I think this is basically right, but I would add the suffering of the family as well.
Obesity will not lead you to abuse your spouse or children. Obese people can hold down a job. Obese people don't lose custody of their children.
The closest analogue, I think, is smoking. It will demonstrably take years of your lifespan and healthspan. It does lead to minor harm of people in your immediate vicinity (2nd hand smoke, those kids probably get fat too).
I think smoking is bang on as a comparison. Massive lifetime average costs to the health system, spending on which is by definition zero sum. Both smoking and morbid obesity are enormously damaging life paths. I say this as someone who struggles with their weight.
I want to acknowledge that weight isn't a simple calories in, calories out situation. That other illnesses, medications, childbirth and gut health have enormous impacts on the capacity to maintain or lose weight. And that many people (particularly in the US) live in food deserts. What I'd criticise is the valorisation or excusing of obesity as equivalent to healthy living.
'Healthy at any size' social messaging is enormously damaging on a social and personal level. I've personally known a few people who became politicised in this direction (as a subset of radical queer politics) and went from being highly functional to disabled due to overeating and other health consequences of inactivity and overeating. Life is difficult, aging is terrifying. Making it worse by pretending that these conditions aren't awful is extremely irresponsible.
Maybe not abuse of children per se, but most obese parents have obese children, so the self-caused sickness is passed down. I see it very often in such cases.
It boils down the lifestyle, 2 generations ago their grandparents were most probably skinny due to simple food they ate and physical labor they went through every day. If kids see lazy tired parents, chances of them being athletic and eating healthily are very low, and its a baggage that gets heavier to shed off with each passing year.
I grew up in a relatively high tax country with universal healthcare. My government in particular didn't publish everything I'd need to figure this out, but if they were comparable to similar countries with similar budgets and similar obesity rates, then I'd be paying 100% of my income for about two weeks every year in taxes to pay for the additional healthcare costs caused by obesity.
So if I didn't have to pay for obese people's additional healthcare costs, I could have either gotten myself a rather sizeable tax break, or a couple week of extra holiday free every year.
I tried to look for some overview, and ... found this study .. and even more interestingly in the Netherlands obesity seems to be cheaper than the alternative (probably because living longer leads to having more cancers, and those are fucking expensive)
This one is much easier to interpret as the result is just "In per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia." ... and yeah a thousands bucks could have been spent on something nice. Drugs for example!
A study in my home country (which aligned with my own back of the napkin estimation) put the additional cost of obesity at around 8% of government expenditure. Which given I was giving up over half my salary in taxes (well over half once you count sales taxes), comes out to over two weeks of work exclusively for obese people’s additional medical costs. That’s not too far off the study you linked, which states an average of 1.8% GDP (though I’m not sure that sample of 8 countries is representative of much), which again would be somewhere between 4.5-6% of government expenditure depending on their expenditure to GDP ratios (assuming 30-40% is pretty normal).
Perhaps one week of work dedicated exclusively to subsidising obese people excess medical costs every year would be more reasonable for a more typical tax payer. But that’s still a lot.
I’m not sure I buy the increased mortality bringing that number down story very much either. Obesity tends to only take about 5-10 years off your life expectancy (depending on how obese…), but it’s going to drive your medical care costs up for your whole life. Obesity kills you a lot slower than cancer does.
I was surprised too, and for the other countries in the sample the result is the way you would expect. (But it seems that the Netherlands is an outlier exactly because the cost of end of life care is very expensive compared to "obesity care". But it would probably be much less surprising if we would see the data on graphs, as health problems - so associated costs too - tend to spike waaay up above 80, so in this model it seems that ~5 year difference makes up for a lot of money...)
Obesity will not lead you to abuse your spouse or children. Obese people can hold down a job. Obese people don't lose custody of their children.
The closest analogue, I think, is smoking. It will demonstrably take years of your lifespan and healthspan. It does lead to minor harm of people in your immediate vicinity (2nd hand smoke, those kids probably get fat too).