Cost–effectiveness of Preventing Weight Gain and Obesity

What We Know and What We Need to Know

Afschin Gandjour

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2012;12(3):297-305. 

In This Article

Abstract and Introduction

Abstract

The objective of this study was to show gaps and inconsistencies in selected literature on the cost–effectiveness of preventing weight gain and obesity and to set an agenda for future research. A review and qualitative analysis of the literature was carried out on the cost–effectiveness of preventing weight gain and obesity, with a primary focus on programs that influence health outcomes and directly change individual behavior through physical activity promotion (i.e., energy expenditure increase). A literature search reveals that computer simulation models on the lifetime cost of obese versus normal-weight persons show conflicting results. Studies on programs to promote physical activity as a means to prevent obesity also show varying cost–effectiveness ratios, with a key variable from a societal perspective being the cost of time required to exercise. In particular, this review found a need for more parsimonious simulation models and more information on the comparative cost–effectiveness of programs to prevent weight gain/obesity.

Introduction

Obesity in adults is defined as a BMI of 30 kg/m2 or higher, whereas overweight is defined as a BMI between 25 and 29.9 kg/m2.[101] Today, overweight and obesity are among the leading causes of illness and mortality in the world.[1] Overweight and obesity also have an increasing economic impact. For example, in the US healthcare system, medical costs of obesity are estimated to have increased from US$78.5 billion in 1998 to $147 billion in 2008.[2]

Prevention of obesity is often considered a means to reduce this economic burden. Still, information on the cost–effectiveness (CE) and long-term costs of preventing weight gain and obesity is limited to a few, mostly recently published analyses (see reviews by Müller-Riemenschneider et al.[3] and John et al.[4]). Note that an intervention that is cost saving is also cost effective; however, an intervention that is cost effective may not be cost saving. In other words, an intervention may increase costs but still be considered cost effective because of large health gains. Also note that preventing weight gain in normal-weight persons who otherwise would have become overweight but not obese is, strictly speaking, not obesity prevention. Therefore, this paper will separately refer to obesity prevention and weight gain prevention.

The purpose of this review is to show gaps and inconsistencies in the literature on the CE and long-term costs of preventing weight gain and obesity, and set an agenda for future research. In contrast to previous reviews, this one places an emphasis on computer simulation models and discusses implementation and time costs in detail. The paper primarily focuses on physical activity as opposed to diet as a means of weight control (i.e., the focus is on energy expenditure as opposed to energy intake). The following section reviews models on the lifetime cost of obesity. The subsequent sections discuss CE models of policies or programs to prevent weight gain and obesity, thus also considering program costs, programs that prevent weight gain and obesity by promoting physical activity, the comparative CE of physical activity programs (an important topic given the large number and variety of potential approaches), and the time cost of physical activity as an important determinant of the CE of physical activity programs from a societal viewpoint. The last section summarizes the open points that need to be addressed by future research. To narrow down the literature on the topic, this paper focuses primarily on health outcomes of overweight and obesity prevention as opposed to nonhealth outcomes such as labor market outcomes. Furthermore, it emphasizes programs that include efforts to directly change individual behavior as opposed to those that solely focus on indirectly changing individual behavior by making the environment less obesogenic. Moreover, as stated, the paper primarily focuses on physical activity as opposed to diet as a means of weight control. This selection, however, does not mean that the other literature is less important.

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