Anne M. Wolf

The Cost of Obesity

SummaryObesity is associated with an increased risk of many major chronic diseases. We estimated the economic costs of obesity-associated non-insulin-dependent diabetes mellitus, cardiovascular disease, gallbladder disease, cancer, and musculoskeletal disorders in 1990 US dollars, using a prevalence-based approach to cost-of-illness. In addition to direct costs, indirect costs were also estimated. The indirect cost of morbidity was estimated by calculating the costs associated with work days lost, and mortality costs were estimated on the basis of lifetime earnings lost.In 1990, the direct cost of obesity-associated disease in the US was

Social and economic effects of body weight in the United States.

US45.8 billion, and the indirect cost of obesity was estimated to be

Early child-care selection: variation by geographic location, maternal characteristics, and family structure.

US23.0 billion. Therefore the total economic cost of obesity was estimated to be

Estimating the Effect of Changes in Body Mass Index on Health State Preferences

US68.8 billion in 1990.

Economic evaluation of orlistat in overweight and obese patients with type 2 diabetes mellitus.

Given that overweight is clearly associated with increased risk of many major chronic diseases, the United States could have saved approximately

Lifestyle Intervention in Obese Patients with Type 2 Diabetes: Impact of the Patient's Educational Background

45.8 billion or 6.8% of health care expenditures in 1990 alone if obesity were prevented. The question then arises, economically and socially, what is a healthy body weight? Using a prevalence-based approach to cost of illness, we estimated the economic costs (1993 dollars) associated with illness at different strata of body mass indexes (BMIs, in kg/m2) and varying increments of weight gain to address the questions: At what body weight do we initiate preventive services? What are the direct costs associated with weight gain? Second, using the 1988 National Health Interview Survey (NHIS), we evaluated the marginal increase in certain social indexes reflective of functional impairment and morbidity (ie, restricted-activity days, bed days, and work-loss days) as well as physician visits associated with different strata of BMI. With respect to economic and social indexes, a healthy body weight appears to be a BMI < 25, and weight gain should be kept to < 5 kg throughout a lifetime.

Impact of lifestyle intervention on lost productivity and disability: improving control with activity and nutrition.

More than half of all U.S. infants and toddlers spend at least 20 hr per week in the care of a nonparent adult. This article uses survival analysis to identify which families are most likely to place their child in care and the ages when these choices are made, using data from a national probability sample of 2,614 households. Median age at first placement is 33 months, but age varies by geographic region, mothers employment status during pregnancy, mothers education level, and family structure (1 vs. 2 parents, mothers age at 1st birth, and number of siblings). Controlling for these effects, differences by race and ethnicity are small. Implications for studies of child-care selection and evaluations of early childhood programs are discussed.

Cost-Effectiveness of Diabetes Education

AbstractObjective: To investigate the effect of changes in body mass index (BMI) on health state preferences (HSP). Design: Multiple regression analysis on pooled data from a clinical study, predicting final HSP as a function of changes in BMI and initial HSP, controlling for age and gender. Subgroup analyses according to clinically relevant subgroups were performed. Setting: Primary care practice sites. Patients: 402 obese patients of varying disease severity. Main outcome measures: BMI was operationalised as (weight in kilograms)/(height in metres)2. HSP were measured directly as visual analogue scale (VAS) scores, and converted to time trade-off (TTO) scores. Results: A one unit decrease in BMI over a 1-year period was associated with a 0.017 gain in utility units (utils). This estimate is comparable to utility gains observed for other widely used treatments (e.g. revascularisation for intermittent claudication, renal transplantation). It varies little over the observed range of VAS to TTO conversion values, and is a conservative estimate compared with using the unconverted VAS scores. If attempts to use weight reduction treatment in only the patients who successfully meet strict weight reduction targets are successful, the gain in HSP experienced by such patients may exceed this estimate. Patients with BMI values ≥28 with hyperglycaemia appear to have the greatest gain in HSP for a given change in BMI over 1 year. Conclusions: The effect of weight reduction on HSP can be significant, at least in the short term. Estimates of HSP changes presented herein may be useful in economic evaluations of weight reduction treatments.

PROCEED: Prospective Obesity Cohort of Economic Evaluation and Determinants: baseline health and healthcare utilization of the US sample

AbstractObjective: To estimate the economic value of pharmacological treatment of type 2 diabetes mellitus in overweight and obese patients using orlistat in addition to standard diabetes therapy (i.e., a sulphonlyurea, metformin or insulin) and weight management strategies as compared with standard diabetes therapy and weight management strategies alone in a US-based healthcare setting. The perspective of the study was from the viewpoint of a US healthcare provider. Design and setting: Markov state transition model simulating diabetes-related complications and mortality for a period of 11 years. Patients were modelled to continue orlistat therapy for a 52-week period, assuming a 3-year period of weight regain where after 3 years bodyweight would match that of the placebo group. The impact of orlistat on glycosylated haemoglobin (HbA1c) values was evaluated directly using data from four randomised, placebo-controlled, 1-year trials of orlistat in overweight or obese adults with type 2 diabetes who also received standard diabetes pharmacotherapy and intensive lifestyle modification. Incidence rates of micro- and macrovascular complications associated with type 2 diabetes and the estimated relative reduction in incidence rates associated with a decrease in mean updated HbA1C values were derived from the United Kingdom Prospective Diabetes Study (UKPDS) estimates for a reference population of male patients, 52 years of age.US cost estimates were derived from published sources and presented in 2001 US dollars. Discounting of 3% was applied. Probabilistic sensitivity analysis was applied to evaluate the robustness of the results of the persistence of the effect of orlistat after treatment. Main outcome measures: Average costs and event-free life-years gained during the 11-year period expressed as the incremental costs divided by the incremental gain in life expectancy. Results: Treatment with orlistat, 120mg three times daily, increased event-free life expectancy by 0.13 years over an 11-year period. Average treatment costs were estimated to be

Impact of Waist Circumference Difference on Health‐Care Cost among Overweight and Obese Subjects: The PROCEED Cohort

US19 987 in the orlistat group compared with