Obesity prevention doesn’t have to be expensive

Obesity can be a difficult-and costly-issue to manage, but there is new evidence to help make interventions to fight obesity more effective and less expensive.

In the presentation “The 5 most cost-effective strategies to prevent childhood obesity” at the American Academy of Pediatrics (AAP) 2017 National Conference and Exhibition on September 18, Steven Gortmaker, PhD, professor of the Practice of Health Sociology at the Harvard TH Chan School of Public Health, Boston, Massachusetts, provided an overview of the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES). The session included the evidence behind the strategies assessed in the study to decrease childhood obesity, and the cost-effectiveness of each plan. Gortmaker also discussed ways pediatricians could advocate for these strategies in their community, barriers to implementing these changes, and ways to work around them.

“Our research has documented the impact that clinical treatment can have on pediatric obesity over the next decade. And while studies indicate effectiveness for some approaches, the impact at the population level of these clinical treatment strategies can be described as ‘too little and too late,’ and often quite expensive,” Gortmaker says.

“With current clinical practice, the United States will not be able to treat its way out of the obesity epidemic. Instead, policymakers will need to expand investment in primary prevention, focusing on interventions with broad population reach, proven individual effectiveness, and low cost of implementation,” Gortmaker and his colleagues noted in a 2015 paper.

As discussed in the paper, policymakers have to prioritize investment in treatment and prevention methods.

“We estimated the cost-effectiveness of 7 interventions high on the obesity policy agenda-a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery,” the study authors noted.

They found that 3 of these 7 interventions saved more in healthcare costs than they cost to implement. Each of the interventions would reduce between 129,000 and 576,000 cases of childhood obesity by 2025, according to the report. Meanwhile, researchers estimated that adolescent bariatric surgery had a negligible impact on obesity prevalence.

“Our results highlight the importance of primary prevention for policymakers aiming to reduce childhood obesity,” the research team noted.

According to CHOICES, adults in the United States consume about 220 calories more than they need each day, and children are consuming about an extra 200 calories as well. Body-mass index (BMI) has increased by 0.5 per decade in children since the 1970s, and children could weigh 1.8 kilograms more by 2020 than they did in 2007 if this trend continues. More than 1 in 5 children will be obese, according to the report.

How to slow or stop this trend is the question, and Gortmaker and his team have been testing interventions with the help of various cities and state health departments for the last 2 years.

In an experiment in Seattle investigating the impact of a $0.0175-per-ounce excise tax on sugar-sweetened beverages, Gortmaker and his team found that numerous lives and healthcare dollars could be saved with just small, cheap changes.

According to a statement on the Seattle experiment, the excise tax resulted in a 21.5% price increase on an average sugar-sweetened beverage, but similar experiments have shown that such a tax could reduce consumption as much as 21%. Over 18 months, Gortmaker’s team estimated that each 8-ounce serving of a sugar-sweetened beverage equaled 1 kilogram in weight gain and increased the risk of diabetes by 18%. There were some municipal labor and paperwork costs associated with the tax, but the team’s cost and benefit estimates also did not include expected tax revenue.

What the tax would produce, according to the team’s estimates, was a 4% reduction in diabetes incidence in just 1 year once the tax takes effect, more than 3000 cases of obesity prevented, and 73 lives saved. The tax could save $29 million over a decade, with $48.60 healthcare dollars saved per dollar invested in the program. The team estimated the total cost to implement the tax would be around $61,500 per year but could generate $24.7 million per year in tax dollars in addition to the health savings.

Gortmaker also presented information from a newer 2017 paper during the session, which notes the importance of cost-effective treatments for childhood obesity, as well as 2 other papers still in the review process.

“We would hope that clinicians will see the importance of supporting cost-effective policies that can lead to reduced childhood obesity in the future,” Gortmaker says.

The presentation also included examples of various approaches that could be used to prevent cases of childhood obesity in all settings.

Gortmaker says he became passionate about addressing childhood obesity back in 1985 when he began investigating the link between excess television viewing and obesity prevalence. From there, he moved on to research tying sugar-sweetened beverage intake to obesity prevalence.

Now, the CHOICES study offers evidence-based prevention and programs that Gortmaker says will help more kids achieve and maintain healthy weight with the least amount of dollars invested.

The data presented in this program can help prioritize steps for policy and program intervention efforts at the local level, identify cost-effective and efficient strategies for change, and engage change-makers, Gortmaker says.