A new approach to assessing the health benefit from obesity interventions in children and adolescents: the assessing cost-effectiveness in obesity project

Abstract

Objective: To report on a new modelling approach developed for the assessing cost-effectiveness in obesity (ACE-Obesity) project and the likely population health benefit and strength of evidence for 13 potential obesity prevention interventions in children and adolescents in Australia. Methods: We used the best available evidence, including evidence from non-traditional epidemiological study designs, to determine the health benefits as body mass index (BMI) units saved and disability-adjusted life years (DALYs) saved. We developed new methods to model the impact of behaviours on BMI post-intervention where this was not measured and the impacts on DALYs over the child's lifetime (on the assumption that changes in BMI were maintained into adulthood). A working group of stakeholders provided input into decisions on the selection of interventions, the assumptions for modelling and the strength of the evidence. Results: The likely health benefit varied considerably, as did the strength of the evidence from which that health benefit was calculated. The greatest health benefit is likely to be achieved by the 'Reduction of TV advertising of high fat and/or high sugar foods and drinks to children', 'Laparoscopic adjustable gastric banding' and the 'multi-faceted school-based programme with an active physical education component' interventions. Conclusions: The use of consistent methods and common health outcome measures enables valid comparison of the potential impact of interventions, but comparisons must take into account the strength of the evidence used. Other considerations, including cost-effectiveness and acceptability to stakeholders, will be presented in future ACE-Obesity papers. Information gaps identified include the need for new and more effective initiatives for the prevention of overweight and obesity and for better evaluations of public health interventions.

Reducing the volume, exposure and negative impacts of advertising for foods high in fat, sugar and salt to children: A systematic review of the evidence from statutory and self-regulatory actions and educational measures

“…Seven modelling studies extrapolated existing data to assess whether regulatory actions would be effective in reducing the volume and wider impacts of advertising for foods HFSS to children (Cecchini et al, 2010;Chou et al, 2008;Haby et al, 2006;Kelly et al, 2007;Magnus et al, 2009;Ofcom, 2006;Veerman et al, 2009). Three studies used cross-sectional survey designs (Buijzen, 2009;Harris and Bargh, 2009;Yu, 2011), and nine studies used experimental or quasi-experimental designs (Bickham and Slaby, 2012;Dhar and Baylis, 2011;Dixon et al, 2007;Ferguson et al, 2012;Goldberg, 1990;Gorn and Goldberg, 1982;Hindin et al, 2004;Potvin Kent et al, 2011a, 2012.…”

“…Range of actions to reduce the impact of children's exposure to advertising for foods HFSS Nineteen studies provided evidence for statutory actions to reduce the volume, exposure or other negative impacts of advertising for foods HFSS to children (Adams et al, 2012;Cecchini et al, 2010;Chou et al, 2008;Dhar and Baylis, 2011;Dixon et al, 2007;Ferguson et al, 2012;Goldberg, 1990;Gorn and Goldberg, 1982;Haby et al, 2006;Kelly et al, 2007;Kim et al, 2012;Magnus et al, 2009;Ofcom 2006Ofcom , 2008Ofcom , 2010Potvin Kent et al, 2011a, 2012Taras and Gage, 1995;Veerman et al, 2009). Actions included total bans on all advertising, bans on advertising of foods HFSS during specific hours, length of advertisements, and advertising of healthy food products, with the aim of reducing the volume of, and children's exposure to, advertising of foods HFSS, Body Mass Index, health costs, and improving diet.…”

Sydney Principles’ for reducing the commercial promotion of foods and beverages to children

“…Modelled estimates suggest that increased restrictions are potentially a very effective measure in reducing childhood obesity (14) . Several countries already have some form of regulation in place (7) , although most of the recent developments have been in the form of industry self-regulation, with fewer examples of statutory regulations (15) .…”

Economic evaluation of obesity interventions in children and adults

“…We of course join with Haby et al 1 in highlighting the need to fill gaps in the evidence base, particularly into the long-term effect (into middle-age and beyond) of childhood obesity interventions.…”

“…We refer to a recent article by Haby et al, 1 describing the effectiveness side of a cost effectiveness study of 13 different obesity interventions in children. In order to model the disability adjusted life years (DALYs) saved for these interventions, the authors have adopted an approach that involves a number of steps, which we illustrate in Figure 1.…”