Why Germany urgently needs to do something about obesity

Global trends

Handelsblatt author Thomas Hanke analyzes interesting data and trends from all over the world in the column.

(Photo: Klawe Rzeczy)

A heart for unhealthy nutrition? The FDP is opposed to Cem Özdemir’s proposal to restrict advertising for fattening foods that specifically target children. The Liberals see the initiative by the Minister of Food and Agriculture as a restriction of the free will of the citizens. You are in a bad German tradition. In this country it has always taken a little longer for overweight to be recognized as a serious public health problem and not as a private preference.

The World Health Organization (WHO) included obesity, severe overweight with a body mass index over 30 – body weight divided by height in meters (squared) – in its catalog of diseases as early as 1948. Germany needed a little more time, 72 years to be exact, before the Bundestag followed suit.

The WHO warned last year that obesity in Europe had become an epidemic with serious consequences: type 2 diabetes, cardiovascular diseases or damage to the joints. “More than four million people die every year as a result of being overweight or obese,” writes the WHO. From 1975 to 2016, the proportion of overweight or obese children and adolescents aged five to 19 worldwide more than quadrupled from four to 18 percent.

Health insurance companies do not reimburse effective medication

According to data from the Organization for Economic Cooperation and Development (OECD), every seventh death in Germany is due to unhealthy eating, Özdemir’s department warns. It hits the lower class more often than average. “Around 15 percent of three to seventeen-year-olds in Germany are overweight, including almost six percent obese,” the ministry said. Children ate twice as much junk food, snacks and sweets, but half as much fruit and vegetables as recommended.

But our healthcare system still doesn’t want to admit it. Health insurance companies often tie treatment such as eating or exercise therapy for severely overweight people to conditions that must be met in advance, or do not pay.

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It is even more restrictive with the new drugs that come from diabetes therapy. The European Medicines Agency (Ema) has now approved six of them for the treatment of obesity. With medical care and combined with a changed diet, they have very good success rates.

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But in Germany, health insurance companies refuse to reimburse the costs. These drugs are “excluded from the statutory health insurance fund’s obligation to provide benefits as part of the so-called lifestyle regulation,” says the Central Association of Statutory Health Insurance Funds. Obesity as a lifestyle?

With prices between 300 and 1000 euros for a monthly dose, patients can hardly shoulder the costs on their own. “The fact that the costs are not covered makes evidence-based treatment enormously difficult,” criticizes Professor Jens Aberle, President of the German Obesity Society.

It would be expensive. But the lack of timely treatment leads to billions in costs for the community of solidarity, mainly due to secondary diseases. “The direct and indirect costs of obesity to society as a whole are estimated at 63 billion euros per year in Germany,” states the Federal Ministry of Food and Agriculture (BMEL).

For a long time, a similarly restrictive policy was followed in the USA as in Germany. That all changed at the beginning of the year when the American Association of Pediatricians published comprehensive new guidelines for obesity treatment.

The American paediatricians criticize the marketing of foods that make children fat, reject the hitherto merely observational approach and propose an active treatment approach. This includes diet modification, physical activity, behavioral therapy, drug therapy, and metabolic and weight-related surgery.

Perhaps Özdemir’s suggestion will contribute to taking more active action against obesity in Germany as well.

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