Tackling Child And Adolescent Obesity: An Economical Challenge

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Author(s):

	Valerio Serse
	Valerio is a Senior Economist at Compass Lexecon and an Adjunct Professor of Economics of Competition Policy at the Université catholique de Louvain.
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INTRODUCTION 

Childhood obesity is one of the most pressing issues of our time. In 2022, over 160 million children worldwide are classified as obese, with an additional 390 million considered overweight . In the absence of market inefficiencies associated with this epidemic, government interventions are primarily driven by public health concerns . Nevertheless, many economists argue that the obesity epidemic not only strains healthcare systems but also exposes inefficiencies in the marketplace, driven by price distortions, aggressive advertising, and consumer behavioral biases. This suggests that policies aimed at reducing obesity may also be justified on the grounds of economic efficiency. Reflecting this perspective, a growing number of economists are exploring how this epidemic can be understood and addressed through an economic framework.

This article summarizes the economic literature on the obesity issue to highlight:
1. The market mechanisms driving the obesity epidemic.
2. The economic rationale for government intervention.
3. Policy solutions that can help address this issue from an economic perspective. 

The aim of this contribution is to provide an economic perspective on childhood obesity and highlight how economics can help tackle this epidemic. 

ECONOMIC CAUSES OF CHILDHOOD OBESITY 

Understanding the causes of childhood obesity is a complex multidisciplinary issue. Economic research can provide valuable insights into the market factors that can have contributed to the dramatic spread of this epidemic. In this section, I introduce three ways in which the market environment may have led children and adolescents to increase their energy intake over the past 40 years. 

– Evolution of Food prices  

The real price of food has declined substantially over the past few decades. In OECD countries, it dropped by almost 14% between 1975 and 2005, although it restarted increasing after 2020 in the post COVID-19 period. During the same period, the prices of healthy foods increased significantly relative to less healthy and high-calorie options. For example, in the United States, the relative price of fruits and vegetables have increased substantially in the last four decades. These shifts in food prices could have had two primary consequences for dietary habits. First, as foodstuffs became relatively cheaper than other goods, consumers increased their overall consumption, leading to higher energy intake. Second, the rising cost of fruits and vegetables compared to other food categories could have incentivized consumers to substitute healthier options with cheaper, calorie-dense, and less nutritious alternatives, further contributing to increased calorie consumption and weight gain. 

Figure 1 – Changes in food prices (1970 – 2024)1

Source: Author, with data from OECD (2024) and US Bureau of Labor Statistics (2024). 

– Reduction in the “time-cost” of consuming calories 

Starting in the early 1970s, the food industry introduced a wide variety of ready-to-eat and ultra-processed foods, enabled by advancements in production techniques and preservation methods. These innovations allowed pre-prepared food to maintain its quality over extended periods, facilitating its widespread distribution and accessibility. As a result, the responsibility for cooking and meal preparation shifted significantly from households to food suppliers, drastically reducing the time and effort needed to prepare meals and clean up afterward. This shift made food cheaper per calorie, leading to increased consumption of both the quantity and variety of available food products .  

Numerous studies have documented how these changes contributed to higher caloric intake, particularly among children, who have substantially increased their energy intake from pre-packaged snacks over the last decades . Furthermore, a recent study in the UK found that children who consume more ultra-processed foods tend to experience faster increases in body weight and BMI compared to their peers . This evidence suggests that higher caloric intake from ultra-processed foods may be another significant driver of the obesity epidemic.  

– Advertising aimed at children 

The food and beverage industries spend massive sums on the marketing of unhealthy food, with a significant portion aimed directly at children and adolescents . In Europe, annual expenditures on food advertising are estimated at approximately €7 billion, while in the U.S., the figure reaches $10 billion . A consistent part of these expenditures concerns advertising directly aimed at children and adolescents. Although television remains the primary platform for these campaigns, digital media is playing an increasingly prominent role. Viral advertisements on the internet, mobile devices, and social media have become key strategies to target young audiences .  

Most of the products promoted through these channels are high in fat, sugar, or salt, raising serious public health concerns . Research consistently shows that food advertising negatively impacts children’s diets and body weight. Exposure to junk food ads, particularly on TV, is linked to higher consumption of unhealthy foods . A 2022 systematic review of 96 studies found that food marketing was associated with significant increases in food intake and purchase requests in children and adolescents . Some estimates also suggest that childhood obesity rates in the U.S. would likely have been significantly lower in the absence of these marketing techniques .2  

Some researchers suggest that digital advertising may surpass traditional marketing tools in effectiveness. Digital ads are often more engaging and interactive, increasing exposure while being subtler in their content . These characteristics amplify their influence, further encouraging unhealthy dietary habits among young audiences. A 2024 study in Germany analyzed 162 videos from child and youth influencers on YouTube and found that 67% of the 901 food cues identified were for products not permitted for marketing to children under the WHO Nutrient Profile Model . Notably, 91.1% of child-appealing food cues featured non-permitted foods, indicating a significant presence of unhealthy food promotion in content aimed at young audiences. Similarly, a recent Canadian study reported that 51% of youth were exposed to food marketing, with 83% of marketing instances occurring on social media . Of these, nearly 90% promoted less healthy foods according to Health Canada’s Nutrient Profile Model. The study also highlighted frequent use of youth-appealing techniques, such as graphic effects and music, which enhanced the appeal of these unhealthy products to children. 

ECONOMIC RATIONALES FOR GOVERNMENT INTERVENTION 

Childhood obesity has raised as a significant public health concern, prompting many governments to implement policy solutions aimed at addressing this epidemic. However, improving public health may not be the sole justification for government intervention. In certain cases, excessive energy intake can be related to an inefficient allocation of market resources. These inefficiencies provide governments with an economic rationale for reducing obesity beyond public health considerations. Key examples of such market failures can include: (1) health insurance externalities, (2) imperfect information, and (3) limited rationality. 

 What is a market failure? 

In economics, the allocation of goods and services through free markets is often considered the most efficient outcome, as it is assumed that firms and consumers acting in their own self-interest will maximize overall social welfare. However, in certain situations, this result is not achieved because self-interest decision-making could lead to an inefficient allocation of resources. These scenarios are referred to as market failures, and they provide a strong economic rationale for government intervention. 

Negative externalities are a common example of market failure. These occur when the actions of firms or individuals impose costs on third parties who did not choose to bear them. For example, a polluting firm produce at a level that disregards the broader social costs of its pollution. This creates a negative externality for nearby residents, who suffer health and environmental damage without being responsible for the pollution. 

Governments can address such failures by implementing corrective measures, such as imposing a pollution tax. This tax would incentivize the firm to reduce production to a level that aligns private and social costs, thereby achieving a more socially desirable outcome. 

– Health insurance externalities 

Obesity-related illnesses may generate societal costs that are not privately borne by affected individuals. It may indeed be the case that people find it easier to live unhealthy lifestyles, consuming more junk food or avoiding healthy physical activity, precisely because they don’t have to bear the cost of medical treatments that are caused by their irresponsible behaviour.  This can lead to a problem of negative externalities in the public health care system and in the private health insurance market. In order for this to occur, two necessary conditions must be met: (1) the obese must cost more than the non-obese in terms of health care while paying the same insurance premiums;3 and (2) in response to this, the non-obese must either be forced to reduce their health insurance coverage because the cost of premiums has risen too much or they must have started to live unhealthy lifestyles involving increased risks to their health .  

While many researchers have focussed on estimating the health care costs of obesity, very few empirical studies have investigated this kind of externality. Not surprisingly, research has suggested that the obese do in fact impose a higher burden on the health care system than individuals of normal weight . There is also evidence that, due to indiscriminate risk pooling, this can lead to negative health insurance externalities since people’s BMIs usually tend to rise after they have taken out a health insurance policy . This is presumably because they know that a less healthy style of life will not entail any additional medical costs, since insurance premiums are the same for everyone. According to Bhattacharya and Sood , in the U.S., this source of externality can impose a welfare cost of $150 per capita each year.  

– Imperfect information 

Another source of market failure can be the consumers’ lack of information about food products . Consumers can find it difficult to assess the effective quality of this food and its possible effects on the health of those who eat it. Retailers, in contrast, are often much better informed than consumers. Food producers and restaurants usually have all the relevant information on the ingredients, the proper procedures for preparation and cooking and the nutritional values of each product they produce or meal they serve. If consumers do not have access to all this information, they may consume too much unhealthy food or not enough healthy products.  

Whether this lack of information exists and the extent to which it leads to an inefficient allocation of market resources is still hotly debated. This does not seem to be a significant problem for most European consumers, as less than 9% of European adults claim to have troubles following a healthy diet because of information problems . Furthermore, in both Europe and the U.S., producers are legally obliged to divulge the nutritional and energy values of their products on the market. Thus, as long as parents seem to be fully aware and dispose of all the relevant information about food products, we may not expect kids’ health to be at stake for a lack of information in the food market.  

Yet, as a number of authors point out, understanding nutrition information can be difficult and very costly, and so the mere presence of information on food packaging does not necessarily imply that consumers are well-informed about the healthiness of a product . The literature on knowledge of nutrition and people’s diets shows indeed that individuals with a better understanding of nutritional information usually have healthier diets than others . Hence, if consumers are not sufficiently knowledgeable about food and nutrition, their understanding of food information can be limited and their food choices, together with the ones of their children, may not be optimal.  

– Limited rationality 

A third economic rationale for government intervention is that individuals, particularly children, are not fully rational consumers. That is, they cannot correctly consider the consequences of their consumption behaviour on their health when making food consumption choices. Following the literature on behavioural economics, there could be at least two ways in which this can happen. These are lack of self-control and limited attention to product attributes. 

1.  Lack of self-control 

Deciding whether or not to consume unhealthy food often involves a trade-off between instant gratification and future health consequences. Truly rational consumers would be able to reasonably consider this trade-off at any moment of their lives, on the basis of their own specific food preferences. This means that if they were to decide that the benefits of going on a diet outweigh the pleasure of consuming tasty food in future, then they would actually go on a diet, and stick to it. For consumers with problems of self-control this is never a realistic scenario. Even if they are willing to go on a diet, they always prefer the instant gratification and pleasure they get from a tasty meal to the possible future health benefits of going on a diet. These consumers are therefore destined to suffer the negative consequences of their unhealthy eating habits, as well as regretting their previous consumption decisions. In economics, this time-inconsistency in consumer preferences is often expressed by means of models of hyperbolic discounting . In these models the consumer’s discount rate between the present time and the near future is larger than the discount rate between any other future periods. Interestingly, empirical research confirms that this consumption behaviour is positively related to an increase in BMI and obesity .  

1. Limited attention 

Another possibility is that individuals are inattentive to the health consequences of consuming unhealthy food. While standard economic models assume that consumers are fully informed and that they correctly process all the information they are given about a product, recent evidence shows that such behaviour should not be taken for granted. Even when consumers are fully informed about the characteristics of a product, they sometimes take in just the more visible or prominently publicized information . This can lead the consumer to misperceive the “true” worth and benefit of a product and thus to make suboptimal consumption choices .4 As we have previously seen, while child-oriented junk food advertising is massively present in food markets, little or no media coverage is given to raising the awareness of children and families regarding the negative health consequences of these products . 

POLICY SOLUTIONS 

To address these market failures, governments can implement targeted policy solutions to promote the optimal allocation of market resources. Policies that also help reduce obesity—such as taxes on sugary beverages, subsidies for healthier food options, or improved nutritional labelling—can achieve dual objectives: economic efficiency and enhanced public health. In this section, I will analyse several policy interventions that could be implemented to mitigate these market failures, particularly in the context of excessive food consumption. 

How to evaluate the impact of policy interventions on market efficiency? 

When market failures occur, governments may enhance social welfare by implementing policy interventions that lead to a more efficient allocation of market resources. To evaluate the impact of such policies, economists must first derive a social welfare function, which ranks different allocations of market resources based on their desirability from a societal perspective. This function is typically constructed as the summation of individual well-being across all members of society, considering various market outcomes. 

Once the social welfare function is established, the next step involves assessing how the policy in question influences the behaviour of firms and consumers. This can be conducted through ex-ante evaluations (estimating the potential effects before implementation) or ex-post evaluations (analysing the actual effects after implementation). Key aspects to evaluate include changes in production, consumption patterns, and prices, as well as their impact on individual and aggregate well-being. 

By comparing the pre-policy and post-policy allocations of market resources using the social welfare function, economists can determine whether the intervention leads to a more socially desirable outcome. A policy is considered effective if it corrects the market failure and results in a net improvement in social welfare, accounting for potential trade-offs or unintended consequences.. 

– Fiscal policies 

The taxation of junk food and subsidizing of healthy food are often seen as being possible solutions to the problem of obesity. These policies can indeed raise the relative price of unhealthy food and thus discourage its consumption. They can also be useful to solve at least two market inefficiencies associated with an excessive energy intake. First, the taxation of unhealthy food could act like an implicit insurance premium aimed at eliminating the social losses due to health care insurance externalities. An excise tax levied on unhealthy food could eventually lead obese consumers to internalise this source of negative externality . The resulting tax revenues could then be used either to directly cover individuals’ medical expenditures, in the case of publicly funded health care, or to reimburse private insurance companies, in the case of national health care administered by the private sector .  Second, taxing junk food and/or subsidising healthier products could be used to correct self-control problems. By raising the relative price of unhealthy food, these policy instruments can persuade people to resist the temptation to consume unhealthy food and to start buying less tempting but healthier products . Importantly, the effectiveness of such policies heavily relies on the consumers’ behavioural response to price variations, as more sensitive consumer demand is to food prices, the more effective these commitment devices will be.  

Numerous empirical studies have focused on estimating the impact of food taxation and subsidies on food demand . For example, a systematic review of this literature indicates that a 10% decrease in price (i.e., a subsidy) can lead to a 12% increase in the consumption of healthful foods, while a 10% increase in price (i.e., a tax) can result in a 6% decrease in the consumption of unhealthful foods. However, most of this literature primarily examines the impact of these fiscal policies on food demand without addressing the broader welfare benefits. Specifically, it often neglects to consider how such policies might alleviate market inefficiencies, such as externalities associated with public health costs or consumer self-control issues, which could further justify their implementation from a societal perspective. 

Nevertheless, a recent U.S. study examines the rationale and effectiveness of taxing sugar-sweetened beverages (SSBs) to address obesity-related market inefficiencies, such as externalities and limited rationality in SSBs consumption . The authors argue that SSB taxes can mitigate these inefficiencies by reducing consumption, thereby improving public health outcomes. They calculate that a $0.01 per ounce tax on SSBs would generate welfare gains between $1.50 and $2.20 per person per year, accounting for both externalities and internalities. These gains would arise from reduced healthcare costs and improved consumer decision-making (correcting for internalities due to self-control issues or misperceptions). 

– Informational programmes  

Governments can solve the lack of information about food on the markets either by directly providing it to consumers or by imposing a legal obligation upon firms to disclose it. For instance, public authorities can fund media campaigns that provide additional information to children and parents about the health risks of consuming too much junk food or they can oblige food manufactures and restaurants to divulge detailed nutritional information regarding their products . On average, evidence indicates that these measures do actually affects consumer choices, with research showing that the introduction of nutritional labels on pre-packaged food is often associated with an increase in healthier diets and that media campaigns can increase the general consumption of healthy products . Nevertheless, there is little evidence that the indication of calories on restaurant menus significantly affects people’s choices .  

Many authors, however, suggest that both governments and researchers should make greater efforts to find more effective formats in order to present nutritional information in ways that are simple and understandable, especially for children and adolescents . For example, it has been shown that consumers are more responsive to the calorie labels on restaurant menus when information on recommended daily energy intake is also included or that introducing “traffic light” food labels can lead people to further improve their diets . 

Recent studies have also evaluated the effectiveness of informational programs implemented in schools aimed at reducing unhealthy food consumption among children. A 2022 systematic review found that such interventions led to a significant increase in fruit and vegetable consumption, although the overall effect remained modest . However, the authors note challenges in sustaining long-term changes in consumption, emphasizing the need for interventions that address adherence and the sustainability of healthy eating behaviours. This suggests that providing information about healthy eating habits alone may be insufficient as a standalone policy measure. 

– Limiting food advertising 

The evidence that unhealthy food advertising may have caused obesity rates in children and adolescents to rise is now pushing governments to implement limitations to these marketing practices aimed at the young. In this regard, some studies have reported that limiting television food advertising can have a beneficial impact on kids’ diet . Besides improving public health, however, these measures may be also justified on grounds of market efficiency if it is the case that consumers are inattentive to junk food information. By emphasising the more attractive qualities (such as flavour, appealing packaging or low price), junk food advertising can in fact distract inattentive children and parents from considering the health consequences of an excessive consumption of these products.  

Assessing the impact of restricting food advertising on market efficiency in such a context of limited rationality presents significant challenges. Firstly, estimating the inefficiencies arising from limited attention is inherently complex, as neither the economic nor psychological literature offers clear methodologies for measuring information salience . Secondly, such assessments require highly intricate experimental designs to establish a robust causal link between reduced exposure to food advertising and subsequent food choices .  

Nevertheless, new insights from neuroscience may help address these challenges. For instance, recent brain imaging studies reveal that obese children have a diminished ability to regulate their responses to food cues, making them more vulnerable to the effects of food advertising and marketing compared to their lean counterparts . This vulnerability is particularly pronounced in response to high-calorie food images, indicating that advertising such products can be impactful and potentially harmful for obese children . These findings underscore the importance of considering population heterogeneity when evaluating the impact of food advertising and highlight the potential for future research to quantify the salience of food-related information and its influence on dietary choices.  

CONCLUSIONS 

Economic research suggests that childhood obesity can be analysed and addressed through an economic framework. At least three market factors have likely contributed to the rise of this epidemic: (i) the evolution of food prices, which incentivized increased consumption of unhealthy foods; (ii) technological advancements in food production that lowered the time-cost of accessing calories; and (iii) extensive unhealthy food advertising campaigns targeting children. 

Additionally, several market inefficiencies are linked to excessive calorie intake, including health insurance externalities, information asymmetries, and limited rationality. These inefficiencies provide governments with economic justifications for addressing obesity beyond public health rationale. However, further research is required to better understand these inefficiencies, as empirical evidence—particularly in Europe—remains limited. 

Policy options to address these market failures include taxation of unhealthy foods, improved labeling requirements, and restrictions on junk food advertising. To effectively evaluate their impact on economic welfare, it is crucial to develop policy evaluation frameworks that account for the potential sources of market inefficiency associated with the obesity epidemic. This presents a promising avenue for future research. 

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