The economics of childhood obesity

Rising levels of childhood obesity presents a serious global public health problem amounting to 7% of GDP in developed countries and affecting 14% of children.  As such, many countries are investing increasingly large amounts of resource towards treatment and prevention.  In many international contexts, local Government are responsible for funding childhood obesity services from public health budgets but recently these organisations have been faced with unprecedented financial pressures.  Whilst economic evaluation can assist with making (dis)investment decisions, applying the method to a childhood obesity context is not straightforward as obesity is a complex disease with interventions that are multi-component in nature.  Furthermore, the interventions are implemented in a variety of settings such as schools, the community, and the home, and have costs and benefits that fall outside the health sector. 

This paper will discuss the methods of economic evaluation within a childhood obesity context.  It will discuss the appropriateness of utility-based outcome instruments for use in young children, focusing on the Child-Health Utility 9D instrument and it’s psychometric properties.  Quality-Adjusted Life Years (QALYs) are often used to make judgements about relative cost-effectiveness yet there is a dearth of evidence concerning how weight affects utility-based quality of life in young children and this relationship has implications for the methods of economic evaluation.  Using the CHU-9D instrument, the results of a cost-effectiveness analysis alongside a large UK-based randomised controlled trial will be presented. 

Designing methods of economic evaluation to fit within the decision making context will be a key theme of this paper.  Public health decision makers are concerned with achieving population wellbeing outcomes as well as health outcomes and if health economists are committing to supporting decision making within this context, then the methods of economic evaluation need to go broader than just heath.  Decision makers require economic evidence that fits within tightly regulated financial time cycles and reflects total budget impact, operating costs, as well as long and short term cost-effectiveness.  This paper will introduce a new, innovative approach to measuring wellbeing in children and provide an example of how that is being done to evaluate a childhood obesity intervention within the UK context working closely with public health decision makers.  It will provide a direct comparison between the conventional trial-based approach presented earlier and this new adapted approach to economic evaluation that fits with public health decision makers needs.