The health economics of obesity in Ireland

An abundant literature exists linking obesity to a range of health conditions as well as premature mortality (Calle et al., 1999, Larsson et al., 1984, Jagielski et al., 2014, Kearns et al., 2014, Pi-Sunyer, 1999, Reilly et al., 2003, Garrow, 1999, Guh et al., 2009). Excessive body weight has also been linked with a range of psycho-social issues inlcuding low self esteem, stigmatisation, discrimination and a range of mental health problems (Puhl and Brownell, 2003, Dove et al., 2009, Ozmen et al., 2007). The rising prevalence of obesity and the consequences in terms of health and wellbeing as well as economic welfare have prompted this thesis. Rather than providing an exhaustive examination of one specific issue this thesis seeks to explore a number of inter-related issues to demonstrate the breadth to which obesity impacts on lives and the complexity of the interrelationships those impacts can have. This thesis examines the role of different adiposity measurements in determining the relationship between obesity and service use in Ireland, what factors influence the values attached to alternative treatment modalities as well as how we infer cost effectiveness from other jurisdictions and what impact obesity has upon children in the school environment. .2020-05-1

Exploring the relationship between breastfeeding and the incidence of infant illnesses in Ireland: evidence from a nationally representative prospective cohort study

Abstract Background Ireland has one of the lowest BF rates in the world. This study investigates the association between breastfeeding and infant health in Ireland. Methods A cross-sectional, secondary analysis of data collected from Growing Up in Ireland (GUI): the National Longitudinal Study of Children was conducted. The average morbidity for 2212. infants exclusively breastfed for at least 90 days (EBF90days) was compared to data for 3987 infants in the non-breastfed (Non-BF) group. Data were weighted using entropy balancing to ensure the comparability of groups. Sensitivity analyses considered alternative definitions of the breastfeeding group. Results Infants who were EBF90days were significantly less likely to be admitted to hospital (CI: − 0.06 to − 0.03), spent less nights in hospital (CI: − 0.37 to − 0.11), and were less likely to develop respiratory diseases including asthma (CI: − 0.03 to − 0.01), chest infections (CI: − 0.12 to − 0.08), snuffles/common colds (CI: − 0.07 to − 0.02), ear infections (CI: − 0.08 to − 0.04), eczema (CI: − 0.08 to − 0.04), skin problems (CI: − 0.04 to − 0.00), wheezing or asthma (CI: − 0.06 to − 0.03), vomiting (CI: − 0.03 to − 0.00), and colic (CI: − 0.04 to − 0.01). Further outcomes such as current health of the infant at time of interview (CI: − 0.04 to − 0.00), feeding problems (CI: − 0.04 to − 0.02) and sleeping problems (CI: − 0.02 to − 0.00) indicated a protective effect of EBF90days versus Non-BF. However, these infants were also more likely to fail to gain weight (CI: 0.01 to 0.02) and were at a slightly higher risk of developing nappy rash (CI: 0.00 to 0.02). Conclusion Exclusive breastfeeding for 90+ days is associated with protection against childhood morbidity. Given the protective effect of breastfeeding on adverse health effects in infants, policy makers should prioritise policies that support, promote and protect exclusive breastfeeding

Do mothers accurately identify their child’s overweight/obesity status during early childhood? evidence from a nationally representative cohort study

Background: Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child's weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old. Methods: Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese. Results: In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child's overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child's weight include gestation age, income and urban living. Conclusion: These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child's weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child's overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers' understanding of healthy body size in preschool aged children

Role of integrated knowledge translation in developing and implementing a multi-component infant feeding intervention: Insights from the CHErIsH study

This article provides an overview and insights from the process of using integrated knowledge translation in developing and implementing the Choosing Healthy Eating for Infant Health (CHErIsH) intervention. Integrated knowledge translation involves collaboration between researchers and research users in the research process, including shaping the research questions, interpreting the results and helping to disseminate the research results (Graham and Tetroe, 2009). The central premise of integrated knowledge translation is that involving knowledge users as equal partners alongside researchers will lead to research that is more relevant to, and more likely to be useful to, the knowledge users (Canadian Institutes of Health Research (CIHR), 2012).peer-reviewe

Influence of providing information to participants about development of trial outcomes on response rates and attitudes to questionnaire completion: Protocol for a study within a trial'

Background: Issues with questionnaire completion introduce bias and limit examinations in trials. Improving communication with participants about trial processes, such as outcome and questionnaire development, may improve questionnaire completion and response rates. Providing information about the involvement of stakeholders in the development of core outcome sets (COS) measured in trials may improve responding by tapping into subjective norms and behaviour change mechanisms. The aim of this Study Within a Trial (SWAT) is to examine if questionnaire response rates and participants’ attitudes towards questionnaire completion are impacted by providing information about COS use in a trial of a complex intervention. Methods: This is a randomised, single-blinded, parallel group intervention SWAT, embedded within a feasibility trial of an infant feeding intervention to prevent childhood obesity. The SWAT intervention consists of a brief written description and explanation about the development and use of a COS of infant feeding outcomes to prevent childhood obesity, used in the trial. Participants are parents or caregivers of infants aged two months at questionnaire completion. Participants will be randomly assigned to receive the SWAT intervention prior to questionnaire completion (SWAT Intervention), or not (SWAT Comparator). The primary outcome of interest is response rates, which will be measured as proportion of questionnaire completion and individual item response rates. Participants’ attitudes will also be assessed using closed-ended and an open-ended question to evaluate participants’ attitudes about questionnaire completion. Discussion: We hypothesise that providing information about development and use of a COS will increase questionnaire response rates and attitudes toward questionnaire completion relative to the control condition. Findings will indicate the potential usefulness of this strategy for improving participant attitudes and response rates in trials

Identification and expert panel rating of key structural approaches applied in health economic obesity models

Objectives: This study aims to assess the key structural modelling approaches applied in published obesity models, and to provide an expert consensus to improve the methodology and consistency of the application of decision-analytic modelling in obesity research. Methods: Using a previously published systematic literature search as basis, ten individual interviews, and a face-to-face expert panel meeting were conducted. Within the expert panel meeting, the interview findings were presented and discussed, rated and where possible consensus statements were obtained. In particular, five topics of interest were assessed: time horizon, model type, obesity-related clinical events simulated, event simulation approaches and external event validation. Results: In addition to generic modelling standards, several obesity-specific recommendations were generated: Simulating a lifetime horizon was regarded as optimal (100% agreement); Ideally, both short and long-term results should be presented (100%); Using a risk equation approach for simulating the clinical events was the most preferred approach (60%) followed by applying a body mass index (BMI) related relative risk to a base risk estimate (30%); Continuous BMI approaches were preferred (100%); An individual patient/microsimulation state transition model was regarded as preferred modelling approach (90%); Discrete event simulation (DES) was regarded as the most flexible approach for building an obesity model but it was recognised as complex, and more difficult to build, populate and to disseminate; Performing an external validation was rated as important (100%). Conclusions: The obtained insights, discussion and consensus can provide valuable information for developing decision-analytic models to generate high-quality and transparent economic evidence for obesity interventions. (C) 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved

Development of an infant feeding core outcome set for childhood obesity interventions: study protocol

Background: Childhood obesity is a significant public health challenge that affects approximately one in five children worldwide. Infant feeding practices are implicated in the aetiology of childhood obesity. Infant feeding interventions for childhood obesity are increasingly popular but outcome reporting is inconsistent across trials. Lack of standardisation limits examination of intervention effects and mechanisms of change. The aim of the current project is to develop a core set of infant feeding outcomes for children <= 1 year old, to be evaluated in childhood obesity intervention trials. Methods: This project will use similar methodology to previous core outcome development research. An infant feeding core outcome set (COS) will be developed in four stages: (1) a systematic review of the literature, (2) discussion and clarification of outcomes in a meeting involving multiple stakeholder perspectives, (3) prioritisation of outcomes using the Delphi technique with an expert panel of stakeholders, and (4) achieving consensus on the COS using the nominal group technique (NGT) consensus meeting. An online Delphi survey will be conducted following the NGT meeting to prioritise outcomes identified in the systematic review. An NGT meeting will be conducted with groups of health professionals, non-clinician researchers, and parents of infants <= 1 year old, to achieve final consensus on the infant feeding COS. Discussion: This study aims to develop a core outcome set of infant feeding outcomes for randomised infant feeding studies to prevent childhood obesity. This research will improve examination and syntheses of the outcomes of such studies to prevent and reduce childhood obesity