The cost-effectiveness of a school-based overweight program

Brown, H. Shelton; Pérez, Adriana; Li, Yen-Peng; Hoelscher, Deanna M.; Kelder, Steven H.; Rivera, Roberto C.

doi:10.1186/1479-5868-4-47

Cited by 90 publications

(170 citation statements)

References 45 publications

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“…44 The wide variations in cost-effectiveness shown in Exhibit 1 underscore the importance of prioritizing interventions with the lowest cost per QALY, to avoid wasting resources. Unfortunately, costeffectiveness studies have not yet been conducted for many promising interventions.…”

Section: Childhood Obesity: a Policy Agendamentioning

confidence: 99%

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The Economics Of Childhood Obesity

2010

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In the past few decades, obesity rates among American children have skyrocketed. Although many factors have played a part in this unhealthy increase, this paper focuses on how economic policies may be contributing to our children's growing girth and how these policies might be altered to reverse this trend. It examines the economic causes and consequences of obesity, the rationales for government intervention, the cost-effectiveness of various policies, and the need for more research funding.I n the twenty-five years that elapsed between surveys conducted in 1971-1974 and in 1999-2000, the prevalence of obesity rose from 5 percent to 10.4 percent among two-to-five-year-olds; from 4 percent to 15.3 percent among six-to-elevenyear-olds; and from 6.1 percent to 15.5 percent among twelve-to-nineteen-year-olds. 1,2 Economic Factors And Childhood ObesityChildhood obesity is a complex, multidisciplinary issue, so the search for solutions requires information sharing across many fields. To promote such exchange, this paper describes research findings from the field of economics. Relative to other disciplines, economics has only recently been applied to the study of obesity. As a result, there are many useful applications yet to be made.Economics offers several useful tools for the study of childhood obesity: insights into the economic causes and consequences of obesity, clearly defined rationales for government intervention in markets, and the use of cost-effectiveness analysis for comparing policies to prevent or reduce obesity. This paper summarizes recent research in each of those areas. It concludes by discussing the implications for health policy.Economic explanations for the recent rise in obesity tend to focus on changes that give people incentives to consume more or to burn fewer calories. These include the following.FOOD PRICES The real price of food (the price of food adjusted for inflation across all goods and services) has declined greatly in recent decades. For example, between 1990 and 2007 the real price of a two-liter bottle of Coca-Cola fell 34.89 percent, and that of a McDonald's quarter-pounder with cheese fell 5.44 percent.3 Some research indicates that reductions in the price of food account for 41-43 percent of the rise in young adults' body mass index (BMI) between 1981 and 1994. 4 BMI is most sensitive to the price of fast food in particular for youth from families of low socioeconomic status.5 The real price of fruit and vegetables rose 17 percent between 1997 and 2003, 6 an increase that some studies have linked to higher BMI in American children and adolescents. 7,8 AGRICULTURAL POLICIES The decline in the price of food could be due to agriculture policies. However, several studies have concluded that such policies have little impact on consumer prices of energy-dense foods.9,10 About half of farm subsidies are based on historic, not current, production, which limits incentives for farmers to increase output.9 Moreover, U.S. farm policy raises John Cawley (JHC38@cornell .ed...

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Section: Childhood Obesity: a Policy Agendamentioning

confidence: 99%

“…44 The next most cost-effective program is Planet Health, a comprehensive intervention to promote healthy eating and physical activity in middle schools, which costs $4,305 per QALY saved for girls but is not effective for boys. 45 The adage that "prevention is cheaper than cure" is true in this case.…”

Section: Making Interventions Cost-effectivementioning

confidence: 99%

The Economics Of Childhood Obesity

2010

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“…Similarly, the majority of Kentucky adults would love schools to provide physical activity programs to students (Foundation for a Healthy Kentucky, 2009). In addition, a comprehensive intervention in elementary schools including a classroom curriculum, a physical education program, modifications to the school food services and family-based programs, is supported to be highly cost-effective compared to other programs among adolescents or adults (H. S. Brown et al, 2007;Cawley, 2010). Therefore, comprehensive school-based programs in elementary schools are a public supportive and cost-effective way to prevent and control childhood obesity.…”

Section: Discussionmentioning

confidence: 99%

“…Both family-based and school-based healthy lifestyle programs have shown significant effects on reducing weight and sedentary activity, and increasing physical activity (Bacardi-Gascon, Perez-Morales, & Jimenez-Cruz, 2012;Greening, Harrell, Low, & Fielder, 2011;Sacher et al, 2010). School-based healthy lifestyle programs are cost-effective, and schools are considered an ideal setting for healthy lifestyle promotion programs (BacardiGascon et al, 2012;H. S. Brown et al, 2007).…”

Section: Need For the Studymentioning

confidence: 99%

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Preliminary assessment of a school-based healthy lifestyle program among rural children.

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Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children

et al. 2021

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IMPORTANCECardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear.OBJECTIVE To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools.DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. INTERVENTIONSThe internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). MAIN OUTCOMES AND MEASURESMultistage 20-m shuttle run test for cardiorespiratory fitness. RESULTSOf 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). CONCLUSIONS AND RELEVANCEIn this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level.

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The cost-effectiveness of a school-based overweight program

Cited by 90 publications

References 45 publications

The Economics Of Childhood Obesity

The Economics Of Childhood Obesity

Preliminary assessment of a school-based healthy lifestyle program among rural children.

Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children

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