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The role of economics in advancing the obesity policy agenda
S10 on screen time or physical activity. There are also different responses according to socio-demographic groups. A 30 min reduction in television has approximately equal effects on boys and girls, while a reduction of 30 min in videogame playing is almost twice as beneficial for boys. A comprehensive ‘‘behaviourometric’’ model requires quantification of compliance and attrition, estimates of energy intake compensation for changed energy expenditure, multi-dimensional constructs of the quality of time use, nonlinear modeling of behavioural cross-elasticities, and dose—response relationships between behaviour and health outcomes. doi:10.1016/j.orcp.2011.08.071 Successful weight loss for adolescents: What can diet offer? Helen Truby 1,∗ , K. Baxter 2 , R. Ware 3 , J. Batch 4 1 Dept
of Nutrition and Dietetics, Monash University, Melbourne, Australia 2 Children’s Nutrition Research Centre, University of Queensland, Brisbane, Australia 3 University of Queensland, Brisbane, Australia 4 Dept of Endocrinology & Diabetes, Royal Children’s Hospital Brisbane, Australia The Cochrane review (2009) identified only 6 dietary intervention studies in total providing data from only 350 individuals, thus the evidence base is relatively small. The ‘Eat Smart’ studies have been designed to test a treatment pathway for treatment seeking adolescents and to examine whether a structured eating plan with a reduction in carbohydrate could be an alternative eating pattern to the standard low fat advice. To date, 125 young people (69% female), mean BMI Z score of 2.23, mean age of 13.2 years have undertaken a largely dietary intervention, with 67% presenting with a history of bullying/teasing at school which prompted seeking weight loss advice, ‘Eat Smart’ is preceded by a preparatory psychological program designed to increase coping skills. After 12 weeks, a mean reduction of 6.3% BMI Z score was achieved but a wide response was noted, with change in BMI Z score ranging from −0.45 to +0.01. Multivariate logistic regression explored change in BMI Z score. Those with the greatest benefit had lower baseline BMI, lower fasting insulin, higher social advantage and were referred from a specialist. Dietary macronutrient composition was not a predictor of weight loss neither was physical activity. These results suggest that reduction in dietary carbohydrate can provide an alternative dietary pattern but
Invited Speakers Abstracts there is need to understand further who is likely to be successful and offer a range of treatment options that are more tailored to an individual’s profile so expectations of the likely response to change in dietary energy intake can be managed. Funding source: National Heart Foundation, ANZ Trustees. doi:10.1016/j.orcp.2011.08.072 Role of schools in prevention of obesity and eating disorders Simon Wilksch School of Psychology, Flinders University, Adelaide, Australia To date the fields of eating disorder prevention and obesity prevention have remained largely separate from each other, with some concern that obesity prevention programs might inadvertently increase eating disorder risk and vice versa. However, a growing awareness of shared risk factors for both problems is leading some researchers and clinicians to develop programs aimed at simultaneously reducing the risk of both eating disorders and obesity. This presentation will review these shared risk factors; discuss the evidence for effective program development and delivery in school settings; and, provide a brief overview of three programs currently being evaluated in a RCT with Grades 7 and 8 girls and boys in Victoria, South Australia and Western Australia. It will be argued that schools represent a valuable opportunity to lower risk factors for future eating pathology. doi:10.1016/j.orcp.2011.08.073 The role of economics in advancing the obesity policy agenda Marj Moodie 1,∗ , R. Carter 1 , B. Swinburn 2 1 Deakin Health Economics, Deakin University, Melbourne, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia
This presentation draws on a range of studies to explore the contribution which health economics currently makes and could potentially make to the field of obesity prevention. Most health economic studies to date have adopted a ‘problem-focused’ approach — they have described and predicted the magnitude of the obesity problem and its associated economic impacts. These studies have a valuable advocacy role in placing obesity on the policy agenda. A related and newly emerg-
Invited Speakers Abstracts ing line of enquiry is explanation of the economic determinants of observed trends or activities. However, it is through the adoption of a ‘solutionsfocused’ approach and economic evaluation that health economists stand to make the most valuable contribution in terms of advancing the obesity policy agenda. Economic evaluation of specific interventions can provide policymakers with important information about ‘what works’ and ‘what offers value-for-money’. However, multi-faceted, community-based, inter-sectoral interventions or policy interventions which offer most promise pose particular methodological challenges for economic evaluators. Health economists have now moved beyond the evaluation of single interventions to priority setting and the evaluation of multiple interventions in order to assist policymakers in the development of coordinated obesity prevention strategies. Future challenges lie around the development of more sophisticated modelling around the consideration of joint costs and benefits, the packaging of interventions in the context of budgetary constraints, the incorporation of quality of life, the inclusion of multiple outcome measures, and the disaggregation of models to particular demographic groups. doi:10.1016/j.orcp.2011.08.074 Fiscal approaches to obesity prevention Lisa Gold 1,∗ , G. Sacks 2 , C. Burns 2 1 Deakin
Health Economics, Deakin University, Melbourne, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia Fiscal policy refers to the actions of government to change taxation levels and/or levels of government expenditure in order to raise or lower demand in the economy. Fiscal policy changes are increasingly seen as a key source of population health intervention, acting to affect the ‘‘upstream’’ determinants of health by altering the economic environment. In particular, there are increasing calls to use a tax and/or subsidy to change the relative prices that consumers face for healthy and unhealthy foods and thereby increase healthy eating. This presentation summarises the arguments advanced to date for fiscal interventions for obesity prevention and makes a clear distinction between the effect of taxes and subsidies in theory, the estimated impact of fiscal intervention across a range of current models, and the evidence of effect from intervention trials and observational studies.
S11 Two aspects of economic theory appear central to the food pricing debate: the first is the extent to which the current food pricing environment is imperfect or biased and therefore justifies policy intervention; the second is the importance of both income and substitution effects in determining the net impact of a change in fiscal policy on food purchasing. In terms of evidence, the current literature contains far more model-based estimates of potential fiscal policy impact than empirical studies measuring the impact of policy change on food purchase decisions and consumption. Existing intervention research tends to be restricted to relatively closed settings or to online shopping options, although more population-based studies are underway. doi:10.1016/j.orcp.2011.08.075 The cost-effectiveness of obesity prevention: Results from the ACE prevention study Lennert Veerman 1,∗ , G. Sacks 2 , Y.Y. Lee 1 , L.J. Cobiac 1 , J.J. Barendregt 1 , T. Vos 1 , R. Carter 3 , for the ACE Prevention team 1 The
University of Queensland, School of Population Health, Brisbane, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia 3 Deakin Health Economics, Deakin University, Melbourne, Australia As part of the ‘Assessing Cost-Effectiveness in Prevention’ project, we estimated the health impact, costs and cost-effectiveness of interventions to reduce body mass. We modelled eight different interventions compared to usual practice. Base year was 2003 and costs and effects were modelled over the remaining lifetime. Costs were evaluated from a health care perspective and included savings due to avoided disease cases. Costs and effects were discounted at 3%. Probabilistic and univariate sensitivity analysis were used to quantify uncertainty. The results show that a 10% tax on unhealthy food and front-of-pack ‘traffic light’ nutrition labelling have large but uncertain population health effects and are cost saving. Lifestyle programmes (a diet and exercise intervention, a low-fat diet and a multi-component programme) are moderately cost-effective but have modest health impacts. Pharmacotherapy with sibutramine or orlistat for the obese is costly and has small health effects. Laparoscopic adjustable gastric banding for the very obese is expensive but leads to sizeable long term health gains and cost savings.
of Nutrition and Dietetics, Monash University, Melbourne, Australia 2 Children’s Nutrition Research Centre, University of Queensland, Brisbane, Australia 3 University of Queensland, Brisbane, Australia 4 Dept of Endocrinology & Diabetes, Royal Children’s Hospital Brisbane, Australia The Cochrane review (2009) identified only 6 dietary intervention studies in total providing data from only 350 individuals, thus the evidence base is relatively small. The ‘Eat Smart’ studies have been designed to test a treatment pathway for treatment seeking adolescents and to examine whether a structured eating plan with a reduction in carbohydrate could be an alternative eating pattern to the standard low fat advice. To date, 125 young people (69% female), mean BMI Z score of 2.23, mean age of 13.2 years have undertaken a largely dietary intervention, with 67% presenting with a history of bullying/teasing at school which prompted seeking weight loss advice, ‘Eat Smart’ is preceded by a preparatory psychological program designed to increase coping skills. After 12 weeks, a mean reduction of 6.3% BMI Z score was achieved but a wide response was noted, with change in BMI Z score ranging from −0.45 to +0.01. Multivariate logistic regression explored change in BMI Z score. Those with the greatest benefit had lower baseline BMI, lower fasting insulin, higher social advantage and were referred from a specialist. Dietary macronutrient composition was not a predictor of weight loss neither was physical activity. These results suggest that reduction in dietary carbohydrate can provide an alternative dietary pattern but
Invited Speakers Abstracts there is need to understand further who is likely to be successful and offer a range of treatment options that are more tailored to an individual’s profile so expectations of the likely response to change in dietary energy intake can be managed. Funding source: National Heart Foundation, ANZ Trustees. doi:10.1016/j.orcp.2011.08.072 Role of schools in prevention of obesity and eating disorders Simon Wilksch School of Psychology, Flinders University, Adelaide, Australia To date the fields of eating disorder prevention and obesity prevention have remained largely separate from each other, with some concern that obesity prevention programs might inadvertently increase eating disorder risk and vice versa. However, a growing awareness of shared risk factors for both problems is leading some researchers and clinicians to develop programs aimed at simultaneously reducing the risk of both eating disorders and obesity. This presentation will review these shared risk factors; discuss the evidence for effective program development and delivery in school settings; and, provide a brief overview of three programs currently being evaluated in a RCT with Grades 7 and 8 girls and boys in Victoria, South Australia and Western Australia. It will be argued that schools represent a valuable opportunity to lower risk factors for future eating pathology. doi:10.1016/j.orcp.2011.08.073 The role of economics in advancing the obesity policy agenda Marj Moodie 1,∗ , R. Carter 1 , B. Swinburn 2 1 Deakin Health Economics, Deakin University, Melbourne, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia
This presentation draws on a range of studies to explore the contribution which health economics currently makes and could potentially make to the field of obesity prevention. Most health economic studies to date have adopted a ‘problem-focused’ approach — they have described and predicted the magnitude of the obesity problem and its associated economic impacts. These studies have a valuable advocacy role in placing obesity on the policy agenda. A related and newly emerg-
Invited Speakers Abstracts ing line of enquiry is explanation of the economic determinants of observed trends or activities. However, it is through the adoption of a ‘solutionsfocused’ approach and economic evaluation that health economists stand to make the most valuable contribution in terms of advancing the obesity policy agenda. Economic evaluation of specific interventions can provide policymakers with important information about ‘what works’ and ‘what offers value-for-money’. However, multi-faceted, community-based, inter-sectoral interventions or policy interventions which offer most promise pose particular methodological challenges for economic evaluators. Health economists have now moved beyond the evaluation of single interventions to priority setting and the evaluation of multiple interventions in order to assist policymakers in the development of coordinated obesity prevention strategies. Future challenges lie around the development of more sophisticated modelling around the consideration of joint costs and benefits, the packaging of interventions in the context of budgetary constraints, the incorporation of quality of life, the inclusion of multiple outcome measures, and the disaggregation of models to particular demographic groups. doi:10.1016/j.orcp.2011.08.074 Fiscal approaches to obesity prevention Lisa Gold 1,∗ , G. Sacks 2 , C. Burns 2 1 Deakin
Health Economics, Deakin University, Melbourne, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia Fiscal policy refers to the actions of government to change taxation levels and/or levels of government expenditure in order to raise or lower demand in the economy. Fiscal policy changes are increasingly seen as a key source of population health intervention, acting to affect the ‘‘upstream’’ determinants of health by altering the economic environment. In particular, there are increasing calls to use a tax and/or subsidy to change the relative prices that consumers face for healthy and unhealthy foods and thereby increase healthy eating. This presentation summarises the arguments advanced to date for fiscal interventions for obesity prevention and makes a clear distinction between the effect of taxes and subsidies in theory, the estimated impact of fiscal intervention across a range of current models, and the evidence of effect from intervention trials and observational studies.
S11 Two aspects of economic theory appear central to the food pricing debate: the first is the extent to which the current food pricing environment is imperfect or biased and therefore justifies policy intervention; the second is the importance of both income and substitution effects in determining the net impact of a change in fiscal policy on food purchasing. In terms of evidence, the current literature contains far more model-based estimates of potential fiscal policy impact than empirical studies measuring the impact of policy change on food purchase decisions and consumption. Existing intervention research tends to be restricted to relatively closed settings or to online shopping options, although more population-based studies are underway. doi:10.1016/j.orcp.2011.08.075 The cost-effectiveness of obesity prevention: Results from the ACE prevention study Lennert Veerman 1,∗ , G. Sacks 2 , Y.Y. Lee 1 , L.J. Cobiac 1 , J.J. Barendregt 1 , T. Vos 1 , R. Carter 3 , for the ACE Prevention team 1 The
University of Queensland, School of Population Health, Brisbane, Australia 2 WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne, Australia 3 Deakin Health Economics, Deakin University, Melbourne, Australia As part of the ‘Assessing Cost-Effectiveness in Prevention’ project, we estimated the health impact, costs and cost-effectiveness of interventions to reduce body mass. We modelled eight different interventions compared to usual practice. Base year was 2003 and costs and effects were modelled over the remaining lifetime. Costs were evaluated from a health care perspective and included savings due to avoided disease cases. Costs and effects were discounted at 3%. Probabilistic and univariate sensitivity analysis were used to quantify uncertainty. The results show that a 10% tax on unhealthy food and front-of-pack ‘traffic light’ nutrition labelling have large but uncertain population health effects and are cost saving. Lifestyle programmes (a diet and exercise intervention, a low-fat diet and a multi-component programme) are moderately cost-effective but have modest health impacts. Pharmacotherapy with sibutramine or orlistat for the obese is costly and has small health effects. Laparoscopic adjustable gastric banding for the very obese is expensive but leads to sizeable long term health gains and cost savings.