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The Problem of Obesity and Eating Disorders

Discuss about the Influenza and Pneumococcal Vaccinations.

We know that the Cost effectiveness analysis (CEA) is the joint information regarding the costs and outcomes of the community prevention program. This cost effectiveness analysis produces the most valuable information which is helpful for answering the questions about whether the program is cost effective or not (Rychetnik et al., 2002). Also, we can check whether the program is more or less cost effective as compared to alternative prevention strategies. The cost effectiveness analysis plays an important role in evaluation of the costs required to yield a specific nonmonetary outcome. The time frame for these types of analysis may be varying and it is depends on the several factors such as population or sample size, availability of resources, etc. Here, we are concerning with the cost effectiveness study regarding the surveillance for BMI (Body Mass Index) and ED (Eating Disorder) in different schools. For this research study, we have to critically evaluate previous studies regarding the cost effectiveness. We have to find out main factors in the analysis of the cost effectiveness of a prevention program. We have to find the average cost effectiveness of the program. It is revealed that the recent study on the cost effectiveness of different vaccination strategies and policies in the hospitals used the average CERs of program (Honeycutt et al., 2006). Gift, Haddix, and Corso (2003) provide all details for calculating CER and different measures of program effectiveness.

We know that establishing objectives for the research study is a primary stage of the research study. The main objective of this research study is to critically analyse and evaluate the cost effectiveness of the health programs and surveillance regarding the BMI (Body mass index) and ED (eating disorder). We have to use previous literature or research articles regarding the cost effectiveness of different health programmes. We have to critically analyse different measurements involved in this cost effectiveness program. The main goal of this critical evaluation and analysis of intervention study is to understand different aspects of the cost effectiveness of the health programs. This study does not base on the actual data collection process and analysis of collected data. We will use the secondary data from the previous studies regarding the cost effectiveness of the different health programmes. Here, we will be find out the cost effectiveness for the school based intervention programmes for BMI (Body mass index) and ED (eating disorder). Also, we will find out the incremental or marginal cost effectiveness, and other related factors or measurements regarding this study. A program is often considered to be cost-effective if its CER is below the commonly used threshold of $50,000 per life-year gained (Hlatky, 2002).

BMI Surveillance in Schools

The problem of obesity among the children and adolescents is continuously increasing since past several decades in the United States and across the world. An effective screening program is required for handling this situation. It is required to check the BMI (body mass index) of the children and adolescents on a regular basis. It was found that the eating disorders (ED) are a source of substantial morbidity and mortality and it is costly to treat. Early diagnosis and timely treatment could be help in decreasing economic and health burden of eating disorders. Two main objectives of the public health are given as the disease prevention and health promotion. In 2002, USA President Bush announced the Healthier US initiative. This initiative has four key objectives for people. These objectives include increase physical activity, promote responsible diet, increase use of preventive health screenings, and make healthy choices regarding the smoking and alcohol. Most of the community level prevention approaches are based on the different socio-ecological framework of behaviour change (McLeroy et al., 1998). The school based BMI measurement has attracted the attention of nation. The obesity among children and youth is increasing continuously and it is required to take action on this issue as early as possible. From the past studies it is observed that the expert organizations support the school based BMI surveillance; however the controversy exists over screening programmes (Gold et al., 1996).

BMI is defined as the ratio of the weight of person to the height squared (kg/m2) and this BMI index is used to estimate a person’s risk of weight related health problems. BMI is often used as weight status of person because it is easy to calculate and it related with body fat. BMI measurements in schools would be conducted for the surveillance and screening purposes (Haddix, Teutsch, and Corso, 2003). Surveillance is defined as the systematic collection, analysis, and interpretation of data collected from the census or sample survey. Most of the schools conducted the BMI screening programs for understanding the percentage of students below specific BMI and percentage of students above specific BMI level. These types of screening tests are helpful for calculating the student percentage with obese, overweight, normal weight, and underweight. The school based surveillance data would be used for describing different trends in the weight status over the time. It is also helpful in identifying the demographic or geographic groups which are at high risk for obesity (Hill et al., 2004). These types of surveillance are helpful in creating awareness among the school and related persons (Mandelblatt et al., 1996).

Eating Disorder Screening Programs in Schools

Eating disorder (ED) is commonly held as lifestyle choice. Eating disorder is serious in nature and it produces fatal illnesses which can produce disturbances to a person’s eating behaviours. The main signals of the eating disorder may be obsessions with food, body weight, and shape of the body. Some symptoms of Eating disorder includes extremely restricted eating, extreme thinness, unwillingness to maintain a normal or healthy weight. Eating disorder is related to increasing or decreasing the BMI. So, it is required to implement the screening programmes for monitoring the eating disorders among students. Also, it is found that the ED is a serious public health problem. Although there is comprehensive research is available for the epidemiology, but the ED relevant aspects are neglected. The research study regarding the health care utilization is sparse. Also, study material regarding costs of different treatments and cost effectiveness of these treatments is available in a very less proportion. Cost of illness studies (COIs) are the adequate instruments for assessing the economic burden associated with ED (Hubard and Hayashi, 2003). Cost estimates in CEAs is always varied considerably. So, we cannot compare the cost estimates in CEAs directly. If two different studies are targeted different EDs and comparable CEAs, then we would not be able to draw any premature conclusions. It is important to consider all aspects of study before drawing any conclusions. Instructions and advices for economic calculations are available in Drummond et al. (1997). It is recommended that no any conclusions should be drawn about the cost effectiveness of the different interventions in the long term study.

This study includes the critically analysis and evaluation of the cost effectiveness of the intervention program of BMI and ED among schools. For this research study we do not use the primary data or data collection from respondents. This study will be based on the secondary data from the previous research study regarding the cost effectiveness. The effectiveness of the cost may be vary from different health conditions. Cost effectiveness of the health program is mainly depends on different expenditures required for the health program. Many researchers revealed that Eating Disorders (EDs) are prevalent in adolescents and young adults. We have to check this fact by critically analysis from previous studies. In this study we want to check all aspects of the variables or factors regarding the EDs and BMI. We will find out the significant differences in the two interventions with long time frame.

Perspective of Study/Issue

In the planning of a cost effectiveness study, the first important step is to ask and answer a few questions which will help to identify data needs. These questions will help us in finding the data type, data collection and appropriate methods of analysis. Defining research questions for research study will help in minimizing problems with data collection or analysis during implementation. The following are the key questions which are important during the given research study.

  1. Is there any significant effect observed after implementation of the BMI and ED screenings in the schools?
  2. Is there any significant factors observed for the obesity?


For this research study, the research study design will be arrange in accordance with different available factors. For this research study, first of all we will check the different steps involved in cost effectiveness analysis. The checklist for the cost effectiveness analysis is attached in the appendix. First of all, we will select the outcomes for CEA (Cost Effectiveness Analysis). We will calculate the average CER for the health program regarding the BMI and ED. We will rank possible programs by the effectiveness of the programs. We will eliminate all dominated programs and also perform the sensitivity analysis for these programs. Cost estimates in CEAs are always varied considerably. Eating disorders were creating substantial costs. The available evidence probably underestimates the economic burden. There would be lacking of direct and indirect costs. All results are drawn from the critical analysis of cost effectiveness study based on secondary data.

During the design of the cost effectiveness study, it is important to select the best program within given budget constraints. A fixed amount is available for the given condition for prevent or reduce the obesity. A specific amount is available for each person in given condition. Also, fixed amount will be available for the unit gain in effectiveness. So, these constraints are important while designing the intervention program.

For this research study, the time frame will be depends on different factors. For this research study, we will use the time frame of more than two years, because it will take more time for understanding the nature and effect of program for BMI and ED. This research study would be consist of several steps and each step should be analysed critically.

Conclusions

From the above study of critically evaluation and analysis of cost effectiveness, it is found that CEA (Cost Effectiveness Analysis) is a helpful tool. The CEA is useful for making better decisions for the implementation of different health programs. The CEA have most important role in the different health programs for finding cost factors, implementation of new programs, eliminating or increasing the study factors in the programs, etc. We know that there are so many factors which affect the decision making process in health programs and CEA would be one of them. As per Haddix et al., 2003, ethical and political considerations including the issues of reach, equity, needs, and priorities, plays an important role in the cost effectiveness analysis of the health programs. A lower effectiveness program would be more useful than the mix of two programs.

It is important to become a cautious during the comparison of the cost effectiveness results obtained from the different studies, because these studies used different methods and different outcomes, costs, and baselines. Although CEA is a straightforward process, but performing a CEA is time consuming. The CEA requires a community programs or the health departments commit staff.

Some important conclusions from this cost effectiveness study are summarised below:

  1. All results are drawn from the critical analysis of cost effectiveness study based on secondary data
  2. The CEA have most important role in the different health programs for finding cost factors, implementation of new programs, eliminating or increasing the study factors in the programs, etc.
  3. This study includes the critically analysis and evaluation of the cost effectiveness of the intervention program of BMI and ED among schools.
  4. Many researchers revealed that Eating Disorders (EDs) are prevalent in adolescents and young adults.
  5. Cost estimates in CEAs are always varied considerably. Eating disorders were creating substantial costs. The available evidence probably underestimates the economic burden.
  6. A lower effectiveness program would be more useful than the mix of two programs in cost effectiveness studies.

References

US Department of Commerce, Census Bureau. Historical statistics of the United States, colonial times to 1970. Percent of the population 3 to 34 years old enrolled in school, by race/ethnicity, sex and age: Selected years, 1980 –2003. Available at: https://nces.ed.gov/programs/digest/d04/ listtables1.asp#c12. Accessed May 8, 2009

Centers for Disease Control and Prevention. Guidelines for school health programs to promote lifelong healthy eating. MMWR Recomm Rep. 1996;45(RR-9):1– 41

Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. MMWR Recomm Rep. 1997;46(RR-6):1–36

Drummond, M. F., O’Brien, B., Stoddart, G. L., & Torrance, G. W. (Eds.) (1997). Methods for the economic evaluation of health care programmes. (2nd Edition). New York: Oxford University Press.

Gift,T. L., Haddix, A. C., & Corso, P. S. (2003). Cost-effectiveness analysis. In A. C. Haddix, S. M. Teutsch, and P. A. Corso (Eds.), Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation, 2nd Edition. London: Oxford University Press.

Gold, M. R., Siegel, J. E., Russell, L. B., & Weinstein, M. C. (Eds). (1996). Cost Effectiveness in Health and Medicine. New York: Oxford University Press.

Gortmaker S, Peterson K, Wiecha J, et al. Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;153(4):409–418

Haddix, A. C., Corso, P. S., & Gorsky, R. D. (2003). Costs. In A. C. Haddix, S. M. Teutsch, and P. A. Corso (Eds.), Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation, 2nd Edition. London: Oxford University Press.

Hill, J. O., Peters J. C., & Jortberg, B. T. (2004). The step diet: Count steps, not calories to lose weight and keep it off forever. New York, NY: Workman

Hlatky, M. (2002). Economic endpoints in clinical trials. Epidem Rev, 24(1), 80-84.

Honeycutt, A., Coleman, M, Wirth, K., & Anderson, W. (2006). Cost-effectiveness of standing orders for influenza and pneumococcal vaccinations in North Carolina hospitals. RTI working paper.

Hubard, S. M., & Hayashi, S. W. (2003). Use of diffusion of innovations theory to drive a federal agency’s program evaluation. Evaluation and Program Planning, 26, 49-56.

Mandelblatt, J. S., Fryback, D. G., Weinstein, M. C., Russell, L. B., Gold, M. R., & Hadorn, D. C. (1996). Assessing the effectiveness of health interventions. Cost-Effectiveness in Health and Medicine (pp. 135-175). New York: Oxford University Press.

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377.

Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002). Criteria for evaluating evidence on public health interventions. Journal of Epidemiology and Community Health, 56, 119-127.

Wechsler H, McKenna ML, Lee SM, Dietz WH. The role of schools in preventing childhood obesity. State Educ Stand. 2004;5(2):4 –12

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