by Sarah Hill
It’s December and in the UK there are a few things I can be sure about at this time of year: I can’t go anywhere without hearing Mariah Carey or Michael Bublé at least 10 times a day, wearing jumpers that jingle every time I move is completely acceptable (finally!) and I will see more tempting Christmas foodstuffs than I will daylight on a daily basis. You may expect things to be a little different working at the Institute of Health and Society, however don’t be deceived by the name, it is very much a “do as we say, not as we do” attitude here when it comes to the consumption of cake and biscuits. This is especially the case this time of year between Christmas lunches and festive baking and I can rest assured that we are not exceptional.
Before I get cast as the Grinch who stole the Christmas buffet, I would like to preface the rest of this blog by explaining that I’m not saying we shouldn’t all enjoy ourselves at Christmas. My challenge to work my way through the entire Costa festive drinks menu and daily mince pie habit places me at worst as a hypocrite. I’m also not going to make any outlandish claims that we are all going to become obese from a week or two of excess; however at this particular time of the year when the temptation to overindulge is at its height it seemed a fitting time to discuss the very serious issue of the obesity crisis that has been sweeping our nation for many years now.
We all justify going a little wild at Christmas in some way: “it’s only once a year”, “I’ll do dry January”, “Christmas shopping is cardio”. Most of us accept that we will probably put on a few pounds over Christmas with the expectation that we’ll lose them again come January when all the fun is over. For most people this is probably the case and a bit of Christmas excess isn’t a big deal, but what about those who don’t manage to lose the Christmas weight? A few extra pounds may not seem like a lot but if this is an annual occurrence it will add up over the years to the point where obesity, or at least becoming overweight, is inevitable. You may stop for a moment to think about how this affects your own health given the array of comorbidities that are related to obesity, but do you ever stop to think about how it may affect others?
Christmas is traditionally a time for giving and thinking of others, but do we ever extend this mentality to our health? According to data collected by the Health Survey for England, in 2014 approximately 62% of adults  and a third of children aged 2-15  in England were overweight or obese. Obesity is a real problem in the UK and can have damaging effects on an individual’s health and well-being. However, unlike other public health issues like smoking where the negative effects on others are perhaps more visible, the social costs of obesity are often forgotten. There are 3 main ways that obesity imposes costs on society: through lost productivity, increased welfare payments and opportunity costs of treatment foregone.
Workplace productivity can be influenced in several ways due to obesity; firstly individuals of working age who are unable to work due to obesity-related health conditions are not contributing to the productive economy as they would be in full health. Secondly, individuals who are able to work may be working less efficiently than would be expected (also known as presenteeism) or may be absent from work through sick leave or other unexplained absences regularly (also known as absenteeism). A number of studies  have shown a positive association between rates of presenteeism and absenteeism and high BMI.
Buckhouser and Cawley found that being obese significantly increases the probability of an individual receiving disability payments, therefore those mentioned earlier who are unable to work due to obesity-related disability also incur an avoidable burden on social welfare from the receipt of welfare payments which are funded through tax revenue.
Opportunity cost of treatment foregone
An opportunity cost refers to the cost of foregone spending because resources have been deployed elsewhere. In the UK, the NHS spent over £5 billion (more than 10% of the total NHS budget) in 2006/7 treating obesity related ill-health. In a publicly-funded health system with a fixed budget such as the NHS, that spend on obesity-related treatment represents resources that cannot be used to fund other treatments or prevention services. Therefore, this opportunity cost represents a further cost on society who fund the National Health Service through taxes and who may find that services they would like to be provided cannot be due to resource constraints.
A further issue linked to having a publicly-funded healthcare is that it provides little incentive to prevent or reduce obesity from the side of medical care. Whilst it is hugely valuable to have a non-exclusionary, free-at-the-point-of-access healthcare system, the fact that we know that there will be treatment and help available should we become sick doesn’t encourage self-care and preventive measures on the part of individuals.
So, over the next week when you indulge in that mince pie or slice of Christmas cake perhaps you’ll spare a thought for others and consider going for a walk after and eating those sprouts at dinner to keep everything in balance.
Have a very merry Christmas!
 Goetzel, R. Z., et al. (2010). “A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker productivity.” J Occup Environ Med 52 Suppl 1: S52-58.
 Wang, Y. C., et al. (2011). “Health and economic burden of the projected obesity trends in the USA and the UK.” Lancet 378(9793): 815-825.
 Gupta, S., et al. (2015). “The humanistic and economic burden associated with increasing body mass index in the EU5.” Diabetes Metab Syndr Obes 8: 327-338.