Obesity and other eating disorders have become increasingly common in the UK. Vikki Tranter explains how underwriters view these serious conditions
The Government is currently trying to push the message that obesity is a serious threat to the nation's health and is working on strategies to tackle this growing problem. Eating disorders, such as anorexia nervosa and bulimia nervosa, are also becoming much more widely recognised and publicised as a serious health issue.
When a person is obese they weigh 20% or more above the recommended body weight for their age and height. The morbidly obese weigh 60% or more than their ideal body weight. Obesity is measured using the body mass index (BMI) which is a person's weight in kilos divided by their height in meters squared. A BMI of 20 - 25 is normal, 25 and above is overweight and more than 30 is obese.
Western epidemic
The main cause of obesity is consuming more calories than are burned through work, exercise and other activities. Obesity has become an increased problem in Western society, as food is now plentiful, inexpensive and convenient. There has been a rise in fast food and processed foods, which are high in fat content. Many people nowadays lead a sedentary lifestyle, travelling by car, working at a desk and pursuing activities that require little or no physical activity such as watching television. Comfort eating is also a cause and is used as a way to escape emotional problems. Many people eat when their bodies do not need food.
There may also be specific health problems that can cause obesity, such as malfunctioning thyroid and pituitary glands or physical disabilities that limit exercise or movement. There can be a combination of factors that lead to a person becoming obese; these can include genetic, psychological, physiological, metabolic, socio-economic and cultural factors.
Anorexia nervosa is an eating disorder characterised by deliberate weight loss. An anorexic person will refuse to eat, which can lead them to them becoming very thin and weak. They have a distorted perception of their weight, size and shape and no matter how thin they are, they still see themselves as being overweight. Anorexics often start by dieting as normal but go too far, usually ending up very underweight. Their fear of gaining weight is intense and they often exercise excessively while eating very little.
Bulimia nervosa is an eating disorder characterised by binge eating, then purging in order to avoid gaining weight. Like anorexia sufferers, people with bulimia have a distorted perception of their own weight, size and shape and an intense fear of gaining weight or becoming fat.
Bulimics will eat large amounts of food very rapidly with little self-control, then will purge themselves. Purging may involve self-induced vomiting, misuse of laxatives or excessive exercise.
Health risks associated with obesity:
• Cardiovascular disease. The degree of obesity and location of fat deposits contribute to potential for heart and blood vessel disease.
• Hypertension. A contributor to stroke and heart disease. Overweight young people have a six times' higher incidence of hypertension than young people who are normal weight do.
• Non-insulin dependant diabetes. Even moderate obesity increases the risk 10-fold.
• Cancer. Obese men are at an elevated risk of cancer of the colon, rectum and prostate. Obese women have a heightened risk of cancer of breast, cervix, uterus and ovaries.
• Endocrine problems. Irregular menstrual cycles, pregnancy complications, toxaemia and pregnancy-related hypertension.
• Gall bladder disease. Obese women aged 20 to 30 years old are at a six times' greater risk of gall bladder disease.
• Lung and breathing problems. Obesity can impede the muscles that inflate and ventilate the lungs.
• Arthritis / gouty arthritis. Excess weight stresses vulnerable joints, particularly the back and knees.
• Low self-esteem and depression.
• Sleep disturbance and sleep apnoea.
• Premature death. Research indicates that obese people die sooner than their normal weight peers do.
Health risks and complications associated with anorexia and bulimia:
• Cardiac abnormalities.
• Menstruation abnormalities or cessation of menstruation.
• Anaemia.
• Osteoporosis.
• Gastrointestinal Problems.
• Hypothermia.
• Dehydration.
• Erosion of tooth enamel.
• Tearing of the oesophagus.
• Ulcers.
• Enlargement of the salivary glands.
• Electrolyte (salt) imbalance.
• Mental health problems with an increased risk of suicide.
• Kidney and heart failure.
Vikki Tranter is a life and disability underwriter with Scottish Equitable
Obesity and eating disorders: the statistics
• The number of people who are obese has tripled over the last 20 years. Most adults in England are overweight. One in five is obese. In 1980, 6% of men were obese and 8% of women. In 1998 17% men and 21% of women were obese.
• Approximately 270,000 people suffer a heart attack each year in the UK. 28,000 of these are directly attributable to obesity.
• If the prevalence of obesity continues to rise at the current rate, more than one in four adults will be obese by 2010.
• The report 'Tackling Obesity in England' showed obesity caused 30,000 premature deaths in 1998 alone.
• 18,000 sick days are estimated to be lost each year due to obesity.
• The NHS spends £500m a year on treating obesity. It cost the economy £2 billion a year. It could cost the economy £3.5 billion a year by 2010.
• Research shows that approximately 18% of all people with anorexia will die prematurely.
• Only one in 10 sufferers of anorexia and one in 100 sufferers of bulimia are male.
• An average GP's list of 2,000 patients at any one time is likely to have one or two patients with anorexia, 18 with bulimia and 100 - 200 adolescent girls who are using weight reducing methods other than dieting, i.e. vomiting, excessive exercising, laxative and diuretic abuse.
• No other disorder, e.g. depression or schizophrenia has a higher death rate than eating disorders in the whole field of psychiatry. The Eating Disorder Association estimates that the incidence of eating disorders in the UK is approximately 165,000 with an approximate 10% mortality rate.
Underwriting implications
On insurance application's insurers will ask for the client's current height and weight and if this ratio appears to be outside of what we consider to be healthy we will calculate their BMI. Age does bear a factor when considering a healthy BMI as older people do benefit from carrying a little extra weight.
On life cover for ages 34 and below we would consider loading the premium if the BMI is 30 and above. Ages 35 - 54, we would consider a loading if the BMI was 32 and above. Ages 55 - 69 and 70+, we would consider a loading if the BMI was 37 and above.
Examples of possible loadings for benefits available for clients of different ages with the same BMI of 36 are shown in the table below. For all age groups if the BMI is 47 or above we may consider declining life cover, Total and permanent disability cover and waiver of premium.
A BMI of 41 and above and insurers may consider declining critical illness cover, 43 and above and insurers may consider declining income protection. When underwriting other medical conditions, height and weight may be considered when loadings are applied.
If the client's height and weight on the application warrants a moderate to heavy loading the underwriter will request a medical to be carried out to ensure that height and weight details are correct and that there are no other adverse factors.
If the client is overweight and this is in conjunction with another medical condition of concern, a doctor's report may be requested and the client's GP asked to confirm height and weight details.
In cases where the client has undergone surgical treatment of obesity, such as jaw wiring, gastric partition/bypass or intestinal bypass the underwriter may consider postponing cover for at least six months since surgery took place and may apply a loading if the surgery is within three years. In all cases a doctor's report would be requested to assess any complications and maintenance of weight post-surgery.
Should a client disclose that they are currently suffering from an eating disorder such as anorexia or bulimia, still underweight and on ongoing treatment or counselling, the underwriter would consider postponing life cover until the condition is resolved and declining any secondary benefits.
If they were to disclose history of an eating disorder, where they have fully recovered, are of a healthy weight, with no further treatment or counselling, a doctors report would be requested and following assessment a loading may be placed on the premium according to the period of time since full recovery.
