School obesity-prevention curriculum can reduce medical costs

Teaching middle-school children about nutrition and exercise and
encouraging them to watch less TV can save the health care system a
substantial amount of money, suggests an economic analysis from
Children's Hospital Boston and the Centers for Disease Control and
Prevention.
Using data from a randomized, controlled study conducted at 10
Massachusetts middle schools, five of which adopted the obesity
prevention curriculum Planet Health, the researchers created a model
projecting a net savings of $14,000 for the 254 girls receiving the
curriculum, by averting the costs of treating obesity and eating
disorders. They project that expanding the program to even just 100
schools could save the health care system $680,000.
The study, published in the August issue of the Archives of Pediatrics
& Adolescent Medicine, was led by S. Bryn Austin, ScD, an
epidemiologist in Children's Hospital Boston's Division of Adolescent
Medicine, and CDC health economist Li Yan Wang.
Planet Health, developed at the Harvard School of Public Health, is a
curriculum for academic, physical education and health education
teachers to guide middle-school students in choosing healthy foods,
increasing physical activity and limiting TV and other screen time. It
provides teacher training, lesson plans, materials and FitCheck, a
self-assessment tool for students.
In an earlier study of 10 middle schools, half offering the Planet
Health program and half offering regular programs (schools were
matched by town, school size and ethnic composition), obesity
prevalence declined in the schools with Planet Health but increased in
control schools over the two years of follow-up. In addition,
overweight girls in Planet Health schools were twice as likely as
girls in control schools to return to a healthy weight over the two
years.(Gortmaker SL et al, 1999). Unexpectedly, girls in Planet Health
schools were also less than half as likely as girls in control schools
to begin purging or using diet pills to control their weight (Austin
SB et al, 2005); this study was later replicated in a separate group
of middle schools (Austin SB et al, 2007). The effects were not
statistically significant for boys.
"We were really surprised and encouraged to see how protective Planet
Health was for eating disorder symptoms in girls," says Austin, the
study's senior author. "When we found the same protective effect --
cutting the risk for girls in half -- in a different set of middle
schools several years later, we knew we were on to something
important."
Bulimia typically develops in adolescence, and often begins with a few
behaviors, such as using diet pills or purging to control weight.
Full-blown bulimia is a life-threatening disorder that carries a
variety of medical complications such as electrolyte imbalances,
dehydration, metabolic alkalosis (an imbalance in the body's acid/base
balance), heart rhythm disturbances, tooth erosion and bowel
dysfunction.
"Eating disorders cause an enormous amount of suffering," says Austin.
"They can also be chronic and expensive to treat, which is often a big
financial burden on individuals, their families, and society. That's
what led us to want to do the economic study."
In their economic analysis, Austin and Wang first estimate that 3.4
percent of girls receiving the Planet Health intervention would be
prevented from developing disordered weight-control behaviors by the
age of 13 ½, based on numbers from the original randomized study (7 of
254 girls in the Planet Health schools, or 2.8 percent, developed
these behaviors, versus 14 of 226 controls, or 6.2 percent). Based on
current knowledge about the progression of eating disorders, they
calculate that, in turn, 1 case of bulimia would be prevented by the
age of 17 among the 254 girls.
Factoring in typical treatment costs -- which can be tens of thousands
of dollars over a decade -- and known rates of remission and relapse,
Austin and Wang estimate that an average of $34,000 would be saved by
preventing one girl in the five Planet Health study schools from
developing bulimia nervosa. Adding Wang's previous finding of $27,042
in savings resulting from prevention and reduction of obesity in the
same schools (Wang LI et al, 2003), the program would yield a net
savings of $14,238 after subtracting the $46,803 cost of offering
Planet Health in those schools.
"Because eating disorders can be so expensive to treat, preventing
even one case in the five Planet Health schools translated into
reducing medical costs by $34,000," says Austin. "But if we scale up
our calculations to include, say, 100 middle schools in Massachusetts,
the medical costs reduced by preventing bulimia increase to over half
a million dollars. And if we scale up nationwide, to say 1,000
schools, the potential reduction in the medical cost burden is
sizable."
Austin notes that obesity prevention programs that stigmatize obesity
or create a sense of blame can actually contribute to eating
disorders. "We need to be smart about choosing obesity prevention
strategies that, at the same time, can prevent eating disorders," she
says. "Our study shows that when we do both, we substantially increase
the benefits, both in terms of health and reducing medical costs."
The study was funded by the Maternal and Child Health Bureau of the
Health Resources and Services Administration. Lauren Nichols of the
Division of Adolescent and Young Adult Medicine at Children's Hospital
Boston was coauthor.