
born to obese parents are three to four times more ventions are larger than the savings in healthcare
likely to be obese themselves than those born to nor- expenditure generated by the same interventions. How-
mal-weight parents. Obesity has major impacts on labor ever, the extra costs are largely justified by the benefits
productivity, income, and healthcare expenditures. Esti- generated, in terms of decreased morbidity and mortal-
mates suggest that up to 6% of healthcare budgets are ity from chronic diseases, which make these interven-
spent on diseases related to obesity in the European tions a better investment than many treatments
region [2]. routinely provided by most health care systems.
Economic analyses, like the one by Ginsberg and Although interventions carried out in primary care
Rosenberg reported in this issue of the Journal [3], are settings, like some of those analyzed by Ginsberg and
badly needed to guide policy makers in tackling the ris- Rosenberg, appear to be effective and cost-effective, tak-
ing tide of obesity. Especially in times of economic ing action only with high-risk individuals is not suffi-
cient. These measures must be combined with
community-level interventions aimed at shifting the
* Correspondence: [email protected]
Health Division, OECD, 2 rue André Pascal, 75016 Paris, France
entire BMI distribution and lowering the population

© 2012 Cecchini and Sassi; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Cecchini and Sassi Israel Journal of Health Policy Research 2012, 1:18 Page 2 of 2
http://www.ijhpr.org/content/1/1/18

mean. As there is no smoking gun responsible for obe- Competing interests

The authors declare that they have no competing interests.
sity, there is no magic bullet to cure it. The current obe-
sity epidemic is the result of a large number of changes Received: 9 January 2012 Accepted: 18 April 2012
that affected people’s lifestyles over the past few dec- Published: 18 April 2012
ades, and it can only be tackled through a comprehen-
References
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Tackling of Unhealthy Diets, Physical Inactivity, and Obesity: Health
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Meeting of the General Assembly on the Prevention and Control of
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behaviors. In some cases appropriate measures can be view_doc.asp?symbol=A/66/L.1].
taken to increase coverage and uptake, for instance doi:10.1186/2045-4015-1-18
financial incentives can be provided to increase the Cite this article as: Cecchini and Sassi: Tackling obesity requires efficient
number of physicians who choose to participate in pri- government policies. Israel Journal of Health Policy Research 2012 1:18.

mary-care-based programs. But ensuring a meaningful

uptake in community-based programs can be even more
challenging.
OECD and WHO studies [5,6] provide evidence in
support of the adoption of a multi-sectoral and multi-
stakeholder approach. This conclusion is endorsed by
the political declaration that resulted from the High-
level Meeting of the UN General Assembly on NCDs,
held in New York in September 2011 [7] in which it is
recognized that “The incidence and impacts of non-
communicable diseases can be largely prevented or
reduced with an approach that incorporates evidence-
based, affordable, cost-effective, population-wide and
multisectoral interventions.” A multi-sectoral approach,
combining interventions that target different population
groups, paying special attention to the most vulnerable,
would enhance population health at an affordable cost,
with likely beneficial effects on health inequalities.

Authors’ information
Franco Sassi, PhD, is a Senior Health Economist at the Organisation for Submit your next manuscript to BioMed Central
Economic Cooperation and Development (OECD), based in Paris. Formerly a
and take full advantage of:
senior lecturer at the London School of Economics and Political Science, he
held visiting positions in a number of leading North American universities.
He has published extensively on the economics of public health and health • Convenient online submission
care interventions, and he leads the OECD Economics of Prevention • Thorough peer review
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Michele Cecchini, MD MSc, is a Health Policy Analyst at the Organisation for
Economic Cooperation and Development (OECD), based in Paris. A public • Immediate publication on acceptance
health physician by training, he is part of the OECD Economics of • Inclusion in PubMed, CAS, Scopus and Google Scholar
Prevention team and has played a major role in the analysis of policies to
tackle obesity based on the OECD/WHO Chronic Disease Prevention (CDP) • Research which is freely available for redistribution
microsimulation model.
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