For the first time in history, there are more people suffering from obesity than from starvation worldwide, says SCOR in its report, "Obesity--The health challenge of the 21st century".
A tremendous increase in the number of obese people has taken place in developed countries and is starting to be seen in the emerging countries as well.
In 2005, the World Health Organisation (WHO) estimated that approximately 1.6 billion adults were overweight and at least 400 million adults were obese. By 2015, these numbers had greatly increased: approximately 2.3 billion adults were overweight, and more than 700 million people were obese.
Studies and epidemiological comparisons of obesity in each country have become possible and have shown the following observations: during the last 20 years, the increase in obesity has been substantial, wide-ranging and rapid. It affects the entire world irrespective of age, income and country.
While the US, Australia and the UK are still at the top of the list of countries affected, the countries that have seen the biggest increase in the number of obese and overweight people are in the Middle East and North Africa. In China, the proportion of men who are overweight has been increasing by 1.2% annually every year for the last 10 years. If nothing is done to slow the pace, the total number will have doubled by 2028. Even though the US has the largest number of obese people, other countries like Mexico and the UK are close behind. Meanwhile, countries like Japan, Italy and France have not followed this trend as closely. Generally speaking, over 50% of men over 50 years old are overweight or obese worldwide.
Projections for the future show that obesity rates are expected to continue to rise in a linear fashion, particularly in the US, Mexico and England where 35-50% of the populations are expected to be obese by 2030. These rates are also expected to increase more dramatically in countries with historically low obesity rates, such as Switzerland and Korea.
Mortality and insurance
Globally, all studies looking at all-cause mortality show an excess risk of death from a BMI of 30 upwards, which is more marked from a BMI of 35 and even higher once BMIs increase above 40. The leading causes of mortality are cardiovascular and cerebrovascular, primarily myocardial infarction and stroke. The Lancet published a meta-analysis in 2016 of 239 BMI studies on four different continents. In this study, it was found that the mortality increased linearly with BMIs over 25 and that this impact was more significant in younger people than in people over 70 years of age.
Similarly, some studies show that for the same BMI, there is a significantly higher rate of mortality in men than in women.
The initial approach to the rating of obesity in life insurance is simple: simply adjust the excess mortality to the curves of the all-cause mortality according to BMI. This will show the excess mortality rates increasing progressively depending on sex and BMIs. In practice, it must be recognised that obesity is a parameter often associated and merging with other cardiovascular risk factors: hypertension, dyslipidemia and diabetes, in particular. A simple addition of the excess mortality due to these anomalies overestimates the overall rating for mortality and leaves room for weighting of the raw mortality statistics according to BMI.
The two consequences on rating for insurance purposes are:
• Not applying any additional rating when the BMI is < 35 to avoid applying a "double penalty" if obesity is associated with other cardiovascular risk factors.
• Including obesity in a cardiovascular risk calculator that automatically takes into account and appropriately weights BMI, blood pressure, the cholesterol/HDL ratio and the age of the applicant to arrive at an excess mortality adapted to that of large primary prevention cohorts such as PROCAM and FRAMINGHAM.
For BMIs over 40, the risk is insurable as long as other cardiovascular and pulmonary risk factors are under control. Beyond a BMI of 50, the insurance approach is reserved.
Finally, patients who have undergone bariatric surgery will be able to be rated taking into account their current BMI and their pre-operative BMI, so long a sufficient time has passed since surgery and there are no complications.
SCOR has adapted a pricing and underwriting approach that more precisely assesses the mortality risk associated with obesity, by integrating different cardiovascular risk factors into its evaluation.