Time is running out – Why childhood obesity is more than a medical concern
Author: Diana Sonntag, Dr. rer.pol
Mannheim Institut for Public Health (MIPH), Medical Faculty of Heidelberg University, Mannheim, Germany
Childhood obesity is more than a medical concern; it is receiving an increasing economic attention and here is why.
Most cost-of-illness (COI)-studies (Tsai et al. 2011) have shown that obesity during adulthood causes substantial direct and indirect costs independent of a history of childhood obesity. While direct costs are predominately health care costs due to an increased risk of developing certain health conditions (and responding to treatment) and the risk of death from these conditions, indirect costs are related to sick leave, reduced productivity and early death. Since these studies do not account for an increased risk of mortality and obesity-related diseases associated with a history of childhood obesity (Reilly et al. 2012), long-term health-care consequences and costs cannot be estimated.
Only few international studies (Fernandes 2010, Sonntag et al. 2015 a,b) have estimated the lifetime costs of childhood overweight and obesity. Fernandes, for example, calculated lifetime costs among U.S. elementary school population aged 6–11 in 2008 to be $31,869 for obese males and $39,815 for obese females. When compared with normal weight adults, lifetime excess costs were three times as high among both male and female adults who were obese during childhood (Ferrnandes 2010). The only two pediatric studies in Germany considering the long-term economic impact of childhood obesity estimated total lifetime costs of €1.8 billion of the population in Germany (discounted at 3%, cost year 2010). More specifically, compared to adults who were of normal weight as child, expected lifetime costs for adults who were overweight or obese during childhood were €8,471 for males and €9,473 for females, respectively. Costs attributable to overweight and obesity are three times higher for males and nearly five times higher for females with a history of childhood obesity. Moreover, childhood obesity is the top contributor to the overall cost burden across all decades of life. More specifically, compared to adults who were of normal weight as children, costs are eight times higher for adults (aged between 41 and 51 years) with a history of childhood obesity.
Given high excess lifetime costs of childhood overweight and obesity, an obvious policy question is: how would changing the current childhood obesity trend affect the lifetime indirect costs? For Germany, for example, Sonntag et al. (2015b) estimated that if the prevalence of childhood obesity were reduced by 1%, the expected reduction in lifetime excess costs would be €4.1 million for the population in Germany. Moreover, expected lifetime costs could be additionally reduced by €27 million if the prevalence of childhood overweight and obesity could be additionally reduced by 13% (which is potentially achievable based on a national evaluation study of outpatient and inpatient care in Germany, EvAKuJ study (Hoffmeister et al. 2011)).
These results provide robust evidence that societies will face substantial additional costs related to childhood obesity. This, in turn, underscores the urgent need to prioritize interventions early in the life course. Yet, the implementation of pediatric preventive programmes is low and patchy. Therefore, the target of the World Health Organization (WHO) to halt the rise of diabetes/obesity within the next ten years (WHO, 2013) will not be met without a comprehensive change of pediatric policies. While most preventive programmes are child-centric and thus, only effective in the short run (Yavuz et al. 2015), major global action is needed to go beyond this downstream perspective to a socio-ecological (upstream) perspective.
More specifically, a recent systematic review (Sonntag et al. 2015c) highlighted 6 key obesogenic environments: home, school, TV, internet, retailers and promotional campaigns through which obesity-related dietary behaviours in children are influenced. Since pediatric programmes implemented thus far have failed to account for this level of complexity, an aggressive research agenda must be established that not only deepens our understanding of how obesogenic environments drive childhood obesity and finally but also uses innovative approaches that encourage healthy behaviour among children in a sustainable way.
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