El trasfondo económico de las intervenciones sanitarias en la prevención de la obesidad

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Abstract

Aunque hay dificultades metodológicas, organizativas y económicas para evaluar el coste-efectividad de las políticas contra la obesidad, es necesario conocer la rentabilidad social de los recursos que la sociedad destina a afrontar la epidemia. Este artículo revisa de forma ordenada los argumentos económicos relacionados con dichas políticas, y presenta una revisión de la literatura sobre los costes macro de la enfermedad y sobre la efectividad y el coste-efectividad de las intervenciones individuales y comunitarias contra la obesidad.

Translated abstract

In spite of methodological, organizational and economical difficulties, it is necessary to evaluate the cost-effectiveness of obesity prevention policies and the resources that society allocates to fighting this epidemic. This paper reviews the economic reasoning behind these policies and presents a review of the scientific literature on the economic burden of disease and on the cost-effectiveness of individual and community interventions to prevent obesity.

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A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity.

Timothy Frayling, Nicholas J Timpson, Michael N. Weedon … (2007)

Obesity is a serious international health problem that increases the risk of several common diseases. The genetic factors predisposing to obesity are poorly understood. A genome-wide search for type 2 diabetes-susceptibility genes identified a common variant in the FTO (fat mass and obesity associated) gene that predisposes to diabetes through an effect on body mass index (BMI). An additive association of the variant with BMI was replicated in 13 cohorts with 38,759 participants. The 16% of adults who are homozygous for the risk allele weighed about 3 kilograms more and had 1.67-fold increased odds of obesity when compared with those not inheriting a risk allele. This association was observed from age 7 years upward and reflects a specific increase in fat mass.

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The spread of obesity in a large social network over 32 years.

Nicholas Christakis, James H Fowler (2007)

The prevalence of obesity has increased substantially over the past 30 years. We performed a quantitative analysis of the nature and extent of the person-to-person spread of obesity as a possible factor contributing to the obesity epidemic. We evaluated a densely interconnected social network of 12,067 people assessed repeatedly from 1971 to 2003 as part of the Framingham Heart Study. The body-mass index was available for all subjects. We used longitudinal statistical models to examine whether weight gain in one person was associated with weight gain in his or her friends, siblings, spouse, and neighbors. Discernible clusters of obese persons (body-mass index [the weight in kilograms divided by the square of the height in meters], > or =30) were present in the network at all time points, and the clusters extended to three degrees of separation. These clusters did not appear to be solely attributable to the selective formation of social ties among obese persons. A person's chances of becoming obese increased by 57% (95% confidence interval [CI], 6 to 123) if he or she had a friend who became obese in a given interval. Among pairs of adult siblings, if one sibling became obese, the chance that the other would become obese increased by 40% (95% CI, 21 to 60). If one spouse became obese, the likelihood that the other spouse would become obese increased by 37% (95% CI, 7 to 73). These effects were not seen among neighbors in the immediate geographic location. Persons of the same sex had relatively greater influence on each other than those of the opposite sex. The spread of smoking cessation did not account for the spread of obesity in the network. Network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties. These findings have implications for clinical and public health interventions. Copyright 2007 Massachusetts Medical Society.

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Does social class predict diet quality?

Nicole Darmon, Adam Drewnowski (2008)

A large body of epidemiologic data show that diet quality follows a socioeconomic gradient. Whereas higher-quality diets are associated with greater affluence, energy-dense diets that are nutrient-poor are preferentially consumed by persons of lower socioeconomic status (SES) and of more limited economic means. As this review demonstrates, whole grains, lean meats, fish, low-fat dairy products, and fresh vegetables and fruit are more likely to be consumed by groups of higher SES. In contrast, the consumption of refined grains and added fats has been associated with lower SES. Although micronutrient intake and, hence, diet quality are affected by SES, little evidence indicates that SES affects either total energy intakes or the macronutrient composition of the diet. The observed associations between SES variables and diet-quality measures can be explained by a variety of potentially causal mechanisms. The disparity in energy costs ($/MJ) between energy-dense and nutrient-dense foods is one such mechanism; easy physical access to low-cost energy-dense foods is another. If higher SES is a causal determinant of diet quality, then the reported associations between diet quality and better health, found in so many epidemiologic studies, may have been confounded by unobserved indexes of social class. Conversely, if limited economic resources are causally linked to low-quality diets, some current strategies for health promotion, based on recommending high-cost foods to low-income people, may prove to be wholly ineffective. Exploring the possible causal relations between SES and diet quality is the purpose of this review.

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Journal

Journal ID (publisher-id): resp

Title: Revista Española de Salud Pública

Abbreviated Title: Rev. Esp. Salud Publica

Publisher: Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )

ISSN (Print): 1135-5727

ISSN (Electronic): 2173-9110

Publication date (Print and electronic): February 2009

Volume: 83

Issue: 1

Pages: 25-41

Affiliations

[01] Las Palmas de Gran Canaria orgnameUniversidad de Las Palmas de Gran Canaria

Article

Publisher ID: S1135-57272009000100003 Publisher ID: S1135-5727(09)08300100003

DOI: 10.1590/s1135-57272009000100003

SO-VID: fe6a28df-26ef-425d-8423-4b401275d62e

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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El trasfondo económico de las intervenciones sanitarias en la prevención de la obesidad Translated title: The economic implications of interventions to prevent obesity

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Abstract

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Most cited references 204

A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity.

The spread of obesity in a large social network over 32 years.

Does social class predict diet quality?

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Cited by 11

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