Overcoming Obesity - Ministry of Health...Overcoming Obesity Israeli Health Ministry Briefing 18...
Transcript of Overcoming Obesity - Ministry of Health...Overcoming Obesity Israeli Health Ministry Briefing 18...
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Overcoming Obesity
Israeli Health Ministry Briefing
18 August, 2016
Sorcha McKennaMcKinsey Global Institute
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McKinsey & Company | 111
This presentation is drawn from a MGI report released in November 2014
Central questions
What is the economic cost of obesity?
What are the different levers available to reduce obesity?
What is the relative cost-benefit of levers and how can they be implemented?
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Today’s Agenda
1 The obesity burden
3The road ahead - challenges and
imperatives
2 Reversing the trend
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Global growth in obesity
3SOURCE: OECD Statistics; Food and Agriculture Organisation of the United Nations Statistics (FAOSTAT)
Global prevalence%
Year
Prevalence of overweight, obesity and undernourishment, 1990 - 2012
ObesityBMI > 30
Under-nourished
OverweightBMI > 25
201020082006 2011199619951994 19971992 1993 19991991 2001 200420032002 20051998 2000 2009 20122007
0
5
10
15
20
25
30
35
40
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Today’s Agenda
1 The obesity burden
3The road ahead - challenges and
imperatives
2 Reversing the trend
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Academics have emphasized that the causes of obesity are complex and
manifold
5SOURCE: UK Government Foresight Report on Obesity, 2011
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Traditional targeted interventions do not deliver sustained impact
6SOURCE: Literature review, McKinsey Global Institute analysis
-20
-15
-10
-5
0
0 10 20 30 40 50
Time following weight lossMonths
Ave
rag
e w
eig
ht
los
sK
gAverage weight loss according to different strategies – a meta-study of clinical trials
Very lowenergy diets
Meal replacements
Orlistat (pharma)
Diet and exercise
Diet alone
Exercise
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We have set out to draw the 16th century map of the solution set
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Parental education
We identified 73 interventions sitting across 18 groups
8SOURCE: McKinsey Global Institute analysis
Active transport
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Healthy meals
3
HFSS (high-fat, -salt, and -sugar) food access
4
Media restrictions
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7
Portion control
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Price and promotions
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Reformulation
12
School curriculum
13
Surgery
15
Urban environment
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Workplace wellness
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Health-care payors
2
Labeling
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Pharmaceuticals
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Public-health campaigns
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Subsidies and taxes
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Weight-management programs
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We were able to assess potential scaled impact and cost-effectiveness of
44 interventions for the UK
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Cost-effectiveness and impact of obesity interventions, by group, United Kingdom
Total impact
Thousand DALYs savedAverage cost per DALY
$/DALY saved
Active transport 67
Workplace wellness 139
Tax 203
Media restrictions 401
Pharmaceuticals 430
Labelling 575
Surgery
Public-health campaigns 49
Reformulation 1,709
Portion control 2,126
615
Healthy meals 868
School curriculum 888
Parental education 962
Weight-management programs 967
HFSS access 1,137
561Promotions
220
50
230
560
230
380
2,060
8,170
14,140
2,030
13,110
2,630
31,050
2,660
1,840
5,590
Intervention group
SOURCE: Literature review; expert interviews; McKinsey Global Institute analysis
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Example intervention area: taxation levers receive the highest public and
policy attention, despite being one of the lower impact intervention sets
Number of media counts in past year in major UK news and business publications,by intervention groups
4
13
91
801
Tax 930
233
Labeling 350
School food and curriculum
380
Medical
Parental education
114
Portion control 182
Workplace wellness 197
Reformulation
Weight-managementprograms
Media restrictions
Promotion
970
960
400
900
2,130
140
1,710
580
1,300
1,020
200
Potential impact by intervention cluster,DALYs saved, thousand
10SOURCE: Literature review; expert interviews; McKinsey Global Institute analysis
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Example intervention area: there appears to be a linear relationship
between changes in portion size and changes in consumption
SOURCE J.:Fisher et al., “Effects of portion size and energy density on young children’s intake at a meal,” American Journal of Clinical Nutrition, July 2007; BJ Rolls (2006); McKinsey Global Institute analysis
-50 -40 -30 -20 -10 0 10 20 30 40 50 60 70 80 90 100 110
20
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-10
Change in portion size(%)
Change in consumption(%)
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Example intervention area: Reformulation
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Description:
▪ Reformulation of food and drinks to reduce HFSS ingredients leading to overall reduction in calories consumed
▪ Successfully implemented in the UK to reduce salt consumption by 15% from 11.1g/day to 8.1g/day
Principles to consider:
▪ Support reformulation through regulation/industry-wide engagement – unsupported voluntary reformulation has not been shown to be effective and penalizes first-movers
▪ Allow sufficient time for gradual reformulation to allow consumers and manufacturers to adjust to the change
▪ Measure the scale and impact of reformulation over time to ensure its continued progress
SOURCE: Literature review; expert interviews;
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Example intervention area: Food advertising to children
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Description:
▪ Implementation of regulations to limit or eliminate advertising to children under a certain age
▪ May also include a rebalancing of advertising to support healthy eating messagings
▪ Blanket advertising bans to children under 12 have been implemented in Sweden and Quebec
Principles to consider:
▪ Eliminate advertising to children younger than 10-12 – they cannot differentiate adverts and are much more susceptible to them
▪ Consider all platforms on which children may be exposed to advertising, e.g., TV, print, online, social media etc.
▪ Support with parental education programmes to enable parents effectively manage nutrition
SOURCE: Literature review; expert interviews;
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Example intervention area: Front of Package labelling
14SOURCE: Literature review; expert interviews;
Description:
▪ Addition of labels to packaging that provides information about nutrition to support healthier eating
▪ Multiple approaches being trialled in several geographies, including symbol, RDA % and traffic light system
Principles to consider:
▪ Pick a unified Front of Package labelling system and enforce it – multiple approaches confuse customers and dilute potential impact
▪ Ensure that guidelines include information across multiple ingredient (e.g., Salt, sugar, fat etc. ) and are applied consistently across food and drink categories
▪ Ensure that guidelines are evidence-based and sufficiently strict to have impact – update these as the understanding of nutrition evolves
▪ Invest in explaining the guidelines to consumers to support balanced purchasing
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However, we have to pull many interventions in order to deliver
significant impact
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403530252015105
Health impact of quantified interventions, DALYS, over lifetime UK 2014 population
16,000,000
14,000,000
12,000,000
10,000,000
8,000,000
6,000,000
4,000,000
2,000,000
0
Number of interventions
44
~20 percent reduction
Flat
~10 percent reduction
Estimated impact on obesity prevalence, UK
SOURCE: Literature review; expert interviews; McKinsey Global Institute analysis
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Today’s Agenda
1 The obesity burden
3The road ahead - challenges and
imperatives
2 Reversing the trend
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Interventions sit across a wide range of societal stakeholders
Schools
Local government
Employers
Healthcare systems Fast food restaurants
RetailersHealthcare payors/insurers
National government
Food producers
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Impact is spread fairly evenly across all stakeholders, however
manufacturers, retailers and restaurants together hold significant impactCost effectiveness and impact of obesity levers1, United Kingdom
SOURCE: Literature review; expert interviews; McKinsey Global Institute analysis
Total impactThousand DALYs2 saved
Cost per DALY $ thousand per DALY saved
1,681
Health care
Employer
1,617
Retailers
2,138
1,510
1,033
1,036
Manufacturers
Government
Schools
Restaurants
1,624
0.4
2.6
0.5
4.9
0.8
4.0
3.1
1 Cost and impact assessed over lifetime of 2014 UK population. Uses UK-specific cost effectiveness calculating using GDP and WHPmethodology. 2 Disability-adjusted life years.
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There are some critical success factors for an impactful societal response
Comprehensive set of interventionsA programme to reverse obesity outcomes will require as many interventions as possible to be deployed, across the full set of relevant societal stakeholders
Step up investment in research…Current investment in research in behavioural, clinical and policy areas of obesity is low compared to the scale of the problem. Increased in investment is required
Integrated approachRelevant stakeholders need to overcome misaligned incentives and coordinate efforts to deploy a wide enough set of interventions
… while embracing trial and error
In many intervention areas, perfect RCT quality impact data is impossible. Rather than waiting for it, we should have a bias for action, especially where risks are low, and use trial and error to flesh out our understanding of the solution space
SOURCE: McKinsey Global Institute analysis
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McKinsey & Company |SOURCE: McKinsey Global Institute