ACE-Obesity : priority setting for obesity prevention

The ACE-Obesity study uses an evidence-based approach to evaluate interventions aimed at reducing the prevalence of obesity in Australian youth. It informs decision-makers about the benefits of individual interventions and the packaging of a coherent strategy for obesity prevention and management. To avoid methodological confounding, the approach employs standardised methods including a two stage concept of benefit; a common comparator, setting and decision context; Australian data; and extensive probabilistic uncertainty testing. The technical cost-effectiveness results (cost per DALY) for each of the selected interventions will be reported. Modelling is undertaken to convert changes in behaviour to BMI outcomes and then to DALYs, and issues of the attribution of costs across multiple objectives arise. Due process is achieved by involving stakeholders on a Working Group, and by consideration of second stage filters (such as equity, acceptability and feasibility). The results are brought together in a 'league table' in which all the interventions are ranked in order of economic merit without the usual methodological concerns about results drawn from studies lacking in comparability. In packaging interventions to meet particular budget allocations, the divisibility, mutual exclusivity and returns to scale of individual interventions are considered, as well as issues of program logic, target group coverage and a range of settings.

Selection of priority groups for obesity prevention current approaches and development of an evidence-informed framework

Resources for obesity prevention interventions are inevitably limited, necessitating the selection of priority groups to ensure effective and equitable use of funds. This paper aims to review published approaches to selection of priority groups ('target populations') for obesity prevention, and to present the development of a new systematic framework for organizing and assessing evidence for selecting priority groups. A review was conducted of the process and justification described for selecting priority groups in a sample of obesity prevention publications. Using the results of this review and adaptation of theory and frameworks in both the obesity prevention and health promotion priority-setting literature, a framework was developed for assessment of potential priority groups for obesity prevention. The published literature lacks discussion of and explicit processes for selection of priority groups for obesity prevention intervention. The new framework describes specific types of evidence that should be considered in the assessment of a potential priority group for obesity prevention and has applications for funding and implementing community-based or settings-level obesity prevention interventions and research. Application of this framework has the potential to enhance the effective use of limited obesity prevention resources and to identify areas in need of additional research evidence.