1. Professor Annie S. Anderson Centre for Public Health Nutrition Research Centre for Research into Cancer Prevention and Screening Ninewells Medical School, University of Dundee email: a.s.anderson@dundee.ac.uk The cost of diet related diseases in Scotland?

2. Who knows?.......... Reflections and thoughts…….. The healthy/unhealthy landscape influenced by diet and ways of life……………….

5. Medical Complications of Obesity Phlebitis venous stasis Coronary heart disease Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Gall bladder disease Gout Diabetes Osteoarthritis Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Hypertension Dyslipidemia Cataracts Skin Pancreatitis Idiopathic intracranial hypertension Cancer breast, uterus, ovary, kidney colon, oesophagus, pancreas, gall bladder Gynecologic abnormalities abnormal menses/ infertility polycystic ovarian syndrome Numerous pregnancy comps. Stroke

6. Most people with any long term condition have multiple (diet related) conditions in Scotland

7. People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas

8. Scottish Women aged 50 to 74 70% are overweight or obese 76% do not eat 5 a day 58% do not meet physical activity guidelines 35% regularly drink over 14 units per week Scottish Health Survey, 2013

9. The cost of obesity to Scottish society We estimate that the total cost to Scottish society of obesity in 2007/8 was in excess of £457 million and it is likely that this is an underestimate. Much of this cost is avoidable... (Published 2010)

10. The cost of obesity to the NHS (2007/2008) > £175 million (direct costs) Includes £ 4.5 m associated with drug cost £ 4.5 m associated with drug cost £48 m obesity related diabetes £48 m obesity related diabetes £38 m hypertension £38 m hypertension Add the costs of being overweight… may be half again ADD £137 m TOTAL NHS COSTS for OW and obesity £312m

11. NHS Costs Accounts for around 2% of total healthcare costs Obese individuals had medical costs 30% higher than those with normal wt Around 23% of spending on all drugs is attributable to overweight and obesity.

12. The cost of obesity to Society(2007/2008) Impact on employment obesity 25% less likely to be in employment obesity 25% less likely to be in employment overall attainment less for women overall attainment less for women Production levels Production levels Incapacity benefits est £195 m Premature death est £87 m Infra- structure planning Infra- structure planning Hospital costs Hospital costs TOTAL society COSTS for obesity £282m

13. RCP (2013) Action on Obesity

14. What are the total costs? ? £457 m (estimates of direct and indirect) £0.6b to £1.4b £0.6b to £1.4b

15. Future estimates (Scotland) 10-15 years behind US (2003 S = 1991 US), 41% predicted to be obese by 2030

16. Estimated UK costs of £1.9 to 2 billion /year by 2030