Freia De Bock, Diana Sonntag Mannheim Institute for Public Health - PowerPoint PPT Presentation

Note: for non-commercial purposes only Which costs does childhood obesity cause? Implications for obesity prevention in Germany Freia De Bock, Diana Sonntag Mannheim Institute for Public Health (MIPH) Early Nutrition Conference 2014 “The Power of Programming” Munich, 13 – 15 March 2014

Which costs are caused by obesity? Freia de Bock I MIPH I Slide 2 von 24 I 14.03.2014

Research question: Do overweight and obese children (BMI>25 kg/m 2 ) cause larger lifetime excess costs during adulthood than normalweight children? Freia de Bock I MIPH I Slide 3 von 24 I 14.03.2014

Methods (I) Model I CHILDREN (epidemiology) � (Age: 3-17) ADULTS Model III Model II including including (Age: 18-100) obese children normalweight children Freia de Bock I MIPH I Slide 4 von 24 I 14.03.2014

Methods (II) NORMAL α_child_no αDeath_ OVERWEIGHT_post normal α_child_no α_child_on αDeath_ αDeath_ NORMAL_post overweight α_child_on αDeath_ OVERWEIGHT α_child_oa α_child_ao OBESE DEATH αDeath_ Freia de Bock I MIPH I Slide 5 von 24 I 14.03.2014

Methods (IV) Model I CHILDREN (epidemiology) (Age: 3-17) Model II Model III ADULTS including including obese (Age: 18-100) normalweight children children Freia de Bock I MIPH I Slide 6 von 24 I 14.03.2014

Results (I) Development of BMI categories taking childhood obesity history into account Female 100% 90% Dead 80% Proportion of the cohort 70% Proportion of obese individuals who were obese as child 60% Proportion of obese individuals who 50% become obese during adulthood 40% Proportion of overweight individuals who were overweight as child 30% Proportion of overweight individuals who 20% become overweight during adulthood 10% Normalweight 0% 3 8 13 18 23 28 33 38 43 48 53 58 63 68 73 78 83 88 93 98 Age Freia de Bock I MIPH I Slide 7 von 24 I 14.03.2014

Results (II) Comparison direct/ indirect lifetime excess costs Costs (€ 2010) without Discounting Cost differences Men Women Direct 14,524 19,479 Excess costs X2.99 x3.37 If obese as a child Indirect 11,547 6,428 Excess costs x2.94 x3.85 Costs (€ 2010) with Discounting 3% Direct 4,262 7,028 Excess costs x3.72 x5.3 If obese as a child Indirect 4,206 2,442 Excess costs Freia de Bock I MIPH I Slide 8 von 24 I 14.03.2014 x3.15 x4.15

Literature comparison– obese/non-obese childhood Sonntag/ Fernandes Brunello 2009 De Bock 2013 2009 lifetime cost until age 55 Germany USA Europe Proxy for Proxy incidence Incidence-based incidence (long. Data SHARE) Markov Model Monte-Carlo Micro-simulation with Kohorte Sim., lifetable Direct costs m 2.99 4.9 1.37 f 3.37 3.5 Indirect costs m 2.94 ----- f 3.85 ----- Additional direct 4,262- $18.999- 13,840 for obese lifetime-costs (3% 7,028 Euro $26.775 versus non-obese discount) in adulthood Additional indirect 2,442 – 4,206 lifetime-costs (3% Euro discount) Freia de Bock I MIPH I Slide 9 von 24 I 14.03.2014

Thanks a lot for your attention! Freia de Bock I MIPH I Slide 10 von 24 I 14.03.2014

Additional Slides Freia de Bock I MIPH I Slide 11 von 24 I 14.03.2014

Methods (VII) 1. Estimation of transition probabilities • Kinder- und Jugendgesundheitssurvey (KiGGS): cross-sectional data - Adapting of health status „normalweight “ , „overweight “ and „obese “ since two BMI states have been neglected. - Since data are not available for each year, data are adjusted by linear regressions - determination of genderspecific transition probabilities Freia de Bock I MIPH I Slide 12 von 24 I 14.03.2014

Methods (VIII) • Sample Census 2009: cross-sectional data  Adapting of health status „normalweight “ , „overweight and „obese “ since one BMI state has been neglected.  Since data are not available for each year, data are adjusted by linear regressions.  Determination of genderspecific transition probabilities; backward changes between stages have been considered e.g. tracking from obesity to overweight. Freia de Bock I MIPH I Slide 13 von 24 I 14.03.2014

Methods (IX) 2. Further data • Mortality rates are used from Federal Statistical Office • In order to determine relative risks (RRs) two literature reviews have been conducted:  Age-specific mortality RR associated with obesity or overweight are used from the European Prospective Investigation into Cancer and Nutrition ( EPIC- Study).  Adult mortality RR associated with obesity or overweight in childhood used from Engeland et al. (2004). Freia de Bock I MIPH I Slide 14 von 24 I 14.03.2014

Methods (X) 3. Costs • Methodology: PAF Freia de Bock I MIPH I Slide 15 von 24 I 14.03.2014

Sensitivity Analysis Cost % difference from base result Men Univariate: 2.331 -45% Discount rate 5% Transitition probabilities 3.948 -6% factor 0.8 4.399 5% factor 1.2 4.153 -1% RR adult mortality 11.339 169% Costs Women Univariate: Discount rate 5% 1.423 -42% Transitition probabilities 2.340 -4% factor 0.8 2.519 3% factor 1.2 RR adult mortality 2.372 -3% Costs 5.571 129% Freia de Bock I MIPH I Slide 16 von 24 I 14.03.2014