1. ^*Department of Community Health Sciences, University of Calgary, Calgary, Canada;
2. ^†Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
3. ^‡Department of Economics and Centre for Health Services Research, Centre for Health Services Research and Business School (Economics), University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom.

Correspondence: Larissa Roux Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 5612 Elm Street, Vancouver, British Columbia V6N-1A4, Canada. E-mail: lpr9@cdc.gov

^*The costs of publication of this article were defrayed, in part, by the payment of page charges. This article must, therefore, be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Received 1 March 2005; Revised  0000; Accepted 20 March 2006.

Abstract

Objective: To conduct a clinical and economic evaluation of outpatient weight loss strategies in overweight and obese adult U.S. women.

Research Methods and Procedures: This study was a lifetime cost-use analysis from a societal perspective, using a first-order Monte Carlo simulation. Strategies included routine primary care and varying combinations of diet, exercise, behavior modification, and/or pharmacotherapy. Primary data were collected to assess program costs and obesity-related quality of life. Other data were obtained from clinical trials, population-based surveys, and other published literature. This was a simulated cohort of healthy 35-year-old overweight and obese women in the United States.

Results: For overweight and obese women, a three-component intervention of diet, exercise, and behavior modification cost $12,600 per quality-adjusted life year gained compared with routine care. All other strategies were either less effective and more costly or less effective and less cost-effective compared with the next best alternative. Results were most influenced by obesity-related effects on quality of life and the probabilities of weight loss maintenance.

Discussion: A multidisciplinary weight loss program consisting of diet, exercise, and behavior modification provides good value for money, but more research is required to confirm the impacts of such programs on quality of life and the likelihood of long-term weight loss maintenance.