Obesity is rising at alarming levels. So is its economic impact. Unsurprisingly, the business of weight loss is also getting fatter by the day.

It has been dubbed the story of the decade. And, we really didn’t need the new Lancet report on rising obesity to tell us that. When a weight loss drug makes headlines across the world, and the manufacturing company gets bigger than its own country’s economy, it is an issue with weight (pun intended). The signs have been there much before the likes of Wegovy and Ozempic drilled it in. Concerns over obesity have led to a burgeoning weight-loss industry, be it health food, vegetarianism, the plus size apparel market, weight loss procedures and surgeries, health apps, fitness experts—to count just the basics.

But the Lancet report should be a rattling wake-up call when it reveals that our future generation—children and adolescents—are fatter four times the number in 2022 than they were in 1990. We adults haven’t fared much better either, with double the number falling in the overweight category in the same time. Of the world’s total population of 8.1 billion, over one billion are obese.

While this must spell a business opportunity for many like El Lilly and Novo Nordisk—the Danish pharmaceutical company making Ozempic that is currently valued over $500 billion, while Denmark’s GDP is $406 billion—there is a sombering economic impact to the obesity pandemic too.

A global study predicted in 2023 that the global economic impact of overweight and obesity will reach $4.32 trillion annually by 2035 if prevention and treatment measures do not improve. Published by the World Obesity Federation, the World Obesity Atlas 2023 warns that at almost 3% of global GDP, this is comparable with the impact of COVID-19 in 2020.

The study also predicts that 51% of the world’s population will be overweight by 2035, with 1 in 4 people obese from the current 1 in 8, and the problem with children will double in magnitude, with a 100% increase in boys and 125% increase in obese girls. It is projected that the number of adults living with obesity will rise from 0.81 billion in 2020 to 1.53 billion in 2035.

Talking of the Indian scenario, Dr Ambrish Mithal, chairman & head— endocrinology & diabetes—Max Healthcare, says: “The biggest bane is childhood obesity. Obese children become obese adults, and fall prey to diseases like diabetes, heart disease, high blood pressure, etc.” He reveals that Indians develop metabolic diseases from excess fat at lower body weight than westerners. And, with poor lifestyles, body weight increase is rapidly rising in India, not only in cities but small towns and villages too. “There is a clear correlation between obesity and lifestyle, diet and exercise,” he says.

The numbers prove his words.

The obesity burden

As per The Lancet paper, in India, the obesity rate increased from 0.1% in 1990 to 3.1% in 2022 for girls, and 0.1% to 3.9% for boys. Among adults, for women the obesity rate increased from 1.2% in 1990 to 9.8% in 2022, and in men from 0.5% to 5.4%.

Dr Richa Chaturvedi, senior consultant, endocrinology, Indraprastha Apollo Hospitals, adds, “The Lancet study found differences across religious groups too, with Sikh women showing a higher incidence of obesity. Obesity is more commonly observed in women compared to men, possibly due to limited access to public exercise facilities and inadequate nutrient intake.”

Obesity is not a condition restricted just to higher BMI. Excess weight is a precursor to many diseases, particularly diabetes, hypertension, cardiovascular conditions, cancer and more. Figures from the Institute for Health Metrics and Evaluation, a health research organisation based at the University of Washington School of Medicine, reveal that in 2019, non-communicable diseases (NCDs) caused 41.0 million deaths of a total 50.3 globally, and 12% of these were caused by high BMI.

As Dr Mithal says: “Rise in obesity is fuelling the pandemic of non-communicable diseases.”

As per the World Obesity Atlas 2024, the burden of disease once seen in adults is now common amongst children. It estimates that over 750 million children (age 5-19 years) will be overweight and obese by 2035. In the same time frame, an estimated 68 million children will suffer from high blood pressure due to high BMI; an estimated 27 million will have hyperglycaemia, and 76 million will have low HDL cholesterol due to their high BMI.

Poor are getting fatter

Lower income countries are facing a rapid increase in obesity, and all the 10 countries expected to have the highest increase in obesity globally are from either Asia or Africa. The World Obesity Atlas report’s 2024 edition says 79% of adults with excess weight and obesity will live in low- and middle-income countries (LMICs) by 2035. As many as 88% of children with excess weight and obesity will be living in LMICs by 2035.

Obesity is also an expensive disease to manage—the latest Ozempic costs over $900 per dose, and `20,000 in the grey market in India (given weekly). It is also supposed to be administered forever if you want the weight to stay off. With diet plans, fitness guidance and regimes and medical and surgical treatments, the costs can just spiral.

Not surprisingly, global obesity spending reached nearly $24 billion in 2023, an over seven-fold growth in value in just three years, mostly driven by introduction of new drugs, as per American health company IQVIA Institute’s Global Use of Medicines 2024 report. This market will only accelerate 2024 onwards, with a possible CAGR of 24-27% till 2028, touching a potential value of up to $131 billion by 2028.

But the poor are obviously unable to spend on expensive drugs, even if they are the last line of treatment. The first step of weight control—healthy and quality food—isn’t affordable either. It is cheaper to eat refined carbohydrates than healthy proteins. High quality oils, healthier grains like millets, beans, fruit and vegetables come at a cost. So does medical support. No wonder, of the global deaths attributed to high body mass index (BMI), 78% occur among adults in LMICs, eclipsing the 22% in high-income nations. Similarly, 80% of disability-adjusted life years (DALYs) are attributed to high BMI burden adults in LMICs, compared to a mere 20% in high-income countries, as per the World Obesity Atlas 2024.

The economic hit

When the burden of disease rises, it impacts a person’s bodily health, economic health and productivity, which all collectively take a toll at the national and global levels. With more NCDs rising, healthcare systems are just burdened more. World Economic Forum data suggests that obesity led to an average of 8.4% of total healthcare spending in Organization for Economic Co-operation and Development (OECD) countries. It also causes a reduction in workforce by as much as 54 million people per year across the 52 countries analysed, reducing GDP by 3.3%.

Climate change & obesity

Did you know that climate change is a factor in rising obesity and obesity also causes climate change! It is estimated that to produce 1 kcal food in today’s world, 3 kcal fossil fuel is burned. So whether it is overeating or just meeting the energy needs of a bigger body, those with higher BMI eat more, and are thus responsible for more greenhouse gas emissions. As per estimates, obesity causes an extra 700 megaton of greenhouse gas (CO2 equivalent) emissions annually, which translates to about 1.6% of worldwide GHG emissions.

Given the alarming data, it becomes imperative to treat obesity as a burning issue, for the sake of the planet, the people, nations, and economies. If nothing else, the World Economic Forum’s estimate of $429 billion average savings per year if overweight and obesity prevalence is reduced by 5% between 2020 and 2060 should be incentive enough.

Business of weight loss

  • In 2023, the global market for anti-obesity medications reached $6 billion on an annualised basis. By 2030, it could grow by over 16 times to $100 billion, as per Goldman Sachs Research
  • The global health and fitness club market size is projected to grow from $112.17 billion in 2023 to $202.78 billion by 2030, at a CAGR of 8.83%, as per Fortune Business Insights
  • In 2023, the global functional and natural health food market was valued at $23.5 billion and is projected to increase to $38.5 billion by 2033, as per Statista

Lifestyle the right cure

Even as the anti-obesity drug market is estimated to touch $100 billion by 2030, medical experts are of the firm view that they are the last line of treatment, advocating healthy lifestyles instead for a sustained cure to excess weight. “With drugs like Ozempic a household name, our OPD is full of patients looking for a quick fix to obesity. They are ready to undergo invasive procedures like bariatric surgery and liposuction, etc, mostly for cosmetic purposes and to look good. However, even if these drugs or treatments do cause a rapid fall in weight, unless it is maintained with a healthy lifestyle, the weight will just creep back in. Plus, all drugs and treatments come with their side effects, and are used only in extreme cases,” says Dr Mithal of Max.

He recommends a good public health system with access to healthier food to all, availability of playing grounds and a good lifestyle to manage the pandemic.

Dr Chaturvedi of Apollo gives an example of a 22-year-old individual who weighed 125 kg, had a habit of consuming excessive soft drinks, maintained a nocturnal lifestyle, and had a family history of diabetes. After enrolling in a medical nutrition programme and adopting regular exercise, the patient lost 25 kg in three months, and his diabetes was effectively controlled without the need for medication. “This underscores the importance of therapeutic lifestyle interventions in managing obesity and its associated health risks such as diabetes and hypertension,” she says. She recommends lifestyle modifications such as reducing consumption of processed foods and animal proteins, and increasing the intake of plant-based foods, vegetables, and lentils. “Maintaining regular meal timings, engaging in 30 to 60 minutes of daily exercise, and aligning one’s lifestyle with natural rhythms, including proper sleep patterns, are crucial in combating obesity and related conditions like diabetes,” she adds.