Economic Evaluation Essay: Screening Student Body Mass Index

Question

Task: With the increase in the prevalence of obesity among children and adolescents over the past several decades in the United States and across the globe, researchers, medical providers, and governments worldwide are seeking novel methods to address this epidemic. The use of body mass index (BMI)report cards, where schools weigh and measure students and send parents an assessment of their child’s risk for obesity, is one method that has been popular across the United States and internationally. Experts agree that parents should be informed of their child’s weight status, yet there is considerable debate about how this information should be presented to parents and from whom it should come. Although several states have implemented BMI report card programs, few peer-reviewed studies evaluating their effectiveness have been published to date. Early recognition of the risk factors associated with adolescence obesity and timely intervention could decrease the economic and health burden of obesity on the population. Although population-based screening for BMI has been validated as a feasible method to identify at-risk adolescents who might benefit from early identification and treatment, BMI screening has historically not been conducted as part of routine school-based health screenings in Australia.

Suppose your state premier signed a bill that requires information on child BMI and the associated risk factors to be sent to parents of the state public school students in grades 5-12. The law also calls for the state Health department to work with the Child Care National Association and other stakeholders to develop a plan for implementing BMI screenings in schools.

Suppose you are a health economist at the state Department of Health, and is responsible for the economic evaluation for this project. Assume that the screenings will take place once a year. Further assume that that all children with BMI over 95th percentile in their age-adjusted scale will go on to enroll in a targeted health programme (e.g., behavioural therapy) funded by the state within the year of screening.

Economically evaluate the suggested BMI screening intervention at school for students in grades 5-12 using cost-effectiveness or cost-utility analysis. Outline the recommendations you would make. Support your analysis, evaluation, and recommendations through reference to the existing cost effectiveness literature.

Please consider the following key issues as you undertake your analysis:

1. The perspective of the study: Consider cost of obesity to the individual with illness or to the society as a whole
2. The intervention time frame: The period should be sufficiently long to cover program start-up phase and full program implementation (with ongoing costs and school schedule).
3. The analysis time frame: You need to decide how long we should wait to see change in outcome of interest if the intervention is successful. For prevention strategies, the time frame should capture all potential costs and benefits of the program. However, you must consider how realistic and feasible data collection will be (i.e., very few outcomes might be detectable within a short period after screening, but very long-term follow up may not be feasible).
4. Data on all types of costs to be collected: including costs relating to actual implementation of the treatments.
5. Data on relevant health outcomes within each of the following time frames: short term (e.g., one month), intermediate (e.g., one year), and long term (e.g., 10 years or lifetime). Rank the outcomes identified in (e) on the level of appropriateness for CEA. How feasible is it to obtain data on outcomes you have identified? If too difficult, what are the alternative outcomes that will still reflect the outcome of interest? What assumptions are you making regarding the alternatives as proxies for outcome of interest?

Answer

Introduction
The increase in the trends of obesity in the population over past few decades has brought forth the measures of BMI (Body Mass Index) tests are conducted. The increase has affected the health and wellbeing cost of people along with associated diseases. Hence the research here dose a cost benefit analysis of the tests conducted on the children of schools from grade 5 to 12. The early recognition of the tendencies of obesity helps the child to develop the needful lifestyle that in the long run would help them to benefit and lower the burden of health and wellbeing costs in the long run. So as per the bill signed by the State Premier, the BMI is conducted in the public schools and the reports are to be given to the parents. The Health department would function with the Child Care National Association. The cost for the project that would be conducted once in a year and the children identified would join the state funded behavioral therapy that is a part of change in lifestyle to reduce the risks related too obesity in the long run. Hence the economic evaluations would give the state an idea of what is needed along with the cost to benefit ratio can be calculated which would motivate such program to be conducted.

Literature Review
The obesity is the medical condition where the patient suffers from excessive fat in their bodies which may affect their health. So a doctor would call it a high BMI or Body mass Index. So BMI is the tool that the doctors use to measure the appropriate height, sex, age for a person. The measurement considers the BMI of 25 to 29.9 as the index of excessive weight. Further, factors like waist to hip size (WHR) waist to height (WtHR) are the index measures as well (Garrow & Webster, 1985). Obesity is the cause of many diseases which a person may avoid with BMI tests and thus following the instructions would be like arthritis, blood pressure, metabolic syndromes, diabetes, cardio vascular diseases etc. Hence the person with obesity would have to follow a lifestyle which would help them to reduce the BMI like food habits, exercises etc. in some cases the person may also undergo surgery to reduce the body fat (Freedman et al., 2009).

The reasons for obesity is due to Consumption of Too much calories. When a person eats too much but burns less energy the excessive food is preserved by the body as fat. Some food have the likeliness of weight gain especially the one with high sugar and fat contents. The fast food, processes meats, food with added sugar and fat with higher calories are the cause of obesity among the age group which is been studied. The corn syrup is used in most of the foods which is a big source of fat in the body. When the body is fed with too much food with less exercise the tendencies of obesity is visible. A varied diet like fruits, whole grain products, vegetables keeps the calorie intakes in check and also helps in a good digestive system functioning (Lawlor et al., 2010).

The lifestyle of the day has changed where the children gets lesser time to play or have the kind of physical exercises that their parents or grandparents had. Today the children have lesser physical activities which is now limited to mobile phone games instead of real physical sports. This has made the chances of obesity in the students more due to the lifestyle shift. The activities needed for the child has to be provided and that can only help reducing the chances of adolescent obesity in the long run. Missing sleep or a period that’s needed by the children is not been fulfilled in the modern ages. The Surveys conducted in UK between 1977 and 2012 suggested that sleep deprivation is the cause of obesity. It had a sample size of 28000 children. Since lack of sleep changes the hormonal activity where the increase in appetite is seen which the cause of obesity is in such a tender age (Marengo, 2019).

The consumption of sucrose via food sources like cola, soda, and fruit flavored drinks makes the metabolism in the body go higher. The metabolism of the child changes with the food contents providing such high doses of fructose to the body. Medications would sometime be a cause for obesity. However, medication of the children are not such that may have a large effect but a prolonged use may have the effect of being obese with time. The cases conducted studies in various laboratories of the globe have proven that the longer the person is overweight the longer it would take them to lose it. So it’s something that is based on lifestyle and routine of the individual as well (Steinberger et al., 2005).

A recent discovery in 2013 suggests that genetic disorder may also cause obesity where the habits like higher food intake, impaired ability to feel full with a meal, tendencies to be obese, preference for higher calories may happen. So this disorder may also be kept in mind while developing the treatment methods. Hence the causes of obesity are many and the most efficient treatment method is lifestyle and dietary controls which would control obesity in the children to be screened.

BMI (Body Mass Index)
The BMI is the screening tool used by the medical staffs to identify the health of an individual. The body mass would be assessed by a healthcare professional for each children which has its own determinant that would suggest if the child is showing tendencies of obesity or less weight in both cases so that the assessor may take appropriate steps to diagnose the BMI of an individual to suggest the condition and what actions needs to be taken (BMI Calculator for Child and Teen, 2019).

In this case the BMI for the age group of the public schools are been taken from the secondary sources where the indicators and lab tests were done by the most renowned people in the medical profession to give a scale with age and height along with sex for each individual (Willett et al., 2006). The BMI index study of the public schools and cost related to it in short and long term are discussed below.

Issues
The calculation of cost is been done to implement the program in the public school levels so that the benefits of the direct and indirect nature are identified. This gives the justification of the early measure adoption so that the future cost for the individual is saved due to its initial detection and remedy. The direct benefits would be cost savings for adult healthcare in the long term while the indirect benefits are many like the society health and wellbeing, the activity and proper growth of the children as per the law of nature, better and health lifestyle etc (Wohlfahrt-Veje et al., 2014).

The cost of the entire project can be calculated keeping in mind that the tests would be conducted every month and the identifications would be done by a physician present to note the details of the BMI readings. Hence, the schools have to arrange for instruments like weighing scale, height measuring scale, each district should have a Public Medical officer who would do the rounds of the public schools each day so in the entire month the schools are all covered. The direct cost for the project would include the fixtures and assets like the scale and weighing scale in each school for the monthly tests. Further, the report of the BMI is to be personally filled by the physician and be given to the class teacher to be distributed among the parents. The forms would have the code as ticked by the physician, of the leaflet that the parents should collect from the school that explains how the child has to be treated and what should be changed in food habits, sleep quality, physical exercise etc for each BMI sets. This kind of program would give the long term benefits to the society to help the parents give their children the best of education and lifestyle.

The same experiment conducted in China in their schools to measure the obesity gave a great result where the savings due to early BMI detection was USD 120.3 per person in its cost effectiveness ratio. Thus the study indicates the long term benefits for the child so that the long term cost of the state is reduced by a large percent and thus used the intervention costs well. However, it is also true that a smaller intervention would cost less to a larger intervention. This has guided the public schools there to adopt the needful policies that would prevent obesity from a very tender age so that the policy focus is there to resolve numerous long term public issues (Meng et al., 2013).

A hypothetical assessment of the cost for the intervention is as below:

The aforesaid is the estimated costs which is done in a fictitious manner to elaborate the cost heads and thus give an idea of how costly it is or how the priorities should be set to keep funds aside. Keeping the orders in mind the direct cost of the assets are calculated for one time and the program and its curriculum for children with higher BMI has to be set so that the intervention and the control are all well monitored and executed.

Analysis
The secondary sources suggests that the cost to benefits of the early BMI detection saves a lot of cost which a person spends due to diseases pertaining to obesity. Hence the studies conducted in China for the Percent of Body Fat (PBF) can be taken as a model which shows that the cost to benefit ratio is such great that it can be successfully implemented in a larger scale. The preliminary costs may be high but the long term benefits and the costs from the 2nd year onwards would make the venture successful owing to the suggestions that the Chinese sources gives. However, there is very little data to actually suggest that cost benefits would be great in all cases so the risk may be taken to advocate the public health issues. The Nutrition and food safety, Health department, Department of Child education and development are all to be the stakeholders in the process to make the implementation goals successful. A comprehensive intervention with the diet and lifestyle in mind would give the children the best of health ahead.

Recommendations The cost effectiveness of the program is a big factor which is been observed from the 2nd year and that would show the actual benefits from then on. The reduction of the child health problems as surveyed by the health departments would suggest that with its surveys from the following years to measure the success of the program. The actual cost of treatments for the adults would get reduced in the process where they would adopt a healthy diet and lifestyle from the very beginning. However, the cost of the physician and the assistants should be enhanced in the future with the inclusion of more and more children in the program. The programs for BMI reduction may be outsourced to keep the cost in control where the payments would only be done for the children who needs such treatment else it would be a waste. The cost effectivity of the process is to be derived from the long term calculations which has to be done at least 5 years from implementation to get the actual figure of the cost benefit structures. Nevertheless, this can be conducted anyway since the long term benefits would be very helpful for the national savings on health and wellbeing of the citizens. Economic evaluation essay assignmens are being prepared by our economic assignment help experts from top universities which let us to provide you a reliable essay help online service.

References
BMI Calculator for Child and Teen. (2019). Retrieved from https://www.cdc.gov/healthyweight/bmi/calculator.html

Freedman, D.S. et al., 2009. Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study. Am. J. Clin. Nutr., 90(1), pp.210–216.

Garrow, J.S. & Webster, J., 1985. Quetelet’s index (W/H2) as a measure of fatness. Int. J. Obes., 9(2), pp.147–153.

Lawlor, D.A. et al., 2010. Association between general and central adiposity in childhood, and change in these, with cardiovascular risk factors in adolescence: prospective cohort study. BMJ, 341, p.c6224.

Marengo, K. (2019). Obesity: What is it and what causes it?. Retrieved from https://www.medicalnewstoday.com/articles/323551.php

Meng, L., Xu, H., Liu, A., van Raaij, J., Bemelmans, W., & Hu, X. et al. (2013). The Costs and Cost-Effectiveness of a School-Based Comprehensive Intervention Study on Childhood Obesity in China. Plos ONE, 8(10), e77971.

Steinberger, J. et al., 2005. Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int. J. Obes., 29(11), pp.1346–1352.

Willett, K. et al., 2006. Comparison of bioelectrical impedance and BMI in predicting obesity-related medical conditions. Obes. (Silver Spring), 14(3), pp.480–490.

Willett, K. et al., 2006. Comparison of bioelectrical impedance and BMI in predicting obesity-related medical conditions. Obes. (Silver Spring), 14(3), pp.480–490.