Health-care costs of underweight, overweight and obesity: Australian population-based study

A systematic review of economic evidence for community-based obesity prevention interventions in children

Multicomponent community-based obesity prevention interventions that engage multiple sectors have shown promise in preventing obesity in childhood; however, economic evaluations of such interventions are limited. This systematic review explores the methods used and summarizes current evidence of costs and cost-effectiveness of complex obesity prevention interventions. A systematic search was conducted using 12 academic databases and grey literature from 2006 to April 2022. Studies were included if they reported methods of costing and/or economic evaluation of multicomponent, multisectoral, and community-wide obesity prevention interventions. Results were reported narratively based on the Consolidated Health Economic Evaluation Reporting Standards. Seventeen studies were included, reporting costing or economic evaluation of 13 different interventions. Five interventions reported full economic evaluations, five interventions reported economic evaluation protocols, two interventions reported cost analysis, and one intervention reported a costing protocol. Five studies conducted cost-utility analysis, three of which were cost-effective. One study reported a cost-saving return-on-investment ratio. The economic evidence for complex obesity prevention interventions is limited and therefore inconclusive. Challenges include accurate tracking of costs for interventions with multiple actors, and the limited incorporation of broader benefits into economic evaluation. Further methodological development is needed to find appropriate pragmatic methods to evaluate complex obesity prevention interventions.

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

Importance

Nearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data.

Objective

To estimate medical expenditures among US youth across all BMI categories along with sex and age groups.

Design, Setting, Participants

This cross-sectional study used IQVIA's ambulatory electronic medical records (AEMR) data set linked with IQVIA's PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits.

Exposure

BMI categories.

Main Outcomes and Measures

Total medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions.

Results

The sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively.

Conclusions and Relevance

The study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

Potential cost-effectiveness of e-health interventions for treating overweight and obesity in Australian adolescents

BACKGROUND

E-health, defined as the use of information and communication technologies to improve healthcare delivery and health outcomes, has been promoted as a cost-effective strategy to treat adolescent overweight and obesity. However, evidence supporting this claim is lacking.

OBJECTIVES

Assess the potential cost-effectiveness of a hypothetical e-health intervention for adolescents with overweight and obesity.

METHODS

The costs and effect size (BMI reduction) of the hypothetical intervention were sourced from recent systematic reviews. Using a micro-simulation model with a lifetime time horizon, we conducted a modelled cost-utility analysis of the intervention compared to a 'do-nothing' approach. To explore uncertainty, we conducted bootstrapping on individual-level costs and quality-adjusted life years (QALYs) and performed multiple one-way sensitivity analyses.

RESULTS

The incremental cost-effectiveness ratio (ICER) for the e-health intervention was dominant (cheaper and more effective), with a 96% probability of being cost-effective at a willingness-to-pay (WTP) of $50 000/QALY. The ICER remained dominant in all sensitivity analyses except when using the lower bounds of the hypothetical intervention effect size, which reduced the probability of cost-effectiveness at a WTP of $50 000/QALY to 51%.

CONCLUSION

E-health interventions for treatment of adolescent overweight and obesity demonstrate very good cost-effectiveness potential and should be considered by healthcare decision makers. However, further research on the efficacy of such interventions is warranted to strengthen the case for investment.

Is the cost-effectiveness of an early-childhood sleep intervention to prevent obesity affected by socioeconomic position?

OBJECTIVE

This study aimed to determine whether the cost-effectiveness of an infant sleep intervention from the Prevention of Overweight in Infancy (POI) trial was influenced by socioeconomic position (SEP).

METHODS

An SEP-specific economic evaluation of the sleep intervention was conducted. SEP-specific intervention costs and effects at age 5 years, derived from the trial data, were applied to a representative cohort of 4,898 4- to 5-year-old Australian children. Quality-adjusted life years and health care costs were simulated until age 17 years using a purpose-built SEP-specific model. Incremental cost-effectiveness ratios and acceptability curves were derived for each SEP group.

RESULTS

The incremental cost-effectiveness ratios, in Australian dollars per quality-adjusted life year gained, were smaller in the low- ($23,010) and mid-SEP ($18,206) groups compared with the high-SEP group ($31,981). The probability that the intervention was cost-effective was very high in the low- and mid-SEP groups (92%-100%) and moderately high in the high-SEP group (79%).

CONCLUSIONS

An infant sleep intervention is more cost-effective in low- and mid-SEP groups compared with high-SEP groups. Targeting this intervention to low-SEP groups would not require trade-offs between efficiency and equity.

Cost-effectiveness of scaling up a whole-of-community intervention: The Romp & Chomp early childhood obesity prevention intervention

BACKGROUND

Given the high prevalence of early childhood overweight and obesity, more evidence is required to better understand the cost-effectiveness of community-wide interventions targeting obesity prevention in children aged 0-5 years.

OBJECTIVES

To assess the cost-effectiveness of the Romp & Chomp community-wide early childhood obesity prevention intervention if delivered across Australia in 2018 from a funder perspective, against a no-intervention comparator.

METHODS

Intervention costs were estimated in 2018 Australian dollars. The annual Early Prevention of Obesity in Childhood micro-simulation model estimated body mass index (BMI) trajectories to age 15 years, based on end of trial data at age 3.5 years. Results from modelled cost-effectiveness analyses were presented as incremental cost-effectiveness ratios (ICERs): cost per BMI unit avoided, and cost per quality-adjusted life year (QALY) gained at age 15 years.

RESULTS

All Australian children aged 0-5 years (n = 1 906 075) would receive the intervention. Total estimated intervention cost and annual cost per participant were AUD178 million and AUD93, respectively, if implemented nationally. The ICERs were AUD1 126 per BMI unit avoided and AUD26 399 per QALY gained (64% probability of being cost-effective measured against a AUD50 000 per QALY threshold).

CONCLUSIONS

Romp & Chomp has a fair probability of being cost-effective if delivered at scale.

Children's longitudinal bodyweight in Australia: Influence of migrant mothers' long-term residency, attachment to, and level of childhood overweight in country-of-birth

Immigration creates opportunities and imposes constraints associated with acculturation. We used the Australian national longitudinal survey of children aged 2 to 17 to evaluate the influence of mothers' long-term residency in Australia, mothers' attachment to country-of-birth, and macro indicators of childhood overweight environment at mothers' country-of-birth on children's longitudinal bodyweight. Both mothers' long-term exposure to the Australian environment and attachment to country-of-birth were associated with increased children's bodyweight z-scores. The childhood overweight environment in mothers' country-of-birth continued to influence their children's bodyweight after immigration. A better understanding of factors related to mothers' migration and children's bodyweight status is necessary to identify risk factors and migrant sub-groups needing extra support.

A longitudinal analysis of the effect of maternal region-of-birth on transitions in children's bodyweight status from early childhood to late adolescence in Australia: A population-based cohort study

Although 49% of Australian residents have at least one overseas-born parent, little is known about children's longitudinal bodyweight transitions among the migrant population. This study examines the net associations between maternal region-of-birth and children's longitudinal bodyweight transitions between underweight, normal, and overweight/obese status from ages 2 to 17 years. A sample of 8889 children was drawn from seven waves of a national population-based cohort study, the Longitudinal Study of Australian Children, conducted between 2004 and 2016. A multistate approach was used to investigate (i) the net effect of mother's region-of-birth on children's bodyweight transitions, (ii) the net estimation of cumulative transition probabilities, and (ii) the net conditional bodyweight expectancy, controlling for child-, family-, and neighbourhood-factors associated with children's bodyweight. Our results showed children of Oceania and African mothers had unfavourable outcomes (i.e., lower remission from or higher incidence of underweight or overweight/obese status) than children of non-migrants. Toddlers with suboptimal bodyweight status (especially those from disadvantaged groups) had higher net cumulative probabilities of staying in that status as a 17-year-old adolescent unless they managed to transfer to normal weight in the primary school years. The 15-year bodyweight expectancy depended on the initial bodyweight status at age two years, with some children of migrant mothers affected longer by suboptimal bodyweight status. In Australia, region-of-birth related disparities in bodyweight started early and were of significant duration throughout development until late adolescence. Culturally tailored health programs should begin at least as early as two years of age.

Cost-Effectiveness of a Novel Sleep Intervention in Infancy to Prevent Overweight in Childhood

OBJECTIVE

The purpose of this study was to determine, from a health funder perspective, whether a sleep intervention, delivered in infancy, either alone or in combination with food, activity, and breastfeeding advice was cost-effective compared with usual care.

METHODS

A cost-effectiveness analysis was conducted alongside the Prevention of Overweight in Infancy (POI) randomized controlled trial for outcomes at 5 years and cost-effectiveness was modeled to age 15 years using the Early Prevention of Obesity in Childhood microsimulation model. Intervention costs for the Sleep (n = 192), Combination (n = 196), and control (n = 209) groups were determined in 2018 Australian dollars. Incremental cost-effectiveness ratios (ICERs) were determined for BMI outcomes at 5 and 15 years, with the primary outcome being quality-adjusted life years (QALYs) modeled over 15 years.

RESULTS

The average costs of the Sleep and Combination interventions were $184 and $601 per child, respectively. The ICER for the Sleep intervention was $18,125 per QALY gained, with a 74% probability of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY. The ICER for the Combination intervention was $94,667 per QALY gained with a 23% probability of being cost-effective.

CONCLUSIONS

The POI Sleep intervention, without additional advice, was a low-cost and cost-effective approach to reducing childhood obesity. Sleep modification programs offer a very promising approach to obesity prevention in children.

Health-related quality of life, service utilization and costs of low language: A systematic review

BACKGROUND

Low language (LL) is a common childhood condition affecting 7-17% of children. It is associated with life-long adverse outcomes and can affect various aspects of a child's life. However, the literature on its impact on health-related quality of life (HRQoL), service use and costs are limited. To date, there has been no systematic review of the overall economic burden of LL. A systematic review regarding the economic burden of LL is important for clinical, educational, policy decision-making and theoretical aspects. We adopted the term 'low language' to refer to children whose language performance falls below well-recognized cut-points regardless of known or unknown aetiology.

AIMS

To review the literature systematically on how LL is associated with HRQoL, service utilization and costs.

METHODS & PROCEDURES

A systematic search was conducted across various databases, including MEDLINE, Embase, PsycINFO, CINAHL, up to July 2017. Data on study design, population and outcomes were extracted and screened by two pairs of reviewers with the revision of other experts in the panel on any discrepancies. The Effective Public Health Practice Project tool was used to assess the risk of bias of the included studies. The findings of the included studies were summarized in a narrative synthesis.

OUTCOMES & RESULTS

We identified 22 relevant articles, of which 12 reported HRQoL and 11 reported service utilization and costs associated with LL. Preference-based instruments, which include the relative importance attached to different aspects of HRQoL, were less employed in the literature. Most studies found poorer HRQoL in children with LL compared with their peers. About half the families having children with LL did not actively seek professional help, and many families felt they did not receive sufficient services when needed. Healthcare costs associated with LL were substantial. Non-healthcare costs were largely unexplored.

CONCLUSIONS & IMPLICATIONS

LL was associated with reduced children's HRQoL, higher service use and costs. Under-servicing was evident in children with LL. LL also imposed large costs on the healthcare system. Further research is required to examine (1) the overall HRQoL of children with LL, in particular studies using and testing the performance of preference-based instruments; and (2) the service use and costs specific to LL, especially non-healthcare costs.

Assessment of Clinicians' Views for Managing Children with Obesity in the Primary, Secondary, and Tertiary Settings

Background: The aim of this study was to examine the perceptions of the assessment and management of children with obesity of primary, secondary, and tertiary care clinicians across two health districts in western Sydney and a specialty children's health network. Methods: Participants were 304 clinicians (medical, nursing, and allied health workers) in primary, secondary, and tertiary pediatric-level services. A questionnaire captured the training, assessment, and management approaches and perceived barriers to managing pediatric patients with obesity. Chi-squared tests and logistic regressions examined the differences in responses between clinicians. Results: Clinicians across all levels of health care had only moderate rates of training in obesity (48%), did not routinely measure tandem heights and weights (80%), and infrequently referred children to other services. Only 25% of clinicians frequently referred children to a weight management service (most frequently the dietitian). When comparing across health care settings, those in secondary-level services had higher rates of training (70%) and more frequently initiated treatment for obesity. Conclusion: Frequencies of routine identification and initiation of treatment for children with obesity are low among health professionals across health care settings, with some exceptions for secondary care clinicians. Greater and more intensive health professional training on the assessment and management of children with obesity is needed in Australia and may be a key factor in increasing health care for this common chronic condition.

Australian parents' experiences when discussing their child's overweight and obesity with the Maternal and Child Health nurse: A qualitative study

AIMS AND OBJECTIVES

To explore parents' experiences when discussing child overweight issues with the Maternal and Child Health nurse.

BACKGROUND

Community-based child and family health nurses are in a unique position to discuss child overweight and obesity with parents. However, studies of parents' experiences in this context are lacking.

METHOD

Ten mothers of children identified as overweight or obese from regional Victoria, Australia, were interviewed in 2017. Data were analysed using an inductive qualitative thematic approach. The COREQ guidelines were used to ensure study rigour.

RESULTS

In summary, the analysis revealed experiences of Maternal and Child Health nurses "brushing over" the topic, with a lack of information provided about how to tackle the problem at home. The interpersonal relationship aspect of continuity of care was described as facilitating awareness of the child's overweight, although mothers expressed confusion about what constituted a "healthy weight range." While some mothers perceived the nurse's role was to offer evidence-based information and support, others saw the family doctor as the appropriate health professional to address the problem.

CONCLUSION

The findings of this study indicate that parents are often left unsure how to manage their child's weight despite the child being identified as overweight or obese by their Maternal and Child Health nurse.

RELEVANCE TO CLINICAL PRACTICE

Discussions about overweight and obesity may be facilitated by continuity of care where established relationships serve as a facilitator for effective communication. The findings further indicate a need for more structured support of Maternal and Child Health nurses working with parents of young children identified as overweight or obese, including ongoing education, skill development and improved understanding of parental health literacy and its links to childhood obesity.

The association between body mass index, primary healthcare use and morbidity in early childhood: findings from the Born In Bradford cohort study

OBJECTIVES

The objective of the article was to examine the association between body mass index (BMI), health and general practice (GP) healthcare use in early childhood.

STUDY DESIGN

This study is a prospective cohort study.

METHODS

Multivariate Poisson and logistic regression models were used to explore the association between BMI and health outcomes using data from the Born In Bradford cohort study, linked to routine data capturing objective measures of BMI at age 5 years, alongside GP appointment rates, GP prescriptions and specific morbidities in the subsequent 3-year period.

RESULTS

Compared with healthy weight, children who were obese at the age of 5 years had significantly higher rates of GP appointments (incident rate ratio 1.14, 95% confidence interval [CI]: 1.06-1.23), GP prescriptions (incident rate ratio 1.15, 95% CI: 1.04-1.27), asthma (odds ratio 1.46, 95% CI: 1.21-1.77), sleep apnoea (odds ratio 2.50, 95% CI: 1.36-4.58), infections (incident rate ratio 1.19, 95% CI: 1.08-1.30), antibiotic prescriptions (incident rate ratio 1.25, 95% CI: 1.10-1.42) and accidents (incident rate ratio 1.20, 95% CI: 1.01-1.42) in the subsequent 3 years. Underweight children were found to have higher rates of GP appointments (incident rate ratio 1.25, 95% CI: 1.04-1.52), but there were no differences between overweight and healthy weight children.

CONCLUSIONS

Childhood obesity was found to be associated with increased primary healthcare use and a range of poorer health outcomes at the age of 8 years, underlining the importance of reducing childhood obesity in early childhood.

A New Model for Evaluation of Interventions to Prevent Obesity in Early Childhood

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.

The health care costs of childhood obesity in Australia: An instrumental variables approach

The effect of childhood obesity on medical costs incurred by the Australian Government is estimated using five waves of panel data from the Longitudinal Study of Australian Children, which is linked to public health insurance administrative records from Medicare Australia. Instrumental variables estimators are used to address concerns about measurement error and selection bias. The additional annual medical costs due to overweight and obesity among 6 to 13 year olds is about $43 million (in 2015 AUD). This is driven by a higher utilisation of general practitioner and specialist doctors. The results suggest that the economic consequences of childhood obesity are much larger than previously estimated.

Parent-reported prevalence and persistence of 19 common child health conditions

OBJECTIVE

To estimate prevalence and persistence of 19 common paediatric conditions from infancy to 14-15 years.

DESIGN

Population-based prospective cohort study.

SETTING

Australia.

PARTICIPANTS

Parallel cohorts assessed biennially from 2004 to 2014 from ages 0-1 and 4-5 years to 10-11 and 14-15 years, respectively, in the Longitudinal Study of Australian Children.

MAIN OUTCOME MEASURES

19 health conditions: 17 parent-reported, 2 (overweight/obesity, obesity) directly assessed. Two general measures: health status, special health care needs.

ANALYSIS

(1) prevalence estimated in 2-year age-bands and (2) persistence rates calculated at each subsequent time point for each condition among affected children.

RESULTS

10 090 children participated in Wave 1 and 6717 in all waves. From age 2, more than 60% of children were experiencing at least one health condition at any age. Distinct prevalence patterns by age-bands comprised eight conditions that steadily rose (overweight/obesity, obesity, injury, anxiety/depression, frequent headaches, abdominal pain, autism spectrum disorder, attention-deficit hyperactivity disorder). Six conditions fell with age (eczema, sleep problems, day-wetting, soiling, constipation, recurrent tonsillitis), three remained stable (asthma, diabetes, epilepsy) and two peaked in mid-childhood (dental decay, recurrent ear infections). Conditions were more likely to persist if present for 2 years; persistence was especially high for obesity beyond 6-7 (91.3%-95.1% persisting at 14-15).

CONCLUSIONS

Beyond infancy, most Australian children are experiencing at least one ongoing health condition at any given time. This study's age-specific estimates of prevalence and persistence should assist families and clinicians to plan care. Conditions showing little resolution (obesity, asthma, attention-deficit hyperactivity disorder) require long-term planning and management.

Growing up in Australia: paradox of overweight/obesity in children of immigrants from low-and-middle -income countries

Objective

Children of immigrants from low-and-middle-income countries show excess overweight/obesity risk relative to host populations, possibly due to socioeconomic disadvantage. The present study was conducted to estimate overweight/obesity prevalence and its association with the family socioeconomic-position in 2-11-year-old Australian-born children of immigrants and Australian-mothers.

Methods

A cross-sectional analysis of 10-year data from the Longitudinal Study of Australian Children was undertaken. Overweight/obesity was defined according to the International Obesity Taskforce, age-and sex-specific BMI cut-off-points.

Results

Approximately 24% children aged 2-3 years (22% sons, and 25% daughters), were overweight/obese with no significant difference between children of immigrants and Australian-mothers. Overweight/obesity prevalence consistently increased with age for sons of mothers from low-and-middle-income countries but not daughters. Adjusting for the family socioeconomic-position did not explain excess overweight/obesity in children of mothers from low-and-middle-income countries. The odds of overweight/obesity in sons were significantly higher at 8-9 years (OR 1.5; p = 0.03) and 10-11 years (OR 1.5; p = 0.03) and in daughters at 4-5 years (OR 1.7; p = 0.002) when the mothers were from low-and-middle-income countries.

Conclusion

Excess weight in children of immigrants is not due to socioeconomic disadvantage alone. Other social processes and interactions between immigrants and host cultures may be involved.

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland

BACKGROUND

PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage.

METHODS

The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges.

RESULTS

Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%).

CONCLUSIONS

Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time.

TRIAL REGISTRATION

ACTRN12617000315314 . This trial was registered retrospectively on 28 February, 2017.

Association between short sleep duration and body mass index in Australian Indigenous children

AIM

Associations between short sleep duration and obesity and the relationship between obesity and chronic illness are well documented. Obese children are likely to become obese adults. To date, there is a paucity of information regarding sleep duration and quality for Indigenous Australian people. It may be that poor-quality, short sleep is contributing to the gap in health outcomes for Indigenous people compared with non-Indigenous adults and children. This study sought to investigate the possibility that poor sleep quality may be contributing to health outcomes for Indigenous children by exploring associations between sleep duration and body mass index (BMI).

METHODS

Participants included 1253 children aged 7-12 years in Wave 7 of the national Longitudinal Study of Indigenous Children survey. Interviewers asked primary carers about children's sleep times. BMI was derived from measurements of children made by researchers.

RESULTS

Regardless of age, relative socio-economic disadvantage and level of remoteness, unhealthy weight was associated with less sleep duration than healthy weight for Indigenous children.

CONCLUSION

The relationship between short sleep duration and BMI in Indigenous children has important implications for their future health outcomes. Both overweight conditions and short sleep are established modifiable risk factors for metabolic dysfunction and other chronic illnesses prominent in the Indigenous population. It is important to consider strategies to optimise both for Indigenous children in an attempt to help 'close the gap' in health outcomes and life expectancy between Indigenous and non-Indigenous people.

Comparison of body composition and adipokine levels between thin and normal-weight prepubertal children

OBJECTIVE

Thinness can have substantial consequences for child development and health. Adipokines, including leptin and adiponectin, play a significant role in the regulation of important metabolic functions. The aim of this study was to investigate associations between body composition and serum leptin and adiponectin levels in thin and normal-weight children.

METHODS

The authors examined 100 healthy prepubertal children, who were divided into two subgroups: thin (n=50) and normal-weight children (n=50). Body composition was assessed by dual-energy X-ray absorptiometry. Serum concentrations of adipokines were determined by immunoenzymatic assays.

RESULTS

Thin children had a similar body height but significantly lower (p<0.0001) body weight, body mass index, fat mass, lean mass, and bone mineral content compared with normal-weight children. Serum concentrations of leptin were about 2-fold lower (p<0.0001) in thin vs. normal-weight subjects. Serum levels of total adiponectin, adiponectin multimers, and soluble leptin receptor (sOB-R) were similar in both groups. The leptin/soluble leptin receptor ratio and leptin/adiponectin ratios were lower (p<0.0001) in thin vs. normal-weight children. In both groups of children, it was found that body composition parameters were positively related with leptin but not with adiponectin levels. Additionally, bone mineral content was positively related with body mass index, fat mass, lean mass, and leptin level in thin and normal-weight children.

CONCLUSIONS

Prepubertal thin children have disturbances in body composition and adipokine profile. Early recognition of thinness and determination of body composition parameters and adipokine levels can be useful in medical and nutritional care of thin children for the optimization of bone mineral accrual.

Early childhood obesity: Association with healthcare expenditure in Australia

OBJECTIVE

To determine whether overweight or obesity among children (aged 2 to ≤5 years) is associated with direct healthcare costs, after adjusting for child, household, and socioeconomic characteristics.

METHODS

A longitudinal cohort analysis was performed in 350 children aged 2 years assessed over 3 years of follow-up. Child weight status was determined from mean BMI z-scores at 2, 3.5, and 5 years, and healthcare utilization including medicines, nonhospital, hospital, and emergency care was determined by data linkage. Using adjusted multivariable regression analyses, the relationship between total 3-year healthcare costs and weight status was examined. Observations took place in Sydney, Australia, between 2011 and 2014.

RESULTS

After adjustment for significant maternal and sociodemographic characteristics, healthcare costs of children with obesity (BMI z-score >2SD) were 1.62 (95% CI 1.12-2.34, P = 0.01) times those of children with healthy weight. However, costs of overweight children were similar to those of healthy weight (P = 0.96). The additional 3-year costs of healthcare for a child with obesity compared with healthy weight were $AUD 825 (95% CI $135-$2,117) for general patients and $AUD 1332 (95% CI $174-$4,280) for concession card holders.

CONCLUSIONS

Prevention of obesity in early childhood may have concurrent benefits in reducing healthcare expenditure.