The Effect Of Different Childhood Obesity Interventions And Cost-effectiveness Analysis

BackgroundChildhood obesity has become a global public health problem, and it is increasing at an alarming rate. In2010, the number of overweight/obese school children around the world had reached2-fold of that in1990-2003. Over the same period, the prevalence of overweight/obese children among primary school students in some Chinese cities was25.8%for boys and17.4%for girls. Childhood obesity will not only lead to many health problems, but also increase the economic burden. Many countries including China have been carrying out many different forms of childhood obesity intervention study. The school-based childhood obesity interventions are the most feasible. With the governments’increasing concern about the childhood obesity, more and more researchers have begun to carry out cost-effectiveness analysis of childhood obesity intervention in order to provide the support to the government departments for selecting the appropriate intervention programs.ObjectivesThe school-based childhood obesity intervention including comprehensive intervention, nutrition intervention and physical activity intervention were carried out in the multi-center randomized controlled trial. The effect of different intervention and cost-effectiveness analysis for different intervention were analyzed in order to provide recommendations for developing childhood obesity prevention policy.Subjects and methodsThe study was designed as a multi-center randomized controlled trial, which included6centers located in Beijing, Shanghai, Chongqing, Shandong province, Heilongjiang province and Guangdong province. Both nutrition education and physical activity intervention will be applied in all intervention schools in5cities, while in Beijing, nutrition education intervention will be applied in3schools and physical activity intervention in the other3schools. Nothing will be done in control schools. A total of9500primary students (grade1to grade5or grade4, aged7-13years) will participate in baseline and intervention researches. Three interventions are included in present study:nutrition education, physical activity intervention and comprehensive intervention. The main nutrition education and Happy10program are developed for nutrition intervention and physical activity intervention, respectively.The Mixed-effects Model and Generalized Linear Mixed Model were used for analyzing the effect for continuous variables and categorical variables, respectively. Cost-Effectiveness analysis, Cost-Utility analysis and Cost-Benefit analysis were used for economic evaluation of different interventionsResultsThe increasement of Body Mass Index for comprehensive intervention group was0.3kg/m2less than the control group (P<0.01), the same increasement as the control group (0.6kg/m2) for nutrition intervention group, and0.1kg/m2less than the control group for physical activity intervention group, the difference was not statistically significant. The increasement of the percentage of body fat was0.7%less than the control group for comprehensive intervention group (P<0.01),0.6%more than control group for nutrition intervention group (P<0.01),0.2%less than control group for physical activity intervention group, but the difference was not statistically significant. The prevalence of overweight and obesity found reduced by0.03%for comprehensive intervention group, while the control group increased by2.4%(P<0.01), the nutrition intervention group and the physical activity intervention group increased by0.4%,0.8%less than the control groups, respectively, but the differences were statistical significance.The cost for everyone for comprehensive intervention, nutrition intervention and physical activity intervention was58.9Yuan,49.2Yuan and49.5Yuan, respectively. The cost-effectiveness ratio of BMI was188.6Yuan/(kg/m2) for the comprehensive intervention and33437.4Yuan/(kg/m2) for nutrition intervention. The cost-effectiveness ratio of every1%reduction in percentage of body fat for nutrition intervention and physical activity intervention was73.6Yuan and247.5Yuan per person, respectively. The cost-effectiveness ratio of every1%decline in percentage of overweight and obese children for comprehensive intervention, nutrition intervention and physical activity intervention was23.8Yuan,107.8Yuan and64.1Yuan per person, respectively. The cost utility ratio for comprehensive intervention, nutrition intervention and physical activity intervention was8561.5,15861.4and21145.0, respectively. The cost benefit ratios were1:1.2for comprehensive intervention,1:0.7 for nutrition intervention and1:0.4for physical activity intervention.ConclusionsThe school-based comprehensive intervention can reduce the increasement of BMI, body fat and obesity of school children effectively, the effect is better than the nutrition intervention or physical activity intervention alone. Three interventions can have effect on improving or lowing the lipids level, blood glucose level and insulin level. The cost-effectiveness ratio and cost-utility ratio were lower for comprehensive intervention than both nutrition intervention and physical activity intervention. Cost-benefit analysis found that the net benefit of the comprehensive intervention was more than0, while the net benefit of the nutrition intervention and physical activity intervention was both less than0.