Overcoming Obesity - Ministry of Health...Overcoming Obesity Israeli Health Ministry Briefing 18...

WORKING DRAFT

Last Modified 18/08/2016 07:11 GMT Standard Time

Printed 18/08/2016 07:11 GMT Standard Time

Overcoming Obesity

Israeli Health Ministry Briefing

18 August, 2016

Sorcha McKennaMcKinsey Global Institute

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

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?

1

2

3

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

McKinsey & Company |

Today’s Agenda

1 The obesity burden

3The road ahead - challenges and

imperatives

2 Reversing the trend

2

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Today’s Agenda



imperatives


4

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Academics have emphasized that the causes of obesity are complex and

manifold

5SOURCE: UK Government Foresight Report on Obesity, 2011

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


We have set out to draw the 16th century map of the solution set

7

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Parental education

We identified 73 interventions sitting across 18 groups

8SOURCE: McKinsey Global Institute analysis

Active transport

1

Healthy meals

3

HFSS (high-fat, -salt, and -sugar) food access

4

Media restrictions

6

7

Portion control

9

Price and promotions

10

Reformulation

12

School curriculum

13

Surgery

15

Urban environment

16

Workplace wellness

18

Health-care payors

2

Labeling

5

Pharmaceuticals

8

Public-health campaigns

11

Subsidies and taxes

14

Weight-management programs

17

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


We were able to assess potential scaled impact and cost-effectiveness of

44 interventions for the UK

9

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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

10

50

40

0

30

-10

Change in portion size(%)

Change in consumption(%)

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Example intervention area: Reformulation

12

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;

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Example intervention area: Food advertising to children

13

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


▪ 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;

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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


▪ 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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


However, we have to pull many interventions in order to deliver

significant impact

15

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


La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


Today’s Agenda



imperatives


16

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

17

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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


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.

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime


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

La

st M

od

ified

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

Prin

ted

18

/08

/20

16

07

:11

GM

T S

tan

da

rd T

ime

McKinsey & Company |SOURCE: McKinsey Global Institute

Overcoming Obesity - Ministry of Health...Overcoming Obesity Israeli Health Ministry Briefing 18...

Documents

Transcript of Overcoming Obesity - Ministry of Health...Overcoming Obesity Israeli Health Ministry Briefing 18...