The media ensures everyone is aware of the growing dangers surrounding obesity and binge-drinking, but how easy is it for underwriters to assess their risk? Peter Carvill reports
If the human race does not have enough to contend with as it battens down the hatches against climate change, world food shortages, growing international terrorism and a credit crisis, it seems every day another government department, charitable institution, TV chef or expert warns that the UK is not only in the midst of a global outbreak of obesity but a national scourge of binge-drinking is leading the country's younger generation to an early grave.
The fears that obesity is worsening are as real as its dangers. The Department of Health's Forecasting Obesity report predicts the number of obese men in the UK will increase by nearly 50% to over six million by 2010, a frightening one-tenth of the UK's population. Internationally, the picture is no less bleak. The World Health Organisation (WHO) says, globally, that there were 400 million obese adults in 2005 and predicts this figure to rise to 700 million by the middle of the next decade. Overweight adults were estimated to have been 1.6 billion in 2005. Again, the WHO expects this figure to increase within 10 years to 2.3 billion.
Binge-drinking has also come under hard scrutiny. It is said Europeans drink to enhance consciousness and English drink to obliterate it, and destruction, of one form or another, has been evident for some time in the nation's town centres. Statistics illustrate the story - nearly 70% of all assaults are committed under the influence of alcohol and a report from the Institute of Personnel and Development in 1998 found 46% of businesses reported problems with alcohol misuse, a four-fold increase from two years before.
The medical effects of both are well-stated. Obese people are liable to suffer a litany of ailments including cardiovascular disease such as heart attacks or strokes (currently killing 17 million people a year); type 2 diabetes (set to increase globally by 50% in the next decade); cancers of the colon, oesophagus and kidneys; and musculoskeletal disorders such as arthritis.
Apart from violence suffered or accidents incurred, abusers of alcohol run the risk of strokes and other cardiovascular problems, neurological damage, cirrhosis and - as unpleasant as it sounds - ruptured bladders. Between 1995/6 and 2000/1, the incidence of alcoholic liver disease in the UK climbed from 14,100 to 24,300 and deaths from alcohol misuse trebled in the 21 years following 1980.
The risk for both is measured differently. Body Mass Index (BMI), the gauge of obesity, is determined by dividing weight in kilos by height in metres squared. People are considered overweight if the result is 25 or more, and obesity is classified as a BMI of 30 or over.
Assessing drinking habits is more problematic as there is no standard definition of binge-drinking. Past measures such as the amount of units drank in a week do not reflect or consider how those units are imbibed - whether they are drunk all at once or spread out over a number of days. Roger Edwards, product director at Bright Grey, says: "Binge-drinking is an interesting one as it is in the news all the time. There's so much media and political hype that it's hard to see what the medical ramifications are and while it is not a good thing, it is not quite as clear-cut as the BMI measurement."
Other measures used to assess obesity are waist circumference and bioelectrical impedance analysis (BIA) which estimates body composition. In looking at waist circumference, men with a belt size of more than 37 inches are at risk of heart disease, which substantially increases the further the waist sizes exceed 40 inches. For women, these figures are 31.5 inches and 34.6 inches. In calculating body composition, the acceptable range of fat percentage, according to the American Council on Exercise, is 18% to 25% for men and 25% to 31% for women.
Yet these definitions have their limitations. Firstly, a BMI calculation makes no distinction between the type of tissue in a person's body, meaning someone with a lot of muscle who is extremely fit can be classified as overweight or obese. Rugby player Johnny Wilkinson, at 5'10" and 189lbs, has a BMI of 27.1 which classifies him as overweight. A more extreme example would be that when Frank Bruno stepped into the ring against Mike Tyson for the second time, he weighed 247lbs. Despite having a physique more akin to a bodybuilder than a sumo wrestler, Big Frank, at 6'3" was technically obese with a BMI of 30.1.
Edwards maintains that allowances can be made for this: "A good underwriter will be able to spot that sort of thing so if a person has a high BMI, they will give them the benefit of the doubt or ask for further medical evidence."
BIA may seem a more appropriate measure but until recently the electronic machines largely used for doing so were considered inaccurate as they gave varying readings across models. And while waist circumference may seem to be an accurate indication of future risk, there will be those who are quite rotund but also enjoy a good current and future standard of health.
Assessing the underwriting implications of binge-drinking is even more problematic, especially considering there is no standard definition. Alcohol Concern says in its published literature: "One difficulty faced by the Department of Health, researchers and others in the broader alcohol field is the lack of consensus on the definition of the term 'binge-drinking'. A 1997 report for the US-based International Centre for Alcohol Policies points to the lack of formal definitions both at international level and among studies undertaken within individual countries."
Clouded Judgement
Common definitions of binge-drinking include drinking more than four to five drinks in a sitting, having eight drinks on the same day, raising blood alcohol content to 0.08g/ml, having more than six bottles of beer in one sitting or drinking more than half a bottle of spirits or two bottles of wine in one sitting. As well as the lack of standard classification, other pertinent questions raised by these definitions are: what is meant by 'sitting' or 'drinks'? Even using wine or spirits as barometers is misleading as alcohol content varies widely among drinks.
Added to this is the fact that consumers often, for various reasons, do not state accurately when applying for cover what their true alcohol intake is. "As a general rule, underwriters are aware people will underestimate," says Edwards.
Phil Brown, underwriting and claims director at Zurich, says: "Consumers may understate alcohol consumption perhaps because they don't genuinely realise or are embarrassed to say how much they drink in front of their advisers. In terms of alcohol, the first line of enquiry is the application form and we may want a doctor's report, a medical examination or, in some cases, even a blood test."
Bob Perks, director at Financial Synerges, says understatement of alcohol intake is not, as expected, a problem linked to the younger generations: "The other group who are middle-class and middle-income who are drinking a lot in the evening - you can't be sure because you have to go on what they tell you. They are more of a problem because the younger generation aren't looking at financial products."
Cause and Effect
As assessing BMI and judging the effects of binge-drinking are fairly arbitrary using present methods and definitions, would it be better to assess consumers on how their current lifestyle is affected by their weight or drinking rather than using a general yardstick to assess risk?
"I think it's a good idea," says Edwards, "but the problem is how to do it. We ask so many questions now that it seems difficult. How would we measure it? If you're asking to take that into account upfront, that's very difficult for the underwriting."
However, he adds that policies such as income protection (IP) and critical illness (CI) have exclusions for consequences arising from poor lifestyle choice: "An IP product may have an alcohol exclusion which means that if someone fell over because they were intoxicated, they may not get their claims paid out. Companies write CI for becoming sick as a result of what you do, and you know that someone drinking a bottle of vodka a day is going to be in serious trouble by the time they are 40."
Brown argues that despite the faults of the BMI measure, it is still a good indicator of present and future health: "As a measure of obesity, it is still recognised internationally and endorsed by the WHO. The relative value of waist measurement and waist-to-hip ratio are much debated and, unfortunately, these can be inconsistently measured."
He concludes that with some commentators quoting 38% of adults in England being overweight and 24% actually obese, the industry cannot afford to be complacent.
