This month's newsletter is written by guest authors Ms. Caitlin P. Bailey and Dr. Melissa A. Napolitano. Ms. Bailey is a PhD student in the Department of Prevention and Community Health. Dr. Napolitano is a Professor in the Departments of Prevention and Community Health and Exercise and Nutrition Sciences at The George Washington University Milken Institute School of Public Health. Their current work centers around development and evaluation of healthy weight management programs for young adults.
Almost 20 million students are enrolled in colleges/universities in the US. Cost-effective methods for delivering weight management programs to young adults in higher education settings can provide individuals with important skills for lifelong health while producing population-level impact. However, there are a lack of cost-effectiveness analyses of weight management interventions in the literature to inform college/university decision-makers regarding adoption of such programs for students. More generally, weight loss programs remain relatively scarce on college/university campuses. This programming shortage is especially stark in comparison to other student service offerings (e.g., drug and alcohol use, sexual violence prevention) and may be due, in part, to a combination of institutional barriers (e.g., resources, coordination across departments, competing student health issues taking priority) and participant barriers (e.g., campus built-environment, busy schedules, stigma).
To address the deficit of weight management programming on college/university campuses, our team developed Healthy Body Healthy U (HBHU), a randomized controlled weight management trial designed for young adults in a university setting. In short, the HBHU trial tested two digitally-delivered weight management interventions: 1) a Tailored (or personalized) intervention or 2) a Targeted (or generic) intervention versus control. Trial outcomes indicated a moderating effect of baseline weight status such that the interventions were effective at promoting weight loss at 6 months among young adults with overweight. To demonstrate the value of such programming to university decision-makers, we further tested the cost-effectiveness of the intervention, which we believe is an important next step for all weight management programs seeking to inform and encourage program adoption among stakeholders and decision-makers.
Our analyses compared the cost-effectiveness of the Tailored versus Targeted treatment arms of the HBHU program at 6 months (the most intensive/costly phase of intervention delivery) from a university payer perspective, so that only university implementation costs, not participant costs (e.g., time), were evaluated. Based upon our findings, the full results of which are currently under review, we concluded that personalized technology-based programs are generally cost effective for promoting student weight loss and cardiometabolic health. After 6 months, Tailored participants lost approximately 1 kg and Targeted participants lost approximately 0.5 kg. The Tailored (versus Targeted) intervention cost $5.05 per kilogram lost, and was even lower ($2.28) when including only those with overweight and not obesity. These costs are comparable to other programs currently implemented on college/university campuses across the US. More than 1100 colleges and universities have required completion of programs targeting alcohol (i.e., Electronic Check-up to Go [e-CHUG] and AlcoholEdu), with an average cost of approximately $2.60 per student. Universities have prioritized alcohol and substance use reduction programs, with investments of $2 per student being returned in terms of reductions in health costs, injuries, and death.
Onset of obesity in young adults accounts for approximately half of adult obesity. The success of HBHU and its modest costs suggest that universities invest in weight management initiatives such as this to prevent and mitigate the onset of obesity in this vulnerable population.
Caitlin Bailey and Melissa Napolitano
Caitlin P. Bailey, MS
GW Milken Institute School of Public Health PhD Student
Tufts Friedman School of Nutrition Science and Policy '19
Melissa A. Napolitano, PhD
Fellow, Society of Behavioral Medicine
Professor | Prevention and Community Health & Exercise and Nutrition Science
GW Milken Institute School of Public Health