Evaluation of the impact of the retail food environment, physical activity, and obesity on mortality and medical expenditures using simulation methods.

摘要

In recent decades public health efforts in the United States have shifted from a strong focus on the prevention of infectious disease to an emphasis on the prevention of chronic disease through public health investments. Consequently, there is an increasing need for better tools to assess the potential benefits of these public health investments, as these benefits may be less tangible, and occur further in the future than the benefits of programs to prevent infectious disease.;The purpose of this study was to develop a simulation model to estimate the long-term impact of physical activity and obesity on mortality and medical expenditures, and to use the model to evaluate the potential impact of changes in the food retail environment. To develop the simulation model, the impact of physical and obesity on medical expenditures was estimated for a nationally representative study, and these results were incorporated into the simulation model.;The analysis showed that the impact of obesity on medical expenditures has changed over a ten-year period, suggesting that the cost of obesity, while controlling for the level physical activity, is increasing over time. Moreover, overweight and obesity among young adults has a lasting impact into mid-life and beyond indicating that lowering obesity prevalence among young adults may lower future medical expenditures and improve life expectancy. Changes in the retail food environment may yield benefits in life years and reduced medical expenditures. However, there was substantial uncertainty around the impact estimates making it difficult to conclude whether the investments necessary to make changes in the retail food environment will have a positive benefit. Additional studies to examine the impact of the retail food environment on obesity are necessary to better evaluate the downstream impacts of new policies and programs.