Improvements for these measures include more validity testing and reporting (particularly with subpopulations of interest) and the reporting of both perceived and objective environmental measures. Some policy assessment methods exist, but they are often time-intensive, legislation language can be difficult to interpret, and enactment of a policy does not always equal implementation.
McKinnon recapped measurement techniques and methods presented at the workshop, and reiterated the importance of choosing a study design that focuses on answering the right questions. Measurement techniques included survey instruments, GIS, and diaries, as noted above. Methods included health impact assessment and economic methods. McKinnon provided additional context when summarizing the portion of the workshop covering those methods.
The impact of obesity on health and related costs is great. It has been estimated that 14 to 20 percent of cancer deaths are attributable to obesity (Calle et al., 2003), and the link between obesity and many other diseases, such as type II diabetes and cardiovascular disease, is well established. Obesity is estimated to be responsible for $147 billion in health care costs annually (Finkelstein et al., 2009). Researchers also have estimated that increased obesity rates are responsible for 27 percent of the rise in health care costs (Thorpe et al., 2004), having a greater impact than either smoking or problem alcohol consumption (Sturm, 2002). There are other costs of obesity to society as well, resulting from increased disability and absenteeism and reduced productivity (Finkelstein et al., 2005). It may be important to remind the public health community that there are other outcomes of interest besides health. Cost/benefit analysis can show that health, health care, and related costs are not the only outcomes to consider, and also that interventions may have unexpected associated costs and benefits. On the other hand, as discussed in Chapter 4, the claim that reducing obesity rates will reduce overall costs may be questioned. The public health community might benefit instead from analysis of value (in terms of health outcomes) for money spent that can be used to compare the effectiveness of one intervention versus another.
Partner organizations that reach a broad array of audiences and communities may be helpful in gathering data, as well as disseminating results. Data and policies from the worlds of transportation, urban planning, parks and recreation, and many other sources are important to obesity researchers.