The lifetime medical cost burden of overweight and obesity: implications for obesity prevention

This study quantifies age-specific and lifetime costs for overweight (BMI: 25-29.9), obese I (BMI: 30-34.9), and obese II/III (BMI: >35) adults separately by race/gender strata. We use these results to demonstrate why private sector firms are likely to underinvest in obesity prevention efforts. Not only does the existence of Medicare reduce the economic burden that obesity imposes on private payers, but, from the perspective of a 20-year-old obese adult, the short-term costs of obesity are small. This suggests that legislation that subsidizes wellness programs and/or mandates coverage for obesity treatments might make all firms better off. Ironically, Medicare has a greater incentive to prevent obesity because when an obese 65 year old enters the program, his/her costs are immediate and higher than costs for normal weight individuals.     

Modulation of adipose tissue thermogenesis as a method for increasing energy expenditure

There is a renewed interest in the role of adipose tissue in energy utilization and thermogenesis and its potential application in the treatment of metabolic disorders such as obesity and diabetes. The last few years have seen the identification of brown adipose tissue capable of metabolic activation in adult humans, the possibility of recruiting ‘beige’ adipocytes to increase energy expenditure, and the implication of molecules such as FGF21 and irisin in inducing increases in energy expenditure in adipose tissue. The translation of these findings into human trials to deliver safe, efficacious medicines remains a challenge.     

Willingness to pay for obesity prevention

The purpose of this paper is to estimate consumers’ willingness to pay (WTP) and investigate factors that affect participation in therapy to reduce weight or prevent obesity. As for the decision to participate in obesity prevention therapy, the results show that the price charged for therapy is the key factor. Furthermore, the gender, education, income, the concern that work achievement is affected by obesity, and health condition variables are found to be important and significant determinants of the decision to participate in the therapy. The average willingness to pay for obesity reduction therapy which could reduce weight by 5 kg in 3 months is estimated to be NT$12,531 (US$362) among the sample respondents. The results of the profile analysis suggest that obese females with high education, high income, who think that obesity affects work achievement, and who have tried to control their weight are the most likely to be willing to pay the greatest amount for the weight-reduction therapy.     

The effect of new cooperative medical scheme on health outcomes and alleviating catastrophic health expenditure in china: a systematic review

Background

In 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS) for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure.

Methods

PubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality.

Results

Fifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively.

Conclusions

We still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China’s rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package and information systems around NCMS should be improved in the future.     

Proportional means regression for censored medical costs

The semiparametric proportional means model specifies that the mean function for the cumulative medical cost over time conditional on a set of covariates is equal to an arbitrary baseline mean function multiplied by an exponential regression function. We demonstrate how to estimate the vector-valued regression parameter using possibly censored lifetime costs. The estimator is consistent and asymptotically normal with an easily estimable covariance matrix. Simulation studies show that the proposed methodology is appropriate for practical use. An application to AIDS is provided.     

Periodic health examination, 1999 update: 1. Detection,prevention and treatment of obesity

OBJECTIVES: (1) To evaluate the evidence relating to the effectiveness of methods to prevent and treat obesity, and (2) to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years and for the measurement of the body mass index (BMI) as part of a periodic health examination. OPTIONS: In adults with obesity (BMI greater than 27) management options include weight reduction, prevention of further weight gain or no intervention. OUTCOMES: The long-term (more than 2 years) effectiveness of (a) methods to prevent obesity and (b) methods to treat obesity. EVIDENCE: MEDLINE was searched for articles published from 1966 to April 1998 that related to the prevention and treatment of obesity; additional articles were identified from the bibliographies of review articles and the listings of Current Contents. Selection criteria were used to limit the analysis to prospective studies with at least 2 years'' follow-up. BENEFITS, HARM AND COSTS: Health benefits of weight reduction were evaluated in terms of alleviation of symptoms, improved management of obesity-related diseases and a reduction in major clinical outcomes. The health risk of weight-reduction methods were briefly evaluated in terms of increased mortality and morbidity. VALUES: The recommendations of this report reflect the commitment of the Canadian Task Force on Preventive Health Care to provide a structured, evidence-based appraisal of whether a manoeuvre should be part of a periodic health examination. RECOMMENDATIONS: (1) Prevention: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs; however, because of considerable health risks associated with obesity and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers (grade C recommendation). (2) Treatment: (a) For obese adults without obesity-related diseases, there is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods (grade C recommendation); (b) for obese adults with obesity-related diseases (e.g., diabetes mellitus, hypertension), weight reduction is recommended because it can alleviate symptoms and reduce drug therapy requirements, at least in the short term (grade B recommendation). (3) Detection: (a) for people without obesity-related diseases, there is insufficient evidence to recommend the inclusion or exclusion of BMI measurement as part of a periodic health examination, and therefore BMI measurement is left to the discretion of individual health care providers (grade C recommendation); (b) for people with obesity-related diseases, BMI measurement is recommended because weight reduction should be considered with a BMI of more than 27 (grade B recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.     

Bioimpedance for severe obesity: comparing research methods for total body water and resting energy expenditure

Objective: As the acceptance of surgical procedures for weight loss in morbid obesity is increasing, clinically useful baseline and follow‐up measures of total body water (TBW) and resting energy expenditure (REE) are important. Research methods such as deuterium (D²O) dilution and metabolic carts are problematic in the clinical setting. We compared bioimpedance analysis (BIA) predicted (Tanita TBF‐310) and measured TBW and REE. Methods and Procedures: Forty‐two paired presurgery studies were completed using BIA and D²O in patients with BMI (mean ± s.d.) 50.2 ± 8.8 kg/m² for TBW, and 30 patients with BMI 51.0 ± 13 kg/m² completed paired determinations of REE with metabolic carts and the Tanita balance with weight, height, sex, and age modifiers. Regression analysis and Bland‐Altman plots were applied. Results: When regression analysis was completed for TBW, regression line was consistent with the identity line “y = x.” The intercept was not different from 0 (95% confidence interval ?2.5 ± 7.0). The slope of the line was not different from 1.0 ± 0.1. The measured TBW 51.2 ± 10.1 l had a correlation with the predicted 49.5 ± 11.27 l of 0.92. There also was no significant difference (P = 0.33) between predicted (2,316 ± 559 kcal/day) and measured REE (2,383 ± 576 kcal/day);δ 66.7 ± 273 kcal/day. The two measures were highly correlated (r = 0.88) with no bias detected. Discussion: These observations support the use of the BIA system calibration in subjects with severe obesity. Without the use of complex, costly equipment and invasive procedures, BIA measurements can easily be obtained in clinical practice to monitor patient responses to treatment.     

Constructs of health and environment inform child obesity prevention in American Indian communities

Objective: Obesity prevention efforts have had limited success in American Indian (AI) populations. More effective prevention programs might be designed using insights into linkages between parental health beliefs, environmental constraints and healthy lifestyle choices. Methods and Procedures: Focus group sessions (n = 42 participants) were conducted to explore parental perspectives on children's health, diet and physical activity in three Wisconsin Tribal communities. Focus group questions were derived from preliminary interviews and observations on environmental barriers surrounding nutrition and physical activity. Results: Two broad thematic areas emerged from the focus groups: child health themes and environmental themes. Health themes included views of child health (emphasizing emotional health), views on parenting, and assessment of risks to child safety. Environmental (social and physical) themes included assessments of personal support networks, assessments of local facilities and programs, and values regarding household relationships. A provisional model of family behaviors related to child nutrition and physical activity was developed to better understand these themes and the potential tensions among them. Discussion: Understanding the unique cultural constructs of health and environment of AI communities can inform decision making in community‐level prevention research. The proposed model served as a useful starting point for designing healthy lifestyle interventions in these AI communities. This model may also be applicable to other minority communities.     

iDArTs: increasing the value of genomic resources at no cost

For many years, genetic markers have been the building blocks in assembling genomic knowledge. Improved technology and methods for collecting marker data have increased accuracy, increased throughput, and reduced cost. However, common genotyping technology still produces far fewer markers in plant species than in animals and humans. We propose a new type of genetic marker based on the Diversity Arrays Technology (DArT) genotyping system for organisms lacking a reference genetic sequence. These markers are based directly on microarray probe intensity profiles and hence are called iDArTs. They require no additional genotyping beyond screening with a DArT array. Since standard methods of genetic analysis cannot be used with these continuous markers, we develop novel methods for the common bi-parental experimental designs doubled haploids, recombinant inbred lines, and backcrosses. These enable the augmentation of genetic maps with iDArTs and permit quantitative trait locus mapping with both discrete and continuous markers. We use simulation to demonstrate the power of this approach for marker mapping. In addition, we construct maps and perform linkage analysis for these DArT genotypes using the doubled haploid progeny lines from a cross between the wheat cultivars Chara and Glenlea. These methods allow access to a previously untapped genetic resource by extracting additional information from the raw data. With no additional genotyping cost, we are able to double the number of markers mapped and thereby increase genome coverage.