Obesity is a state of excessive body fat accumulation and is difficult to measure. Body mass index (BMI)—defined as weight in kilograms divided by the square of height in meters—has been used traditionally for its simplicity and the availability of data. Although shortcomings of using BMI have been acknowledged, its correlation with body fat percentage and its sensitivity in diagnosing obesity based on the body fat percentage have been verified for Korean people (Chung et al. 2016).
Examination of the evidence on obesity shows that the obesity rate is higher among adult males than adult females and also higher for the self-employed than employed adults. The obesity rate shows a weak U-pattern with income for employed adults. The rate has also been growing over time, especially for males and younger adults, indicating the likelihood of increasing obesity in the future.
Obesity has a clearly measurable impact on health and health-related costs. The World Health Organization (2009) estimates overweight and obesity to be the third-greatest risk factors after tobacco use and high blood pressure in high-income countries (those with 2004 gross national income per capita in excess of $10,066), including the Republic of Korea, and are responsible for 8.4% of deaths.
My latest research (Chung 2017) estimates obesity-related medical costs using representative and reliable data. The findings show that obesity (relative to having a BMI of less than 25) is associated with W5, 000 (in 2010 won) in higher medical costs for male adults and W77, 000 (in 2010 won) in higher medical costs for female adults. Severe obesity (relative to having a BMI of less than 30) increases medical costs far more than obesity for both males and females, indicating higher cost effects for the severely obese. Moreover, obesity is shown to cause greater increases in medical costs for relatively unhealthy individuals at higher percentiles of medical costs.
Following from these effects of obesity on medical costs, the aggregate obesity-related medical costs in the Republic of Korea are estimated to be W35.8 billion (in 2010 won) for males and W306.5 billion (in 2010 won) for females. Furthermore, obesity is positively associated with disability, indicating another cost of obesity. Therefore, the condition is associated with the significant economic burden of medical costs and disability in the country.
Good and reliable estimates of obesity’s economic burden can help us to develop and prioritize appropriate health interventions for reducing obesity. However, our estimated economic burden of obesity may be underestimated to the extent that those with limited access to medical care, such as the poor, are more likely to be obese, as shown in the literature (Cawley and Meyerhoefer 2012).
The fundamental cause of obesity is an imbalance between calories consumed and calories expended. According to the United States National Institutes of Health (https://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks), other causes include lack of physical activity, unhealthy eating behaviors, not enough sleep, high amounts of stress, age, unhealthy environments, family history and genetics, and race, ethnicity, and gender-related factors.
The Organisation for Economic Co-operation and Development (2010) found that interventions, such as health education and promotion, regulation and fiscal measures, and counselling in primary care, are effective in tackling obesity and have favorable cost-effectiveness ratios relative to the scenario where chronic diseases are treated only as they emerge.
The concerned ministries and laws have introduced many interventions to improve diets and increase physical activity in the Republic of Korea. For example, the Ministry of Health and Welfare provides budget support to local government obesity programs, develops and publicizes educational materials, and provides vouchers for physical activity and diet-related management services for obese children. The National School Lunch Act, introduced in 1981, has provisions on school dietitians, nutritional requirements, and dietary consultations.
However, assessments by experts have deemed such interventions to be poorly coordinated and overly focused on children. Moreover, notably, the Organisation for Economic Co-operation and Development advises that combining interventions in a multiple-intervention strategy can provide affordable and cost-effective solutions and significantly enhance health gains relative to isolated actions.
To read the full working paper, click here.
Cawley, J., and C. Meyerhoefer. 2012. The Medical Care Costs of Obesity: An Instrumental Variables Approach. Journal of Health Economics, 31.
Chung, W. 2017. Economic Impact of Obesity in the Republic of Korea. ADBI Working Paper. Tokyo: Asian Development Bank Institute.
Chung W., C. G. Park, and O. Ryu. 2016. Association of a New Measure of Obesity with Hypertension and Health-related Quality of Life. PLoS One 11(5): e0155399.
Organisation for Economic Co-operation and Development. 2010. Obesity and the Economics of Prevention: Fit not Fat. Paris: OECD Publishing.
World Health Organization. 2009. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: WHO Press.