Economic aspects of childhood obesity epidemic

The rising prevalence of childhood obesity is not only a health but also an economic phenomenon¹. There are economic causes of the obesity epidemic, such as a changing residential environment leading to reduced physical activity and changes in food prices resulting in an increased caloric intake. Obesity has serious economic consequences, such as worse educational outcomes and increasing health care expenditure. Based on a PubMed search in September 2010, we have conducted a survey of recent economic research aiming at, first, estimating the impact of childhood obesity on healthcare expenditure and, second, evaluating the cost-effectiveness of interventions to prevent or manage childhood obesity².

Impact of childhood obesity on healthcare expenditure

Evidence of the impact of childhood obesity on healthcare costs of children is ambiguous. Some recent studies do not find increasing costs with increasing BMI, whereas in some other studies this effect was visible, though partly only in higher age groups or girls.

Nevertheless childhood obesity is a risk factor for obesity in adulthood and associated comorbidities. Therefore it is of utmost importance to identify appropriate interventions to manage and pre-vent childhood obesity.

Economic Evaluation of Interventions to Manage and Prevent Childhood Obesity

Contrary to the large literature on the effectiveness of obesity intervention in children³, only a small number of studies have been published assessing the cost-effectiveness of interventions to prevent or manage obesity in children. Most of the preventive interventions have been school-based and can be characterized by the delivery of nutritional education, promotion of decreased television viewing and sedentary behavior, changes in the food provided by school canteens, and physical activity programs. These results show with some degree of certainty that, in order to reach acceptable cost-effectiveness values, the focus cannot exclusively be on physical activity, but must include nutrition as an intervention target.

In the literature published since 2008 we could identify economic evaluations of four preventive and five management interventions addressing already obese children. The major contribution to this research has been made by the ACE-Obesity (Assessing Cost-Effectiveness in Obesity) Project⁴ which is characterized by the use of a common methodology: two of the prevention studies are cost-utility analyses modeling the costs per DALY (Disability Adjusted Life Years) gained over a lifetime. The results extremely vary from 3.7 AUD$ per DALY saved for a program to reduce television advertising of energy-dense, nutrient-poor food to children to 0.76 million AUD$ per DALY saved for a walking school bus program. Compared to this the cost-effectiveness of the ACE-Obesity-LEAP (Live Eat and Play) Trial, which aims to improve physical activity and nutrition in already obese children through training of general practitioners, was estimated to be AUD$ 4,670 per DALY saved as compared to ‘no intervention’.

Further cost-effectiveness analyses calculate the costs per unit of (differing measures of) weight reduction or physical activity increase over a short or medium time-horizon for prevention and intervention programs targeting nutrition and physical activity.

Conclusion

The new research findings confirm the already existing evidence that childhood obesity management programs as well as prevention programs may be successful in combining health gains with cost savings. However, it is not possible to rank the interventions according to their cost-effectiveness as the health gain measures and evaluation methods differ substantially. Therefore, currently the most efficient strategy to intervene into the obesity epidemic cannot be determined⁵.

Perhaps the most important message from economic evaluations of child obesity prevention is the large variation in the costeffectiveness figures amongst studies using the same measurement scale for health gains. This finding underscores the need for analyzing not only the effectiveness, but also the efficiency of those interventions, in order to ensure the most economical use of the scarce resources available for improving the population health. In addition, more attention should be paid to the economic implications of interventions into childhood obesity, as there can be little doubt that cost-effectiveness increasingly will be a major consideration in reimbursement decisions. However, there are some difficult methodological challenges and problems that must be addressed in future research⁶.