An economic exploration of obesity, quality of life and consumer preferences

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This thesis explores aspects of obesity using economic methods. Specifically, the research provides insight into the issues of conducting economic evaluations of obesity interventions, the relationship between quality of life (QoL) and weight change, and consumer preferences for weight loss programs and future health benefits. The thesis comprises five studies. The first reviews current economic evaluations of interventions to reduce obesity. This study demonstrates that claims of cost-effectiveness are often overstated, with inadequate documentation and questionable modelling. In particular, the modelling approaches inherently assume that individuals gain QoL when weight is lost, even though this has not been demonstrated. The next two studies examine the relationship between obesity and QoL using a national panel data set of 19,914 individuals – the Household Income and Labour Dynamics Australia (HILDA) survey. The cross-sectional analysis supports previous research findings that obese individuals have a lower QoL relative to normal weight individuals. However, the longitudinal analysis demonstrates that reductions in body weight do not correspond to short-term improvements in QoL. Instrumental variable analysis suggests that the impacts on QoL may be mediated through poorer mental health that persists after weight loss. In the fourth study, a discrete choice experiment was developed to elicit preferences between two hypothetical weight-loss programs. An online panel was used to recruit over 1,800 respondents, representative of the Australian population. Respondents preferred lower-cost individually-tailored exercise programs. Surprisingly, programs that led to an improvement in QoL were highly significant, relative to weight-loss alone. This result reinforces the need for a greater focus on QoL outcomes. Preferences were generally similar across weight groups. The final study explores the idea that obese individuals may have different rates of time preference. A multiple staircase approach was used across four different scenarios; the results did not support the theory that obese individuals are more present-focused. However, the results did suggest that obese individuals may discount health and money differently. Overall, the social and economic burden of obesity is a major public health concern and developing interventions and assessing their outcomes is important in addressing the current obesity epidemic. The results from this thesis demonstrate that there is an important association between obesity and QoL. However, the trade-offs for individuals who are overweight or obese are complex and multifaceted.
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