Cost Effectiveness of Childhood Obesity Interventions

Gortmaker, Steven L.; Long, Michael W.; Resch, Stephen; Ward, Zachary J.; Cradock, Angie L.; Barrett, Jessica L.; Wright, Davene R.; Sonneville, Kendrin R.; Giles, Catherine M.; Carter, Rob; Moodie, Marj; Sacks, Gary; Swinburn, Boyd; Hsiao, Amber; Vine, Seanna; Barendregt, Jan J.; Vos, Theo; Wang, Y. Claire

doi:10.1016/j.amepre.2015.03.032

Cited by 117 publications

(129 citation statements)

References 74 publications

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“…This is even more urgent when considering the potential health-and economicrelated effects of the 21th century obesity pandemic. Our data support recent initiatives, e.g., using mobile technology for preventing obesity-related behaviors in at-risk children (9) or pilot research indicating the cost-effectiveness of childhood interventions to combat obesity (10).…”

Section: Santos-lozano Et Al Obesity and Longevity Page 2 Ofsupporting

confidence: 73%

Implications of obesity in exceptional longevity

Santos‐Lozano¹,

Pareja‐Galeano²,

Fuku³

et al. 2016

Ann. Transl. Med.

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Except for the world's poorest regions, it is estimated that global obesity [body mass index (BMI) >30 kg/m 2 ] prevalence will reach 18% (men) and >21% (women) by 2025 (1). Recent nationally representative surveys in the US for the 2013-2014 period indicate age-adjusted obesity prevalence of 35.0% and 40.4% among adult men and women, respectively (2) and of 17.0% for children and adolescents aged 2-19 years (3). On the other hand, because healthy life expectancy also shows global improvement, the world is becoming apparently heavier and healthier (4). This finding is paradoxical given the association of obesity, and especially severe/morbid obesity, and/or its metabolic consequences with all-cause mortality as well as with a broad range of diseases and health complaints (5). In fact, recent data suggest that life expectancy will start to decline in the US over this century. Accordingly, we could be approaching a tipping point where technological and medical care advances might no longer compensate for our poor lifestyle habits (6).Centenarians show exceptional longevity (~20+ years more than the average Westerner) and most have postponed, and some even escaped major diseases despite their advanced age. The latter represents the paradigm of extended healthy life expectancy that any individual would dream of reaching.We assessed BMI in three independent centenarians' cohorts of both sexes that we have studied extensively (7): n=81 from Northern Italy (Lombardy, Piedmont); n=84 from Spain (central area); and n=467 from Japan [participants in the Tokyo Centenarians and semi-supercentenarians (SS) study] (7). The Italian centenarians were free of major agerelated diseases (cancer, CVD, dementia). (7). We compared BMI mean values and categories across cohorts with one-group ANOVA and χ 2 tests, respectively. We obtained approval from the local ethics committees [European University of Madrid (Spain), 2E Science (Italy), and Keio University (Japan)]. The study followed the tenets of the Declaration of Helsinki for Human Research. Results are shown in Table 1. Aside from some geographic-specific differences (Japanese centenarians had the lowest BMI and a high prevalence of underweightwhich is concurrent with the typical profile of this country compared with most Western societies), a main result is that the percentage of obese centenarians was well below the estimated current values for adults [age-standardized obesity of 10.8% (95% CI: 9.7-12.0) in men and 14.9% (95% CI: 13.6-16.1) in women] (1). Notably, we found no obese male centenarians in any of the cohorts. Italy has one of the world's highest percentages of obese people [ranked number 9 (men) and 14 (women) in 2014] (1). And yet there were no obese disease-free centenarians in the Italian cohort.According to our results, obese people do not show healthy life expectancy. Compared to other hominoids, humans show an evolved predisposition to deposit fat.

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Section: Santos-lozano Et Al Obesity and Longevity Page 2 Ofsupporting

confidence: 73%

Implications of obesity in exceptional longevity

Santos‐Lozano¹,

Pareja‐Galeano²,

Fuku³

et al. 2016

Ann. Transl. Med.

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“…Two models were identified. 62,63 Five models (reported in nine publications) were subsequently identified that were published between 2012 and 2015, [64][65][66][67]69 with the majority of these published in the last 2 years.…”

Section: Resultsmentioning

confidence: 99%

“…Nine of the studies [64][65][66][67][68][69][70][71][72] were published in 2012 or later, and of note in the current report is that the initial searching of the literature in 2012 was used as the basis for the conceptual modelling framework for HeLP, as set out below, and it was, therefore, based on a limited literature (as described below and in Table 26). However, a number of the more recent studies adopt the methodological framework used in the earlier literature, which has influenced the conceptual framework used for the HeLP-specific research.…”

Section: Resultsmentioning

confidence: 99%

“…[62][63][64][65][66][67][68][69][70][71][72] The study identification process is summarised in Figure 5.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the models identified in the review were from North America, 62,63,[67][68][69][70][71][72] with two European studies 64,65 (one being a multisite study across six countries in Europe 65 ) and one from New Zealand. 66 The studies varied in terms of the modelling approach used, the range of health states (including weight-related events) included in the models, the techniques used to predict weight status in adulthood as a function of childhood weight status and the outcomes included in the models.…”

Section: Resultsmentioning

confidence: 99%

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Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

et al. 2018

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Dean SG, Hillsdon M, et al. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. Public Health Res 2018;6(1). This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). Public Health ResearchEditorial contact: journals.library@nihr.ac.ukThe full PHR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/phr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Public Health Research journalReports are published in Public Health Research (PHR) if (1) they have resulted from work for the PHR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Public Health Research are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. PHR programmeThe Public Health Research (PHR) programme, part of the National Institute for Health Research (NIHR), evaluates public health interventions, providing new knowledge on the benefits, costs, acceptability and wider impacts of non-NHS interventions intended to improve the health of the public and reduce inequalities in health. The scope of the programme is multi-disciplinary and broad, covering a range of interventions that improve public health. The Public Health Research programme also complements the NIHR Health Technology Assessment programme which has a growing portfolio evaluating NHS public health interventions.For more information about the PHR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/phr This reportThe research reported in this issue of the journal was funded by the PHR programme as project number 10/3010/01. The contractual start date was in March 2012. The final report began editorial review in November 2016 and was accepted for publication in February 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PHR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the PHR programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions express...

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Practical Considerations for the US Preventive Services Task Force Recommendations on Obesity in Children and Adolescents

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Oken

2017

JAMA Intern Med

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Comprehensive strategies to address childhood obesity are needed. Despite recent stabilization of prevalence among 2to 11-year-old children, nearly one-third of US children and adolescents are overweight (body mass index [BMI] 85th-95th percentile for age and sex on US Centers for Disease Control and Prevention growth charts) or have obesity (BMI ≥95th percentile). 1 Substantial disparities exist by race/ ethnicity: more than 20% of Hispanic boys and girls and non-Hispanic black girls have obesity compared with 14% to 15% of non-Hispanic white girls and boys. The prevalence of extreme obesity (BMI ≥120% of the 95th percentile) is rising and is nearly 6% among all children and adolescents and 9% among black girls.The benefit of treatment for obesity is clear. Updating its 2010 statement, the US Preventive Services Task Force (USPSTF) has provided another meticulous evidence-based recommendation on obesity screening and treatment for children and adolescents. 2 Unchanged from the 2010 recommendation statement, the top-line conclusion supports screening and treatment for obesity for children older than 6 years of age (grade B). The specific treatments recommended are "comprehensive, intensive behavioral interventions" 2 that are multicomponent and incorporate activities such as counseling children and their families regarding nutrition, physical activity, and techniques to help change behavior through self-monitoring, goal setting, and problem solving. Based on growth in the evidence base, including the quality of studies, the recommendations are more far-reaching and specific than in 2010. For the 2017 recommendation, the USPSTF incorporated results from 42 trials with multicomponent behavioral interventions involving nearly 7000 children. 3 These trials included 8 rated as "good quality." 3 However, only about one-quarter of these studies included adolescents, limiting inferences about this group. Screening is still recommended, using age-and sex-specific BMI, as are obesity treatment programs that provide at least 26 contact hours; contact hours were calculated based on the number and length of intervention sessions. Evidence points to a dose response of treatment, with the greatest success achieved by programs with at least 52 contact hours (7 trials tested interventions of this length). These longer-duration programs have clear evidence of improvements in weight status and some related cardiometabolic risk factors after 6 or 12 months of follow-up. The findings on cardiometabolic risk factors are notable considering that sustained improvements early in life will likely have longterm benefits in preventing diabetes and metabolic diseases in adulthood. 4 The USPSTF found no overall evidence of harm resulting from treatment (10 studies assessed harm). They found no studies that directly examined harms from screening. Several states have implemented BMI screening in schools, and parental responses to those efforts have been mixed. Some parents reported skepticism and concern, especially regarding possible stigma o...

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Cost Effectiveness of Childhood Obesity Interventions

Cited by 117 publications

References 74 publications

Implications of obesity in exceptional longevity

Implications of obesity in exceptional longevity

Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

Practical Considerations for the US Preventive Services Task Force Recommendations on Obesity in Children and Adolescents

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