A published CHOICES overview paper discusses the rigorous methods behind four preventive childhood obesity strategies that were found to be more cost-effective than existing clinical interventions to treat obesity.
Gortmaker SL, Long MW, Resch SC, Ward ZJ, Cradock AL, Barrett JL, Wright DR, Sonneville KR, Giles CM, Carter RC, Moodie ML, Sacks G, Swinburn BA, Hsiao A, Vine S, Barendregt J, Vos T, Wang YC. Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES. Am J Prev Med. 2015 Jul;49(1):102-11. doi: 10.1016/j.amepre.2015.03.032.
As the childhood obesity epidemic continues in the U.S., fiscal crises are leading policymakers to ask not only whether an intervention works, but also whether it offers good value for money spent. However, cost-effectiveness analyses have been limited, and currently practiced strategies such as individual clinical interventions are often an expensive burden on the healthcare system.
“Reversing the obesity epidemic will require a broad range of intervention strategies, and identifying the best strategies necessitates analysis of the costs, impact, healthcare cost savings, and broader context of each strategy,” says lead investigator of the CHOICES Project, Dr. Steve Gortmaker, who also serves as the Director of the Harvard Prevention Research Center and a Professor of the Practice of Health Sociology at the Harvard T.H. Chan School of Public Health. “The consideration of all these key metrics is crucial, yet currently absent from our national conversation on obesity prevention and control.”
The four papers, published by the American Journal of Preventive Medicine, are the first to evaluate the cost-effectiveness of these four strategies implemented nationally:
- a sugar-sweetened beverage excise tax (SSB)
- eliminating the tax subsidy of TV advertising unhealthy food to children (TV AD)
- early care and education policy changes targeting unhealthy beverages, physical activity, and screen time (ECE)
- policy changes and teacher training to increase physical activity during existing PE classes (ACTIVE PE)
CHOICES researchers selected these initial interventions as they represent a broad range of nationally scalable strategies to reduce childhood obesity, using a mix of both policy and program-based changes. The interventions were modeled for nationwide implementation using a simulation of the 2015 U.S. population over ten years. Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At the 10-year mark in 2025, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue.
The overview also discusses various limitations in current research and results, including the lack of established benchmarks for the metric of cost per unit changes in BMI. However for comparison, the paper cites the costs of existing clinical interventions for obese children or adolescents. When primary care-based interventions can total about $1,000 per BMI unit change, and bariatric surgery is roughly estimated at $2,100 per BMI unit change, the results from the four CHOICES broad-reaching policy and preventive interventions may produce changes in BMI at much lower cost than these commonly reimbursed medical treatments.
Though the critical question remains of whether these cost-effective interventions can actually be implemented over the modeled length of time (and whether implementation is at the local, state, or national level), this analysis is an important step in providing policymakers with the right tools to focus on strategies that can demonstrate best value for money.