counted for 27 percent of the rise in inflation-adjusted per-capita health care spending during that time period, of which spending for diabetes accounted for 38 percent of the increase; spending for hyperlipidemia accounted for 22 percent; and spending for heart disease accounted for 41 percent.

Based on 1998 to 2000 data from BRFSS, an estimated 5.7 percent of medical expenditures were attributable to obesity (Finkelstein et al., 2003, 2004). For the Medicare and Medicaid populations, the expenditure percentages were higher: 6.8 and 10.6 percent, respectively. The higher percentage for Medicaid recipients reflects the higher prevalence of obesity among individuals of lower socioeconomic status (SES). Among the states, the percentage of medical expenditures attributable to obesity ranged from 4.0 percent in Arizona to 6.7 percent in Alaska and the District of Columbia. In ten states, the percentage of Medicaid spending attributable to obesity was equal to or greater than 12 percent (Finkelstein et al., 2003, 2004).

Total health care spending for children who receive a diagnosis of obesity (a small subset of the 17.1 percent of U.S. children considered to be obese) is approximately $280 million per year for those with private insurance and $470 million per year for those covered by Medicaid. The national costs for childhood-related obesity (including those who do not receive a diagnosis) are estimated to be $11 billion for private insurance and $3 billion for those with Medicaid. The medical costs for a child who is treated for obesity are approximately three times higher than those for the average insured child (Thomson Medstat, 2006).

ISSUES IN ASSESSING PROGRESS

In response to the rising prevalence and economic costs of childhood obesity, efforts are increasingly being initiated to address this public health concern. However, these efforts are not being consistently evaluated thereby limiting the opportunity to learn from them. The opportunity and the responsibility at hand are the development of a robust evidence base that can be used to deepen and broaden childhood obesity prevention efforts.

Evaluation serves to foster collective learning, accountability, and responsibility, and to guide improvements in obesity prevention policies and programs. As further discussed in Chapter 2, the committee uses the term evaluation to denote a systematic assessment of the quality and effectiveness of an initiative, program, or policy. Evaluation results can be used to identify and scale up those efforts that are successful in achieving desirable outcomes (e.g., improving diets, increasing physical activity, reducing sedentary behaviors, and numerous other intermediate outcomes), refine those that need restructuring and adaptation to different contexts, and revamp or discontinue those found to be ineffective. Harnessing the resources needed



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