{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T23:35:24Z","timestamp":1783985724017,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2016,9,13]],"date-time":"2016-09-13T00:00:00Z","timestamp":1473724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Olympia Morata Programme University of Heidelberg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Despite methodological advances in the field of economic evaluations of interventions, economic evaluations of obesity prevention programmes in early childhood are seldom conducted. The aim of the present study was to explore existing methods and applications of economic evaluations, examining their limitations and making recommendations for future cost-effectiveness assessments. A systematic literature search was conducted using PubMed, Cochrane Library, the British National Health Service Economic Evaluation Databases and EconLit. Eligible studies included trial-based or simulation-based cost-effectiveness analyses of obesity prevention programmes targeting preschool children and\/or their parents. The quality of included studies was assessed. Of the six studies included, five were intervention studies and one was based on a simulation approach conducted on secondary data. We identified three main conceptual and methodological limitations of their economic evaluations: Insufficient conceptual approach considering the complexity of childhood obesity, inadequate measurement of effects of interventions, and lack of valid instruments to measure child-related quality of life and costs. Despite the need for economic evaluations of obesity prevention programmes in early childhood, only a few studies of varying quality have been conducted. Moreover, due to methodological and conceptual weaknesses, they offer only limited information for policy makers and intervention providers. We elaborate reasons for the limitations of these studies and offer guidance for designing better economic evaluations of early obesity prevention.<\/jats:p>","DOI":"10.3390\/ijerph13090911","type":"journal-article","created":{"date-parts":[[2016,9,13]],"date-time":"2016-09-13T10:10:00Z","timestamp":1473761400000},"page":"911","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Economic Evaluation of Obesity Prevention in Early Childhood: Methods, Limitations and Recommendations"],"prefix":"10.3390","volume":"13","author":[{"given":"Nora","family":"D\u00f6ring","sequence":"first","affiliation":[{"name":"Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm 17177, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna 1090, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7915-7809","authenticated-orcid":false,"given":"Finn","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm 17177, Sweden"},{"name":"Health Care Services, Stockholm County Council, Centre for Epidemiology and Community Medicine, Stockholm 17129, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Sonntag","sequence":"additional","affiliation":[{"name":"Mannheim Institute of Public Health, Social Prevention and Medicine (MIPH), Medical Faculty of Heidelberg University, Mannheim 68167, Germany"},{"name":"Department of Health Science, University of York, Heslington, York YO10 5DD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2016,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/j.1467-789X.2008.00475.x","article-title":"Tracking of childhood overweight into adulthood: A systematic review of the literature","volume":"9","author":"Singh","year":"2008","journal-title":"Obes. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1161\/01.CIR.0000060923.07573.F2","article-title":"Obesity, insulin resistance, diabetes, and cardiovascular risk in children: An American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism)","volume":"107","author":"Steinberger","year":"2003","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1067\/mpd.2002.125228","article-title":"Isolated systolic hypertension, obesity, and hyperkinetic hemodynamic states in children","volume":"104","author":"Sorof","year":"2002","journal-title":"J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"118","DOI":"10.2337\/diacare.26.1.118","article-title":"Prevalence and concomitants of glucose intolerance in European obese children and adolescents","volume":"26","author":"Invitti","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1111\/j.1467-789X.2010.00751.x","article-title":"Parental influence and obesity prevention in pre-schoolers: A systematic review of interventions","volume":"12","author":"Skouteris","year":"2011","journal-title":"Obes. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Frew, E.J., Pallan, M., Lancashire, E., Hemming, K., and Adab, P. (2015). Is utility-based quality of life associated with overweight in children? Evidence from the UK WAVES randomised controlled study. BMC Pediatr., 15.","DOI":"10.1186\/s12887-015-0526-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/j.1475-6773.2011.01326.x","article-title":"The health care cost implications of overweight and obesity during childhood","volume":"47","author":"Au","year":"2012","journal-title":"Health Serv. Res."},{"key":"ref_8","unstructured":"European Commision (2014). Ten Key Facts about Nutrition and Obesity-Nutrition and Obesity, European Commision."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1467-789X.2008.00521.x","article-title":"Obesity status and sick leave: A systematic review","volume":"10","author":"Neovius","year":"2009","journal-title":"Obes. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1038\/oby.2006.106","article-title":"Population-based analysis of obesity and workforce participation","volume":"14","author":"Klarenbach","year":"2006","journal-title":"Obesity"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.amepre.2015.11.010","article-title":"Interventions for childhood obesity in the first 1000 days: A systematic review","volume":"50","author":"Locks","year":"2016","journal-title":"Am. J. Prev. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1111\/obr.12277","article-title":"What childhood obesity prevention programmes work? A systematic review and meta-analysis","volume":"16","author":"Wang","year":"2015","journal-title":"Obes. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.ijnurstu.2015.10.017","article-title":"Interventions to prevent and manage overweight or obesity in preschool children: A systematic review","volume":"53","author":"Ling","year":"2016","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/jcpp.12330","article-title":"Interventions aimed at reducing obesity in early childhood: A meta-analysis of programs that involve parents","volume":"56","author":"Yavuz","year":"2015","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Carter, R., Moodie, M., Markwick, A., Magnus, A., Vos, T., Swinburn, B., and Haby, M.M. (2009). Assessing cost-effectiveness in obesity (ACE-obesity): An overview of the ACE approach, economic methods and cost results. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-419"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1038\/sj.ijo.0803469","article-title":"A new approach to assessing the health benefit from obesity interventions in children and adolescents: The assessing cost-effectiveness in obesity project","volume":"30","author":"Haby","year":"2006","journal-title":"Int. J. Obes."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.amepre.2015.03.032","article-title":"Cost effectiveness of childhood obesity interventions: Evidence and methods for CHOICES","volume":"49","author":"Gortmaker","year":"2015","journal-title":"Am. J. Prev. Med."},{"key":"ref_18","unstructured":"Akers, J.A.-I.R., Aguiar-Ib\u00e1\u00f1ez, R., Baba-Akbari, S.A., Beyon, S., Booth, A., Burch, J., Chambers, D., Craig, D., Dalton, J., and Duffy, S. (2009). CRD\u2019s Guidance for Undertaking Reviews in Health Care, Centre for Reviews and Dissemination, University of York."},{"key":"ref_19","unstructured":"Global Strategy on Diet, Physical Activity and Health 2004. Available online: www.who.int\/dietphysicalactivity\/strategy\/eb11344\/en."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/obr.12179","article-title":"Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood","volume":"15","author":"Pil","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1002\/oby.20747","article-title":"Economic evaluation of \u201chealthy beginnings\u201d an early childhood intervention to prevent obesity","volume":"22","author":"Hayes","year":"2014","journal-title":"Obesity"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1002\/oby.20472","article-title":"The cost-effectiveness of a successful community-based obesity prevention program: The be active eat well program","volume":"21","author":"Moodie","year":"2013","journal-title":"Obesity"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.ehb.2008.06.001","article-title":"Cost-effectiveness of a family-based GP-mediated intervention targeting overweight and moderately obese children","volume":"6","author":"Moodie","year":"2008","journal-title":"Econ. Hum. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ambp.2008.06.006","article-title":"Economic evaluation of a primary care trial to reduce weight gain in overweight\/obese children: The LEAP trial","volume":"8","author":"Wake","year":"2008","journal-title":"Ambul. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.acap.2011.04.005","article-title":"A simulation of affordability and effectiveness of childhood obesity interventions","volume":"11","author":"Ma","year":"2011","journal-title":"Acad. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1002\/hec.1486","article-title":"Systematic reviews of economic evaluations: Utility or futility?","volume":"19","author":"Anderson","year":"2010","journal-title":"Health Econ."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Drummond, M.F. (2005). Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press.","DOI":"10.1093\/oso\/9780198529446.001.0001"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s13679-015-0160-0","article-title":"A review of primary care-based childhood obesity prevention and treatment interventions","volume":"4","author":"Seburg","year":"2015","journal-title":"Curr. Obes. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Dietz, W.H., and Gortmaker, S.L. (2016). New strategies to prioritize nutrition, physical activity, and obesity interventions. Am. J. Prev. Med.","DOI":"10.1016\/j.amepre.2016.03.014"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"175","DOI":"10.2165\/00148365-200504030-00006","article-title":"Methodological challenges posed by economic evaluations of early childhood intervention programmes","volume":"4","author":"Petrou","year":"2005","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Frew, E. (2016). Economic evaluation of childhood obesity interventions: Reflections and suggestions. Pharmacoeconomics.","DOI":"10.1007\/s40273-016-0398-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"8565","DOI":"10.3390\/nu7105414","article-title":"Beyond food promotion: A systematic review on the influence of the food industry on obesity-related dietary behaviour among children","volume":"7","author":"Sonntag","year":"2015","journal-title":"Nutrients"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1001\/jamapediatrics.2015.0258","article-title":"Sustainability of effects of an early childhood obesity prevention trial over time: A further 3-year follow-up of the healthy beginnings trial","volume":"169","author":"Wen","year":"2015","journal-title":"JAMA Pediatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.ehb.2008.06.003","article-title":"Obesity and skill attainment in early childhood","volume":"6","author":"Cawley","year":"2008","journal-title":"Econ. Hum. Biol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/9\/911\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T19:30:53Z","timestamp":1760211053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/13\/9\/911"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,13]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2016,9]]}},"alternative-id":["ijerph13090911"],"URL":"https:\/\/doi.org\/10.3390\/ijerph13090911","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,9,13]]}}}