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Multidisciplinary Approach to Obesity Management: A Case Report
Published on: May 30, 2025
Cost and effectiveness of treatment options for childhood obesity
S Hollinghurst1, L P Hunt, J Banks
1Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK.
Insights
Childhood obesity interventions vary in cost and effectiveness. The intensive Mandometer® approach showed significant results but at a higher price per body mass index standard deviation score (BMI SDS) reduction compared to standard care.
Area of Science:
- Pediatric Endocrinology
- Public Health Nutrition
- Health Economics
Background:
- Childhood obesity affects approximately 20% of UK children, with limited effective interventions.
- There is a scarcity of data on the cost-effectiveness of childhood obesity interventions, hindering service commissioning.
- Simple, multi-component interventions can be cost-effective for improving body mass index standard deviation score (BMI SDS).
Purpose of the Study:
- To compare the costs and outcomes of three distinct childhood obesity management models.
- To evaluate a hospital-based multidisciplinary team, a primary care nurse-led clinic, and an intensive behavioral intervention (Mandometer®).
- To assess the cost-effectiveness of these interventions in reducing BMI SDS in children over 12 months.
Main Methods:
- Two pilot randomized trials in England collected patient-level resource utilization data.
- Intervention costs were primarily driven by staff time, with Mandometer® having an additional equipment cost.
- Body mass index standard deviation score (BMI SDS) reduction at 12 months served as the primary outcome measure.
Main Results:
- Cost per child varied: Mandometer® (£1749), primary care (£301), and hospital clinics (£263, £209).
- Mean BMI SDS reductions were 0.40 for Mandometer®, 0.17 for primary care, and 0.15-0.14 for hospital clinics.
- Cost per 0.1 BMI SDS reduction was £432 for Mandometer® versus £153-£173 for conventional care.
Conclusions:
- The intensive Mandometer® intervention was effective in reducing BMI SDS but significantly more expensive than conventional care.
- Conventional care achieved a clinically meaningful BMI SDS reduction in 26% of children.
- Mandometer® may be a justifiable option for children unresponsive to standard lifestyle interventions.
Unlabelled:
What is already known about this subject Approximately one-fifth of children in the UK are obese. There are currently few, effective interventions available in the UK. There are very little data on relative cost-effectiveness of childhood obesity interventions, which hampers the commissioning of future services. What this study adds Simple multi-component obesity interventions can be provided at relatively low cost per 0.1 body mass index standard deviation score (BMI SDS) improvement. More intensive and effective interventions incur greater cost per 0.1 BMI SDS reduction but this may be justified given the improved overall BMI SDS reduction attained.
Objective:
To describe the costs and outcomes of three models of care for childhood obesity previously evaluated in two 2-arm pilot randomized trials in England. The treatments were (i) a hospital clinic (control in both trials), comprising a multidisciplinary team of consultant, dietitian and exercise specialist; (ii) a nurse-led primary care clinic replicating the service provided by the hospital and (iii) an intensive intervention using Mandometer®, a behaviour modification tool aimed at encouraging slower eating and better recognition of satiety.
Method:
Patient-level data on resources used to deliver each intervention were collected during the trials. Apart from the cost of the Mandometer® the majority of cost was staff time, dependent on discipline and grade. Outcome for both trials was body mass index standard deviation score (BMI SDS) measured at 12 months.
Results:
Cost and outcome data were available for 143 children in total. Cost per child was £1749 (SD £243) in the Mandometer® group, £301 (£76) in the primary care group, and £263 (£88) and £209 (£81) in the hospital groups. Mean reduction in BMI SDS was 0.40 (0.35), 0.17 (0.26), 0.15 (0.25) and 0.14 (0.32), respectively.
Conclusion:
Intensive management using Mandometer® was effective but costly (£432 per 0.1 reduction in BMI SDS) compared to conventional care (range £153-£173). A total of 26% children receiving conventional care achieved a clinically meaningful reduction in BMI SDS; however, use of Mandometer® training may be justified in children not responding to conventional lifestyle interventions.
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