McKinsey Global Institute McKinsey Global Institute Overcoming obesity: An initial economic analysis obesity: An initial Overcoming November 2014 Overcoming obesity: An initial economic analysis Discussion paper The McKinsey Global Institute The McKinsey Global Institute (MGI), the business and economics research arm of McKinsey & Company, was established in 1990 to develop a deeper understanding of the evolving global economy. Our goal is to provide leaders in the commercial, public, and social sectors with the facts and insights on which to base management and policy decisions. MGI research combines the disciplines of economics and management, employing the analytical tools of economics with the insights of business leaders. Our “micro-to-macro” methodology examines microeconomic industry trends to better understand the broad macroeconomic forces affecting business strategy and public policy. MGI’s indepth reports have covered more than 20 countries and 30 industries. 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For further information about MGI and to download reports, please visit www.mckinsey.com/mgi. Copyright © McKinsey & Company 2014 McKinsey Global Institute November 2014 Overcoming obesity: An initial economic analysis Discussion paper Richard Dobbs Corinne Sawers Fraser Thompson James Manyika Jonathan Woetzel Peter Child Sorcha McKenna Angela Spatharou Preface The world has made huge advances in containing developed an initial assessment of their cost-effectiveness infectious diseases, but that progress is being partially and the potential scale of their impact if they were applied offset by a sharp rise in the incidence of heart and lung at a national level. As a start, we have tested this for the disease, diabetes, lifestyle-related cancers, and other United Kingdom, an example of a developed economy non-communicable diseases. One of the major drivers in which the prevalence of obesity is rising. In doing this, of the increase in these diseases is the rising prevalence we have relied on the evidence of the impact of these of obesity. interventions when applied somewhere in the world. We have not independently verified the analysis of each Obesity is a complex, systemic, multi-causal problem, intervention or the third-party research, an important rooted in the sedentary nature of modern post-industrial caveat that we return to in this paper’s discussion of the life, more widely available and more affordable food, quality of the evidence in this complex area. a change in the nature and mix of diets, psychological stimuli such as stress and epigenetic triggers, and We explore the key questions about what action is going potentially even physiological disruption to the gut to be required to abate obesity, and we discuss some of microbiome. There is considerable ongoing academic the major barriers to that action for different sectors of research into the scale and causes of the rapidly rising society. We identify priority intervention areas that could obesity epidemic. Researchers are digging deep into form part of an effective response to turn the obesity specific questions and analyzing potential solutions. trajectory, and we suggest approaches that could help However, there is a lack of integrated analysis of the to get that program off the ground. We have a particular holistic program that would be needed to reverse rising focus on behavioral interventions that can improve obesity, and what it would take to start to deliver such nutrition and physical activity. We do not directly address a program. clinical questions such as the role of different nutrients or genetics, leaving those to the scientists. Moreover, This discussion paper seeks to start to close this gap. because this research focuses on obesity, we capture We set out to learn as much as possible from existing only the health benefits delivered by physical activity and research and build on it with our own understanding other interventions that change body mass index (BMI). of micro- and behavioral economics, and McKinsey’s However, we acknowledge that BMI changes give only a experience and research across sectors, including partial picture of the full health benefits of physical activity. consumer-facing, public, and health-care sectors. Our aim then has been to step back and attempt to develop Almost everyone reading this discussion paper will a perspective on what might be the building blocks of a disagree with some parts of it, partly because of the societal response that could overcome rising obesity. As polarized nature of the debate on obesity but arguably with all MGI research, this has not been funded by any more because obesity is a complex, systemic issue company, government, or external organization but by the with no simple solution. This means that analysis on the partners of McKinsey. potential impact of an intervention is valid from some perspectives, but limited from others. We regard this In this discussion paper, the McKinsey Global Institute has discussion paper as an initial contribution and thought- cataloged a comprehensive list of interventions that are starter on what it is likely to take to address rising obesity. being used or piloted somewhere in the world by central Our hope is that this analysis will be built on in the future and local governments, employers, schools, health-care as the collective knowledge base, and therefore the ability systems, food retailers, manufacturers, and foodservice to respond to this crisis, is expanded. providers. We have identified 74 interventions and This analysis was led by Richard Dobbs, a McKinsey Worthing West; Baroness Virginia Bottomley, Nettlestone; and MGI director based in London; Peter Child, a Karen Campbell, Deakin University; Frank Chaloupka, McKinsey director based in London specializing in University of Illinois at Chicago; Michel Chauliac, Ministry consumer goods; Sorcha McKenna, a McKinsey partner of Health and Sport, France; Rachel Craig, Health in Dublin specializing in consumer goods and health Survey for England, United Kingdom; Steven Cummins, care; Robin Nuttall, a partner in McKinsey’s Strategy London School of Hygiene and Tropical Medicine; Practice in London; James Manyika, a McKinsey and Antoine de Saint-Affrique, Unilever; Ravi Dhar, Yale MGI director based in San Francisco; Angela Spatharou, School of Management; Peter Dolan, ChildObesity180; a McKinsey partner specializing in health care in Mexico Dustin Duncan, New York University Langone Medical City; Fraser Thompson, a MGI senior fellow based in Center; Brian Elbel, New York University Langone Singapore; and Jonathan Woetzel, a McKinsey and MGI Medical Center; Charlotte Evans, University of Leeds; director based in Shanghai. Corinne Sawers, a McKinsey Peter Freedman, managing director, The Consumer consultant in London, led the project team, which Goods Forum; Simone French, University of Minnesota; comprised Simon Alfano, Alexia Cesar, Kate Forster, Alan Garber, Harvard University; Fiona Geaney, University Sumeet Jha, Sakshi Mor, Ainhoa Manterola Solans, and College Cork; Moria Golan, Hebrew University of Alison Underwood. Jerusalem; David Halpern, UK Government Behavioural Insights Team; Lisa Harnack, University of Minnesota; We would like to thank the panel of academic advisers Corinna Hawkes, World Cancer Research Fund; to this discussion paper, whose diversity of expertise Katy Hunter, Transport for London; Stephen Jan, reflects the multifaceted nature of the issue, and University of Sydney Medical School; Martyn Jones, who have provided invaluable advice, guidance, and Morrisons; David Just, Cornell University Center for pressure test: Dr. William H. Dietz, director, Strategies Behavioral Economics; Scott Kahan, Johns Hopkins to Overcome and Prevent Obesity Alliance, Milken and George Washington universities; Ariane Kehlbacher, Institute School of Public Health, George Washington University of Reading; David Lee, Department for University; Kevin D. Hall, senior investigator, Laboratory Environment, Food, and Rural Affairs, United Kingdom; of Biological Modeling, Integrative Physiology Section, George Loewenstein, Carnegie Mellon University and National Institute of Diabetes and Digestive and Kidney London School of Economics; Carlos Monteiro, University Diseases; Philip James, president of the International of São Paulo; Mike Rayner, Nuffield Department of Association for the Study of Obesity and projects Population Health, University of Oxford; Christina Roberto, director of the World Public Health Nutrition Association; Harvard School of Public Health; Kim Roberts, HENRY; Susan Jebb,