The "Cost of Obesity":
Who Really Pays When We Put a Price on Health?
14th May 2025, Dr Asher Larmie
The “cost of obesity” calculations aren’t just flawed – they’re weaponized against fat people in ways that perpetuate harm.
Every so often, I see another headline about the “cost of obesity” to society, and it fills me with righteous fury. These calculations have become commonplace – a way to frame fat bodies as economic burdens rather than as people deserving dignity and respect.
When reports claim that “the cost of obesity to the UK is £98 billion annually,” I find myself asking: Who came up with that figure and how did they come up with it? Who benefits from framing health in economic terms and, more importantly, who suffers?
The Manufactured Economics of Fat Bodies: Unpacking the Cost of Obesity Claims
According to widely cited figures, the “cost of obesity” to the United Kingdom is estimated at £98 billion annually – nearly 4% of the country’s GDP. This astronomical figure comes from a study by the Tony Blair Institute and supposedly includes costs to the NHS, social care, lost productivity, and reduced quality of life.
But who commissioned this “cost of obesity” report? None other than Novo Nordisk – a global pharmaceutical company specializing in diabetes medication and weight loss treatments, particularly Ozempic and Wegovy. This isn’t coincidental – it’s strategic.
The timing is not coincidental either. The report was commissioned in 2021, just as the National Institute for Clinical Excellence (NICE) was reviewing Wegovy for weight loss. Novo Nordisk needed to demonstrate cost-effectiveness for their drug to be approved in our nationalized health system.
Previously, the “cost of obesity” was cited as £27 billion. Suddenly, that figure ballooned to £98 billion. Did the number of fat people triple during that time? Of course not!
Breaking Down the Numbers
The report separates costs into three categories:
- Individual costs: £63 billion (reduced longevity and quality of life)
- NHS costs: £19 billion
- Wider society costs: £16 billion (including workplace productivity and social care)
Already, we see a problem. The bulk of these “costs” – £63 billion – aren’t costs to society at all but claimed reductions in individuals’ quality and length of life.
The Fundamental Flaw: Causation vs. Correlation
The entire calculation rests on something called the “population attributable factor” (PAF), which asks: what percentage of this disease would disappear if we eliminated fatness?
This framework assumes being fat causes conditions like diabetes, heart disease, and depression. Yet despite numerous studies, we’ve never been able to prove causality. In fact, evidence often suggests the opposite.
Many factors could explain these correlations:
- Socioeconomic factors
- Social deprivation
- Healthcare access barriers
- Systemic oppression
- Weight stigma itself
Then there’s reverse causality – some conditions cause weight gain rather than the other way around. For example, insulin resistance causes weight gain; weight gain doesn’t cause insulin resistance. This completely undermines their calculations.
The Absurdity of Calculating Human Worth
Perhaps most disturbing is how they calculate the “individual costs” – using quality-adjusted life years (QALYs). This measure assigns one year of “perfect health” a value of 1, with death at 0.
But what exactly is “perfect health”? We’ve never defined it because it’s undefinable. Yet this undefined concept forms the foundation for calculating most of the £98 billion figure.
Even more troubling is how they convert QALYs to monetary values. How exactly does one put a price on the quality of life? Whilst it’s somewhat of a mystery, their calculations include:
- Asking what people would pay for an extra year of “perfect health”
- Estimating a person’s economic contribution (which excludes non-workers)
- Observing financial compensation for risky jobs
- Studying what people are willing to pay for health risks
The UK government currently values a QALY at about £66,800. Think about that – someone in government decided your year of “perfect health” is worth exactly that amount.
This system inevitably devalues people who are already marginalized. If our value is tied to economic contribution, what does that say about disabled people, elderly people, or anyone unable to work?
A Thought Experiment: The Cost of Being Male
If we applied the same methodology to calculate the “cost of being male” to society, what would we find?
- Men live 3-4 years less than women on average
- Cardiovascular disease strikes men earlier and more severely
- Many cancers appear at higher rates in men
- Accidental injuries and deaths are much higher in males
- Suicide rates are approximately three times higher in males
- Men exhibit higher rates of risk-taking behaviors and substance use
Like being Fat, being male has some modifiable components (that primarily arise from social conditioning), but is essentially written in to your DNA. Using the same QALY valuation, the “cost of being male” would likely exceed £98 billion annually. After all, males make up 50% of the population compared to the 30% classified as “obese.”
Would anyone seriously suggest we need to “eliminate” maleness to save healthcare costs? Would we recommend gender reassignment or create drugs to ensure fewer male babies are born? Of course not – the suggestion is absurd.
Yet similar logic is applied to fat people every day.
The Real Cost of "Obesity" Calculations
When we examine the “cost of obesity” calculations, we must ask: what is the cost of creating these cost frameworks? We know that they:
- Perpetuate weight stigma that damages physical and mental health
- Justify denied healthcare to fat patients seeking treatment
- Give insurance companies excuses to charge higher premiums based on BMI
- Place financial burdens on fat people through expensive weight loss expectations
- Exclude marginalized groups from society by framing them as economic burdens
- Create profit opportunities for pharmaceutical companies selling weight loss “solutions”
When we calculate the cost of any group of people to society, we are intentionally stigmatizing them, excluding them, and creating industries that profit from their oppression. The “cost of obesity” narrative becomes a self-fulfilling prophecy.
The Research Tells a Different Story
Higher weight is linked to higher rates of depression. This staistic is used by the weight loss indutrsy to sell weight loss as a cure for depression. The “cost of obesity” calculation prepared by the Tony Blair Institute even went so far as to include the cost of antidepressant prescriptions into their calculations.
But a 2017 study by Stevens and colleagues found that weight stigma – not weight itself – explained the link between BMI and depression. The model they developed explained 45% of the variation in depression and 28% in body dissatisfaction.
What does this tell us? Instead of spending billions trying to eradicate fatness (which has proven impossible), we could spend our energy and resrouces addressing weight stigma – a much more achievable and cost-effective goal.
Reducing weight stigma would improve body image and reduce depression far more effectively than focusing on weight loss. Yet it appears that Novo Nordisk continues to pour millions into mental health research despite not manufacturing a single psychiatric medication.
The “Cost of Obesity” vs. The Value of Human Dignity
The “cost of obesity” narrative fundamentally asks: Do we owe society a debt of health? My answer is emphatically no.
While I believe we have some responsibility to each other as a community, that responsibility must be mutual. When society creates equitable healthcare access, stops stigmatizing marginalized bodies, and ceases punishing people for their size, then we can talk about collective responsibility.
As long as thin, white, cisgender, heterosexual, non-disabled, wealthy men make decisions that affect all of society while calculating the “cost of obesity” to justify stigmatizing those who don’t fit their mold, I don’t believe we owe them anything.
The next time someone mentions the “cost of obesity,” challenge them. Ask what the cost is of calculating that cost. Ask if they’ve calculated the cost of being male using the same methodology. Ask who profits from these calculations and who suffers.
Because in a society that reduces human bodies to econonic statistics, the only real beneficiaries are those selling the solutions to problems they’ve manufactured. The “cost of obesity” framework isn’t about health – it’s about profit and control.
This post was adapted from Episode 19, Season 5 of the Fat Doctor podcast. You can listen to it wherever you stream your podcasts or watch it on YouTube.