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Cobiac LJ, Rogers NT, Adams J, Cummins S, Smith R, Mytton O, White M, Scarborough P. Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS Med 2024; 21:e1004371. [PMID: 38547319 PMCID: PMC11008889 DOI: 10.1371/journal.pmed.1004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England. METHODS AND FINDINGS We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males. CONCLUSIONS We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.
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Affiliation(s)
- Linda J. Cobiac
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Nina T. Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Smith
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Oliver Mytton
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK & NIHR Oxford Health Biomedical Research Centre at Oxford, Oxford, United Kingdom
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Ma G, Meyer CL, Jackson-Morris A, Chang S, Narayan A, Zhang M, Wu D, Wang Y, Yang Z, Wang H, Zhao L, Nugent R. The return on investment for the prevention and treatment of childhood and adolescent overweight and obesity in China: a modelling study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 43:100977. [PMID: 38456086 PMCID: PMC10920044 DOI: 10.1016/j.lanwpc.2023.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/05/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024]
Abstract
Background The rapid increase in child and adolescent overweight and obesity (OAO) in China has a significant health and economic impact. This study undertook an investment case analysis to evaluate the health and economic impacts of child and adolescent OAO in China and the potential health and economic returns from implementing specific policies and interventions. Methods The analysis estimates the reduction in mortality and morbidity from implementing a set of evidence-based interventions across China between 2025 and 2092 using a deterministic Markov cohort model. Modelled interventions were identified by literature review and expert recommendation and include fiscal and regulatory policies, eHealth breastfeeding promotion, school-based interventions, and nutritional counselling by physicians. The study applies a societal costing perspective to model the economic impact on healthcare cost savings, wages, and productivity during adulthood. By projecting and comparing the costs between a status quo scenario and an intervention scenario, the study estimates the return on investment (ROI) for interventions separately and in combination. Findings Without intervention China will experience 3.3 billion disability-adjusted life years (DALYs) due its current levels of child and adolescent OAO and a lifetime economic impact of CNY 218 trillion (USD 31.6 trillion), or a lifetime CNY 2.5 million loss per affected child or adolescent (USD 350 thousand). National implementation of all five interventions would avert 179.4 million DALYs and result in CNY 13.1 trillion of benefits over the model cohort's lifetime. Implementing fiscal and regulatory policies had the strongest ROI, with benefits accruing at least 10 years after implementation. Scaling up China's current school-based interventions offers China significant health and economic gains, however, the ROI is lower than other modelled interventions. Interpretation Effective prevention and treatment of child and adolescent OAO is critical to China's health and economic development. Multiple interventions offer a comprehensive approach to address the various factors that increase risk of child and adolescent OAO. Nonetheless, fiscal and regulatory policies offer the strongest health and economic gains. Funding Funding was provided by UNICEF China.
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Affiliation(s)
- Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Christina L. Meyer
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | | | | | | | - Man Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Daphne Wu
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Youfa Wang
- International Obesity and Metabolic Disease Research Center, Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an, Shannxi, China
| | - Zhenyu Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Zhao
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
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Azhar Hilmy SH, Nordin N, Yusof MYPM, Soh TYT, Yusof N. Components in downstream health promotions to reduce sugar intake among adults: a systematic review. Nutr J 2024; 23:11. [PMID: 38233923 PMCID: PMC10792802 DOI: 10.1186/s12937-023-00884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.
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Affiliation(s)
- Syathirah Hanim Azhar Hilmy
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
- Department of Periodontology & Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, 57000, Malaysia
| | - Norhasnida Nordin
- Centre of Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Tuan Yuswana Tuan Soh
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia.
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Sultana M, Nichols M, Moodie M, Allender S, Brown V. A systematic review of economic evidence for community-based obesity prevention interventions in children. Obes Rev 2023; 24:e13592. [PMID: 37308321 PMCID: PMC10909472 DOI: 10.1111/obr.13592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 05/03/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Multicomponent community-based obesity prevention interventions that engage multiple sectors have shown promise in preventing obesity in childhood; however, economic evaluations of such interventions are limited. This systematic review explores the methods used and summarizes current evidence of costs and cost-effectiveness of complex obesity prevention interventions. A systematic search was conducted using 12 academic databases and grey literature from 2006 to April 2022. Studies were included if they reported methods of costing and/or economic evaluation of multicomponent, multisectoral, and community-wide obesity prevention interventions. Results were reported narratively based on the Consolidated Health Economic Evaluation Reporting Standards. Seventeen studies were included, reporting costing or economic evaluation of 13 different interventions. Five interventions reported full economic evaluations, five interventions reported economic evaluation protocols, two interventions reported cost analysis, and one intervention reported a costing protocol. Five studies conducted cost-utility analysis, three of which were cost-effective. One study reported a cost-saving return-on-investment ratio. The economic evidence for complex obesity prevention interventions is limited and therefore inconclusive. Challenges include accurate tracking of costs for interventions with multiple actors, and the limited incorporation of broader benefits into economic evaluation. Further methodological development is needed to find appropriate pragmatic methods to evaluate complex obesity prevention interventions.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social DevelopmentDeakin UniversityGeelongVictoriaAustralia
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Brero M, Meyer CL, Jackson-Morris A, Spencer G, Ludwig-Borycz E, Wu D, Espinosa De Candido AF, Ferre Eguiluz MI, Bonvecchio Arenas A, Jewell J, Nugent R. Investment case for the prevention and reduction of childhood and adolescent overweight and obesity in Mexico. Obes Rev 2023; 24:e13595. [PMID: 37464960 DOI: 10.1111/obr.13595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/11/2023] [Accepted: 05/21/2023] [Indexed: 07/20/2023]
Abstract
Despite efforts to curb the rise in Mexico's child and adolescent overweight and obesity rates, prevalence in Mexico has grown by 120% since 1990 to 43.3% in 2022. This investment case identifies policies that will produce the largest returns for Mexico. The investment case model builds beyond a cost-of-illness analysis by predicting the health and societal economic impact of implementing child and adolescent overweight and obesity interventions in a cohort aged 0-19 from 2025 to 2090. The Markov model's impacts include healthcare expenditures, years of life lost, and reduced wages and productivity. We projected and compared costs in a status quo scenario to an intervention scenario to estimate cost savings and calculate return-on-investment (ROI). Total lifetime health and economic costs amount to USD 1.8 trillion-USD 30 billion on average per year. Implementing five interventions can reduce lifetime costs by approximately 7%. Each intervention has a low cost per disability-adjusted life year averted over 30-year, 50-year, and lifetime horizons. The findings demonstrate that a package of interventions mitigating child and adolescent overweight and obesity offers a strong ROI. The novel investment case methods should be applied to other countries, particularly low- and middle-income countries.
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Affiliation(s)
| | - Christina L Meyer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Angela Jackson-Morris
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | - Garrison Spencer
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | | | - Daphne Wu
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
| | | | | | - Anabelle Bonvecchio Arenas
- Directora de Investigación en Políticas y Programas de Nutrición, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, USA
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Pereira TN, Bortolini GA, Campos RDF. Barriers and Facilitators Related to the Adoption of Policies to Reduce Ultra-Processed Foods Consumption: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4729. [PMID: 36981638 PMCID: PMC10048733 DOI: 10.3390/ijerph20064729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Cost-effective regulatory and fiscal interventions are recommended to address non-communicable diseases. While some countries are advancing regarding these actions, others have found it difficult to approve them. AIM to conduct a scoping review to answer the question "What factors have influenced the adoption of food taxes, front-of-pack labeling and restrictions on marketing to children?". METHODS A scoping review was developed from four databases. Studies that described and analyzed policy processes were included. Analysis was performed to identify the barriers and enablers mentioned under the guidance of Swinburn et al., Huang et al., Mialon et al., and Kingdon. RESULTS 168 documents were identified, describing experiences from five regions or groups and 23 countries, which have generated 1584 examples of 52 enablers (689 examples; 43.5%) and 55 barriers (895 examples; 56.5%) that may have influenced policies. The main enablers were related to the government environment and governance and to civil society strategies. Corporate political activity strategies were the main examples of barriers. CONCLUSIONS This scoping review consolidated barriers and facilitators related to policies aimed at reducing ultra-processed foods consumption, demonstrating that factors related to the actions of governments and civil society are the main facilitators. On the other hand, as the most interested actor in promoting the consumption of these products, the strategies adopted by the companies that produce these products constitute the main barrier to these policies in all the studied countries and should be overcome.
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Affiliation(s)
| | - Gisele Ane Bortolini
- Food and Nutrition National Coordination, Ministry of Health, Brasilia 70058-900, Brazil
| | - Roberta de Freitas Campos
- Center for Studies on Bioethics and Diplomacy in Health, Oswaldo Cruz Foundation, Brasilia 70910-900, Brazil
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Guarino M, Matonti L, Chiarelli F, Blasetti A. Primary prevention programs for childhood obesity: are they cost-effective? Ital J Pediatr 2023; 49:28. [PMID: 36864472 PMCID: PMC9983264 DOI: 10.1186/s13052-023-01424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 03/04/2023] Open
Abstract
Childhood obesity is increasing all over the world. It is associated with a reduction in quality of life and a relevant burden on society costs. This systematic review deals with the cost-effectiveness analysis (CEA) of primary prevention programs on childhood overweight/obesity, in order to benefit from cost-effective interventions.We screened and evaluated all the studies with a cost-effectiveness analysis on childhood obesity primary prevention program by PUBMED and Google Scholar, using inclusion and exclusion criteria. The quality of the studies was assessed by Drummond's checklist.Ten studies were included. Two of them examined the cost-effectiveness of community-based prevention programs, four focused only on school-based programs while four more studies examined both community-based and school-based programs. The studies were different in terms of study design, target population, health and economic outcomes. Seventy per cent of the works had positive economic results.The majority of the studies showed effective economic outcomes applying primary prevention programs on childhood obesity. It is important to increase homogeneity and consistency among different studies.
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Affiliation(s)
| | - Lorena Matonti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Francesco Chiarelli
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
| | - Annalisa Blasetti
- grid.4708.b0000 0004 1757 2822University of Study G. d’Annunzio, Chieti-Pescara, Italy
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Mahdi S, Marr C, Buckland NJ, Chilcott J. Methods for the economic evaluation of obesity prevention dietary interventions in children: A systematic review and critical appraisal of the evidence. Obes Rev 2022; 23:e13457. [PMID: 35478373 PMCID: PMC9542346 DOI: 10.1111/obr.13457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aim to describe and provide a discussion of methods used to conduct economic evaluations of dietary interventions in children and adolescents, including long-term modelling, and to make recommendations to assist health economists in the design and reporting of such evaluations. METHODS A systematic review was conducted in 11 bibliographic databases and the grey literature with searches undertaken between January 2000 and December 2021. A study was included if it (1) was an economic evaluation or modelling study of an obesity-prevention dietary intervention and (2) targeted 2- to 18-year-olds. RESULTS Twenty-six studies met the inclusion criteria. Twelve studies conducted an economic evaluation alongside a clinical trial, and 14 studies modelled long-term health and cost outcomes. Four overarching methodological challenges were identified: modelling long-term impact of interventions, measuring and valuing health outcomes, cost inclusions and equity considerations. CONCLUSIONS Variability in methods used to predict, measure and value long-term benefits in adulthood from short-term clinical outcomes in childhood was evident across studies. Key recommendations to improve the design and analysis of future economic evaluations include the consideration of weight regain and diminishing intervention effects within future projections; exploration of wider intervention benefits not restricted to quality-of-life outcomes; and inclusion of parental or caregiver opportunity costs.
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Affiliation(s)
- Sundus Mahdi
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
| | - Colette Marr
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
| | - Nicola J Buckland
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, UK
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK
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Alustiza E, Perales A, Mateo-Abad M, Ozcoidi I, Aizpuru G, Albaina O, Vergara I. Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi. An Pediatr (Barc) 2021; 95:186-196. [PMID: 34384737 DOI: 10.1016/j.anpede.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/05/2020] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project in a health system, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM). PATIENTS AND METHODS Randomised clinical trial with two groups of 12-14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups. RESULTS There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity. CONCLUSIONS The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM.
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Affiliation(s)
- Elena Alustiza
- Osakidetza, Centro de Salud de Egia, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Amaia Perales
- Consulta de Asesoramiento en Alimentación y Salud, Beasain, Gipuzkoa, Spain
| | - Maider Mateo-Abad
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barakaldo, Bizkaia, Spain.
| | - Irene Ozcoidi
- Osakidetza, Centro de Salud de Amara Berri, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Garbiñe Aizpuru
- Consulta de Dietética y Asesoramiento Nutricional, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Olatz Albaina
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, Spain
| | - Itziar Vergara
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barakaldo, Bizkaia, Spain; Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, Spain
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10
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Alustiza E, Perales A, Mateo-Abad M, Ozcoidi I, Aizpuru G, Albaina O, Vergara I. [Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi]. An Pediatr (Barc) 2020. [PMID: 33388268 DOI: 10.1016/j.anpedi.2020.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project PRE-STARt in Euskadi, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM). PATIENTS AND METHODS Randomised clinical trial with two groups of 12-14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups. RESULTS There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity. CONCLUSIONS The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM.
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Affiliation(s)
- Elena Alustiza
- Osakidetza, Centro de Salud de Egia, Donostia-San Sebastián, Gipuzkoa, España
| | - Amaia Perales
- Consulta de Asesoramiento en Alimentación y Salud, Beasain, Gipuzkoa, España
| | - Maider Mateo-Abad
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barakaldo, Bizkaia, España.
| | - Irene Ozcoidi
- Osakidetza, Centro de Salud de Amara Berri, Donostia-San Sebastián, Gipuzkoa, España
| | - Garbiñe Aizpuru
- Consulta de Dietética y Asesoramiento Nutricional, Donostia, San-Sebastián, Gipuzkoa, España
| | - Olatz Albaina
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, España
| | - Itziar Vergara
- Instituto de Investigación en Servicios de Salud Kronikgune, Barakaldo, Bizkaia, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barakaldo, Bizkaia, España; Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, España
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11
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Lier LM, Breuer C, Ferrari N, Friesen D, Maisonave F, Schmidt N, Graf C. Cost-effectiveness of a family-based multicomponent outpatient intervention program for children with obesity in Germany. Public Health 2020; 186:185-192. [PMID: 32858303 DOI: 10.1016/j.puhe.2020.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Facing an epidemic of childhood obesity and budget constraints, public health administrations are showing an urgent interest in interventions that are both health effective and cost-effective. Thus, this study intends to analyze the return on investment of these existing programs. STUDY DESIGN All analyses are based on a comprehensive data set from 249 children with obesity and overweight children who participated in the Children's Health InterventionaL Trial (CHILT), an 11-month outpatient multidisciplinary family-based program. METHODS Cost-effectiveness was assessed by comparing estimated savings associated with a reduction in weight and improvement of obesity-related health parameters with intervention costs. Projected future savings in health care expenditures were modeled on existing research, using estimates of health care costs associated with juvenile obesity and remission thresholds of obesity-related disease. RESULTS On average, participants achieved a 0.19-unit reduction in the body mass index standard deviation score, showed reduction in their blood pressure values (systolic = -1.76 mmHg, diastolic = -2.82 mmHg), and showed improvement in their high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol values (HDL = +1.31 mg/dL, LDL = -4.82 mg/dL). The intervention costs were 1799€ per participant, and the benefits of avoided future health care costs varied by individual. On an aggregated level, future savings amounted to between 1859€ and 1926€ per person, translating into a return on investment of 3.3-7.0%. CONCLUSIONS This study shows that a multicomponent obesity intervention, such as the CHILT, not only results in weight loss and improves important health parameters but also is cost-effective.
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Affiliation(s)
- L M Lier
- MA. Strategy & International Management, BSc Business Administration & Economics Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany, Eisenstraße 5, 50925, Cologne, Germany.
| | - C Breuer
- Habilitation Sport Science Department of Sports Economics and Sport Management, German Sport University Cologne, Cologne, Germany
| | - N Ferrari
- PhD Sport Science Cologne Center for Prevention and Youth/Heart Center Cologne, University Hospital Cologne, Germany
| | - D Friesen
- MA Sports Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - F Maisonave
- Diploma in Sport Science Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - N Schmidt
- BA Sport Science, Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
| | - C Graf
- Habilitation Sport Science, PhD Sports Medicine Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, Germany
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12
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Ananthapavan J, Sacks G, Brown V, Moodie M, Nguyen P, Veerman L, Mantilla Herrera AM, Lal A, Peeters A, Carter R. Priority-setting for obesity prevention-The Assessing Cost-Effectiveness of obesity prevention policies in Australia (ACE-Obesity Policy) study. PLoS One 2020; 15:e0234804. [PMID: 32559212 PMCID: PMC7304600 DOI: 10.1371/journal.pone.0234804] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
The aim of the ACE-Obesity Policy study was to assess the economic credentials of a suite of obesity prevention policies across multiple sectors and areas of governance for the Australian setting. The study aimed to place the cost-effectiveness results within a broad decision-making context by providing an assessment of the key considerations for policy implementation. The Assessing Cost-Effectiveness (ACE) approach to priority-setting was used. Systematic literature reviews were undertaken to assess the evidence of intervention effectiveness on body mass index and/or physical activity for selected interventions. A standardised evaluation framework was used to assess the cost-effectiveness of each intervention compared to a 'no intervention' comparator, from a limited societal perspective. A multi-state life table Markov cohort model was used to estimate the long-term health impacts (quantified as health adjusted life years (HALYs)) and health care cost-savings resulting from each intervention. In addition to the technical cost-effectiveness results, qualitative assessments of implementation considerations were undertaken. All 16 interventions evaluated were found to be cost-effective (using a willingness-to-pay threshold of AUD50,000 per HALY gained). Eleven interventions were dominant (health promoting and cost-saving). The incremental cost-effectiveness ratio for the non-dominant interventions ranged from AUD1,728 to 28,703 per HALY gained. Regulatory interventions tended to rank higher on their cost-effectiveness results, driven by lower implementation costs. However, the program-based policy interventions were generally based on higher quality evidence of intervention effectiveness. This comparative analysis of the economic credentials of obesity prevention policies for Australia indicates that there are a broad range of policies that are likely to be cost-effective, although policy options vary in strength of evidence for effectiveness, affordability, feasibility, acceptability to stakeholders, equity impact and sustainability. Implementation of these policies will require sustained co-ordination across jurisdictions and multiple government sectors in order to generate the predicted health benefits for the Australian population.
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Affiliation(s)
- Jaithri Ananthapavan
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Vicki Brown
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Marj Moodie
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Phuong Nguyen
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Ana Maria Mantilla Herrera
- Queensland Centre for Mental Health Research, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Anita Lal
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Rob Carter
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Australia
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Goldthorpe J, Epton T, Keyworth C, Calam R, Armitage CJ. Are primary/elementary school-based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews. Obes Rev 2020; 21:e13001. [PMID: 32162477 DOI: 10.1111/obr.13001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Rachel Calam
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Zochonis Building, University of Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Coupland 1 Building University of Manchester, M13 9PL, UK Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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14
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Ekwaru JP, Ohinmaa A, Veugelers PJ. An Enhanced Approach for Economic Evaluation of Long-Term Benefits of School-Based Health Promotion Programs. Nutrients 2020; 12:nu12041101. [PMID: 32316099 PMCID: PMC7230436 DOI: 10.3390/nu12041101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic diseases constitute a tremendous public health burden globally. Poor nutrition, inactive lifestyles, and obesity are established independent risk factors for chronic diseases. Public health decision-makers are in desperate need of effective and cost-effective programs that prevent chronic diseases. To date, most economic evaluations consider the effect of these programs on body weight, without considering their effects on other risk factors (nutrition and physical activity). We propose an economic evaluation approach that considers program effects on multiple risk factors rather than on a single risk factor. For demonstration, we developed an enhanced model that incorporates health promotion program effects on four risk factors (weight status, physical activity, and fruit and vegetable consumption). Relative to this enhanced model, a model that considered only the effect on weight status produced incremental cost-effectiveness ratio (ICER) estimates for quality-adjusted life years that were 1% to 43% higher, and ICER estimates for years with chronic disease prevented that were 1% to 26% higher. The corresponding estimates for return on investment were 1% to 20% lower. To avoid an underestimation of the economic benefits of chronic disease prevention programs, we recommend economic evaluations consider program effects on multiple risk factors.
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15
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Bandurska E, Brzeziński M, Metelska P, Zarzeczna-Baran M. Cost-Effectiveness of an Obesity Management Program for 6- to 15-Year-Old Children in Poland: Data from Over Three Thousand Participants. Obes Facts 2020; 13:487-498. [PMID: 32957099 PMCID: PMC7670340 DOI: 10.1159/000509130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Obesity and overweight, including childhood obesity and overweight, pose a public health challenge worldwide. According to the available research findings, long-term interventions focusing on dietary behavior, physical activity, and psychological support are the most effective in reducing obesity in children aged 6-18 years. There are limited studies showing the financial effectiveness of such interventions. OBJECTIVE The objective of the present study was to evaluate cost-effectiveness of the 6-10-14 for Health weight management program using pharmacoeconomic indicators, i.e., cost-effectiveness analysis using the incremental cost-effectiveness ratio. METHODS We used anthropometric data of 3,081 children included in a 1-year-long intervention with a full financial cost assessment. RESULTS The cost of removing a child from the overweight group (BMI >85th percentile) was PLN 27,758 (EUR 6,463), and the cost of removing a child from the obese group (BMI >95th percentile) was slightly lower, i.e., PLN 23,601 (EUR 5,495). Given the obesity-related medical costs calculated in the life-long perspective, these results can be considered encouraging. At the same time, when comparing the total costs per participant with the costs of other interventions, it can be noted that they are similar to the costs of school programs containing more than 1 type of intervention. CONCLUSIONS The 6-10-14 for Health program can be considered cost-effective. As a result of committing financial resources in the approximate amount of EUR 1,790 per child, around half of the children participating in the program have improved their weight indicators.
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Affiliation(s)
- Ewa Bandurska
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Michał Brzeziński
- 6-10-14 for Health Program, University Clinical Center in Gdansk, Gdansk, Poland,
- Department of Paediatrics, Gastroenterology, Allergology and Paediatric Nutrition, Gdansk, Poland,
| | - Paulina Metelska
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
- 6-10-14 for Health Program, University Clinical Center in Gdansk, Gdansk, Poland
| | - Marzena Zarzeczna-Baran
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
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16
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Mears R, Jago R, Sharp D, Patel A, Kipping R, Shield JPH. Exploring how lifestyle weight management programmes for children are commissioned and evaluated in England: a mixed methodology study. BMJ Open 2019; 9:e025423. [PMID: 31848157 PMCID: PMC6937081 DOI: 10.1136/bmjopen-2018-025423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess how lifestyle weight management programmes for children aged 4-16 years in England are commissioned and evaluated at the local level. DESIGN This was a mixed-methods study comprising an online survey and semistructured telephone interviews. SETTING An online survey was sent to all local authorities (LAs) in England regarding lifestyle weight management services commissioned for children aged 4-16 years. Online survey data were collected between February and May 2016 and based on services commissioned between April 2014 and March 2015. Semistructured telephone interviews with LA staff across England were conducted between April and June 2016. PARTICIPANTS Commissioners or service providers working within the public health department of LAs. MAIN OUTCOME MEASURES The online survey collected information on the evidence base, costs, reach, service usage and evaluation of child lifestyle weight management services. The telephone interviews explored the nature of child weight management contracts commissioned by LAs, the type of outcome data collected and whether these data were shared with other LAs or organisations, the challenges faced by these services, and the perceived 'markers of success' for a programme. RESULTS The online survey showed that none of the participating LAs was aware of any peer-reviewed evidence supporting the effectiveness of their specific commissioned service. Despite this, the telephone interviews revealed that there was no national formal sharing of data to enable oversight of the effectiveness of commissioned services across LAs in England to help inform future commissioning decisions. Challenges with long-term data collection, service engagement, funding and the pressure to reduce the prevalence of obesity were frequently mentioned. CONCLUSIONS Robust, independent, cost-effectiveness analyses of obesity strategies are needed to determine the appropriate allocation of funding to lifestyle weight management treatment services, population-level preventative approaches or development of whole system approaches by an LA.
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Affiliation(s)
- Ruth Mears
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russ Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Deborah Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anamica Patel
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Bristol, UK
| | - Julian P H Shield
- NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
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17
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Hayes A, Tan EJ, Lung T, Brown V, Moodie M, Baur L. A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood. Front Endocrinol (Lausanne) 2019; 10:132. [PMID: 30881347 PMCID: PMC6405882 DOI: 10.3389/fendo.2019.00132] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 02/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Childhood obesity is a serious public health issue. In Australia, 1 in 4 children is already affected by overweight or obesity at the time of school entry. Governments around the world have recognized this problem through investment in the prevention of pediatric obesity, yet few interventions in early childhood have been subjected to economic evaluation. Information on cost-effectiveness is vital to decisions about program implementation. A challenge in evaluating preventive interventions in early childhood is to capture long-term costs and outcomes beyond the duration of an intervention, as the benefits of early obesity prevention will not be realized until some years into the future. However, decisions need to be made in the present, and modeling is one way to inform such decisions. Objective: To describe the conceptual structure of a new health economic model (the Early Prevention of Obesity in CHildhood (EPOCH) model) for evaluating childhood obesity interventions; and to validate the epidemiologic predictions. Methods and Results: We use an individual-level (micro-simulation) method to model BMI trajectories and the progression of obesity from early childhood to adolescence. The equations predicting individual BMI change underpinning our model were derived from data from the population-representative study, the Longitudinal Study of Australian Children (LSAC). Our approach is novel because it will account for costs and benefits accrued throughout childhood and adolescence. As a first step to validate the epidemiological predictions of the model, we used input data representing over 250,000 children aged 4/5 years, and simulated BMI and obesity trajectories until adolescence. Simulated mean BMI and obesity prevalence for boys and girls were verified by nationally-representative data on children at 14/15 years of age. Discussion: The EPOCH model is epidemiologically sound in its prediction of both BMI trajectories and prevalence of obesity for boys and girls. Future developments of the model will include socio-economic position and will incorporate the impacts of obesity on healthcare costs. The EPOCH model will help answer: when is it best to intervene in childhood; what are the most cost-effective approaches and which population groups will benefit most from interventions.
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Affiliation(s)
- Alison Hayes
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Eng J Tan
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, Australia
| | - Thomas Lung
- Health Economics and Process Evaluation, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vicki Brown
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Marj Moodie
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Louise Baur
- Centre for Research Excellence in Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
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18
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Conesa M, Llauradó E, Aceves-Martins M, Moriña D, de Solà-Morales O, Giralt M, Tarro L, Solà R. Cost-Effectiveness of the EdAl (Educació en Alimentació) Program: A Primary School-Based Study to Prevent Childhood Obesity. J Epidemiol 2018; 28:477-481. [PMID: 30058612 PMCID: PMC6242786 DOI: 10.2188/jea.je20170111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The cost-effectiveness of childhood obesity prevention interventions is critical for their sustained implementation. This study evaluated the cost-effectiveness of the Educació en Alimentació (EdAl) program, a school-based intervention for reducing obesity. Methods Total EdAl program implementation costs and per-child costs were estimated. Cost-effectiveness, defined using the incremental cost-effectiveness ratio (ICER), was estimated as the difference between the intervention and control group costs divided by the obesity-related outcome effects for boys (avoided cases of obesity, obesity prevalence, body mass index [BMI], and BMI z-score units) for each group. As a significant difference (4.39%) in the reduction of obesity prevalence between the intervention and control groups was observed for boys in the EdAl program, the data were calculated only for boys. Results The intervention cost was 24,246.53 € for 1,550 children (15.64 €/child/3 years) or 5.21 €/child/year. The ICERs/boy were 968.66 € to avoid one case of obesity, 3.6 € to reduce the obesity prevalence by 1%, 44.68 € to decrease BMI by one unit, and 65.16 € to reduce the BMI z-score by one unit. Conclusions The cost of reducing the obesity prevalence in boys by 4.39% was 5.21 €/child/year, half the cost proposed by the Spanish Health Ministry, indicating that the EdAl program is cost-effective.
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Affiliation(s)
- Marta Conesa
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion
| | - Elisabet Llauradó
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion
| | - Magaly Aceves-Martins
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion
| | - David Moriña
- Unit of Infections and Cancer (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat
| | - Oriol de Solà-Morales
- Institut d'Investigació Sanitaria Pere Virgili (IISPV), Reus, Spain; Health Institute for Technology Transfer (HITT)
| | - Montse Giralt
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Unit of Pharmacobiology, Health Education and Promotion
| | - Lucia Tarro
- Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion
| | - Rosa Solà
- Universitat Rovira i Virgili, Reus, Spain. Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, Hospital Universitari Sant Joan de Reus
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19
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Black N, Hughes R, Jones AM. The health care costs of childhood obesity in Australia: An instrumental variables approach. ECONOMICS AND HUMAN BIOLOGY 2018; 31:1-13. [PMID: 30064082 DOI: 10.1016/j.ehb.2018.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 05/27/2023]
Abstract
The effect of childhood obesity on medical costs incurred by the Australian Government is estimated using five waves of panel data from the Longitudinal Study of Australian Children, which is linked to public health insurance administrative records from Medicare Australia. Instrumental variables estimators are used to address concerns about measurement error and selection bias. The additional annual medical costs due to overweight and obesity among 6 to 13 year olds is about $43 million (in 2015 AUD). This is driven by a higher utilisation of general practitioner and specialist doctors. The results suggest that the economic consequences of childhood obesity are much larger than previously estimated.
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Affiliation(s)
- Nicole Black
- Centre for Health Economics, Monash Business School, Monash University, Australia.
| | - Robert Hughes
- Centre for Health Economics, Monash Business School, Monash University, Australia
| | - Andrew M Jones
- Centre for Health Economics, Monash Business School, Monash University, Australia; Department of Economics and Related Studies, University of York, United Kingdom
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20
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Oosterhoff M, Bosma H, van Schayck OCP, Evers SMAA, Dirksen CD, Joore MA. A systematic review on economic evaluations of school-based lifestyle interventions targeting weight-related behaviours among 4-12 year olds: Issues and ways forward. Prev Med 2018; 114:115-122. [PMID: 29959951 DOI: 10.1016/j.ypmed.2018.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 12/12/2022]
Abstract
Current guidelines for economic evaluations do not provide specific recommendations for the evaluation of school-based lifestyle interventions. This study examined and discussed the key aspects in the design of economic evaluations on school-based interventions targeting weight-related behaviours among 4-12 year olds. The PubMed and CRD databases (NHS EED) were searched. Grey literature was identified from reference lists and websites of relevant organizations. Full economic evaluations on school-based interventions targeting physical activity, sedentariness, or diet were selected. Key aspects included the objective, audience, intervention, comparator, population, type of analysis, perspective, costs, outcomes, and time horizon. Information was also extracted on measuring and valuing costs and outcomes, linking and extrapolating outcomes, and the maintenance of intervention effects. The 23 included studies reported on cost-effectiveness (CEAs) (N = 12), cost-utility (CUAs) (N = 9), social cost benefit (SCBA) (N = 2), and social return on investment (SROI) (N = 1) analysis. The usual practice comparator was generally not clearly defined. The SROI analysis was the single study that included outcomes in other persons than the child. Healthcare costs (N = 14), productivity costs (N = 4), and costs to the household (N = 3), or education (N = 2) sector were examined. The outcome in trial-based CEAs consisted of a variety of weight-related measures. Seven distinctive models were used to extrapolate health and/or productivity costs. To enhance the usefulness of economic evaluations on school-based lifestyle interventions in allocating public health budgets, transparent reporting on key aspects, broadening the scope of economic evaluations, and standardizing the measurement, valuation, and extrapolation of costs and outcomes should be improved. This study was conducted in Maastricht, the Netherlands.
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Affiliation(s)
- Marije Oosterhoff
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Social Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Family Medicine, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Health Services Research, P.O. Box 616, 6200, MD, Maastricht, the Netherlands; Trimbos, Netherlands Institute of Mental Health and Addiction, Trimbos, P.O. Box 725, 3500, AS, Utrecht, the Netherlands
| | - Carmen D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), KEMTA, P. Debyelaan 25, P.O. Box 5800, 6202, AZ, Maastricht, the Netherlands
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21
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Pimpin L, Cortez-Pinto H, Negro F, Corbould E, Lazarus JV, Webber L, Sheron N. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018; 69:718-735. [PMID: 29777749 DOI: 10.1016/j.jhep.2018.05.011] [Citation(s) in RCA: 424] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 02/06/2023]
Abstract
The burden of liver disease in Europe continues to grow. We aimed to describe the epidemiology of liver diseases and their risk factors in European countries, identifying public health interventions that could impact on these risk factors to reduce the burden of liver disease. As part of the HEPAHEALTH project we extracted information on historical and current prevalence and mortality from national and international literature and databases on liver disease in 35 countries in the World Health Organization European region, as well as historical and recent prevalence data on their main determinants; alcohol consumption, obesity and hepatitis B and C virus infections. We extracted information from peer-reviewed and grey literature to identify public health interventions targeting these risk factors. The epidemiology of liver disease is diverse, with variations in the exact composition of diseases and the trends in risk factors which drive them. Prevalence and mortality data indicate that increasing cirrhosis and liver cancer may be linked to dramatic increases in harmful alcohol consumption in Northern European countries, and viral hepatitis epidemics in Eastern and Southern European countries. Countries with historically low levels of liver disease may experience an increase in non-alcoholic fatty liver disease in the future, given the rise of obesity across most European countries. Liver disease in Europe is a serious issue, with increasing cirrhosis and liver cancer. The public health and hepatology communities are uniquely placed to implement measures aimed at reducing their causes: harmful alcohol consumption, child and adult obesity, and chronic infection with hepatitis viruses, which will in turn reduce the burden of liver disease.
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Affiliation(s)
| | - Helena Cortez-Pinto
- Departamento de Gastrenterologia, CHLN, Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain; CHIP, Rigshospitalet, University of Copenhagen, Øster Alle 56, 5. sal, DK-2100 Copenhagen, Denmark
| | | | - Nick Sheron
- University of Southampton, Southampton SO17 1BJ, United Kingdom.
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22
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Milliken OV, Ellis VL. Development of an investment case for obesity prevention and control: perspectives on methodological advancement and evidence. Rev Panam Salud Publica 2018; 42:e62. [PMID: 31093090 PMCID: PMC6385999 DOI: 10.26633/rpsp.2018.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/22/2018] [Indexed: 12/13/2022] Open
Abstract
This paper opens a discussion on the main features of an investment case for obesity prevention and control, by scanning available evidence on existing approaches and by highlighting contextual considerations and evidence for Latin America and the Caribbean. We call on researchers and analysts in the field to update and broaden existing methods of economic analyses to better reflect the multisectoral nature of an investment case for obesity prevention and control. We also identify research gaps and further work required to advance methods and evidence towards investment cases throughout the Americas.
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Affiliation(s)
- Olga V. Milliken
- Centre for Chronic Disease Prevention and Health Equity and WHO Collaborating Centre on Noncommunicable Disease Policy, Public Health Agency of Canada, Ottawa, Canada
| | - Vivian L. Ellis
- Centre for Chronic Disease Prevention and Health Equity and WHO Collaborating Centre on Noncommunicable Disease Policy, Public Health Agency of Canada, Ottawa, Canada
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23
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Sweeney R, Moodie M, Nguyen P, Fraser P, Bolton K, Brown A, Marks J, Crooks N, Strugnell C, Bell C, Millar L, Orellana L, Allender S. Protocol for an economic evaluation of WHO STOPS childhood obesity stepped-wedge cluster randomised controlled trial. BMJ Open 2018; 8:e020551. [PMID: 29764881 PMCID: PMC5961569 DOI: 10.1136/bmjopen-2017-020551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Prevention of overweight and obesity in childhood is a priority because of associated acute and chronic conditions in childhood and later in life, which place significant burden on health systems. Evidence suggests prevention should engage a range of actions and actors and target multiple levels. The Whole of Systems Trial Of Prevention Strategies for childhood obesity (WHO STOPS) will evaluate the outcomes of a novel systems-based intervention that aims to engage whole communities in a locally led multifaceted response. This paper describes the planned economic evaluation of WHO STOPS and examines the methodological challenges for economic evaluation of a complex systems-based intervention. METHODS AND ANALYSIS Economic evaluation alongside a stepped-wedge cluster randomised controlled trial in regional and rural communities in Victoria, Australia. Cost-effectiveness and cost-utility analyses will provide estimates of the incremental cost (in $A) per body mass index unit saved and quality adjusted life year gained. A Markov cohort model will be employed to estimate healthcare cost savings and benefits over the life course of children. The dollar value of community resources harnessed for the community-led response will be estimated. Probabilistic uncertainty analyses will be undertaken to test sensitivity of results to plausible variations in all trial-based and modelled variables. WHO STOPS will also be assessed against other implementation considerations (such as sustainability and acceptability to communities and other stakeholders). ETHICS AND DISSEMINATION The trial is registered by the Australian New Zealand Clinical Trials Registry (ACTRN12616000980437). Full ethics clearances have been received for all methods described below: Deakin University's Human Research Ethics Committee 2014-279, Deakin University's Human Ethics Advisory Group-Health (HEAG-H) HEAG-H 194_2014, HEAG-H 17 2015, HEAG-H 155_2014, HEAG-H 197_2016, HEAG-H 118_2017, the Victorian Department of Education and Training 2015_002622 and the Catholic Archdiocese of Ballarat. Trial findings (including economic evaluation) will be published in peer-reviewed journals and presented at international conferences. Collected data and analyses will be made available in accordance with journal policies and study ethics approvals. Results will be presented to relevant government authorities with an interest in cost-effectiveness of these types of interventions. TRIAL REGISTRATION NUMBER ACTRN12616000980437; Pre-results.
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Affiliation(s)
- Rohan Sweeney
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Phuong Nguyen
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Penny Fraser
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Kristy Bolton
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Jennifer Marks
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Nic Crooks
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
| | - Lynne Millar
- Australian Health Policy Collaboration, Victoria University, Melbourne, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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24
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Zanganeh M, Adab P, Li B, Frew E. Protocol for a systematic review of methods and cost-effectiveness findings of economic evaluations of obesity prevention and/or treatment interventions in children and adolescents. Syst Rev 2018; 7:54. [PMID: 29609652 PMCID: PMC5879570 DOI: 10.1186/s13643-018-0718-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/22/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global public health problem, with governments increasingly having to undertake various strategies to reduce excess weight in their populations. Considering the increasing number of well-conducted intervention studies in the field of childhood obesity prevention, there are relatively few published economic evaluations. The proposed systematic review will explore the methods of these economic evaluations, examine the limitations and establish the evidence base for cost-effectiveness analyses. METHODS/DESIGN Systematic review methodology will be applied to identify, select and extract data from published economic evaluation studies (trial-based, non-trial based, simulation-based, decision model and trial based model economic evaluations) of obesity prevention and/or treatment interventions in children and adolescents. A systematic literature search will be conducted using bibliographic databases (MEDLINE, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Cochrane Library, Centre for Reviews and Dissemination (CRD) and Cost-Effectiveness Analysis (CEA) Registry). The review will only include full economic evaluations. There will be no restrictions based on language, perspective, follow-up duration, sample size, country or setting. To minimise selection bias, translation of non-English language articles will be undertaken. The quality of included studies will be assessed. Following data extraction, a narrative synthesis of the results from the included studies will be undertaken. Subgroup analysis will be considered where deemed appropriate. DISCUSSION The findings from this review, which will include primary studies, will provide evidence to assist health policy decision makers interpret economic evaluations in this field. In addition, we will identify gaps in the current literature to inform future-related research. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42017062236.
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Affiliation(s)
- Mandana Zanganeh
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Bai Li
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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25
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Panca M, Viner RM, White B, Pandya T, Melo H, Adamo M, Batterham R, Christie D, Kinra S, Morris S. Cost-effectiveness of bariatric surgery in adolescents with severe obesity in the UK. Clin Obes 2018; 8:105-113. [PMID: 29224241 DOI: 10.1111/cob.12232] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/25/2017] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
Evidence shows that surgery for severe obesity in adults improves health and psychological functioning, and is cost-effective. Data on bariatric surgery for adolescents with severe obesity are extremely limited, with no evidence on cost-effectiveness. We evaluated the lifetime cost-effectiveness of bariatric surgery compared with no surgery in adolescents with severe obesity from the UK's National Health Service perspective. Eighteen adolescents with body mass index ≥40 kg m-2 who underwent bariatric surgery (laparoscopic Roux en Y Gastric Bypass [RYGB] [N = 9], and laparoscopic Sleeve Gastrectomy [SG] [N = 9]) at University College London Hospitals between January 2008 and December 2013 were included. We used a Markov cohort model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and no surgery. Mean cost of RYGB and SG procedures were £7100 and £7312, respectively. For RYGB vs. no surgery, the incremental cost/QALY was £2018 (95% CI £1942 - £2042) for males and £2005 (95% CI £1974 - £2031) for females. For SG vs. no surgery, the incremental cost/QALY was £1978 (95% CI £1954 - £2002) for males and £1941 (95% CI £1915 - £1969) for females. Bariatric surgery in adolescents with severe obesity is cost-effective; it is more costly than no surgery however it markedly improved quality of life.
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Affiliation(s)
- M Panca
- Research Department of Primary Care & Population Health, UCL Institute of Epidemiology & Health Care, London, UK
| | - R M Viner
- Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
| | - B White
- UCLH Adolescent Diabetes & Obesity, UCL Institute of Child Health, London, UK
| | - T Pandya
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - H Melo
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - M Adamo
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - R Batterham
- Department of Medicine, UCL Centre for Obesity Research, Rayne Institute, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, London, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - D Christie
- UCL Hospitals, NHS Foundation Trust, London, UK
| | - S Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - S Morris
- Department of Applied Health Research, UCL Institute of Epidemiology & Health Care, London, UK
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26
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Reilly KL, Reeves P, Deeming S, Yoong SL, Wolfenden L, Nathan N, Wiggers J. Economic analysis of three interventions of different intensity in improving school implementation of a government healthy canteen policy in Australia: costs, incremental and relative cost effectiveness. BMC Public Health 2018; 18:378. [PMID: 29558931 PMCID: PMC5859495 DOI: 10.1186/s12889-018-5315-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background No evaluations of the cost or cost effectiveness of interventions to increase school implementation of food availability policies have been reported. Government and non-government agency decisions regarding the extent of investment required to enhance school implementation of such policies are unsupported by such evidence. This study sought to i) Determine cost and cost-effectiveness of three interventions in improving school implementation of an Australian government healthy canteen policy and; ii) Determine the relative cost-effectiveness of the interventions in improving school implementation of such a policy. Methods An analysis of the cost and cost-effectiveness of three implementation interventions of varying support intensity, relative to usual implementation support conducted during 2013–2015 was undertaken. Secondly, an indirect comparison of the trials was undertaken to determine the most cost-effective of the three strategies. The economic analysis was based on the cost of delivering the interventions by health service delivery staff to increase the proportion of schools ‘adherent’ with the policy. Results The total costs per school were $166,971, $70,926 and $75,682 for the high, medium and low intensity interventions respectively. Compared to usual support, the cost effectiveness ratios for each of the three interventions were: A$2982 (high intensity), A$2627 (medium intensity) and A$4730 (low intensity) per percent increase in proportion of schools reporting ‘adherence’). Indirect comparison between the ‘high’ and ‘medium intensity’ interventions showed no statistically significant difference in cost-effectiveness. Conclusions The results indicate that while the cost profiles of the interventions varied substantially, the cost-effectiveness did not. This result is valuable to policy makers seeking cost-effective solutions that can be delivered within budget.
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Affiliation(s)
- Kathryn L Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Simon Deeming
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
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27
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Sharifi M, Franz C, Horan CM, Giles CM, Long MW, Ward ZJ, Resch SC, Marshall R, Gortmaker SL, Taveras EM. Cost-Effectiveness of a Clinical Childhood Obesity Intervention. Pediatrics 2017; 140:peds.2016-2998. [PMID: 29089403 PMCID: PMC5654390 DOI: 10.1542/peds.2016-2998] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To estimate the cost-effectiveness and population impact of the national implementation of the Study of Technology to Accelerate Research (STAR) intervention for childhood obesity. METHODS In the STAR cluster-randomized trial, 6- to 12-year-old children with obesity seen at pediatric practices with electronic health record (EHR)-based decision support for primary care providers and self-guided behavior-change support for parents had significantly smaller increases in BMI than children who received usual care. We used a microsimulation model of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the United States with fully functional EHRs to estimate cost, impact on obesity prevalence, and cost-effectiveness. RESULTS The expected population reach of a 10-year national implementation is ∼2 million children, with intervention costs of $119 per child and $237 per BMI unit reduced. At 10 years, assuming maintenance of effect, the intervention is expected to avert 43 000 cases and 226 000 life-years with obesity at a net cost of $4085 per case and $774 per life-year with obesity averted. Limiting implementation to large practices and using higher estimates of EHR adoption improved both cost-effectiveness and reach, whereas decreasing the maintenance of the intervention's effect worsened the former. CONCLUSIONS A childhood obesity intervention with electronic decision support for clinicians and self-guided behavior-change support for parents may be more cost-effective than previous clinical interventions. Effective and efficient interventions that target children with obesity are necessary and could work in synergy with population-level prevention strategies to accelerate progress in reducing obesity prevalence.
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Affiliation(s)
- Mona Sharifi
- Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Calvin Franz
- Eastern Research Group Inc, Lexington, Massachusetts
| | - Christine M. Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | | | - Michael W. Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia; and
| | | | - Stephen C. Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates and Atrius Health Inc, Boston, Massachusetts
| | | | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts;,Nutrition, and
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Evaluation of compliance with the Spanish Code of self-regulation of food and drinks advertising directed at children under the age of 12 years in Spain, 2012. Public Health 2017; 150:121-129. [DOI: 10.1016/j.puhe.2017.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/05/2017] [Accepted: 05/22/2017] [Indexed: 11/21/2022]
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Larsen KT, Huang T, Møller NC, Andersen LB, Sørensen J. Cost-effectiveness of a day-camp weight-loss intervention programme for children: Results based on a randomised controlled trial with one-year follow-up. Scand J Public Health 2017; 45:666-674. [PMID: 28758542 DOI: 10.1177/1403494816688374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The aim was to analyse the cost-effectiveness of an intensive weight-loss intervention for children compared with a low-intensity intervention. METHODS One hundred and fifteen overweight children (mean age 12.0 ± 0.4) were randomised to either the camp group (CG) ( N=59) or the standard group (SG) ( N=56). Participants in the CG were offered a six-week day-camp weight-loss programme followed by a family-based supportive programme containing four meetings during the succeeding 46 weeks. Participants in the SG were offered a weekly two-hour exercise session for six weeks. Changes in body mass index (BMI) and BMI z-score 12 months after inclusion were used to compare the effects of the two interventions. Incremental cost-effectiveness ratios (ICER) were estimated from the perspective of a Danish municipality. To achieve the required number of participants, an additional intervention was initiated one year later. RESULTS In comparison with the SG, the CG changed their mean BMI by -1.2 (95% CI -1.8 to -0.5). Compared with the SG children, the CG children changed their BMI z-score by -0.20 (95% CI -0.35 to -0.05). The ICER per decreased BMI point in the CG compared with the SG was DDK 24,928. CONCLUSIONS Compared with the SG, the CG showed favourable effects after 12 months. However, the CG was more costly. The results observed in the present study may be helpful in guiding decision makers to take more informed decisions when choosing different types of intervention.
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Affiliation(s)
- Kristian Traberg Larsen
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Tao Huang
- 2 Department of Physical Education, Shanghai Jiao Tong University, China
| | - Niels Christian Møller
- 1 Centre of Research in Childhood Health (RICH), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
| | - Lars Bo Andersen
- 3 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jan Sørensen
- 4 Center for Health Economic Research (COHERE), Department of Public Health, University of Southern Denmark, Denmark
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30
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Sheng B, Feng C, Zhang D, Spitler H, Shi L. Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E183. [PMID: 28208824 PMCID: PMC5334737 DOI: 10.3390/ijerph14020183] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/03/2017] [Accepted: 01/19/2017] [Indexed: 01/02/2023]
Abstract
Background: The link between body weight status and spinal diseases has been suggested by a number of cross-sectional and cohort studies with a limited range of patient populations. No population-representative samples have been used to examine the link between obesity and spinal diseases. The present study is based on a nationally representative sample drawn from the Medical Expenditure Panel Survey. Methods: Using the cross-sectional sample of the 2014 Medical Expenditure Panel Study, we built four weighted logistic regression analyses of the associations between body weight status and the following four spinal diseases: low back pain, spondylosis, other cervical disorders and intervertebral disc disorder (IDD). Each respondent's body weight status was used as the key independent variable with three categories: normal/underweight, overweight, and obese. We controlled for marital status, gender, age, smoking status, household income, health insurance coverage, educational attainment and the use of health services for other major categories of diseases. Results: A total sample of 23,048 respondents was used in our analysis. Overweight and obese respondents, as compared to normal/underweight respondents, were more likely to develop lower back problems (Overweight: logged odds = 0.218, p < 0.01; Obese: logged odds = 0.395, p < 0.001) and IDD (Overweight: logged odds = 0.441, p < 0.05; Obese: logged odds = 0.528, p < 0.001). The associations between bodyweight status and spondylitis were statistically insignificant (Overweight: logged odds = 0.281, p = 0.442; Obese: logged odds = 0.680, p = 0.104). The associations between body weight status and other cervical disorders (Overweight: logged odds = -0.116, p = 0.304; Obese: logged odds = -0.160, p = 0.865) were statistically insignificant. Conclusions: As the first study using a national sample to study bodyweight and spinal diseases, our paper supports the hypothesis that obesity adds to the burden of low back pain and IDD. Longitudinal and interventional studies are needed to understand the specific mechanisms behind these positive associations.
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Affiliation(s)
- Binwu Sheng
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Chaoling Feng
- Samuel Curtis Johnson Graduate School of Management, Cornell University, Ithaca, NY 14853, USA.
| | - Donglan Zhang
- Department of Health Policy and Management, University of Georgia, Athens, GA 30609, USA.
| | - Hugh Spitler
- Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA.
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC 29631, USA.
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31
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Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three Interventions That Reduce Childhood Obesity Are Projected To Save More Than They Cost To Implement. Health Aff (Millwood) 2017; 34:1932-9. [PMID: 26526252 DOI: 10.1377/hlthaff.2015.0631] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.
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Affiliation(s)
- Steven L Gortmaker
- Steven L. Gortmaker is a professor of the practice of health sociology at the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts
| | - Y Claire Wang
- Y. Claire Wang is an associate professor at the Mailman School of Public Health, Columbia University, in New York City
| | - Michael W Long
- Michael W. Long is an assistant professor at the Milken Institute School of Public Health, the George Washington University, in Washington, DC
| | - Catherine M Giles
- Catherine M. Giles is a program manager at the Harvard T.H. Chan School of Public Health
| | - Zachary J Ward
- Zachary J. Ward is a programmer analyst at the Harvard T.H. Chan School of Public Health
| | - Jessica L Barrett
- Jessica L. Barrett is a research assistant IV at the Harvard T.H. Chan School of Public Health
| | - Erica L Kenney
- Erica L. Kenney is a postdoctoral research fellow at the Harvard T.H. Chan School of Public Health
| | - Kendrin R Sonneville
- Kendrin R. Sonneville is an assistant professor at the University of Michigan School of Public Health, in Ann Arbor
| | - Amna Sadaf Afzal
- Amna Sadaf Afzal is an assistant professor at the Albert Einstein College of Medicine, in New York City
| | - Stephen C Resch
- Stephen C. Resch is deputy director of the Center for Health Decision Science at the Harvard T.H. Chan School of Public Health
| | - Angie L Cradock
- Angie L. Cradock is a senior research scientist at the Harvard T.H. Chan School of Public Health
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Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090911. [PMID: 27649218 PMCID: PMC5036744 DOI: 10.3390/ijerph13090911] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 01/03/2023]
Abstract
Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.
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Schwander B, Hiligsmann M, Nuijten M, Evers S. Systematic review and overview of health economic evaluation models in obesity prevention and therapy. Expert Rev Pharmacoecon Outcomes Res 2016; 16:561-570. [DOI: 10.1080/14737167.2016.1230497] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Bjoern Schwander
- AHEAD GmbH – Agency for Health Economic Assessment and Dissemination, Loerrach, BW, Germany
- Department of Health Services Research, CAPHRI – School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI – School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | | | - Silvia Evers
- Department of Health Services Research, CAPHRI – School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
- Trimbos-Instituut – Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
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Briggs ADM, Wolstenholme J, Blakely T, Scarborough P. Choosing an epidemiological model structure for the economic evaluation of non-communicable disease public health interventions. Popul Health Metr 2016; 14:17. [PMID: 27152092 PMCID: PMC4857239 DOI: 10.1186/s12963-016-0085-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
Non-communicable diseases are the leading global causes of mortality and morbidity. Growing pressures on health services and on social care have led to increasing calls for a greater emphasis to be placed on prevention. In order for decisionmakers to make informed judgements about how to best spend finite public health resources, they must be able to quantify the anticipated costs, benefits, and opportunity costs of each prevention option available. This review presents a taxonomy of epidemiological model structures and applies it to the economic evaluation of public health interventions for non-communicable diseases. Through a novel discussion of the pros and cons of model structures and examples of their application to public health interventions, it suggests that individual-level models may be better than population-level models for estimating the effects of population heterogeneity. Furthermore, model structures allowing for interactions between populations, their environment, and time are often better suited to complex multifaceted interventions. Other influences on the choice of model structure include time and available resources, and the availability and relevance of previously developed models. This review will help guide modelers in the emerging field of public health economic modeling of non-communicable diseases.
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Affiliation(s)
- Adam D. M. Briggs
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Jane Wolstenholme
- />Health Economics Research Centre (HERC), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Blakely
- />Health Inequalities Research Programme (HIRP), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Peter Scarborough
- />BHF Centre on Population Approaches for Non-Communicable Disease Prevention (BHF CPNP), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
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Assessing long-term QALYs gain from averting and reversing overweight and obesity in childhood. Qual Life Res 2016; 25:2611-2618. [PMID: 27052420 DOI: 10.1007/s11136-016-1285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Interventions to tackle childhood obesity have been devised in response to the rising prevalence of childhood obesity. However, efficiency of these interventions remains a concern. Cost-utility analysis, representing health benefits in terms of quality-adjusted life years (QALYs), is a type of economic evaluation that has widely been recommended in assessing efficiency of health interventions. However, certain limitations in using QALYs remain specifically difficult in QALYs estimation. This study estimates the long-term QALYs gain from reversing childhood obesity in Thailand. METHODS An economic model was developed to estimate long-term QALYs of the youth aged 3-18 for the BMI status in childhood, which were categorized into three groups: normal weight, overweight, and obese. Long-term QALYs were estimated between ages 35 and 100, according to children's age, sex, and BMI status. Differences in QALYs between BMI status groups were calculated to represent the QALYs gain for youth from reversing obesity and overweight. The future outcomes were discounted at 3 % per annum in the base-case analysis; the discount rates of 0, 1.5, 3.5, and 5 % were also applied in the sensitivity analyses. RESULTS QALYs gained from reversing childhood obesity increase with age, starting from 0.040 and 0.083 QALYs at age 3 to 0.590 and 0.553 QALYs at age 18 in boys and girls, respectively. Reversing overweight and obesity in girls produces more QALYs than in boys between ages 3 and 17. CONCLUSIONS Efficiency is an important issue in allocating public healthcare resources to maximize social benefits. The results of this study facilitate long-term QALYs estimation with respect to BMI status in childhood, which could encourage more routine economic evaluation of child obesity interventions and maximize their health benefits.
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Abstract
Parallel to rising obesity rates is an increase in costs associated with excess weight. Estimates of future direct (medical) and indirect (nonmedical) costs related to obesity suggest rising expenditures that will impose a significant economic burden to individuals and society as a whole. This article reviews research on direct and indirect medical costs and future economic trends associated with obesity and associated comorbidities. Cost disparities associated with subsets of the population experiencing higher than average rates of obesity are explored. Finally, potential solutions with the highest estimated impact are offered, and future directions are proposed.
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Affiliation(s)
- Elena A Spieker
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Fort Lewis, WA 98431, USA; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Natasha Pyzocha
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Fort Lewis, WA 98431, USA
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Kelley GA, Kelley KS, Pate RR. Exercise and BMI in Overweight and Obese Children and Adolescents: A Systematic Review and Trial Sequential Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:704539. [PMID: 26579538 PMCID: PMC4633529 DOI: 10.1155/2015/704539] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Determine the effects of exercise on body mass index (BMI in kg · m(-2)) among overweight and obese children and adolescents. METHODS Trial sequential meta-analysis of randomized controlled exercise intervention trials ≥ 4 weeks and published up to November 11, 2014. RESULTS Of the 5,436 citations screened, 20 studies representing 971 boys and girls were included. Average length, frequency, and duration of training were 13 weeks, 3 times per week, for 46 minutes per session. Overall, random-effects models showed that exercise decreased BMI by 3.6% (mean: -1.08; 95% CI: -0.52 to -1.64; Q = 231.4; p < 0.001; I (2) = 90.9%; 95% CI: 87.6% to 93.4%; D (2) = 91.5%). Trial sequential meta-analysis showed that changes in BMI crossed the monitoring boundary for a type 1 error in 2010, remaining stable thereafter. The number needed to treat was 5 while the percentile improvement was 26.9. It was estimated that approximately 2.5 million overweight and obese children in the US and 22.0 million overweight and obese children worldwide could reduce their BMI by participating in a regular exercise program. Overall quality of evidence was rated as moderate. CONCLUSIONS Exercise is associated with improvements in BMI among overweight and obese children and adolescents. This trial is registered with PROSPERO Trial Registration #CRD42015017586.
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Affiliation(s)
- George A. Kelley
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Kristi S. Kelley
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Russell R. Pate
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
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Sonneville KR, Long MW, Ward ZJ, Resch SC, Wang YC, Pomeranz JL, Moodie ML, Carter R, Sacks G, Swinburn BA, Gortmaker SL. BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth. Am J Prev Med 2015; 49:124-34. [PMID: 26094233 DOI: 10.1016/j.amepre.2015.02.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/27/2015] [Accepted: 03/24/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. METHODS We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. RESULTS We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. CONCLUSIONS Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.
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Affiliation(s)
- Kendrin R Sonneville
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Michael W Long
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Stephen C Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
| | - Jennifer L Pomeranz
- Department of Public Health, Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania
| | - Marj L Moodie
- Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Rob Carter
- Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia
| | - Boyd A Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, Massachusetts
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Long MW, Gortmaker SL, Ward ZJ, Resch SC, Moodie ML, Sacks G, Swinburn BA, Carter RC, Claire Wang Y. Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S. Am J Prev Med 2015; 49:112-23. [PMID: 26094232 PMCID: PMC8969866 DOI: 10.1016/j.amepre.2015.03.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 02/18/2015] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Reducing sugar-sweetened beverage consumption through taxation is a promising public health response to the obesity epidemic in the U.S. This study quantifies the expected health and economic benefits of a national sugar-sweetened beverage excise tax of $0.01/ounce over 10 years. METHODS A cohort model was used to simulate the impact of the tax on BMI. Assuming ongoing implementation and effect maintenance, quality-adjusted life-years gained and disability-adjusted life-years and healthcare costs averted were estimated over the 2015-2025 period for the 2015 U.S. POPULATION Costs and health gains were discounted at 3% annually. Data were analyzed in 2014. RESULTS Implementing the tax nationally would cost $51 million in the first year. The tax would reduce sugar-sweetened beverage consumption by 20% and mean BMI by 0.16 (95% uncertainty interval [UI]=0.06, 0.37) units among youth and 0.08 (95% UI=0.03, 0.20) units among adults in the second year for a cost of $3.16 (95% UI=$1.24, $8.14) per BMI unit reduced. From 2015 to 2025, the policy would avert 101,000 disability-adjusted life-years (95% UI=34,800, 249,000); gain 871,000 quality-adjusted life-years (95% UI=342,000, 2,030,000); and result in $23.6 billion (95% UI=$9.33 billion, $54.9 billion) in healthcare cost savings. The tax would generate $12.5 billion in annual revenue (95% UI=$8.92, billion, $14.1 billion). CONCLUSIONS The proposed tax could substantially reduce BMI and healthcare expenditures and increase healthy life expectancy. Concerns regarding the potentially regressive tax may be addressed by reduced obesity disparities and progressive earmarking of tax revenue for health promotion.
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Affiliation(s)
- Michael W Long
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen C Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marj L Moodie
- Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Gary Sacks
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia
| | - Boyd A Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia; Section of Epidemiology and Biostatistics, the School of Population Health, University of Auckland, New Zealand
| | - Rob C Carter
- Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
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Gortmaker SL, Long MW, Resch SC, Ward ZJ, Cradock AL, Barrett JL, Wright DR, Sonneville KR, Giles CM, Carter RC, Moodie ML, Sacks G, Swinburn BA, Hsiao A, Vine S, Barendregt J, Vos T, Wang YC. Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES. Am J Prev Med 2015; 49:102-11. [PMID: 26094231 PMCID: PMC9508900 DOI: 10.1016/j.amepre.2015.03.032] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. RESULTS Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.
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Affiliation(s)
- Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Michael W Long
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stephen C Resch
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Zachary J Ward
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Angie L Cradock
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jessica L Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Davene R Wright
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kendrin R Sonneville
- Division of Adolescent Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine M Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rob C Carter
- Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Marj L Moodie
- Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Gary Sacks
- Deakin Health Economics, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Boyd A Swinburn
- WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Victoria, Australia; School of Population Health, University of Auckland, Auckland, New Zealand
| | - Amber Hsiao
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
| | - Seanna Vine
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
| | - Jan Barendregt
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Theo Vos
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
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Cost Effectiveness of an Elementary School Active Physical Education Policy. Am J Prev Med 2015; 49:148-59. [PMID: 26094235 DOI: 10.1016/j.amepre.2015.02.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 01/14/2015] [Accepted: 02/10/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). CONCLUSIONS Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.
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Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, James WPT, Wang Y, McPherson K. Child and adolescent obesity: part of a bigger picture. Lancet 2015; 385:2510-20. [PMID: 25703114 PMCID: PMC4594797 DOI: 10.1016/s0140-6736(14)61746-3] [Citation(s) in RCA: 685] [Impact Index Per Article: 76.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of childhood overweight and obesity has risen substantially worldwide in less than one generation. In the USA, the average weight of a child has risen by more than 5 kg within three decades, to a point where a third of the country's children are overweight or obese. Some low-income and middle-income countries have reported similar or more rapid rises in child obesity, despite continuing high levels of undernutrition. Nutrition policies to tackle child obesity need to promote healthy growth and household nutrition security and protect children from inducements to be inactive or to overconsume foods of poor nutritional quality. The promotion of energy-rich and nutrient-poor products will encourage rapid weight gain in early childhood and exacerbate risk factors for chronic disease in all children, especially those showing poor linear growth. Whereas much public health effort has been expended to restrict the adverse marketing of breastmilk substitutes, similar effort now needs to be expanded and strengthened to protect older children from increasingly sophisticated marketing of sedentary activities and energy-dense, nutrient-poor foods and beverages. To meet this challenge, the governance of food supply and food markets should be improved and commercial activities subordinated to protect and promote children's health.
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Affiliation(s)
- Tim Lobstein
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK.
| | - Rachel Jackson-Leach
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Marjory L Moodie
- Deakin Health Economics, Deakin University, Melbourne, VIC, Australia
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Steven L Gortmaker
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Boyd A Swinburn
- WHO Collaborating Centre for Obesity Prevention Deakin University, Melbourne, VIC, Australia; School of Population Health, University of Auckland, New Zealand
| | - W Philip T James
- World Obesity Federation (formerly the International Association for the Study of Obesity), London, UK
| | - Youfa Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, NY, USA
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Leeman J, Myers AE, Ribisl KM, Ammerman AS. Disseminating policy and environmental change interventions: insights from obesity prevention and tobacco control. Int J Behav Med 2015; 22:301-11. [PMID: 25037977 PMCID: PMC4520223 DOI: 10.1007/s12529-014-9427-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Public health and other practitioners increasingly are being asked to implement policy and environmental change interventions, yet many practitioners lack the knowledge, skills, and resources to do so. In response to this need, a growing number of organizations are disseminating evidence-based interventions (EBIs) and building practitioners' capacity to use those interventions in practice. Although advances have been made on approaches to disseminating individual-level EBIs, little is known about the optimal way to disseminate EBIs to promote policy and environmental change. PURPOSE This paper describes the approach that two projects developed to disseminate policy and environmental change interventions. The Center for Training and Research Translation (Center TRT) disseminates EBIs to promote physical activity and healthy eating. Counter Tobacco disseminates EBIs to counter tobacco product sales and marketing in the retail environment. METHOD Both Centers (1) identify the best available evidence, (2) disseminate menus of intervention strategies, (3) provide implementation guidance, (4) incorporate stories from the field, (5) build practitioners' capacity, and (6) integrate dissemination into practitioners' existing social networks. The Centers' process evaluations included website analytics and online surveys. RESULT Over 26,000 unique visitors accessed the Center TRT website in 2012 and over 17,000 have accessed Counter Tobacco's site since its launch in August 2011. The majority of respondents to Centers' surveys agreed that resources were easy to access and use. CONCLUSION Both Centers have had success reaching their intended audiences. Research is now needed to assess the extent of practitioners' use of Center resources and the impact of the resulting interventions.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, 1200 Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA,
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Chambers SA, Freeman R, Anderson AS, MacGillivray S. Reducing the volume, exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: A systematic review of the evidence from statutory and self-regulatory actions and educational measures. Prev Med 2015; 75:32-43. [PMID: 25735606 DOI: 10.1016/j.ypmed.2015.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To identify and review evidence on 1) the effectiveness of statutory and self-regulatory actions to reduce the volume, exposure or wider impact of advertising for foods high in fat, sugar and salt (HFSS) to children, and 2) the role of educational measures. DESIGN/METHODOLOGY/APPROACH A systematic review of three databases (Medline, CINAHL and PsycINFO) and grey literature was carried out. Relevant evidence included studies evaluating advertising bans and restrictions, advertising literacy programmes and parental communication styles. Relevant media included TV, internet, radio, magazines and newspaper advertising. No studies were excluded based on language or publication date. FINDINGS Forty-seven publications were included: 19 provided evidence for the results of statutory regulation, 25 for self-regulation, and six for educational approaches. Outcome measures varied in approach, quality and results. Findings suggested statutory regulation could reduce the volume of and children's exposure to advertising for foods HFSS, and had potential to impact more widely. Self-regulatory approaches showed varied results in reducing children's exposure. There was some limited support for educational measures. DISCUSSION Consistency in measures from evaluations over time would assist the development and interpretation of the evidence base on successful actions and measures to reduce the volume, exposure and impact of advertising for foods HFSS to children.
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Affiliation(s)
- Stephanie A Chambers
- Oral Health and Health Research Group, Dental Health Services Research Unit, University of Dundee, Dundee Dental School, Park Place, Dundee DD1 4HN, United Kingdom; Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom.
| | - Ruth Freeman
- Oral Health and Health Research Group, Dental Health Services Research Unit, University of Dundee, Dundee Dental School, Park Place, Dundee DD1 4HN, United Kingdom.
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom.
| | - Steve MacGillivray
- Social Dimensions of Health Institute, University of Dundee, Airlie Place, Dundee DD1 4HJ, United Kingdom.
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Otim ME, Asante AD, Kelaher M, Anderson IP, Jan S. Acceptability of programme budgeting and marginal analysis as a tool for routine priority setting in Indigenous health. Int J Health Plann Manage 2015; 31:277-95. [DOI: 10.1002/hpm.2287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/24/2015] [Accepted: 01/27/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael E. Otim
- School of Allied Health Australian Catholic University North Sydney NSW Australia
| | - Augustine D. Asante
- School of Public Health and Community Medicine University of New South Wales Sydney NSW Australia
| | - Margaret Kelaher
- Centre for Health Policy University of Melbourne Victoria Australia
| | - Ian P. Anderson
- Murrup Barak, Melbourne Institute for Indigenous Development University of Melbourne Victoria Australia
| | - Stephen Jan
- The George Institute for Global Health University of Sydney Sydney NSW Australia
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An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta. Public Health Nutr 2015; 18:3211-23. [PMID: 25753315 DOI: 10.1017/s1368980015000476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING Malta. SUBJECTS Whole population, with a focus on children. RESULTS Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.
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Bairdain S, Samnaliev M. Cost-effectiveness of Adolescent Bariatric Surgery. Cureus 2015; 7:e248. [PMID: 26180672 PMCID: PMC4494559 DOI: 10.7759/cureus.248] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 01/25/2023] Open
Abstract
Background: The current estimates of the prevalence of adolescent morbid obesity and severe morbid obesity are about 21% and 6.6%, respectively. Obesity, if left untreated, may result in a variety of comorbid conditions and earlier mortality. Adolescent bariatric surgery is an effective, but expensive means to ameliorate these conditions and the risk of earlier mortality. We aimed to develop a model to evaluate the long-term cost-effectiveness of bariatric surgery. Methods: All adolescents who participated in our bariatric surgery multidisciplinary program from January 2010 to December 2013 were included if they had at least 12 months follow-up after their surgery. Intervention costs included all operative as well as preoperative and 12-month postoperative care. We used the US Medical Expenditures Panel Survey (MEPS) to estimate the association between reductions in BMI after surgery with future savings from reduced medical care use and with increased health-related quality of life (HRQL). We linked BMI with life expectancy using data from the Centers for Disease Control and Prevention. A Markov cohort model was then used to project health care-related costs (2013 US$), and quality-adjusted life years (QALYs) over time starting at age 18. Incremental costs per QALY of surgery vs. no surgery from a health care system perspective were then estimated. Results: At one year follow-up, mean weight loss was 37.5 (std. = 13.5) kg and the corresponding BMI was 35.4 (reduction of 13.2, p<0.01). Mean total intervention costs/person were $25,854 (std. = 2,044). A unit change in BMI was associated with future medical care savings of $157/year (p<0.01) and with an increase in HRQL of 0.004 (p<0.01) and life expectancy. At a threshold of a 100,000/QALY, bariatric surgery was not cost-effective in the first three years, but became cost-effective after that ($80,065/QALY in year four and $36,570/QALY in year seven). Conclusion: Our results suggest that bariatric surgery among adolescents may be cost-effective when evaluated over a long period of time. Future studies on a large scale are needed to show a continued improvement in QALYs and to evaluate earlier cost-effectiveness of the procedure.
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Wyke S, Hunt K, Gray CM, Fenwick E, Bunn C, Donnan PT, Rauchhaus P, Mutrie N, Anderson AS, Boyer N, Brady A, Grieve E, White A, Ferrell C, Hindle E, Treweek S. Football Fans in Training (FFIT): a randomised controlled trial of a gender-sensitised weight loss and healthy living programme for men – end of study report. PUBLIC HEALTH RESEARCH 2015. [DOI: 10.3310/phr03020] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BackgroundThe prevalence of male obesity is increasing alongside low uptake of existing weight management programmes by men. Football Fans in Training (FFIT) is a group-based, weight management and healthy living programme delivered by community coaches.ObjectivesTo assess (1) the effectiveness and cost-effectiveness of FFIT, (2) fidelity of delivery and (3) coach and participant experiences of FFIT.DesignA two-arm, pragmatic, randomised controlled trial; associated cost-effectiveness [in terms of incremental cost per quality-adjusted life-year (QALY) within trial and over individuals’ lifetimes]; and process evaluation. Participants were block randomised in a 1 : 1 ratio, stratified by club; the intervention group started FFIT within 3 weeks and the comparison group were put on a 12-month waiting list.SettingThirteen professional football clubs in Scotland, UK.ParticipantsA total of 747 men aged 35–65 years with an objectively measured body mass index (BMI) of ≥ 28 kg/m2.InterventionsFFIT was gender sensitised in context, content and style of delivery. A total of 12 weekly sessions delivered at club stadia combined effective behaviour change techniques with dietary information and physical activity sessions. Men carried out a pedometer-based walking programme. A light-touch maintenance programme included six e-mails and a reunion session at 9 months. At baseline, both groups received a weight management booklet, feedback on their BMI and advice to consult their general practitioner if blood pressure was high.Primary outcomeMean difference in weight loss between groups at 12 months expressed as absolute weight and a percentage. Intention-to-treat analyses used all available data.Data sourcesObjective measurements, questionnaires, observations, focus groups and coach interviews.ResultsA total of 374 men were allocated to the intervention and 333 (89%) completed 12-month assessments; a total of 374 were allocated to the comparator and 355 (95%) completed 12-month assessments. At 12 months, the mean difference in weight loss between groups, adjusted for baseline weight and club, was 4.94 kg [95% confidence interval (CI) 3.95 kg to 5.94 kg]; percentage weight loss, similarly adjusted, was 4.36% (95% CI 3.64% to 5.08%), in favour of the intervention (p < 0.0001). Sensitivity analyses gave similar results. Pre-specified subgroup analyses found no significant predictors of primary outcome. Highly significant differences in favour of the intervention were observed for objectively measured waist, percentage body fat, systolic and diastolic blood pressure, and self-reported physical activity, diet and indicators of well-being and physical aspects of quality of life. Eight serious adverse events were reported, of which two were reported as related to FFIT participation. From the within-trial analysis, FFIT was estimated to cost £862 per additional man maintaining a 5% weight reduction at 12 months and £13,847 per additional QALY, both compared with no intervention. For a cost-effectiveness threshold of £20,000/QALY, the probability that FFIT is cost-effective, compared with no active intervention, is 0.72. This probability rises to 0.89 for a cost-effectiveness threshold of £30,000/QALY. From the longer-term analysis, FFIT was estimated to cost £2535 per life-year gained and £2810 per QALY gained. FFIT was largely delivered as intended. The process evaluation demonstrated the powerful draw of football to attract men at high risk of ill health. FFIT was popular and analyses suggest that it enabled lifestyle change in ways that were congruent with participants’ identities.ConclusionsParticipation in FFIT led to significant reductions in weight at 12 months. It was cost-effective at standard levels employed in the UK, attracted men at high risk of future ill health and was enjoyable. Further research should investigate whether or not participants retained weight loss in the long term, how the programme could be optimised in relation to effectiveness and intensity of delivery and how group-based programmes may operate to enhance weight loss in comparison with individualised approaches.Study registrationCurrent Controlled Trials ISRCTN32677491.FundingScottish Government and The Football Pools funded the delivery of FFIT. National Institute for Health Research Public Health Research programme funded the evaluation and will be published in full inPublic Health Research; Vol. 3, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hunt
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Cindy M Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Elisabeth Fenwick
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher Bunn
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter T Donnan
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Petra Rauchhaus
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Nanette Mutrie
- Moray House School of Education, University of Edinburgh, Edinburgh, UK
| | - Annie S Anderson
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
| | - Nicole Boyer
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Adrian Brady
- Cardiology Department, Glasgow Royal Infirmary, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alan White
- Centre for Men’s Health, Leeds Metropolitan University, Leeds, UK
| | - Catherine Ferrell
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elaine Hindle
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Bhatnagar N, Kaur R, Dudeja P. Food marketing to children in India: comparative review of regulatory strategies across the world. Indian J Pediatr 2014; 81:1187-92. [PMID: 24854368 DOI: 10.1007/s12098-014-1480-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 04/30/2014] [Indexed: 11/25/2022]
Abstract
Food marketing directed to children is an issue of concern in the present day society. Revolution in food industry, increasing globalization and boom in information technology has introduced various types of food products and the way they are placed in front of likely consumers. This has resulted in rising trend of obesity and switch from communicable to non-communicable diseases, which is not cost effective for nation as a whole. Multinational companies have targeted children as a naïve audience to boost their sales. In-ethical practice of misleading claims in the advertisements is instrumental in many cases. Food marketing to children has been assumed a public health threat since times of yore. World Health Organization has resolutions and recommendations on this subject. Member countries, including India are a signatory to this declaration. However, much needs to be done to counter these multinational food giants. Regulations and policies need to be enforced at national and institutional levels. Parents must be educated; schools and social organizations to be made proactive on this aspect.
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Affiliation(s)
- Nidhi Bhatnagar
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India,
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Flego A, Keating C, Moodie M. Cost–effectiveness of whole-of-community obesity prevention programs: an overview of the evidence. Expert Rev Pharmacoecon Outcomes Res 2014; 14:719-27. [DOI: 10.1586/14737167.2014.953933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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