Lifetime reductions in medical expenditures as a result of participation in diet and exercise counseling programs designed to reduce child and adolescent obesity

Despite the recent plateau in the prevalence of child and adolescent obesity, one third of children and adolescents remain overweight and over 18% are obese.¹ Childhood obesity has been associated with increased morbidity in childhood, including type II diabetes^2-4, hypertension^2,3, and asthma^2,3,5. Overweight children also report lower self-esteem and display more behavior problems than normal weight peers.⁶ Most of these overweight and obese children will remain overweight or obese into adulthood and incur much greater health and economic costs.^7,8 Diet and/or exercise counseling has been the primary method of treatment for overweight and obese children. Using recently published data evaluating the effectiveness of these programs, as well as data from the 2004 – 2010 rounds of the Medical Expenditure Panel Survey (MEPS), we have constructed a microsimulation to quantify potential savings in lifetime medical costs produced by these diet and exercise counseling programs. After participation in these programs in their adolescent years, the simulation models BMI trajectories and medical expenditures from ages 18 to 80. In addition to the initial reduction in body-mass index (BMI) at the time of treatment, we model several potential BMI trajectories based on learning skills that result in avoidance of varying degrees of obesity. We also independently simulate treatment of children specifically identified as overweight and a general population of children based on U.S. national demographics. The later is intended to represent treatment in a school setting.

When no healthy learning effects are included in the model, we find between $808 and $2,190 in reduced lifetime medical expenditures. Discounted to 2013 U.S. Dollars, the present value of these savings ranged from $396 to $1,904. After incorporating various degrees of healthy learning, we find between $7,801 and $29,322 in lifetime savings per child, the present value of which ranged from $3,368 to $15,068. Savings were significantly greater for women and when programs were targeted towards children with a BMI>25 at age 17. With the understanding that many children who participate in these counseling programs quickly regain any initial weight lost, we calculated population average savings under a number of scenarios in which these estimated lifetime savings were only applied to a small proportion of treated children. We show that even if most children are considered treatment failures, substantial reductions in lifetime medical expenditures among children who do respond favorably are likely to make these programs cost-effective. The model does not consider the cost of administering the counseling program so the present value of these savings can be considered break-even points for cost-effectiveness.

State Medicaid programs, under the Early and Periodic Screening and Diagnostic Treatment (EPSDT) benefit can cover nutritional and behavioral interventions designed to prevent and treat childhood obesity. However, as of 2008, only 11 states were definitively covering such services.⁹ Similarly, few private insurers cover childhood obesity prevention and treatment programs.¹⁰ Our results indicate that diet and exercise counseling programs for children and adolescents, particularly those already overweight in adolescence, are likely to be cost-effective investments.