Gortmaker Steven L, Wang Y Claire, Long Michael W, Giles Catherine M, Ward Zachary J, Barrett Jessica L, Kenney Erica L, Sonneville Kendrin R, Afzal Amna Sadaf, Resch Stephen C, Cradock Angie L
Steven L. Gortmaker (
Y. Claire Wang is an associate professor at the Mailman School of Public Health, Columbia University, in New York City.
Health Aff (Millwood). 2015 Nov;34(11):1932-9. doi: 10.1377/hlthaff.2015.0631.
Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.
寻求降低儿童肥胖率的政策制定者必须优先投资于治疗和一级预防。我们估计了肥胖政策议程上的七种干预措施的成本效益：对含糖饮料征收消费税；取消对向儿童宣传不健康食品的税收补贴；餐厅菜单标注卡路里；学校膳食营养标准；学校销售的所有其他食品和饮料的营养标准；改善早期护理和教育；以及增加青少年减肥手术的可及性。我们利用系统评价和一个关于2015年至2025年期间全国实施这些干预措施的微观模拟模型，来估计它们对肥胖率的影响以及它们在降低个体体重指数方面的成本效益。在我们的模型中，七种干预措施中的三种——消费税、取消税收减免以及学校非膳食类食品和饮料的营养标准——节省的医疗保健成本超过了实施成本。这三种干预措施在2025年各自预防了129,000至576,000例儿童肥胖病例。青少年减肥手术对肥胖率的影响微乎其微。我们的结果凸显了一级预防对于旨在降低儿童肥胖率的政策制定者的重要性。
