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Reitzinger S, Czypionka T. Low-, moderate-, and high-risk obesity in association with cost drivers, costs over the lifecycle, and life expectancy. BMC Public Health 2024; 24:2069. [PMID: 39085809 PMCID: PMC11293064 DOI: 10.1186/s12889-024-19574-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal-annual perspective and an individual-life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy. METHODS We used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources. RESULTS About 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years. CONCLUSIONS We have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal-annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future.
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Affiliation(s)
| | - Thomas Czypionka
- Institute for Advanced Studies, Josefstaedter Strasse 39, Vienna, 1080, Austria.
- London School of Economics and Political Science, London, UK.
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Ling J, Chen S, Zahry NR, Kao TSA. Economic burden of childhood overweight and obesity: A systematic review and meta-analysis. Obes Rev 2023; 24:e13535. [PMID: 36437105 PMCID: PMC10078467 DOI: 10.1111/obr.13535] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
To update existing literature and fill the gap in meta-analyses, this meta-analysis quantitatively evaluated the worldwide economic burden (in 2022 US $) of childhood overweight and obesity in comparison with healthy weight. The literature search in eight databases produced 7756 records. After literature screening, 48 articles met the eligibility criteria. The increased annual total medical costs were $237.55 per capita attributable to childhood overweight and obesity. Overweight and obesity caused a per capita increase of $56.52, $14.27, $46.38, and $1975.06 for costs in nonhospital healthcare, outpatient visits, medication, and hospitalization, respectively. Length of hospital stays increased by 0.28 days. Annual direct and indirect costs were projected to be $13.62 billion and $49.02 billion by 2050. Childhood obesity ascribed to much higher increased healthcare costs than overweight. During childhood, the direct medical expenditures were higher for males than for females, but, once reaching adulthood, the expenditures were higher for females. Overall, the lifetime costs attributable to childhood overweight and obesity were higher in males than in females, and childhood overweight and obesity resulted in much higher indirect costs than direct healthcare costs. Given the increased economic burden, additional efforts and resources should be allocated to support sustainable and scalable childhood obesity programs.
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Affiliation(s)
- Jiying Ling
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Sisi Chen
- Georgia Southwestern State University School of Health Sciences, Americus, Georgia, USA
| | - Nagwan R Zahry
- Department of Communication, University of Tennessee at Chattanooga, Chattanooga, Tennessee, USA
| | - Tsui-Sui Annie Kao
- Michigan State University College of Nursing, East Lansing, Michigan, USA
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Abstract
Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Already during childhood, almost all organs are at risk of being affected by obesity. In this review, we present the current knowledge about diseases associated with childhood obesity and how they are affected by weight loss. One major causative factor is obesity-induced low-grade chronic inflammation, which can be observed already in preschool children. This inflammation-together with endocrine, paracrine, and metabolic effects of obesity-increases the long-term risk for several severe diseases. Type 2 diabetes is increasingly prevalent in adolescents and young adults who have had obesity during childhood. When it is diagnosed in young individuals, the morbidity and mortality rate is higher than when it occurs later in life, and more dangerous than type 1 diabetes. Childhood obesity also increases the risk for several autoimmune diseases such as multiple sclerosis, Crohn's disease, arthritis, and type 1 diabetes and it is well established that childhood obesity also increases the risk for cardiovascular disease. Consequently, childhood obesity increases the risk for premature mortality, and the mortality rate is three times higher already before 30 years of age compared with the normal population. The risks associated with childhood obesity are modified by weight loss. However, the risk reduction is affected by the age at which weight loss occurs. In general, early weight loss-that is, before puberty-is more beneficial, but there are marked disease-specific differences.
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Affiliation(s)
- Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Emilia Hagman
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Factors associated with conversion to open reduction of type 3 supracondylar humerus fractures in children. J Clin Orthop Trauma 2022; 30:101893. [PMID: 35668919 PMCID: PMC9163578 DOI: 10.1016/j.jcot.2022.101893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The US News and World report utilizes the number of supracondylar humerus fractures treated in an open procedure, excluding open fractures and vascular exploration, as a metric in assessing Pediatric Orthopedic trauma care. The purpose of this study was to identify factors that increase the likelihood of a patient needing open reduction for Gartland Type 3 SCH fractures. METHODS All pediatric patients who underwent surgical management of closed, Type 3 SCH fractures at our Pediatric Level 1 Trauma Center between 2011 and 2017 were considered for inclusion. Patient age greater than 16 years, patients with closed physes and open fractures were excluded. Electronic medical records and radiographic imaging were reviewed. Student's t- and chi-squared tests were used, and logistic regression was performed comparing closed v open reduction. RESULTS 362 subjects were included in this study. 318/362 (87.8%) were treated with closed reduction. 44/362 (12.2%) required open reduction. There were no statistically significant differences in age, gender, BMI, concomitant ipsilateral extremity fractures, Type 4 unstable fracture or patients that underwent hospital transfer. The mechanisms of injury with the greatest percentage requiring open reduction were fall from furniture and trampoline. Of those patients that underwent open reduction, 65.9% had posterolateral displacement of the fracture. Those with displacement >4 mm had 3.14 higher odds of requiring an open reduction (p = 0.002). The anterior spike fracture pattern had the highest rate of failed closed reduction of 66.7%. Of those patients that had an open reduction, 13/44 (29.5%) had a neuropraxia and 5/44 (11.4%) had vascular compromise. Those with neuropraxia had 3.26 higher odds of requiring an open reduction (p = 0.005). Time to operating room was significantly shorter in patients that underwent open reduction (p < 0.001). CONCLUSION Our rate of open reduction for Type 3 SCH fractures, 12.2%, is consistent with previously described rates. Posterolateral displacement of fractures, displacement >4 mm, fractures with an anterior spike and fractures associated with neurovascular compromise are more likely to undergo open reduction. Transfer status, BMI and patient age were not associated with open reduction. Open reduction was associated with shorter time to the operating room, likely representing the urgent care of significantly displaced fractures associated with neurovascular compromise. LEVEL OF EVIDENCE Level III.
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Baek Y, Owen AJ, Fisher J, Tran T, Ademi Z. Lifetime impact of being underweight or overweight/obese during childhood in Vietnam. BMC Public Health 2022; 22:645. [PMID: 35379208 PMCID: PMC8981956 DOI: 10.1186/s12889-022-13061-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/23/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is limited evidence about lifetime burden of child malnutrition. This study aimed to estimate the lifetime impact of being underweight or overweight/obese during childhood in Vietnam. METHODS We developed a life table model in combination with a Markov model for Vietnamese children aged 5-19 years and simulated until they reached 75 years of age or died using published data. The starting year was 2019 and the model estimated number of deaths, years of life lived and quality-adjusted life years (QALY) with an annual discount rate of 3%. We performed scenario, one-way, and probabilistic sensitivity analyses to assess the impact of uncertainties in input parameters. RESULTS The model estimated 9.68 million deaths (6.44 million men and 3.24 million women), 622 million years of life lived (317 million men and 305 million women), and 601 million QALYs (308 million men and 293 million women). Scenario analyses showed that the reduction in either underweight or overweight/obesity alone, and reduction in both underweight and overweight/obesity resulted in fewer deaths, more years of life lived and more QALYs gained. In the scenario where everyone was a healthy weight, the model estimated 577,267 fewer deaths (6.0% less), 2 million more years of life lived (0.3% more), and 3 million QALYs gained (0.6% more) over base-case results which represents current situation in Vietnam. CONCLUSIONS Our results suggest that addressing underweight and overweight/obesity will contribute to reducing deaths and increasing years of life lived and QALYs. Policies and interventions in alignment with Sustainable Development Goals to address underweight and overweight/obesity are necessary to achieve health for all.
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Affiliation(s)
- Yeji Baek
- grid.1002.30000 0004 1936 7857Present Address: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Alice J. Owen
- grid.1002.30000 0004 1936 7857Present Address: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Jane Fisher
- grid.1002.30000 0004 1936 7857Present Address: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Thach Tran
- grid.1002.30000 0004 1936 7857Present Address: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,Research and Training Centre for Community Development, Hanoi, Vietnam
| | - Zanfina Ademi
- grid.1002.30000 0004 1936 7857Present Address: School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Onyimadu O, Violato M, Astbury NM, Jebb SA, Petrou S. Health Economic Aspects of Childhood Excess Weight: A Structured Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:461. [PMID: 35455505 PMCID: PMC9028108 DOI: 10.3390/children9040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/17/2022]
Abstract
An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK;
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; (O.O.); (N.M.A.); (S.A.J.)
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7
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Lee J, Kim JH. Endocrine comorbidities of pediatric obesity. Clin Exp Pediatr 2021; 64:619-627. [PMID: 34445852 PMCID: PMC8650822 DOI: 10.3345/cep.2021.00213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 01/19/2023] Open
Abstract
Pediatric obesity has become a serious public health issue. The prevalence of obesity in children and adolescents has increased worldwide and in Korea over several decades. Obese children are more likely to be obese adults with an increased cardiovascular risk. Therefore, maintaining a healthy weight and preventing obesity during childhood are of critical importance. Moreover, obese children and adolescents often have endocrine comorbidities such as prediabetes, type 2 diabetes, dyslipidemia, metabolic syndrome, polycystic ovary syndrome, and central precocious puberty. Hence, the early implementation of obesity management using a multidisciplinary team approach and screening for these comorbidities in obese children and adolescents are required with the appropriate management of each comorbidity and/or specialist referral.
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Affiliation(s)
- Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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8
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Burton ZA, Lewis R, Bennett T, McLernon DJ, Engelhardt T, Brooks PB, Edwards MR. Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study. Br J Anaesth 2021; 127:953-961. [PMID: 34627621 DOI: 10.1016/j.bja.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. METHODS During a site-selected consecutive 7-day study period, all children (2-16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. RESULTS For this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2-73.0%) children of healthy weight were compared with 537 (12.7%; 11.7-13.7%) children who were overweight and 478 (11.3%; 10.3-12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58-2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48-0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3-4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. CONCLUSIONS This large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03994419.
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Affiliation(s)
- Zoë A Burton
- Department of Anaesthesia, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
| | - Rosie Lewis
- Department of Anaesthesia, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Tom Bennett
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Thomas Engelhardt
- McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada
| | - Peter B Brooks
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mark R Edwards
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Rudolf Virchow, poverty and global health: from “politics as medicine on a grand scale” to “health in all policies”. GLOBAL HEALTH JOURNAL 2021. [DOI: 10.1016/j.glohj.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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10
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Schell RC, Just DR, Levitsky DA. Methodological Challenges in Estimating the Lifetime Medical Care Cost Externality of Obesity. JOURNAL OF BENEFIT-COST ANALYSIS 2021; 12:441-465. [PMID: 35419252 PMCID: PMC9004795 DOI: 10.1017/bca.2021.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There is a great deal of variability in estimates of the lifetime medical care cost externality of obesity, partly due to a lack of transparency in the methodology behind these cost models. Several important factors must be considered in producing the best possible estimate, including age-related weight gain, differential life expectancy, identifiability, and cost model selection. In particular, age-related weight gain represents an important new component to recent cost estimates. Without accounting for age-related weight gain, a study relies on the untenable assumption that people remain the same weight throughout their lives, leading to a fundamental misunderstanding of the evolution and development of the obesity crisis. This study seeks to inform future researchers on the best methods and data available both to estimate age-related weight gain and to accurately and consistently estimate obesity's lifetime external medical care costs. This should help both to create a more standardized approach to cost estimation as well as encourage more transparency between all parties interested in the question of obesity's lifetime cost and, ultimately, evaluating the benefits and costs of interventions targeting obesity at various points in the life course.
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Affiliation(s)
- Robert C Schell
- School of Public Health, University of California at Berkeley, 2121 Berkeley Way 5302, Berkeley, CA 94720
| | - David R Just
- Charles H. Dyson School of Applied Economics and Management, Cornell University, 137 Reservoir Ave, Ithaca NY 14850
| | - David A Levitsky
- College of Human Ecology, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY 14850
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11
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Kim JH. Overview of pediatric obesity: diagnosis, epidemiology, and significance. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.6.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: The prevalence of pediatric obesity has increased over the past several decades worldwide and in Korea. Childhood obesity has become a serious social problem.Current Concepts: Diagnosis of obesity is based on body mass index (BMI) in children and adolescents aged ≥2 years. Overweight and obese are defined as BMI ≥85th percentile to <95th percentile and BMI ≥95th percentile, respectively, corresponding to sex and age. Obesity is further classified as Class I (BMI ≥95th percentile to <120% of 95th percentile), Class II (BMI ≥120% of 95th percentile to <140% of 95th percentile), and Class III (BMI ≥140% of 95th percentile). Waist circumference and waist-height ratio are used to evaluate abdominal obesity. Pediatric obesity can cause childhood comorbidities, including type 2 diabetes, dyslipidemia, non-alcoholic fatty liver disease, and hypertension. Adult obesity, cardiovascular diseases, and other adult comorbidities, together with increased medical costs are additional consequences of pediatric obesity.Discussion and Conclusion: Prevention, diagnosis, and proper management of pediatric obesity are important.
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12
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Almutairi NS, Burns S, Portsmouth L. Identifying factors associated with overweight and obesity among intermediate school students aged 12-15 years in school settings: mixed-methodology protocol. BMJ Open 2021; 11:e045877. [PMID: 34049915 PMCID: PMC8166636 DOI: 10.1136/bmjopen-2020-045877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Childhood obesity is a public health concern globally. In Arab countries, the prevalence of overweight and obesity has increased significantly over the last three decades. The level of childhood overweight and obesity in the Kingdom of Saudi Arabia (KSA) is high and continues to increase. This study will explore factors associated with overweight and obesity among adolescents and identify barriers and enablers to the implementation of comprehensive school-based obesity prevention interventions. METHODS AND ANALYSIS Socioecological model will inform this mixed-methods study. The study will include three phases: (1) a scoping review of the literature; (2) the development of a student survey instrument and (3) a mixed-method study comprising a cross-sectional survey targeting students aged 12-15 years with the collection of the students' height and weight measurements; one-on-one interviews with physical education teachers and school principals; and the administration of school climate audits using the Health Promoting School framework. Reliability and validity of the survey instrument will be examined during survey development. Descriptive, inferential and thematic analysis will be employed using appropriate statistical software. ETHICS AND DISSEMINATION Ethical approval has been granted from the Curtin University of Human Research Ethics Committee (HR2020-0337) and from the KSA Ministry of Education (4181827686). School principals will provide permission to conduct the study in individual schools. Individual consent/assent will be obtained from students and their parents, and teachers. Study findings will be disseminated via peer-review publications, reports and conferences.
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Affiliation(s)
- Naif Saleh Almutairi
- School of Population Health, Curtin University Bentley Campus, Perth, Western Australia, Australia
- Department of Public Health, College of Health Sciences at Al-Leith, Umm Al-Qura University, Al-Leith, Kingdom of Saudi Arabia
| | - Sharyn Burns
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Linda Portsmouth
- Collaboration for Evidence, Research and Impact in Public Health, School of Population Health, Curtin University, Perth, Western Australia, Australia
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13
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Reeves P, Edmunds K, Szewczyk Z, Grady A, Yoong SL, Wolfenden L, Wyse R, Finch M, Stacey F, Wiggers J, Searles A. Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines. Implement Sci 2021; 16:1. [PMID: 33413491 PMCID: PMC7789335 DOI: 10.1186/s13012-020-01068-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods and decrease provision of discretionary foods in long day-care services in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial. Methods The prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool and online resources. Effectiveness measures included mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare service. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost-effectiveness ratios (ICERs) including uncertainty intervals were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money. Results Over the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of − $482 (95% UI − $859, − $56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated. Conclusion Compared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616000974404
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Affiliation(s)
- Penny Reeves
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia. .,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Kim Edmunds
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Zoe Szewczyk
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Alice Grady
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Wyse
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Meghan Finch
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia
| | - John Wiggers
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
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14
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Bjørnelv GMW, Halsteinli V, Kulseng BE, Sonntag D, Ødegaard RA. Modeling Obesity in Norway (The MOON Study): A Decision-Analytic Approach-Prevalence, Costs, and Years of Life Lost. Med Decis Making 2021; 41:21-36. [PMID: 33256539 PMCID: PMC7783689 DOI: 10.1177/0272989x20971589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited knowledge exists on the expected long-term effects and cost-effectiveness of initiatives aiming to reduce the burden of obesity. AIM To develop a Norwegian obesity-focused disease-simulation model: the MOON model. MATERIAL AND METHODS We developed a Markov model and simulated a Norwegian birth cohort's movement between the health states "normal weight,""overweight,""obese 1,""obese 2," and "dead" using a lifetime perspective. Model input was estimated using longitudinal data from health surveys and real-world data (RWD) from local and national registers (N = 99,348). The model is deterministic and probabilistic and stratified by gender. Model validity was assessed by estimating the cohort's expected prevalence, health care costs, and mortality related to overweight and obesity. RESULTS Throughout the cohort's life, the prevalence of overweight increased steadily and stabilized at 45% at 45 y of age. The number of obese 1 and 2 individuals peaked at age 75 y, when 44% of women and 35% of men were obese. The incremental costs per person associated with obesity was highest in older ages and, when accumulated over the lifetime, higher among women (€12,118, €9,495-€15,047) than men (€6,646, €5,252-€10,900). On average, obesity shortened the life expectancy of women/men in the whole cohort by 1.31/1.08 y. The life expectancy for normal-weight women/men at age 30 was 83.31/80.31. The life expectancy was reduced by 1.05/0.65 y if the individual was overweight, obese (2.87/2.71 y), or obese 2 (4.06/4.83 y). CONCLUSION The high expected prevalence of obesity in the future will lead to substantial health care costs and large losses in life-years. This underscores the need to implement interventions to reduce the burden of obesity; the MOON model will enable economic evaluations for a wide range of interventions.
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Affiliation(s)
- Gudrun M. W. Bjørnelv
- />Regional Centre for Health Care Development, St. Olavs Hospital, Trondheim, Norway
- />Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Vidar Halsteinli
- />Regional Centre for Health Care Development, St. Olavs Hospital, Trondheim, Norway
- />Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Bård E. Kulseng
- />Regional Center for Obesity Research and Innovation, Department of Surgery, St. Olavs Hospital, Trondheim, Norway
- />Department of Clinical Molecular Medicine, NTNU, Trondheim, Norway
| | - Diana Sonntag
- />Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty of the Heidelberg University, Mannheim, Germany
- />Department of Health Sciences, University of York, UK
| | - Rønnaug A. Ødegaard
- />Regional Center for Obesity Research and Innovation, Department of Surgery, St. Olavs Hospital, Trondheim, Norway
- />Department of Clinical Molecular Medicine, NTNU, Trondheim, Norway
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15
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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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16
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Liu Z, Li Q, Maddison R, Ni Mhurchu C, Jiang Y, Wei DM, Cheng L, Cheng Y, Wang D, Wang HJ. A School-Based Comprehensive Intervention for Childhood Obesity in China: A Cluster Randomized Controlled Trial. Child Obes 2020; 15:105-115. [PMID: 30565955 DOI: 10.1089/chi.2018.0251] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A comprehensive approach involving both environmental and individual strategies offers opportunities to strengthen school-based interventions for childhood obesity. OBJECTIVES To evaluate a theory-based comprehensive intervention implemented within primary schools for childhood obesity in China. METHODS A 1-year, cluster randomized controlled trial was conducted in twelve primary schools (7-11 years old) in Beijing, China. Environmental and individual factors were improved in the intervention group (6 schools, 930 children) to promote knowledge and behaviors related to energy balance. The control group (6 schools, 959 children) did not receive any intervention. The primary outcome was body mass index (BMI) and its Z-score at 12 months. Generalized linear mixed models were used controlling for the cluster effect of school. RESULTS No significant differences were found between groups on BMI (0.07 kg/m2 [95% confidence interval (CI) -0.16 to 0.31, p = 0.54]) and its Z-score (0.02 [95% CI: -0.08 to 0.11, p = 0.73]) at 12 months. Self-reported knowledge, daily consumption of sugar-sweetened beverage, and frequency of moderate to vigorous physical activity improved at 12 months. CONCLUSIONS The intervention did not mitigate excess weight gain, but did improve children's knowledge and several behaviors related to energy balance.
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Affiliation(s)
- Zheng Liu
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Qin Li
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Ralph Maddison
- 2 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | - Cliona Ni Mhurchu
- 3 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Yannan Jiang
- 3 National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Dong-Mei Wei
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Lan Cheng
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Yu Cheng
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Di Wang
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Hai-Jun Wang
- 1 Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
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17
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Choudhury RA, Hoeltzel G, Prins K, Chow E, Moore HB, Lawson PJ, Yoeli D, Pratap A, Abt PL, Dumon KR, Conzen KD, Nydam TL. Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis. J Gastrointest Surg 2020; 24:756-763. [PMID: 31044345 DOI: 10.1007/s11605-019-04225-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/29/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The use of bariatric surgery has increased for morbidly obese patients with end stage renal disease (ESRD) for whom listing on the waitlist is often restricted until a certain BMI threshold is achieved. Effective weight loss for this population improves access to life-saving renal transplantation. However, it is unclear whether sleeve gastrectomy (SG) vs Roux-en-Y gastric bypass (RYGB) is a more effective therapy for these patients. METHODS A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with ESRD who were deemed ineligible to be waitlisted for renal transplantation unless they achieved a BMI less than 35 kg/m2. Life expectancy following weight management (MWM), RYGB, and SG were estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review. RESULTS RYGB improved survival compared with SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 1.3 additional years of life compared with patient's who underwent SG and 2.6 additional years of life compared with MWM. CONCLUSIONS RYGB improves access to renal transplantation and thereby increases long-term survival compared with SG and MWM. The use of SG may be incongruent with the goal of improving access to renal transplantation for morbidly obese patients.
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Affiliation(s)
- Rashikh A Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA.
| | - Gerard Hoeltzel
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kas Prins
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Eric Chow
- Department of Medicine- Quantitative Sciences Unit, Stanford University Medical Center, Palo Alto, CA, USA
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Peter J Lawson
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Dor Yoeli
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Akshay Pratap
- Department Surgery, Division of MIS/Bariatric Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kendra D Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
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18
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Suzuki Y, Kido J, Matsumoto S, Shimizu K, Nakamura K. Associations among amino acid, lipid, and glucose metabolic profiles in childhood obesity. BMC Pediatr 2019; 19:273. [PMID: 31387549 PMCID: PMC6683574 DOI: 10.1186/s12887-019-1647-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background Plasma-free amino acid profiles have been reported to correlate with obesity and glucose metabolism, and have been studied as potentially useful biomarkers of lifestyle-related diseases affecting metabolism in adulthood. However, knowledge of these relationships is lacking in children, despite the growing public health problem posed by childhood obesity. The aim of this study was to assess whether plasma-free amino acid profiles can serve as useful biomarkers of lifestyle-related diseases in children with obesity. Methods This retrospective study used the medical records of 26 patients (15 male, 11 female) aged 9 or 10 years presenting with moderate to severe obesity and hyperlipidemia between April 2015 and March 2017. A degree of obesity of 30% or more was defined as moderate or severe. Amino acid levels were compared between obese children with and without impaired glucose tolerance using a t-test or Mann–Whitney U test. In addition, the influence of factors such as intima media thickness, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, amino acids, and homeostasis model assessment-insulin resistance (HOMA-IR) were analyzed pairwise using Pearson’s correlation or Spearman’s rank correlation. Results HOMA-IR was positively correlated with valine, leucine (Leu), isoleucine, phenylalanine, tryptophan, methionine, threonine, lysine, alanine, tyrosine, glutamate (Glu), proline, arginine, ornithine, total free amino acids (all P < 0.01), and aspartate (P = 0.010). Moreover, blood uric acid levels were positively correlated with Leu (P = 0.005) and Glu (P = 0.019), and negatively correlated with serine, glycine, and asparagine (P = 0.007, P = 0.003, and P = 0.013, respectively). Conclusions Amino acid profile reflects impaired glucose tolerance and hyperuricemia at an early stage of obesity. It is therefore a useful marker to inform early intervention in children with obesity, as in adults. Electronic supplementary material The online version of this article (10.1186/s12887-019-1647-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yosuke Suzuki
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Jun Kido
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
| | - Shirou Matsumoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan.
| | - Kie Shimizu
- Department of Central Radiology, Kumamoto University Hospital, Kumamoto University, Kumamoto City, Kumamoto, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto Prefecture, 860-8556, Japan
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19
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Brown V, Ananthapavan J, Sonntag D, Tan EJ, Hayes A, Moodie M. The potential for long-term cost-effectiveness of obesity prevention interventions in the early years of life. Pediatr Obes 2019; 14:e12517. [PMID: 30816024 DOI: 10.1111/ijpo.12517] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost-effectiveness of interventions over time. OBJECTIVES To estimate the long-term health benefits and health care cost-savings of reductions in BMI for the Australian population of children aged between 2 and 5 years. METHODS A proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost-savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children. RESULTS Results suggest significant potential for cost-effectiveness of obesity prevention interventions in preschool-aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z-score (-0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health-adjusted life years saved (95% uncertainty interval [UI], 30 283-42 945) and health care cost-savings of approximately $301 million (95% UI $234 million-$369 million) if modelled over the lifetime. CONCLUSIONS Scenario results highlight the importance of obesity intervention in the early years of life.
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Affiliation(s)
- Vicki Brown
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty of the Heidelberg University, Mannheim, Germany.,Department of Health Sciences, University of York, York, UK
| | - Eng Joo Tan
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Hayes
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marj Moodie
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, The University of Sydney, New South Wales, Australia.,Deakin Health Economics, Centre for Population Health Research, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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20
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Assessing the Lifetime Cost-Effectiveness of Low-Protein Infant Formula as Early Obesity Prevention Strategy: The CHOP Randomized Trial. Nutrients 2019; 11:nu11071653. [PMID: 31331027 PMCID: PMC6682975 DOI: 10.3390/nu11071653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/26/2019] [Accepted: 07/09/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Although there is a growing number of early childhood obesity prevention programs, only a few of them are effective in the long run. Even fewer reports exist on lifetime cost-effectiveness of early prevention strategies. This paper aimed to assess the lifetime cost-effectiveness of infant feeding modification aiming at reducing risk of later obesity. Methods: The simulation model consists of two parts: (a) Model I used data from the European Childhood Obesity Project (CHOP) trial (up to 6 years) and the German Interview and Examination Survey for Children (KiGGS) (6–17 years) to evaluate BMI trajectories of infants receiving either lower protein (LP) or higher protein (HP) content formula; and (b) Model II estimated lifetime cost-effectiveness based on Model I BMI trajectories. Compared to HP formula, LP formula feeding would incur lower costs that are attributable to childhood obesity across all decades of life. Results: Our analysis showed that LP formula would be cost-effective in terms of a positive net monetary benefit (discounted 3%) as an obesity prevention strategy. For the 19% of infants fed with formula in Germany, the LP strategy would result in cost savings of € 2.5 billion. Conclusions: Our study is one of the first efforts to provide much-needed cost-effectiveness evidence of infant feeding modification, thereby potentially motivating interventionists to reassess their resource allocation.
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21
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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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22
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Hamilton D, Dee A, Perry IJ. The lifetime costs of overweight and obesity in childhood and adolescence: a systematic review. Obes Rev 2018; 19:452-463. [PMID: 29271111 DOI: 10.1111/obr.12649] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research into lifetime costs of obesity in childhood is growing. This review synthesizes that knowledge. METHODOLOGY A computerized search of the international literature since 2000 was conducted. Mean total lifetime healthcare and productivity costs were estimated and inflated to 2014 Irish euros. RESULTS This resulted in 13 published articles. The methodology used in these studies varied widely, and only one study estimated both healthcare and productivity costs. Cognizant of this heterogeneity, the mean total lifetime cost of a child or adolescent with obesity was €149,206 (range, €129,410 to €178,933) for a boy and €148,196 (range, €136,576 to €173,842) for a girl. This was divided into an average of €16,229 (range, €6,580 to €35,810) in healthcare costs and €132,977 (range, €122,830 to €143,123) in productivity losses for boys and €19,636 (range, €8,016 to €45,283) and €128,560, respectively, for girls. Income penalty accounted for the greater part of productivity costs, amounting to €97,118 (range, €86,971 to €107,264) per male adolescent with obesity and €126,108 per female adolescent. CONCLUSIONS Healthcare costs and income penalty appear greater in girls while costs because of workdays lost seem greater in boys. There is proportionality between body mass index and costs. Productivity costs are greater than healthcare costs.
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Affiliation(s)
- D Hamilton
- Department of Public Health, Health Service Executive Mid-West, Mount Kenneth House, Limerick, Ireland
| | - A Dee
- Department of Public Health, Health Service Executive Mid-West, Mount Kenneth House, Limerick, Ireland
| | - I J Perry
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
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23
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Benmohammed K, Valensi P, Nguyen MT, Benmohammed F, Lezzar A. Prevalence and complications of obesity and overweight among Algerian adolescents. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2018. [DOI: 10.3233/mnm-17173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To determine the prevalence of overweight and obesity in Algerian adolescents and investigate the associated cardiometabolic complications. METHODS: The study was conducted in the city of Constantine (Algeria). The population included 1100 schooled adolescent, aged 12–18 years, randomly selected. All had anthropometric measurements, and 989 had blood tests. The BMI was calculated and the prevalence of overweight and obesity was determined using the International Obesity Task Force reference values. RESULTS: 179 (16.3%) adolescents were overweight including 74 boys (13.8%) and 105 girls (18.6%), 51 (4.6%) adolescents were obese including 25 (4.6%) boys vs 26 (4.6%) girls (p = 0.09). Overweight and obese adolescents had higher systolic blood pressure/diastolic blood pressure (p = 0.001/p < 0.0001) and abnormal blood lipid levels. Furthermore, the HOMA index was higher in overweight and obese adolescents (p < 0.0001). CONCLUSION: These findings show a high prevalence of overweight and obesity in a population of Algerian adolescents leading to significant cardiometabolic abnormalities.
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Affiliation(s)
- Karima Benmohammed
- Department of Endocrinology and Diabetology, Benbadis University Hospital, Constantine University, Algeria
| | - Paul Valensi
- Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - Minh Tuan Nguyen
- Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - Farah Benmohammed
- Hôpital Santa Cabrini Ospedal, Montreal University, Montréal, Canada
| | - Alkassem Lezzar
- Department of Endocrinology and Diabetology, Benbadis University Hospital, Constantine University, Algeria
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Abstract
BACKGROUND As childhood obesity remains an ongoing issue for the United States there has been an increasing number of studies detailing its effect on fracture complexity, management, and outcomes. This study utilizes a national database to examine whether obese children with supracondylar humerus fractures are more likely to require open reduction and internal fixation than nonobese children. METHODS The Healthcare Cost and Utilization Project Kid's Inpatient Database of 2003, 2006, 2009, 2012 were queried for pediatric supracondylar humerus fractures [International Classification of Disease (ICD-9), 812.41] between 2 and 12 years. Patients were separated into those undergoing closed reduction percutaneous pinning (CRPP), open reduction internal fixation (ORIF), or both. Obesity was determined by comorbidity and ICD-9 coding (ICD-9, 278.00, 278.01). Univariable and multivariable logistic regression models were utilized with P<0.05 considered significant. RESULTS Between 2003 and 2012, 31,905 patients between the ages of 2 and 12 years sustained supracondylar humerus fractures. In total, 105 patients (0.3%) were obese. A majority of patients, 27,658 (86.7%), underwent CRPP. Odds for ORIF increased in association with age, obesity, white race, and private insurance. Significant association was found between age and obesity (P<0.05) in those undergoing ORIF. Obese children between 2 and 7 years of age had no difference in ORIF or CRPP compared with normal-weight children. Those between 8 and 12 years who were obese were significantly more likely to undergo ORIF (OR, 4.29; 95% confidence interval, 1.78-10.36). CONCLUSIONS Supracondylar humerus fractures sustained in obese children between 8 and 12 years are over 4 times more likely to require ORIF compared with normal-weight children of the same age. Providers should identify and counsel older obese children and their families regarding the potential for increased difficulty in fracture management that may require open surgical intervention. LEVEL OF EVIDENCE Level IV-case series.
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Döring N, Zethraeus N, Tynelius P, de Munter J, Sonntag D, Rasmussen F. Economic Evaluation of PRIMROSE-A Trial-Based Analysis of an Early Childhood Intervention to Prevent Obesity. Front Endocrinol (Lausanne) 2018; 9:104. [PMID: 29593658 PMCID: PMC5861136 DOI: 10.3389/fendo.2018.00104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Childhood obesity is a major clinical and economic health concern. Alongside the clinical understanding of obesity, there is a growing interest in designing and implementing interventions that are worth their money given the scarce resources in the health care sector. This study is one of the first efforts to provide evidence by assessing the effects and costs of a population-based primary prevention intervention targeting pre-school children attending child health centers in Sweden. METHODS The economic evaluation is based on the PRIMROSE cluster-randomized controlled trial aiming to establish healthy eating and physical activity among pre-school children (9-48 months of age) through motivational interviewing applied by trained nurses at child health centers. The cost-effectiveness is assessed over the trial period from a societal perspective. The primary outcome was BMI at age 4. Cost data was prospectively collected alongside the trial. Scenario analyses were carried out to identify uncertainty. RESULTS The estimated additional mean total costs of the PRIMROSE intervention were 342 Euro (95% CI: 334; 348) per child. During pre-school years direct costs mainly consist of training costs and costs for the additional time used by nurses to implement the intervention compared to usual care. Early indirect costs mainly consist of parents' absence from work due to their participation in the intervention. The incremental cost-effectiveness ratio in the base case analysis was 3,109 Euro per 1 BMI unit prevented. CONCLUSION We cannot provide evidence that the PRIMROSE intervention is cost-effective, given the uncertainty in the effect measure. Until further evidence is provided, we recommend resources to be spent elsewhere within the field of obesity prevention. Furthermore, to achieve valid and reliable cost-effectiveness results, the economic evaluation of obesity prevention programs in early childhood should incorporate the life time impact to capture all relevant costs and benefits.
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Affiliation(s)
- Nora Döring
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Nora Döring,
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Per Tynelius
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jeroen de Munter
- Prevention, Intervention and Mechanisms in Public Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Diana Sonntag
- Medical Faculty of Heidelberg University, Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Mannheim, Germany
- Department of Health Science, University of York, York, United Kingdom
| | - Finn Rasmussen
- Department of Health Sciences, Lund University, Lund, Sweden
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Guercio Nuzio S, Di Stasi M, Pierri L, Troisi J, Poeta M, Bisogno A, Belmonte F, Tripodi M, Di Salvio D, Massa G, Savastano R, Cavallo P, Boffardi M, Ziegenhardt D, Bergheim I, Mandato C, Vajro P. Multiple gut-liver axis abnormalities in children with obesity with and without hepatic involvement. Pediatr Obes 2017; 12:446-452. [PMID: 27350543 DOI: 10.1111/ijpo.12164] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gut-liver axis (GLA) dysfunction appears to play a role in obesity and obesity-related hepatic complications. OBJECTIVES This study sought to concurrently explore several GLA components in a paediatric obese population with/without liver disease. METHODS Thirty-two children (mean age 11.2 years) were enrolled: nine controls with normal weight and 23 patients with obesity (OB+). Of the 23 patients OB(+), 12 had not steatosis (ST-), and 11 had steatosis (ST+) (associated [n = 8] or not [n = 3] with hypertransaminasaemia [ALT +/-]). Subjects were characterized by using auxologic, ultrasonographic and laboratory parameters. A glucose hydrogen breath test was performed to test for small intestinal bacterial overgrowth, a urinary lactulose/mannitol ratio (LMR) was obtained to assess intestinal permeability, and tests for transaminases, blood endogenous ethanol, endotoxin and faecal calprotectin were also conducted. RESULTS Eleven out of 23 patients OB(+) (p < 0.05) exhibited pathological (>90th percentile of the control group values) LMR, with values paralleling the grade of liver involvement (normal weight < OB[+] < OB[+]ST[+]ALT[-] < OB[+)]ST[+]ALT[+] [p < 0.05]). LMR significantly correlated with ethanolaemia (r = 0.38, p = 0.05) and endotoxaemia (r = 0.48, p = 0.015) concentrations. Increased permeability was a risk factor for the development of steatosis (p < 0.002). SIBO was present only in patients with obesity. Faecal calprotectin concentrations were within normal limits in all subjects. CONCLUSIONS Increased permeability, endogenous ethanol and systemic endotoxin concentrations reflect some GLA dysfunction in obesity and its hepatic complications. Pending further results to establish their potential causative roles, the modulation of the GLA appears to represent a possible target for the prevention and treatment of these conditions.
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Affiliation(s)
- S Guercio Nuzio
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - M Di Stasi
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - L Pierri
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - J Troisi
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.,Laboratory of Metabolomics Theoreo, Pugliano, Italy
| | - M Poeta
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - A Bisogno
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - F Belmonte
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - M Tripodi
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - D Di Salvio
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - G Massa
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - R Savastano
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - P Cavallo
- Department of Physics, University of Salerno, Fisciano, Italy
| | - M Boffardi
- Laboratory, Section of Cava dei Tirreni, AOU Salerno, Salerno, Italy
| | - D Ziegenhardt
- Institute of Nutritional Sciences, SD Model Systems of Molecular Nutrition, Friedrich-Schiller-University Jena, Jena, Germany
| | - I Bergheim
- Institute of Nutritional Sciences, SD Model Systems of Molecular Nutrition, Friedrich-Schiller-University Jena, Jena, Germany
| | - C Mandato
- Department of Pediatrics, AORN Santobono - Pausilipon, Naples, Italy
| | - P Vajro
- Pediatrics, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.,European Laboratory for Food Induced Intestinal Disease (ELFID), Naples, Italy.,8 AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
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Battle of plates: a pilot study of an approach–avoidance training for overweight children and adolescents. Public Health Nutr 2017; 21:426-434. [DOI: 10.1017/s1368980017002701] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveApproach–avoidance training (AAT) is a promising approach in obesity treatment. The present study examines whether an AAT is feasible and able to influence approach tendencies in children and adolescents, comparing implicit and explicit training approaches.Design/Setting/SubjectsFifty-nine overweight children and adolescents (aged 8–16 years; twenty-six boys) participated in an AAT for food cues, learning to reject snack items and approach vegetable items. Reaction times in the AAT and an implicit association test (IAT) were assessed pre- and post-intervention.ResultsA significant increase in the AAT compatibility scores with a large effect (η2=0·18) was found. No differences between the implicit and explicit training approaches and no change in the IAT scores were observed.ConclusionsAutomatic tendencies in children can be trained, too. The implementation of AAT in the treatment of obesity might support the modification of an unhealthy nutrition behaviour pattern. Further data from randomized controlled clinical trials are needed.
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Doherty E, Queally M, Cullinan J, Gillespie P. The impact of childhood overweight and obesity on healthcare utilisation. ECONOMICS AND HUMAN BIOLOGY 2017; 27:84-92. [PMID: 28550809 DOI: 10.1016/j.ehb.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/23/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
Rising levels of childhood overweight and obesity represent a major global public health challenge. A number of studies have explored the association between childhood overweight and obesity and healthcare utilisation and costs. This paper adds to the literature by estimating the causal effect of child overweight and obesity status on use of general practitioner (GP) and hospital inpatient stays at two time points using instrumental variable (IV) methods The paper uses data from two waves of the Growing Up in Ireland survey of children when they are 9 and 13 years respectively and uses the biological mother's body mass index (BMI) as an instrument for the child's BMI. Our results demonstrate that child overweight and obesity status do not have a significant effect on healthcare utilisation for children when they are 9 years, but do have a large and significant effect at 13 years. Across all our models, the effects on both GP and hospital inpatient stays are found to be larger when endogeneity in childhood BMI status is addressed. Previous studies that did not address endogeneity concerns are likely to have significantly underestimated the impact of child overweight and obesity status on healthcare utilisation.
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Affiliation(s)
- Edel Doherty
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland.
| | - Michelle Queally
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
| | - John Cullinan
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
| | - Paddy Gillespie
- Health Economics and Policy Analysis Centre, J.E. Cairnes School of Business and Economics, NUI Galway, Ireland
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Abstract
OBJECTIVE The increasingly high levels of overweight and obesity among the workforce are accompanied by a hidden cost burden due to losses in productivity. This study reviews the extent of indirect cost of overweight and obesity. METHODS A systematic search was conducted in eight electronic databases (PubMed, Cochrane Library, Web of Science Core Collection, PsychInfo, Cinahl, EconLit and ClinicalTrial.gov). Additional studies were added from reference lists of original studies and reviews. Studies were eligible if they were published between January 2000 and June 2017 and included monetary estimates of indirect costs of overweight and obesity. The authors reviewed studies independently and assessed their quality. RESULTS Of the 3626 search results, 50 studies met the inclusion criteria. A narrative synthesis of the reviewed studies revealed substantial costs due to lost productivity among workers with obesity. Especially absenteeism and presenteeism contribute to high indirect costs. However, the methodologies and results vary greatly, especially regarding the cost of overweight, which was even associated with lower indirect costs than normal weight in three studies. CONCLUSION The evidence predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customised prevention programmes and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.
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Affiliation(s)
- Andrea Goettler
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Anna Grosse
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Mannheim, Germany
- Department of Health Sciences, University of York, York, UK
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Sonntag D, Jarczok MN, Ali S. DC-Obesity: A New Model for Estimating Differential Lifetime Costs of Overweight and Obesity by Socioeconomic Status. Obesity (Silver Spring) 2017; 25:1603-1609. [PMID: 28845610 DOI: 10.1002/oby.21913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study was to quantify the magnitude of lifetime costs of overweight and obesity by socioeconomic status (SES). METHODS Differential Costs (DC)-Obesity is a new model that uses time-to-event simulation and the Markov modeling approach to compare lifetime excess costs of overweight and obesity among individuals with low, middle, and high SES. SES was measured by a multidimensional aggregated index based on level of education, occupational class, and income by using longitudinal data of the German Socioeconomic Panel (SOEP). Random-effects meta-analysis was applied to combine estimates of (in)direct costs of overweight and obesity. RESULTS DC-Obesity brings attention to opposite socioeconomic gradients in lifetime costs due to obesity compared to overweight. Compared to individuals with obesity and high SES, individuals with obesity and low SES had lifetime excess costs that were two times higher (€8,526). In contrast, these costs were 20% higher in groups with overweight and high SES than in groups with overweight and low SES (€2,711). CONCLUSIONS The results of this study indicate that SES may play a pivotal role in designing cost-effective and sustainable interventions to prevent and treat overweight and obesity. DC-Obesity may help public policy planners to make informed decisions about obesity programs targeted at vulnerable SES groups.
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Affiliation(s)
- Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Department of Health Sciences, University of York, York, UK
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Shehzad Ali
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim University, Heidelberg, Germany
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Hamřík Z, Sigmundová D, Pavelka J, Kalman M, Sigmund E. Trends in Overweight and Obesity in Czech Schoolchildren from 1998 to 2014. Cent Eur J Public Health 2017; 25 Suppl 1:S10-S14. [DOI: 10.21101/cejph.a5099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 06/13/2017] [Indexed: 11/15/2022]
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Abstract
Obesity in children and adolescents is a severe health, psychosocial, and economic problem. Treatment of obesity should be based on the physiology, biochemistry, and genetics of the disease. Treatment is designed to prevent the comorbidities of obesity and allow a healthy, high-quality, and productive life. Treatment is based on healthy living and usually involves tools such as pharmacotherapy, medical device therapy, and bariatric surgery. Bariatric surgery is not acceptable to most patients, parents, primary care providers, and payers. The most successful treatment of obesity follows a chronic disease model, provides a continuum of care, and involves many different disciplines.
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Restricting the marketing of foods and non-alcoholic beverages to children in South Africa: are all nutrient profiling models the same? Br J Nutr 2017; 116:2150-2159. [DOI: 10.1017/s0007114516004244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe WHO has called for governments to improve children’s food environment by implementing restrictions on the marketing of ‘unhealthy’ foods to children. Nutrient profiling (NP) models are used to define ‘unhealthy’ foods and support child-directed food marketing regulations. The aim of the present study was to assess the suitability of the South African NP model (SANPM), developed and validated for health claim regulations, for child-directed food marketing regulations. The SANPM was compared with four NP models specifically developed for such regulations. A representative list of 197 foods was compiled by including all foods advertised on South African free-to-air television channels in 2014 and foods commonly consumed by South African children. The nutritional information of the foods was sourced from food packaging, company websites and a food composition table. Each individual food was classified by each of the five NP models. The percentage of foods that would be allowed according to the different NP models ranged from 6 to 45 %; the models also varied considerably with regard to the type of foods allowed for marketing to children. The majority of the pairwise comparisons between the NP models yieldedκstatistics >0·4, indicating a moderate agreement between the models. An almost perfect pairwise agreement (κ=0·948) existed between the SANPM and the UK Food Standards Agency model (United Kingdom Office of Communication nutrient profiling model), a model extensively tested and validated for such regulations. The SANPM is considered appropriate for child-directed food marketing regulations in South Africa.
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Makkes S, van Dongen JM, Renders CM, van der Baan-Slootweg OH, Seidell JC, Bosmans JE. Economic Evaluation of Intensive Inpatient Treatments for Severely Obese Children and Adolescents. Obes Facts 2017; 10:458-472. [PMID: 28988240 PMCID: PMC5741163 DOI: 10.1159/000458759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/25/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Considering the large economic consequences of severe childhood obesity for the society, we aimed to conduct an economic evaluation comparing two intensive 1-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to standard deviation score BMI (SDS-BMI) and quality-adjusted life years (QALYs). METHODS An economic evaluation from a societal perspective accompanying a randomized controlled trial with a 24-month follow-up. 80 participants (8-19 years) with severe obesity were included. Participants received an intensive 1-year lifestyle treatment with an inpatient period of 2 months (short-stay group) or 6 months (long-stay group). Data were collected at baseline, 6, 12 ,and 24 months and included SDS-BMI and QALYs. RESULTS SDS-BMI decreased in the first 6 months of treatment, stabilized in the second 6 months, and increased during the 2nd year in both groups. After 24 months, SDS-BMI was similar in both groups, but remained lower than baseline values (mean difference -0.24, 95% CI -0.42; -0.06). There was no difference in QALYs between the groups after 24 months. For SDS-BMI, the probability of the short-stay treatment being cost-effective in comparison with the long-stay treatment was 1 at a willingness-to-pay of 0 EUR/unit of effect, which slowly decreased to 0.54 for larger willingness-to-pay values. CONCLUSIONS Based on the results of this study, the short-stay treatment is considered to be more cost-effective from the societal perspective in comparison with the long-stay treatment. Future research should provide insight in whether the short-stay treatment is cost-effective in comparison with usual care.
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Affiliation(s)
- Sabine Makkes
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Jacob C. Seidell
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
- *Prof. Dr. Jacob C Seidell, Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands,
| | - Judith E. Bosmans
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands
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Bohn B, Wiegand S, Kiess W, Reinehr T, Stachow R, Oepen J, Langhof H, Hermann T, Widhalm K, Wabitsch M, Gellhaus I, Holl R. Changing Characteristics of Obese Children and Adolescents Entering Pediatric Lifestyle Intervention Programs in Germany over the Last 11 Years: An Adiposity Patients Registry Multicenter Analysis of 65,453 Children and Adolescents. Obes Facts 2017; 10:517-530. [PMID: 29131049 PMCID: PMC5741166 DOI: 10.1159/000479631] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/17/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To examine whether characteristics of children and adolescents who start lifestyle intervention (LI) for obesity in Germany changed over the last decade. METHODS 65,453 subjects (<21 years) from the APV database (Adiposity Patients Registry) with a BMI ≥ 90th percentile were included (years 2005-2015). Logistic regression models (confounders: age, sex, migration background) were created for overweight, obesity, extreme obesity, and obesity-related comorbidities. Comorbidities were further adjusted for weight category. Results were stratified by inpatient or outpatient care. RESULTS Extreme obesity was found to be more frequent at the onset of LI (2005: 11.6; 2015: 12.7%) with a similar trend in subgroups (p < 0.001). Obesity increased (2005: 50.3%; 2015: 55.1%), and overweight decreased (2005: 34.1%; 2015: 29.0%) in the whole study population. Trends were similar for inpatient or outpatient care (all p < 0.001). Hypertension increased from 45.7% to 49.2% in the whole study population, and similar data were obtained in the subgroup of inpatients (both p < 0.0001). Dyslipidemia increased in all patients (2005: 21.9%; 2015: 28.0%) and in inpatients (2005: 20.2%; 2015: 25.7%; both p < 0.0001). Abnormal carbohydrate metabolism rose in all patients (from 5.2 to 6.4%; p = 0.0002) without significant trends in subgroups. CONCLUSION During the last decade, children and adolescents presented with higher BMI SDS at the onset of LI and the proportion with obesity-related comorbidities increased. Particularly the presence of comorbidities differed between outpatients and inpatients.
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Affiliation(s)
- Barbara Bohn
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- *Dr. biol. hum. Barbara Bohn; M.Sc. Public Health Nutrition, Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, 89081 Ulm, Germany,
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Charité University Medicine, Berlin, Germany
| | - Wieland Kiess
- University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children's Hospital; University of Witten/Herdecke, Datteln, Germany
| | - Rainer Stachow
- Specialized Clinic Sylt, Rehabilitation Clinic for Children and Adolescents, Westerland, Germany
| | - Johannes Oepen
- Rehabilitation Clinic for Children and Adolescents, Viktoriastift Bad Kreuznach, Bad Kreuznach, Germany
| | | | - Thomas Hermann
- Specialized Rehabilitation Clinic Prinzregent Luitpold, Scheidegg/Allgäu, Germany
| | - Kurt Widhalm
- Division of Clinical Nutrition, Obesity and Lipid Disorders, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, University Hospital for Children and Adolescents, Ulm, Germany
| | - Ines Gellhaus
- Consensus Group Obesity Education for Children and Adolescents (KgAS), Paderborn, Germany
| | - Reinhard Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
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Brei C, Stecher L, Much D, Karla MT, Amann-Gassner U, Shen J, Ganter C, Karampinos DC, Brunner S, Hauner H. Reduction of the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on offspring body composition: follow-up results from a randomized controlled trial up to 5 y of age. Am J Clin Nutr 2016; 103:1472-81. [PMID: 27053380 DOI: 10.3945/ajcn.115.128520] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/10/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It has been hypothesized that the n-6:n-3 (ω-6:ω-3) long-chain polyunsaturated fatty acid (LCPUFA) ratio in the maternal diet during the prenatal and early postnatal phase positively affects the body composition of the offspring. However, only limited data from prospective human intervention studies with long-term follow-up are available. OBJECTIVE We assessed the long-term effects of a reduced n-6:n-3 LCPUFA ratio in the diets of pregnant and lactating women [1020 mg docosahexaenoic acid (DHA) plus 180 mg eicosapentaenoic acid (EPA)/d together with an arachidonic acid-balanced diet compared with a control diet] on the body weights and compositions of their offspring from 2 to 5 y of age with a focus on the 5-y results. DESIGN Participants in the randomized controlled trial received follow-up assessments with annual body-composition measurements including skinfold thickness (SFT) measurements (primary outcome), a sonographic assessment of abdominal subcutaneous and preperitoneal fat, and child growth. In addition, abdominal MRI was performed in a subgroup of 5-y-old children. For the statistical analysis, mixed models for repeated measures (MMRMs) were fit with the use of data from each visit since birth (except for MRI). RESULTS Maternal LCPUFA supplementation did not significantly influence the children's sum of 4 SFTs [means ± SDs at 5 y of age: intervention, 23.9 ± 4.7 mm (n = 57); control, 24.5 ± 5.0 mm (n = 55); adjusted mean difference, -0.5 (95% CI: -2.2, 1.2)], growth, or ultrasonography measures at any time point in the adjusted MMRM model (all P values < 0.05). Results were consistent with abdominal MRI measurements (n = 44) at 5 y of age, which showed no significant differences in subcutaneous and visceral adipose tissue volumes and ratios. CONCLUSION The current study provides no evidence that a dietary reduction of the n-6:n-3 LCPUFA ratio in the maternal diet during pregnancy and lactation is a useful early preventive strategy against obesity at preschool age. This trial was registered at clinicaltrials.gov as NCT00362089.
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Affiliation(s)
| | - Lynne Stecher
- Else Kröner-Fresenius-Center for Nutritional Medicine
| | - Daniela Much
- Forschergruppe Diabetes, and Institute of Diabetes Research, Helmholtz Zentrum München, Munich, Germany; and
| | | | | | - Jun Shen
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Carl Ganter
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Hans Hauner
- Else Kröner-Fresenius-Center for Nutritional Medicine, ZIEL-Institute for Food and Health, Nutritional Medicine Unit, Technische Universität München, Freising, Germany
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Mei H, Xiong Y, Xie S, Guo S, Li Y, Guo B, Zhang J. The impact of long-term school-based physical activity interventions on body mass index of primary school children - a meta-analysis of randomized controlled trials. BMC Public Health 2016; 16:205. [PMID: 26931236 PMCID: PMC4774105 DOI: 10.1186/s12889-016-2829-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/04/2016] [Indexed: 12/22/2022] Open
Abstract
Background Physical activity (PA) intervention is a commonly recommended strategy to combat childhood obesity. However, its effectiveness has long been controversial. This paper aims to examine the effectiveness of long-term (≥12 months) school-based PA interventions on body mass index (BMI) in primary school children, who are gaining BMI. Methods Original papers were retrieved from PubMed, Google Scholar, the Cochrane Library and Web of Science, published between 1990 and 2015. The inclusion criteria were those research studies that were: randomized controlled trials (RCTs), conducted in primary school settings, had valid data on BMI at baseline and at the final follow up (or on BMI changes), and involved PA intervention that lasted for at least 12 months. Results Out of 11,158 potentially eligible articles, 18 papers were included in the analysis, involving 22,381 primary school children with intervention durations ranging from 12 to 72 months. Compared to the control groups, the BMI increment was 2.23 kg/m2 less in the intervention groups (p < 0.05). The heterogeneity was high across the studies (99.8 %), but declined after sub-group analyses. The intervention type, intervention duration, and weekly PA intervention time were among the factors leading to the heterogeneity. Conclusion Long-term school-based interventions containing PA as a core component appear to be effective in achieving healthier BMI. However, the results should be interpreted with caution due to the high heterogeneity among the studies. More high quality school-based RCTs among diverse populations are needed to improve the homogeneity and to yield a more robust conclusion.
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Affiliation(s)
- Hong Mei
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Yuelin Xiong
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Shuixian Xie
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Siyu Guo
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Yukun Li
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Bingbing Guo
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
| | - Jianduan Zhang
- Department Woman and Child's Care and Adolescent Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd., Wuhan, 430030, Hubei, P.R. China.
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Sonntag D, Ali S, De Bock F. Lifetime indirect cost of childhood overweight and obesity: A decision analytic model. Obesity (Silver Spring) 2016; 24:200-6. [PMID: 26638187 DOI: 10.1002/oby.21323] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/05/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the indirect lifetime cost of childhood overweight and obesity for Germany. METHODS The lifetime cohort model consisted of two parts: (a) Model I used data from the German Interview and Examination Survey for Children on prevalence of BMI categories during childhood to evaluate BMI trajectories before the age of 18; and (b) Model II estimated lifetime excess indirect cost based on the history of childhood BMI. Indirect costs were defined as the opportunity cost of lost productivity due to mortality and morbidity and were identified through a systematic literature review. RESULTS Our analysis showed that the majority of children with overweight and obesity remained in the same BMI category during their adult life, resulting in significant indirect lifetime costs. We estimated that overweight and obesity during childhood resulted in an excess lifetime cost per person of €4,209 (men) and €2,445 (women). For the current prevalent German population, the excess lifetime cost was €145 billion. CONCLUSIONS Our study showed that childhood obesity results in significant economic burden on the society. Therefore, cost-effective strategies targeted at reducing the prevalence of obesity during the early years of life can significantly reduce both healthcare and nonhealthcare costs over the lifetime.
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Affiliation(s)
- Diana Sonntag
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Heidelberg University, Mannheim, Germany
| | - Shehzad Ali
- Department of Health Sciences and Centre for Health Economics, University of York, York, United Kingdom
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty of Heidelberg University, Mannheim, Germany
- Department of Pediatrics, University Medicine Mannheim, Mannheim, Germany
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Beyond Food Promotion: A Systematic Review on the Influence of the Food Industry on Obesity-Related Dietary Behaviour among Children. Nutrients 2015; 7:8565-76. [PMID: 26501319 PMCID: PMC4632434 DOI: 10.3390/nu7105414] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/08/2015] [Indexed: 01/08/2023] Open
Abstract
An increased consumption of energy-dense, nutrient-poor food and beverages as a result of a changing obesogenic environment contributes substantially to the increasing prevalence of childhood overweight and obesity. This paper reviews the nature and extent of food industry influences which expose children to commercial influences and thus might affect unhealthy dietary behaviour and finally contributes to obesity. A systematic search of nine electronic databases (including PubMed, PsycINFO, EconLit) and reference lists of original studies and reviews using key search terms identified 1900 articles. Of these only thirty-six articles met the inclusion and quality criteria. A narrative synthesis of the reviewed studies revealed six key obesogenic environments by which the food industry possibly influences obesity-related dietary behaviours in young children. These were schools, retailers, mass media “television”, mass media “internet”, home and promotional campaigns. Identifying these obesogenic environments is critical for monitoring and controlling the food industry, the development of effective environmental-level interventions to prevent childhood overweight and obesity and to identify knowledge gaps to be addressed in future research to support informed decisions of policy makers.
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