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Fat Tuesday

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Mardi Gras. Fat Tuesday. That annual tradition of gluttony before the season of austerity that is Lent. At least, that’s how it goes if you actually observe Lent, which not everybody does. But everybody observes Fat Tuesday, because it is a cheap excuse for epople to justify eating too much, drinking too much and watching every restaurant and saloon in town put up tacky purple, yellow and green decorations for the evening and pretend like everywhere is New Orleans. I have been to New Orleans, and to Bourbon Street. And while it’s the kind of place everybody should see at least once, it is also the kind of place that you really don’t want the rest of the world to resemble. Anybody who has lost memory there will know what I’m talking about.

The Fat Tuesday celebration has become a bit like Cinco de Mayo – another tradition that is observed more as a hollow excuse to eat and drink than to actually observe the real tradition at hand. I am reminded of when I used to work for the Risk and Insurance Management Society. One year, our annual conference was to be held in New Orleans, and for what seemed like months leading up to Fat Tuesday, we had one king cake after another in the kitchen, sent by grateful New Orleans merchants and planning boards. By the time Fat Tuesday rolled around, we had all eaten so much king cake, that nobody really felt the need to have a culturally sanctioned day of gluttony. But darned if the king cake didn’t get scarfed down anyway. The reality is, wherever we work, wherever we live, whatever we do, in this country, every day is Fat Tuesday.

There are those who will pish-posh this notion, either because they see no harm in it or because life is worth living, right? Indeed it is, but there is a price to pay for all of that rich living, and it is our ongoing obesity problem. I know what you’re thinking: Obesity again, Bill? Are you really going off about this again? 


As long as the health insurance industry continues to bemoan the cost of healthcare, and as long as we endure the increased healthcare costs of obesity itself, this is an issue that really should not be overlooked. It is to modern Americans what smoking was a few decades ago, and the sooner the health insurance industry takes really strong action (as Cigna has done, for example) to modify the eating and drinking behavior of its policyholders, the sooner we can start to get a handle on a problem that is killing many of us a bite at a time.

To that end, allow me to turn my attention to one of the great fringe bennies of subscribing to the Economist: their annual World in Figures book. It is an annual a compilation of all kinds of statistics they send to subscribers, and to a factoid hound like myself, might as well come wrapped in a red bow. One of the things they track is obesity rate, as defined by metric body mass index – weight in kilograms divided by height in meters squared. An index of 30.0 or more is considered obese. A rating of 25.0 – 29.9 is considered overweight. This can be adjusted for age and gender. 

So, what are the most obese nations on the Earth? Let’s turn the page and find out.

Men, % of total population 

  1. Lebanon (36.3)
  2. Qatar (34.6)
  3. United States (33.1)
  4. Ireland (31.0)
  5. Saudi Arabia (28.3)
  6. Panama (27.9)
  7. Kuwait (27.5)
  8. Iraq (26.2)
  9. Greece (26.0)
  10. Australia (25.6)
  11. New Zealand (24.7)
  12. Mexico (24.4)
  13. Czech Republic (23.9)
  14. England (23.6)
  15. Austria (23.3)
  16. Canada (22.9)
  17. Malta (22.9)
  18. Albania (22.8)
  19. Scotland (22.4)
  20. Croatia (21.6)
  21. Germany (21.0)
  22. Lithuania (20.6)
  23. Wales (20.0)
  24. Chile (19.6)
  25. Argentina (19.5)

Women, % of total population 

  1. Qatar (45.3)
  2. Saudi Arabia (43.8)
  3. Egypt (39.5)
  4. Lebanon (38.3)
  5. Iraq (38.2)
  6. Panama (36.1)
  7. Albania (35.6)
  8. Mexico (34.5)
  9. United States (34.3)
  10. Fiji (32.7)
  11. United Arab Emirates (31.4)
  12. Kuwait (29.9)
  13. Chile (29.3)
  14. South Africa (27.4)
  15. New Zealand (26.0)
  16. Scotland (26.0)
  17. England (24.4)
  18. Jamaica (23.9
  19. Turkey (23.9)
  20. Oman (23.8)
  21. Canada (23.2)
  22. Swaziland (23.1)
  23. Peru (23.0)
  24. Croatia (22.7)
  25. Czech Republic (22.3)

For the most part, we see the same countries, perhaps in different orders, on both lists, with the United States placing fairly similar numbers across the genders. And this does not really capture the whole picture. These are just people who are obese. If you factor in the people who are merely overweight, the numbers go much higher. In the case of the United States, it crosses the 50% mark; not a good sign, that.

But even this is not that spectacular on its own. We know we are dangerously overweight. we see it everywhere we go. And whether we are choosing to ignore it, tell ourselves it’s actually a good thing, or pretend like it cannot be helped, it all plays into another interesting stat, courtesy of the Economist: highest health spending.

It will come as no surprise to anyone in this audience that the United States, as of 2009 (that’s pre-healthcare reform, mind you) led the world in healthcare spending, at 16.2% of our GDP. That is an enormous amount of money; the size of the total economy of any number of smaller nations. (Don’t believe me? Run that through the CIA World Factbook and see where our healthcare spending ranks among national GDPs.)

Below is the table on highest health spending. I’ve taken the liberty of boldfacing every nation on the table that also scored as one of the world’s obese nations. Let’s see how many there are, shall we? Next page!

Highest health spending, as % of GDP, 2009 

  1. United States (16.2)
  2. Liberia (13.2)
  3. Burundi (13.1)
  4. Sierra Leone (13.1)
  5. Timor-Leste (12.3)
  6. Moldova (11.9)
  7. Belgium (11.8)
  8. Cuba (11.8)
  9. France (11.7)
  10. Germany (11.3)
  11. Portugal (11.3)
  12. Switzerland (11.3)
  13. Denmark (11.2)
  14. Austria (11.0)
  15. Bosnia (10.9)
  16. Canada (10.9)
  17. Netherlands (10.6)
  18. Greece (10.6)
  19. Costa Rica (10.5)
  20. Botswana (10.3)
  21. Georgia (10.1)
  22. Serbia (9.9)
  23. Sweden (9.9)
  24. Finland (9.7)
  25. Ireland (9.7)
  26. New Zealand (9.7)
  27. Norway (9.7)
  28. Spain (9.7)

Interesting…not as many as mght be expected. but then again, this table is a little skewed because not every country is apples to apples when comparing how its GDP gets divvied up. Costa Rica, for example, can spend 10.5 of its GPD on health care, in part, because it has no standing army. (And because it’s a socialist state.) Perhaps looking at life expectancy would be a better metric. I’ll do the same before, and peg the most obese countries on this list to see how many make the grade. Next page!

Highest life expectancy, Years, 2010-2015 

  1. Japan (83.7)
  2. Hong Kong (82.5)
  3. Switzerland (82.5)
  4. Andorra (82.4) (estimated)
  5. Iceland (82.3)
  6. Australia (82.2)
  7. France (81.9)
  8. Italy (81.6)
  9. Spain (81.6)
  10. Sweden (81.6)
  11. Israel (81.5)
  12. Canada (81.4)
  13. Macau (81.4)
  14. Norway (81.3)
  15. New Zealand (81.0)
  16. Singapore (81.0)
  17. Austria (80.8)
  18. Belgium (80.8)
  19. Bermuda (80.7) (estimated)
  20. Cayman Islands (80.7) (estimated)
  21. Netherlands (80.6)
  22. Finland (80.5)
  23. Germany (80.5)
  24. Ireland (80.5)
  25. Luxembourg (80.3)
  26. Malta (80.3)
  27. Cyprus (80.2)
  28. Martinique (80.2)
  29. Greece (80.1)
  30. United Kingdom (80.1)
  31. South Korea (80.0)
  32. United States (79.9)
  33. Channel Islands (79.8)
  34. Guadeloupe (79.8)
  35. Faroe Islands (79.7)
  36. Virgin Islands (US) (79.7)
  37. Costa Rica (79.4)
  38. Portugal (79.4)
  39. Puerto Rico (79.4)
  40. Chile (79.1)
  41. Cuba (79.1)
  42. Slovenia (79.1)
  43. Denmark (79.0)
  44. Taiwan (78.3) (estimated)
  45. Barbados (78.2)
  46. Kuwait (78.2)
  47. United Arab Emirates (78.1)
  48. Brunei (77.7)

Fifteen, it turns out. That’s a fair number, I think, all things considered. Again, this table doesn’t weight things like population size. (How comparable, really is the population of a country like Iceland, with 300,000 people, to a country like the United States, with 350 million people?) But at least, we have some starting point. It is not a perfect one, because there are countries like Russia, China, India and Brazil that didn’t make the obesity list, but then again, they didn’t make the longevity list, either, so it’s not like getting on one automatically ensures or precludes you from making the other.

Still, these numbers should provide for some interesting food for thought (if not the waistline). I have already written about the financial impact of obesity on healthcare insurance costs, but the life expectancy numbers have got me thinking about how obesity might be playing into life insurance costs as well. We all know the longer a policyholder lives, the better, which is why Japan is such a great market for life insurance (among other reasons).

The United States currently lists 32nd on the longevity list. And while being #1 isn’t necessarily the point, I think it is worth considering that the higher we rank, the better it is for both sides of the life and health insurance industry, not to mention for all of us as a people.


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