Health-Ecore colleagues Bart Slob and Lisa de Jong attended the European Congress of Obesity (ECO) in Istanbul and had the chance to present their research as a poster presentation called 'Facilitating investments in obesity prevention and treatments in the Netherlands'. The research shows that investing in obesity prevention and treatment pays off. The study quantifies the societal costs associated with overweight and obesity in the Netherlands from 2025 to 2050, and evaluates the financial headroom created by three evidence-based interventions: a sugar tax, the Healthy Schools programme, and GLP-1 pharmacotherapy for people living with severe obesity. Without intervention, cumulative societal costs amount to €650 billion over 25 years. All three interventions generate substantial savings. The findings make the investment case clear: acting now, across prevention and treatment, returns far more than it costs.
Half of Dutch adults are currently living with overweight or obesity. Without structural policy change, that share will reach 64% by 2050 [1,2]. The societal costs, including healthcare expenditure, productivity losses, and patient and family costs, associated with overweight and obesity, are projected to rise from €29.5 billion per year today to €42.8 billion by 2050. Cumulative discounted costs over the full 25-year horizon amount to €650 billion.
Projected prevalence of individuals (≥ 18 years) living with overweight and obesity
This study models the societal costs attributable to overweight and obesity in the Netherlands from 2025 to 2050 and evaluates the financial headroom generated by three evidence-based interventions: a sugar tax, the Healthy Schools program, and GLP-1 receptor agonists (RA) pharmacotherapy for people living with severe obesity.
The three interventions were selected through expert consultations with clinicians, policymakers, and health economists. They represent two preventive strategies and one treatment-focused approach, each addressing a different segment of the population at a different point in the health value chain:
The model distributes the Dutch adult population across five BMI classes in each annual cycle, and multiplies population size per class by the incremental costs attributable to overweight and obesity compared to someone with a healthy weight. Costs are discounted at 3% per year, in line with Dutch health economic guidelines. For each intervention, we calculate the headroom (the reduction in societal costs) under base-case, conservative, and optimistic scenarios.
Without intervention (null-alternative), annual societal costs attributable to overweight and obesity rise from €29.5 billion per year today to €42.8 billion in the year 2050 (+45%), accumulating to a total of €650 billion. This increase is driven by both rising prevalence and a shift toward more severe obesity classes within the population.
The sugar tax generates cumulative headroom of €28.3 billion (4.4%). The Healthy Schools program generates €22.2 billion (3.4%), with savings building gradually as more cohorts pass through the program. For GLP-1 RA pharmacotherapy, people living with obesity classes II and III shift into less severe weight classes, but total prevalence of overweight and obesity does not decrease under current model assumptions; the value lies in severity reduction. Headroom amounts to €42.6 billion (6.5%). After correcting for the cost of medication, a net societal saving of €23.6 billion (3.6%) remains..6%re remains.
Table 1. Cumulative discounted costs (2025-2050)*
| Strategy | 2050 costs per annum (€B) | Cumulative discounted costs 2025-2050 (€B)* | Cumulative cost difference related to strategy (€B) | Cost difference (%) |
| Null-alternative | 42.8 | 650.4 | - | - |
| Sugar tax | 39.0 | 622.1 | 28.3 | 4.4 |
| Healthy Schools program | 40.0 | 628.2 | 22.2 | 3.4 |
|
Pharmacotherapy |
38.4 |
607.8 |
42.6 |
6.5 |
|
Pharmacotherapy (corrected for treatment costs) |
39.6 |
626.8 |
23.6 |
3.6 |
*Discounted at 3%/year per Dutch guideline for economic evaluations in healthcare
No single intervention reverses the trend alone. Prevention and treatment are complementary; they reach different people at different stages of their lives. A comprehensive strategy that spans population-level food policy, school-based prevention, and pharmacotherapy is needed to shift the trajectory.
The more fundamental point is this: the question is not whether we can afford to invest in prevention and treatment for people living with obesity. The analyses show that each of these interventions generates substantial headroom. The question is how quickly that investment is made; because waiting is, as the null alternative illustrates, the most expensive option.
Transparency
This study was funded by Eli Lilly.
References
1. Hoofdrapport VTV-2024 | Volksgezondheid Toekomst Verkenning 2024 [Internet]. [cited 2024 Nov 28]. https://www.volksgezondheidtoekomstverkenning.nl/vtv-2024/hoofdrapport. Accessed 28 Nov 2024
2. Eykelenboom M, Boer J, ten Dam J, Sanderman-Nawijn E, Hoekstra J. Doorrekening impact Nationaal Preventieakkoord: deelakkoord overgewicht. Worden de ambities voor 2040 bereikt? [Internet]. Rijksinstituut voor Volksgezondheid en Milieu RIVM; 2024. https://doi.org/10.21945/RIVM-2023-0414
3. van der Ende M, Orhan Pees R, Horlings C, Batura O, Wouterse B, Hoogendoorn-Lips M. Suikerbelasting. Rotterdam; 2024 May. Report No.: Suikerbelasting.
4. van Giessen A, Oosterhoff M, Hoekstra J, Over E, Joore M, van Schayk O, et al. Gezonder op de basisschool: schoollunches en meer bewegen : Een verkenning naar draagvlak, haalbaarheid, betaalbaarheid en impact [Internet]. Rijksinstituut voor Volksgezondheid en Milieu; 2020. https://doi.org/10.21945/RIVM-2020-0161
5. Aronne LJ, Horn DB, Roux CW le, Ho W, Falcon BL, Valderas EG, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. New England Journal of Medicine. Massachusetts Medical Society; 2025;393:26–36. https://doi.org/10.1056/NEJMoa2416394