Equitability of Individual and Population Interventions to Reduce Obesity: A Modeling Study in Mexico

Abstract

Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.