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Economic evaluation of obesity interventions in children and adults

International Journal of Obesity volume 31, pages 1183–1184 (2007)Cite this article

Each of these steps requires the description of a relationship between the prior and succeeding step. In the absence of complete data, these relationships are modelled using selected assumptions. As a matter of logic, the less confidence in the evidence base for each of these ‘transitions’ the greater the uncertainty in each transition. The level of uncertainty multiplies with each step. We have chosen to focus our comments on the most critical assumption of the study methods, that 100% of body mass index (BMI) reduction observed at intervention end is maintained over the child's lifetime. This is acknowledged by Haby et al.,1 as the ‘biggest limitation of the ACE-Obesity project methods.’ It has an overwhelming impact on estimated benefits, such that as noted by Haby et al.,1 if assumptions of 50 or 25% maintenance of effect are used instead, benefits are similarly reduced to 50 and 25% of the original estimate. As the ‘use of best available evidence’ is defined as an important feature of the model, a clear justification by the authors to support this core assumption would be expected. The general point is that the key assumptions in this or other childhood obesity models (and other health economic models) should be justified.2, 3

Although we recognize that there is a dearth of published evidence relating to long-term follow-up of weight reduction programs in children, highlighted by recent systematic reviews,4, 5, 6 studies in adults consistently show considerable weight regain following intervention end. For example, a recent meta-analysis7 reports a mean 66% weight regain after 3 years follow-up, and one of the authors Swinburn et al.,8 reporting on a 1 year low-fat diet intervention in adults with impaired glucose tolerance, found at trial end a fall in BMI of −0.09 kg/m2 in the intervention group compared with +0.22 kg/m2 in the control group, but by year 5 follow-up BMI was +0.72 kg/m2 in the intervention group and +0.59 kg/m2 in the control group). In light of such evidence in adults, the adoption of 100% maintenance of effect from childhood throughout a lifetime is surprising.

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References

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  1. Centre for Health Economics, Monash University, Clayton, Australia

    L Segal & K Dalziel

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  2. K Dalziel
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Correspondence to K Dalziel.

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Segal, L., Dalziel, K. Economic evaluation of obesity interventions in children and adults. Int J Obes 31, 1183–1184 (2007). https://doi.org/10.1038/sj.ijo.0803557

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