SC Connecticut News

In two new studies, Yale researchers evaluated the cost-effectiveness of a pediatric obesity intervention and identified barriers to its implementation, aiming to improve access to effective treatments for childhood obesity. Obesity affects over one in five children in the United States, yet recommended interventions remain limited in availability.

"We have treatment options that work," said Mona Sharifi, an associate professor of pediatrics at Yale School of Medicine and author of both studies. "But we have these systematic barriers to access that we need to address rapidly."

The studies were published on August 28 in the journal Obesity. They coincide with a proposal under consideration by the Centers for Medicare and Medicaid Services (CMS) for a new billing code. This code would enable health insurance reimbursement for intensive health behavior and lifestyle treatment interventions for childhood obesity.

Previous research indicates that comprehensive, family-centered nutrition and behavioral education programs are effective when they provide at least 26 contact hours with families over 3 to 12 months. These programs are recommended by both the U.S. Preventative Service Task Force and the American Academy of Pediatrics.

Cost is a significant concern affecting healthcare programs, including obesity treatments. In the first study, Sharifi and colleagues assessed costs associated with implementing the Healthy Weight Clinic intervention in federally qualified health centers (FQHCs). The clinic provides intensive health behavior and lifestyle treatment consistent with guidelines from the American Academy of Pediatrics.

The researchers focused on FQHCs because they serve underserved communities disproportionately affected by obesity disparities. They broke down the intervention into its smallest components—personnel, materials—and determined their costs, also considering time, transportation, and childcare expenses incurred by families.

Using a model simulating patients over ten years, they estimated that if Healthy Weight Clinics were available in all FQHCs, 888,000 children could be reached, preventing 12,100 cases of obesity and 7,080 cases of severe obesity. Costs were estimated at $667 per child reached—$456 paid by healthcare sectors and $211 incurred by families—with potential savings of approximately $14.6 million in healthcare costs due to reduced obesity cases.

“It’s a relatively low-cost intervention that our study team previously found to be effective,” said Sharifi. “And given the populations federally qualified health centers serve, our findings also project that scaling up this intervention could mitigate health inequities affecting underserved populations.”

The second study examined another intervention through dissemination of Smart Moves curriculum from Yale's Bright Bodies program. Previous research has shown Bright Bodies is effective at improving health outcomes in children with obesity or overweight while being cost-saving compared to usual clinical care.

From 2003 to 2018, SmartMoves was disseminated to over 30 U.S.-based sites. The study collected experiences from staff at those sites identifying factors facilitating implementation and barriers hindering success. Local partnerships with schools and exercise facilities were strong facilitators while funding insecurity was a significant barrier often leading to failed implementation or sustainability efforts.

"When a child breaks their arm...the clinic or hospital bills their insurance company," explained Sharifi. "This model doesn’t work as well for health behavior and lifestyle treatment programs...Programs often rely on grants but grants run out leaving communities lacking access."

To address this issue several organizations submitted an application for a new billing code which CMS will deliberate over coming months.

"If approved...it would open the door to funding...and give families more options," said Sharifi adding policy change is needed ensuring first-line treatment accessibility nationwide stating “Expanding access is an urgent need...not providing equitable access…is unethical.”