Little boy with large beverage

The cost of childhood obesity

July 22, 2014 — What’s the most cost-effective way to prevent childhood obesity?

Is it by taxing sugary beverages? Requiring more physical education classes in schools? Eliminating the corporate tax deduction for marketing and advertising when it comes to food and beverage ads targeted at children? Doing away with sugary beverages and screen time in day care centers?

All of these interventions are potentially helpful in keeping children at healthy weights, says Steven Gortmaker, professor of the practice of health sociology and director of HSPH’s Health Prevention Research Center. But evaluating an intervention’s cost-effectiveness—often overlooked in the arena of public health research—is a crucial factor in gaining the support of politicians and policymakers.

“As I’ve talked with decision makers over the years about possible interventions, I’ve found that they generally want to find out what’s feasible, how effective it is, and what it costs,” Gortmaker said.

Comparing interventions

Gortmaker is comparing the cost-effectiveness of the four interventions listed above, and many others, as principal investigator for the CHOICES Project (CHildhood Obesity Intervention Cost-Effectiveness Study), a collaboration between HSPH, Columbia University, and research partners at Deakin University and The University of Queensland in Australia. He outlined the nature and scope of the project on July 8, 2014 in Kresge G-2 as part of HSPH’s Summer “Hot Topics” lecture series.

The goal of the CHOICES project is to generate cost-effectiveness estimates for 40 different child obesity interventions in the U.S., many of which are in widespread use but have never been fully evaluated to determine how effective they are, both compared with each other and in terms of costs, Gortmaker said. The researchers consider factors such as how many millions of people an intervention could reach; its overall cost; and its impact on reducing BMI (body mass index) and lengthening healthy life.

A sugary tax

Gortmaker discussed pros and cons for each intervention. For instance, an excise tax on sugar-sweetened beverages of one cent per ounce (which would increase the cost of a 20-ounce beverage by about 25%) would likely sway people to buy fewer such drinks—and cutting out even one 150-calorie sugary beverage a day could be enough to stave off weight gain over time for the average person. Over the long term, the tax could lead to a decrease in the number of obese children and adults and thus lower health costs for the nation. On the other hand, Gortmaker noted, proposals in several states to impose a per-ounce excise tax on sugary beverages have been fought vehemently by the beverage industry, and none have passed.

“It’s about a $55 billion-a-year industry,” Gortmaker said. “They would not like to see that change.”

Gortmaker said that some of the interventions being studied in the CHOICES project are highly cost effective and some even save money while achieving healthier weights in children. He compared that with some clinical interventions, such as bariatric surgery, which cost thousands to achieve similar results.

Karen Feldscher

photo: iStock