Perspectives on Innovative Approaches to Obesity Treatment and Prevention in Denmark A mixed methods interview and survey study A Master Thesis Project by Liubov Aleksandrova Programme: MSc in Business Administration and Innovation in Healthcare Department of Strategy and Innovation Primary supervisor: Professor John C. Christiansen, Department of Operations Management Secondary supervisor: Susie Ruff, MBA, External Lecturer Student number: 91441 Total number of characters (with spaces): 100000 Total number of pages: 65 pages Date of Submission: January 15th 2020 1 Page intentionally left blank 2 Acknowledgements I would like to express my gratitude to everyone, who supported and guided me through this project. First of all, my academic supervisors, John and Susie, for being objective and critical throughout the project and engaging in content development. I would also like to thank Ksenia Chekina for supporting me through the final stages of the project and offering her guidance on the biochemistry content and the industry landscape. I am beyond happy to have met and spoken with the talented people working in Novo Nordisk and patient organisations - Cancer Prevention (Kræftens Bekæmpelse) and the Adiposity Union (Adipositasforeningen). Without your passion for improving the obesity care in Denmark and worldwide, this project would not have been possible. I would like to thank Nicholas Finer, Pernille Auerbach, Lene Kring, Gitte Laub Hansen and Bjarne Lynderup for your interest in and personal contribution to the project. I am grateful for my family and friends for bearing with me when the going got rough and when all the conversation topics mysteriously ended on obesity prevention and nutrition, and for any stranger who was brave enough to ask what my Master Thesis topic was. I only hope that this can be one of the many steps necessary to offer understanding, recognition and care that is needed in this area! Foreword I believe that exploring and vocalizing challenges in this area is extremely important for the benefit of the general population. Obesity and the health complications associated with it are no longer limited to a smaller group of people in a population and beyond influencing individual quality of life also have a significant impact on the challenged healthcare budgets worldwide. In some countries, half or more of the population is overweight and a third is obese. I have always been doing competitive sports and have taken physical fitness and health for granted. I have also coached children in Denmark (Herlev Atletikklub) almost ever since I came to Denmark and I can unfortunately see the negative development in the fitness of the children every time we recruit at the beginning of the season. It is excruciating that some people end up with poor health because of the lack of understanding and that more and more children become overweight and obese even before puberty. Through the MSc in Business Administration and Innovation in Healthcare, I have become more and more curious of the mechanisms that govern the public health priorities, the treatments offered and the health trends in populations. This topic is of utter relevance to the Danish welfare landscape, since obesity has roots in many factors that the welfare system can control and has consequences for many budget areas, such as healthcare, early retirement and unemployment benefits. 3 Table of Contents Abbreviations ................................................................................................................................ 8 1. Introduction .......................................................................................................................... 9 1.1 Obesity: Background ......................................................................................................... 12 1.1.1 What is obesity and why is this disease a concern for public health? ....................... 12 1.1.2 Lipogenesis and evolution: Mechanism and Rationale .............................................. 13 1.1.3 What are the symptoms of obesity? .......................................................................... 15 1.1.4 What are stages of obesity? ....................................................................................... 16 1.1.5 Importance of appearance, ethics and body positivity .............................................. 17 1.2 Causes of obesity ............................................................................................................... 18 1.2.1 Why do persons become obese? ............................................................................... 18 1.2.2 Can obesity be cured? ................................................................................................ 19 1.2.3 Can obesity be prevented, when and how? ............................................................... 19 1.2.4 Reasons for the increase in the number of persons with obesity despite the evidence of adverse health effects ..................................................................................................... 20 1.3 Consequences for individuals ............................................................................................ 21 1.3.1 Who is at risk of obesity? ........................................................................................... 21 1.3.2 What are co-morbidities associated with obesity? .................................................... 21 1.4 Consequences for society.................................................................................................. 24 1.5 Treatment options ............................................................................................................ 26 1.6 Evaluation of Health Care Interventions ........................................................................... 27 1.6.1 Cost-Benefit and Cost-Effectiveness Analyses in Public Health Policy Decision Making ............................................................................................................................................. 27 1.7 Structure and Financing of the Danish Health Care System ............................................. 29 1.7.1 Burden of diseases in Denmark .................................................................................. 30 2. Mission of the thesis ............................................................................................................... 31 2.1 Problem Formulation ........................................................................................................ 31 2.2 Research Questions ........................................................................................................... 32 3. Materials and Methods ........................................................................................................... 32 3.1 Important literature .......................................................................................................... 33 3.2 Methodology ..................................................................................................................... 33 3.4 Interviews ...................................................................................................................... 38 4 4. Analysis .................................................................................................................................... 39 4.1 Treatment options and costs ........................................................................................ 39 4.3 Interviews (Awareness): titles, relationship to obesity ................................................. 44 4.4 Survey results ................................................................................................................ 45 5. Results ..................................................................................................................................... 46 5.1 Treatment cost (table) .................................................................................................. 46 5.2 Survey results ................................................................................................................ 47 6. Innovation in Obesity Treatments ........................................................................................... 48 6.1 Innovation ......................................................................................................................... 48 6.2 Change Management in Healthcare ................................................................................. 49 6.3 “LypoTales” ....................................................................................................................... 51 Discussion .................................................................................................................................... 52 The 2013 AMA Decision and Implications for Public Health ................................................... 52 Value-based Health Care ......................................................................................................... 53 Public Health Care goals and value ......................................................................................... 53 Health Care System Models .................................................................................................... 56 Challenges of modern health care .......................................................................................... 57 What is health and why is it important? ................................................................................