Fighting Obesity in Asia and the Pacific

It is estimated that the direct cost of overweight and obesity in Asia and the Pacific equates to about 0.56% of the combined GDP in this region while the indirect cost is about 0.22%.

It is also estimated that the direct cost of overweight and obesity is heavily affecting the East Asia, Central Asia, and Southeast Asia regions. On the other hand, the indirect cost of overweight and obesity is a heavy burden, particularly for the Pacific and Central Asia regions.

Overall, experts estimate a burden of 12.36% of healthcare expenditure, or 0.78% of GDP. In terms of direct costs, it is estimated that overweight and obesity contribute to about 8.9% of healthcare expenditure. The subregion with the lowest costs in South Asia with 0.56%, while East Asia faces the highest costs with 9.78% of health expenditure. The low direct costs of South Asia are not an indication that overweight and obesity are a minor issue; rather, it is due to the fact that the health systems in these countries only provide a fraction of the health care that would actually be needed.

Millions of overweight and obese people who suffer from related diseases are thus either not treated or undertreated. As the health care systems in the region should improve with economic growth, we expect that the share of non- or undertreated patients will decline. If the prevalence of overweight and obesity remains high or even increases, it will increasingly absorb the health expenditure.

Although the problem of excess body weight has received tremendous public attention in recent years, no country has implemented successful policy interventions to curb the increasing number of overweight and obese individuals in the past 33 years.

This may partly be due to the paucity of data to quantify and document until more recently, or the lack of comprehensive policy approaches.

Overweight and obesity can be tackled from at least two policy angles: improving nutritional intake and increasing physical activity.

These, in turn, are closely associated with cultural, environmental and socioeconomic factors, which make manipulating these angles difficult. Policy makers have chosen to influence food choices through market mechanisms (price changes) and government interventions (regulations against unhealthy foods) and to target behaviors as early as possible (at childhood and in school).

To increase physical activity, policymakers have targeted sports curricula at school and better urban planning, designing cities with well-functioning public transportation as well as sidewalks and green areas.

Costs of these interventions vary substantially. For example, regulations to restrict marketing to children have relatively low costs and possibly a high effectiveness. Food labeling requirements can impose substantial costs on producers; if badly designed, rather than leading to better food choices, labels may confuse the consumer.

Programs to improve school food may impose a substantial burden on schools already operating on tight budgets. Making the urban landscape conducive to physical activity can also be costly.

Another important area of action concerns the health care system. Overweight and obesity are often observed by health care workers, but are typically not well responded to health care professionals tend to be trained in curative health services, not in weight management, and facilities are often ill-equipped to receive obese patients.

In these areas and beyond, more cost-effectiveness research is warranted, especially in developing countries.

In the Republic of Korea, concerned ministries (especially the Ministry of Health and Welfare and the Ministry of Education) have introduced many interventions to improve diets and increase physical activity.

For example, the Ministry of Health and Welfare provides budget support to local governments’ obesity programs, develops educational materials and publicizes them, and provides vouchers for management services of physical activity and diets of obese children. The National School Lunch Act, introduced in 1981, has provisions on school dietitians, nutritional requirements, and dietary consultation.

In Thailand, most policies developed in the first decades were initiated by the Thai Ministry of Public Health. Other government authorities, professional communities, and members of civil society have also been active in recent years as the obesity problem has become more evident and the impact of the work of the Thai Health Promotion Foundation has become more prominent.

There are few national policies and activities related to physical activity, save the recent national campaign in 2015 led by the Crown Prince to promote bicycle use, called “Ride for Mom and Dad,” which achieved the world record for the largest number of people riding a bicycle in a public event.

Further, five types of food policies in Thailand have been classified to prevent obesity at the national level: i) school focused policy; ii) labeling, packaging, and restaurant focused policy; iii) marketing policy; iv) pricing policy; and v) nutrition education and national dietary guidelines.

In Indonesia, the Indonesian Ministry of Industry plans in 2018 to introduce regulations for reducing the contents of sugar, salt, and fat in food in response to the growing concern about rising overweight and obesity.

The form of the sugar taxes is still being discussed and there are suggestions to include an excise tax. This will include introducing a sugar levy on soft drinks.

ADB. 2018. Wealthy But Unhealthy: Overweight and Obesity in Asia and the Pacific: Trends, Costs, and Policies for Better Health.

World Health Organization. 2016. Fiscal policies for diet and the prevention of noncommunicable diseases.

World Health Organization. Global Strategy on Diet, Physical Activity and Health.