Estimating the benefits of obesity prevention on productivity: an Australian perspective

Perspectives on Obesity Management and the Use of Anti-Obesity Medicine from US Employees and Employers: Results from the OBSERVE Study

Personal health factors and direct and indirect costs of obesity affect employers and employees. This research aimed to understand perceptions of obesity management and anti-obesity medications (AOMs) among employers and employees. In 2022, people with obesity and employers completed cross-sectional surveys about perceptions of obesity and its management, including AOMs. Data were analyzed with descriptive statistics. Data from 461 employed people with obesity (EwO) and 51 employer representatives (ER) were analyzed. Both EwO and ER acknowledged the impact of obesity on future health problems (88.3%; 100.0%) and perceived obesity as a disease (60.5%; 80.4%) to varied degrees. Both groups perceived an incremental value in combining self-directed lifestyle changes and AOMs (57.5%; 66.7%) and perceived healthcare provider-guided lifestyle change alongside AOMs as the most effective approach for maintaining long-term weight reduction (56.4%; 66.6%). More than two-thirds (68.6%) of ER expressed willingness to revisit their AOM coverage decisions, though cost of medication coverage (72.5%) and affordability of medications for employees (68.7%) were identified as barriers. ER believed that data showing reductions in premiums and claims at their organizations (78.4%) would be helpful in supporting the coverage of AOMs. While EwO and ER were receptive toward AOMs, organization-level barriers existed with AOM coverage. Evidence demonstrating the benefits of evidence-based obesity care, direct/indirect cost reductions, and the impact of obesity may address barriers to AOM coverage and improve obesity care and outcomes of their workforces.

Exploring parental preferences for childhood obesity prevention program in China: a discrete choice experiment

BACKGROUND

Childhood obesity has emerged as one of the most critical public health challenges in China. Despite its urgency, the existing research on parental preference for tackling childhood obesity remains insufficient. This study aimed to determine the factors that parents prioritise most when commissioning hypothetical programs that target childhood obesity prevention in China.

METHODS

A discrete choice experiment (DCE) was conducted to assess parental preferences for a hypothetical childhood obesity prevention programme attributes. Recruitment occurred between 20th October 2022 and 30th December 2022, using snowball sampling facilitated through social media platforms. Eligibility criteria were limited to parents with at least one child aged between 5 and 17 years old. Relevant attributes of the childhood obesity prevention programme were identified through a literature review and expert consultation. The study encompassed six attributes, and the coefficient of these different attributes was analysed using multinomial logit models (MNL) and latent class models (LCM).

RESULTS

This study, involving 631 participants, demonstrates that in prioritizing attributes of childhood obesity prevention programs, parents place the greatest importance on additional costs (32.36%). This is followed by daily sleep duration (18.42%) and dietary choices (16.49%). A preference for a 9-hour sleep duration is evident (Odds Ratio [OR]: 1.291; 95% Confidence Interval [CI]: 1.186-1.406; p < 0.05, reference: 7 h), as well as a tendency towards high-protein diets over low-fat ones (OR: 1.114; 95% CI: 1.034-1.200; p < 0.05, reference: low-fat diet). School-based exercise is favoured over fitness centres (OR: 0.837; 95% CI: 0.785-0.893; p < 0.001, reference: school-based). A latent class model (LCM) identifies two distinct groups: one preferring school-based exercise, 8-hour sleep, and minimal additional expenses; the other favouring 9-hour sleep and willingness to invest an additional RMB200 for weight control. Both groups prefer high-protein diets and early eating schedules.

CONCLUSIONS

Understanding parental preferences and concerns is vital for crafting effective public health policies aligned with UN SDGs and the SDH framework. Key elements include promoting balanced diets, ensuring safe exercise spaces, and fostering parental engagement. Collaboration among policymakers, educators, and parents is essential to mitigate childhood obesity.

Absenteeism and presenteeism among caregivers of chronic diseases: A systematic review and meta-analysis

INTRODUCTION

Productivity-adjusted life-year (PALY) is a relatively new measure for quantifying the impact of disease on productivity. This study aims to systematically review the productivity factors such as absenteeism and presenteeism among informal caregivers of patients with a wide range of chronic health conditions to inform the PALY quantifications.

METHOD

A literature search across MEDLINE, Embase, EconLIT, PsychInfo, and CINAHL identified 3578 studies from which a final 23 studies were included in the analysis. To explore the pooled estimate of caregiver absenteeism/presenteeism across diseases and possible drivers, a meta-analysis and meta-regression were conducted using studies where relevant data was available.

RESULT

The pooled proportion for absenteeism, presenteeism, and work productivity loss (WPL) was 14% (95% Confidence Interval [CI]:9-19%; I2 = 96.3%), 32% (95% CI:22-42%; I2 = 98.0%) and 44% (95% CI:35-53%; I2 = 95.4%) respectively with a high a level of heterogeneity. Factors such as the disease type, and disease severity can influence the caregivers' work productivity.

CONCLUSION

The data derived in this study will enable the derivation of productivity indices to estimate PALY among caregivers. Future studies can explore the work productivity impact among caregivers of patients with other chronic conditions where they have a significant role but are unexplored, and severity-wise studies in conditions such as stroke and dementia to understand the caregivers' societal productivity impact.

Multilevel Interventions Targeting Obesity: State of the Science and Future Directions

A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity.

Potential health and economic impact of achieving Kenya's overweight and obesity reduction target: a modelling study

Introduction

Kenya has adopted the WHO target of halting the rise of overweight, including obesity, by 2025. This paper assesses the potential impact of achieving the set target on health, healthcare cost and productivity.

Methods

We used a proportional multistate life table model (Kenya Obesity Model) to simulate the 2019 population of Kenya over their lifetime. We compared a scenario in which body mass index (BMI) distributions stabilise in 2025 against one whose BMI distributions stabilise in 2044, and quantified changes in disease-specific health outcomes, healthcare costs and productivity. We searched the literature to identify the best estimates of the total and disease-specific healthcare costs in Kenya. We used the Human Capital Approach to estimate productivity gains.

Results

If BMI distributions stabilised in 2025, an estimated 6.8 million health-adjusted life years (HALYs) (95% uncertainty interval (UI) 5.8-7.9 million) would be saved over the lifetime of the 2019 Kenyan population (135 HALYs per 1000 persons). A total of US$755 million in body mass-related healthcare costs could be saved by 2044 (US$15 per capita). For context, this equates to 16% of Kenya's annual healthcare expenditure. Over the lifetime, ~US$3 billion healthcare costs could be saved (US$62 per capita). By 2044, the total productivity gain resulting from a reduction in high BMI-related mortality and morbidity (combined) was ~US$5.8 billion (~US$237 per capita).

Conclusion

Achieving Kenya's overweight and obesity reduction target could improve health outcomes and also yield substantial healthcare cost savings and productivity gains.

Combined Aerobic Exercise with Intermittent Fasting Is Effective for Reducing mTOR and Bcl-2 Levels in Obese Females

The integration of combined aerobic exercise and intermittent fasting (IF) has emerged as a strategy for the prevention and management of obesity, including its associated health issues such as age-related metabolic diseases. This study aimed to examine the potential of combined aerobic exercise and IF as a preventative strategy against cellular senescence by targeting mTOR and Bcl-2 levels in obese females. A total of 30 obese women, aged 23.56 ± 1.83 years, body fat percentage (FAT) 45.21 ± 3.73% (very high category), BMI 30.09 ± 3.74 kg/m2 were recruited and participated in three different types of interventions: intermittent fasting (IF), exercise (EXG), and a combination of intermittent fasting and exercise (IFEXG). The intervention program was carried out 5x/week for 2 weeks. We examined mTOR and Bcl-2 levels using ELISA kits. Statistical analysis used the one-way ANOVA test and continued with Tukey's HSD post hoc test, with a significance level of 5%. The study results showed that a combination of aerobic exercise and IF significantly decreased mTOR levels (-1.26 ± 0.79 ng/mL) compared to the control group (-0.08 ± 1.33 ng/mL; p ≤ 0.05). However, combined aerobic exercise and IF did not affect Bcl-2 levels significantly (-0.07 ± 0.09 ng/mL) compared to the control group (0.01 ± 0.17 ng/mL, p ≥ 0.05). The IF-only group, exercise-only group, and combined group all showed a significant decrease in body weight and fat mass compared to the control group (p ≤ 0.05). However, the combined aerobic exercise and IF program had a significant effect in reducing the total percentage of body fat and fat mass compared to the IF-only group (p ≤ 0.05). Therefore, it was concluded that the combined intermittent fasting and exercise group (IFEXG) undertook the most effective intervention of the three in terms of preventing cellular senescence, as demonstrated by decreases in the mTOR level, body weight, and fat mass. However, the IFEXG did not present reduced Bcl-2 levels.

Utilization of Counseling Services by Pediatric Patients With Obesity Using MarketScan Data (2017-2019)

The United States has implemented policy efforts for public and private insurance to cover counseling services related to the treatment of obesity. However, no research has yet studied counseling service utilization among pediatric patients with obesity. We used 3 years (2017-2019) of IBM MarketScan Commercial Claims and Encounters Database and IBM MarketScan Multi-State Medicaid Data to examine such utilization patterns. We found the proportion of patients receiving any counseling services to be low among both privately insured (7.06%-7.97%) and Medicaid patients (9.51%-11.61%) within 6 months from diagnosis of obesity. This underutilization is concerning as many pediatric patients go undiagnosed, as evidenced in this research. Among the utilized services, nutrition counseling and face-to-face counseling were utilized the most by privately and Medicaid-insured patients over 6- and 12-month follow-ups. Our study underscores the need for implementing policies and programs to promote the utilization of counseling services among pediatric patients.

Impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life of Australians: a population-based longitudinal data analysis

Background

Health risk factors, including smoking, excessive alcohol consumption, overweight, obesity, and insufficient physical activity, are major contributors to many poor health conditions. This study aimed to assess the impact of health risk factors on healthcare resource utilization, work-related outcomes and health-related quality of life (HRQoL) in Australia.

Methods

We used two waves of the nationally representative Household, Income, and Labor Dynamics in Australia (HILDA) Survey from 2013 and 2017 for the analysis. Healthcare resource utilization included outpatient visits, hospitalisations, and prescribed medication use. Work-related outcomes were assessed through employment status and sick leave. HRQoL was assessed using the SF-6D scores. Generalized estimating equation (GEE) with logit or log link function and random-effects regression models were used to analyse the longitudinal data on the relationship between health risk factors and the outcomes. The models were adjusted for age, sex, marital status, education background, employment status, equilibrium household income, residential area, country of birth, indigenous status, and socio-economic status.

Results

After adjusting for all other health risk factors covariates, physical inactivity had the greatest impact on healthcare resource utilization, work-related outcomes, and HRQoL. Physical inactivity increased the likelihood of outpatient visits (AOR = 1.60, 95% CI = 1.45, 1.76 p < 0.001), hospitalization (AOR = 1.83, 95% CI = 1.66-2.01, p < 0.001), and the probability of taking sick leave (AOR = 1.31, 95% CI = 1.21-1.41, p < 0.001), and decreased the odds of having an above population median HRQoL (AOR = 0.48, 95% CI = 0.45-0.51, p < 0.001) after adjusting for all other health risk factors and covariates. Obesity had the greatest impact on medication use (AOR = 2.02, 95% CI = 1.97-2.29, p < 0.001) after adjusting for all other health risk factors and covariates.

Conclusion

Our study contributed to the growing body of literature on the relative impact of health risk factors for healthcare resource utilization, work-related outcomes and HRQoL. Our results suggested that public health interventions aim at improving these risk factors, particularly physical inactivity and obesity, can offer substantial benefits, not only for healthcare resource utilization but also for productivity.

Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022-2031

OBJECTIVE

The aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade.

METHODS

A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs.

RESULTS

Between 2022 and 2031, a total of 83,618 non-fatal MIs (95% uncertainty interval [UI] 83,170-84,053) and 58,774 non-fatal strokes (95% UI 58,458-59,013) were projected. Total years of life lived and QALYs (discounted) were projected to be 9,549,487 (95% UI 9,416,423-9,654,043) and 6,632,897 (95% UI 5,065,606-7,591,679), respectively. Total healthcare costs and total lost productivity costs (discounted) were projected to be 9.59 billion Australian dollars (AU$) (95% UI 1.90-30.45 billion) and AU$9.07 billion (95% UI 663.53 million-33.19 billion), respectively.

CONCLUSIONS

CVD in people with type 2 diabetes will substantially impact the Australian healthcare system and society over the next decade. Future work to investigate different strategies to optimize the control of risk factors for the prevention and treatment of CVD in type 2 diabetes in Australia is warranted.