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ArticlePublication 2017Simulation of Growth Trajectories of Childhood Obesity into Adulthood
The authors developed a simulation model to estimate the risk of adult obesity at the age …
The authors developed a simulation model to estimate the risk of adult obesity at the age of 35 years for the current population of children in the United States. They used pooled height and weight data from five nationally representative longitudinal studies totaling 176,720 observations from 41,567 children and adults to simulate growth trajectories across the life course adjusted for secular trends. Using 1,000 virtual populations of 1 million children through the age of 19 years, representative of the…
North America | Health Outcomes | Microsimulation | Child/Nutrition | Chronic Disease/Risk | Health/Medicine -
ArticlePublication 2017Cost-Effectiveness of a Clinical Childhood Obesity Intervention
This study estimated the cost-effectiveness of the STAR (Study of Technology to Accelerate Research) trial, …
This study estimated the cost-effectiveness of the STAR (Study of Technology to Accelerate Research) trial, an electronic health record (EHR)-based decision support intervention for primary care providers. Using a microsimulation model, the authors estimated the impact of a national implementation of STAR from 2015 to 2025 among all pediatric primary care providers in the U.S. with fully functional EHRs. The study found that over 10 years, the intervention would reach 2 million children, with costs…
North America | Costing Methods | Microsimulation | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Economics/Finance | Health/Medicine | Science/Technology -
ArticlePublication 2016State-Level Estimates of Childhood Obesity Prevalence in the U.S. Corrected for Report Bias
State-level obesity estimates are critical to public health efforts to address the childhood obesity epidemic. …
State-level obesity estimates are critical to public health efforts to address the childhood obesity epidemic. However, few states have objectively measured body mass index (BMI) surveillance programs. Instead, surveys are used in which parents report the height and weight of their children. However, these estimates are generally biased. This study used a non-parametric statistical matching technique to use measured data from NHANES to correct for this bias and produce adjusted state-level estimates of childhood obesity…
North America | Evidence Synthesis | Child/Nutrition | Chronic Disease/Risk | Health/Medicine -
ArticlePublication 2015Cost Effectiveness of an Elementary School Active Physical Education Policy
While most elementary schools in the U.S. do require some physical education (PE), on average, …
While most elementary schools in the U.S. do require some physical education (PE), on average, students spend less than half of class time engaged in moderate-to-vigorous physical activity (MVPA). PE activity levels are lower when more class time is spent organizing students or reviewing rules, and when PE classes are led by classroom teachers instead of trained PE specialists. Policies aimed at increasing MVPA levels during PE class – “active PE” policies – have been…
North America | Costing Methods | Health Outcomes | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Clinical Care | Economics/Finance | Food/Agriculture | Health/Medicine -
ArticlePublication 2017Cost-Effectiveness of Subsidizing Fruit and Vegetable through SNAP
A diet high in fruits and vegetables is associated with reduced risk of chronic disease …
A diet high in fruits and vegetables is associated with reduced risk of chronic disease - to incentivize consumption among low-income households one proposal is to make them more affordable through the Supplemental Nutrition Assistance Program (SNAP). This cost effectiveness analysis adopts a societal perspective to estimate the value of subsidizing fruit and vegetable (FV) purchases among the one in seven Americans who participate in SNAP. A stochastic microsimulation model of obesity, type 2 diabetes, myocardial infarction,…
North America | Mathematical Models | Microsimulation | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Social Determinants | Policy/Regulation | Economics/Finance | Food/Agriculture | Health/Medicine -
ArticlePublication 2015Modeling the Cost Effectiveness of U.S. Child Care Policy Changes
Risk factors for obesity, including dietary habits, physical activity, and screen time behaviors develop in …
Risk factors for obesity, including dietary habits, physical activity, and screen time behaviors develop in early childhood, highlighting the importance of early intervention for obesity prevention. With nearly 70% of American preschool-aged children in out-of-home childcare facilities, these programs serve as an ideal intervention target. This study estimated the effect of hypothetical state-level regulations focused on beverage consumption, physical activity, and screen time. Using a simulation model, the authors found these regulatory changes would reach…
North America | Costing Methods | Health Outcomes | Mathematical Models | Microsimulation | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Clinical Care | Education/Labor | Food/Agriculture | Government/Law | Health/Medicine -
ArticlePublication 2016New Strategies to Prioritize Nutrition, Physical Activity, and Obesity Interventions
Interventions for obesity have not often been based on considerations that could predict their effectiveness. …
Interventions for obesity have not often been based on considerations that could predict their effectiveness. However, advances in research provide several new approaches that can inform priorities for public health interventions directed at nutrition, physical activity, and obesity. These approaches include estimation of the effect size, comparison of the calorie gap with the caloric deficit induced by the intervention, population reach and impact, cost and cost effectiveness of the intervention, time required to evaluate the…
North America | Child/Nutrition | Chronic Disease/Risk | Social Determinants | Health Systems | Policy/Regulation | Clinical Care | Food/Agriculture | Health/Medicine | Europe -
ArticlePublication 2015BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth
Children in the U.S. are exposed to thousands of food-related TV advertisements, most of which …
Children in the U.S. are exposed to thousands of food-related TV advertisements, most of which promote nutritionally poor foods and drinks. Food marketers spend millions of dollars on youth-directed television each year, and these advertising expenditures are currently treated by the U.S. government as ordinary business expenses, meaning they receive a tax subsidy of nearly $80 million. This study estimated the cost-effectiveness of eliminating this tax subsidy. Using a simulation model, the authors found that…
North America | Costing Methods | Health Outcomes | Microsimulation | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Social Determinants | Policy/Regulation | Culture/Society | Food/Agriculture | Government/Law | Health/Medicine -
ArticlePublication 2016U.S. States' Childhood Obesity Surveillance Practices and Recommendations, 2014–2015
This study examined the extent to which state governments conduct child body mass index (BMI) …
This study examined the extent to which state governments conduct child body mass index (BMI) surveillance. Routine surveillance of child BMI is needed to monitor the childhood obesity epidemic, particularly at the state and local levels. However, child BMI surveillance systems operated by the U.S. government do not provide state or local data on children across a range of ages. The authors conducted structured telephone surveys with state government administrators from August through December 2014…
North America | Evidence Synthesis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Clinical Care | Food/Agriculture | Health/Medicine -
ArticlePublication 2015Cost Effectiveness of a SSB Excise Tax in the U.S.
Sugar-sweetened beverages (SSBs) have been closely linked with excess weight gain, diabetes, and cardiovascular disease, …
Sugar-sweetened beverages (SSBs) have been closely linked with excess weight gain, diabetes, and cardiovascular disease, which has led to public health recommendations for higher taxes on unhealthy drinks like soda and sports drinks. This study estimated the cost-effectiveness of implementing a 1-cent per ounce SSB excise tax in the U.S. The authors developed a simulation model and found that implementing the tax nationally would cost $51 million in the first year and would reduce SSB…
North America | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Social Determinants | Government/Law | Health/Medicine -
ArticlePublication 2015Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES
As the childhood obesity epidemic continues in the U.S., fiscal crises are leading policymakers to …
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. This paper discussed the methods used to evaluate the cost-effectiveness of four strategies to address the obesity epidemic: (1) a sugar-sweetened beverage excise tax; (2) eliminating the tax subsidy of TV advertising of unhealthy food to children; (3) early care and education policy…
North America | Health Outcomes | Evidence Synthesis | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Social Determinants | Culture/Society | Government/Law | Health/Medicine -
ArticlePublication 2015Severe Obesity in Adults Cost State Medicaid Programs Nearly $8 Billion in 2013
Efforts to control healthcare spending while expanding Medicaid must be informed by a better understanding …
Efforts to control healthcare spending while expanding Medicaid must be informed by a better understanding of the state-level medical costs associated with severe obesity. This study analyzed medical costs from the Medical Expenditure Panel Survey (MEPS) and matched them to state-level estimates of severe obesity, adjusting for self-report bias. The authors found that in 2013, severe obesity cost the U.S. $69 billion, which accounted for 60% of total obesity-related costs. Approximately 11% of the costs…
North America | Costing Methods | Evidence Synthesis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Health/Medicine -
ArticlePublication 2016Redrawing the U.S. Obesity Landscape: State-Specific Adult Obesity Prevalence
State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic …
State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. This study described a novel bias-correction method and produced corrected state-level estimates of obesity and severe obesity. Using non-parametric statistical matching, the authors adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924).…
North America | Health Outcomes | Evidence Synthesis | Child/Nutrition | Health/Medicine -
ArticlePublication 2017Cost-Effectiveness Analysis to Prioritize Approaches to Obesity Prevention in Childhood
Recommended levels of physical activity (PA) promote a healthy body weight and reduce chronic disease …
Recommended levels of physical activity (PA) promote a healthy body weight and reduce chronic disease risk. To help prioritize investment in PA promotion initiatives, this study estimated the impact of six recommended strategies to increase physical activity in U.S. school, afterschool, and childcare settings. Using a microsimulation model, the authors found that the number children reached by the interventions ranged from 90,000 attending a Healthy Afterschool Program to over 31 million reached by Active School…
North America | Priority Setting/Ethics | Microsimulation | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Health Systems | Policy/Regulation | Clinical Care | Climate/Environment | Education/Labor | Food/Agriculture | Health/Medicine -
ArticlePublication 2015Three Interventions That Reduce Childhood Obesity
Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. …
Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. The authors estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: (1) a sugar-sweetened beverage excise tax, (2) elimination of the tax subsidy for advertising unhealthy food to children, (3) restaurant menu calorie labeling, (4) nutrition standards for school meals, (5) nutrition standards for all other food and beverages sold in schools, (6) improved early care and…
North America | Costing Methods | Cost-Effectiveness Analysis | Child/Nutrition | Health Systems | Policy/Regulation | Clinical Care | Economics/Finance | Health/Medicine -
ArticlePublication 2014Cost of a Primary Care-Based Childhood Obesity Prevention Intervention
This study evaluated the cost of a primary care-based obesity prevention intervention (High Five for …
This study evaluated the cost of a primary care-based obesity prevention intervention (High Five for Kids) for children ages 2-6 years, compared to usual care. U.S. pediatric guidelines recommend that childhood obesity counseling be done in primary care settings. The clinical trial aimed to modify children’s nutrition and TV viewing habits through a motivational interviewing intervention. The authors assessed the visit-related costs for children enrolled in the trial, and found that the mean costs for…
North America | Costing Methods | Decision Analysis | Child/Nutrition | Chronic Disease/Risk | Clinical Care | Economics/Finance | Health/Medicine -
ArticlePublication 2011Health and Economic Burden of the Projected Obesity Trends in the U.S. and the U.K.
This study used a simulation model to project the health and economic consequences of a …
This study used a simulation model to project the health and economic consequences of a continued rise in obesity in the U.S. and U.K. by 2030. Trends in excess weight gain were forecasted to lead to an increased burden of several diseases, most notably cardiovascular disease, diabetes, and cancer. The study projects that there will be 65 million more adults with obesity in the U.S., and 11 million more in the U.K., leading to an…
North America | Costing Methods | Health Outcomes | Cost-Effectiveness Analysis | Child/Nutrition | Chronic Disease/Risk | Economics/Finance | Food/Agriculture | Health/Medicine | Europe -
ArticlePublication 2019Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity
This analysis estimates state-specific and demographic subgroup-specific trends and projections of the prevalence of categories …
This analysis estimates state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI) in the United States. Self-reported BMI from the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias. Multinomial regressions were then fitted for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI <25), overweight (25 to…
North America | Health Outcomes | Mathematical Models | Calibration/Validation | Chronic Disease/Risk | Social Determinants -
ArticlePublication 2022Excess Mortality and Elevated Body Weight in the U.S.
This analysis estimates excess mortality associated with elevated body weight in the United States by …
This analysis estimates excess mortality associated with elevated body weight in the United States by state and demographic subgroup. The authors developed a nationally-representative microsimulation (individual-level) model of US adults between 1999 and 2016, based on risk factor data from the Behavioral Risk Factor Surveillance System and body-mass index (BMI) mortality hazard ratios from a global pooling dataset. The model was calibrated to empirical all-cause mortality rates from CDC WONDER by state and subgroup, and…
North America | Health Outcomes | Microsimulation | Calibration/Validation | Chronic Disease/Risk | Social Determinants -
ArticlePublication 2021BMI-Related Healthcare Costs in the U.S.
This paper estimates continuous body mass index (BMI) related health care expenditures using data from …
This paper estimates continuous body mass index (BMI) related health care expenditures using data from the Medical Expenditure Panel Survey (MEPS) 2011-2016, adjusting BMI for self-report bias and controlling for potential confounding between BMI and medical expenditures. Costs are reported in $US 2019. The analysis found a J-shaped curve of medical expenditures by BMI, with higher costs for females and the lowest expenditures occurring at a BMI of 20.5 for adult females and 23.5 for…
North America | Costing Methods | Child/Nutrition | Chronic Disease/Risk -
ArticlePublication 2019Estimation of Eating Disorders Prevalence by Age and Associations with Mortality in a Simulated Nationally Representative U.S. Cohort
This analysis models the individual-level disease dynamics of eating disorders (ED) in the United States, …
This analysis models the individual-level disease dynamics of eating disorders (ED) in the United States, and estimates the association of increased treatment coverage with ED-related mortality. Using an individual-level Markov state transition model calibrated to nationally-representative US survey data from 2007 and 2011, the authors simulated a virtual cohort of 100,000 individuals (50% male) from birth to age 40 years and modelled 4 ED diagnoses: anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified…
North America | Health Outcomes | Microsimulation | Calibration/Validation | Child/Nutrition | Mental Health
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