title: Time, monetary and other costs of participation in family-based child weight management interventions: qualitative and systematic review evidence.
abstract: BACKGROUND
  Childhood overweight and obesity have health and economic impacts on individuals and the wider society. Families participating in weight management programmes may foresee or experience monetary and other costs which deter them from signing up to or completing programmes. This is recognised in the health economics literature, though within this sparse body of work, costs to families are often narrowly defined and not fully accounted for. A societal perspective incorporating a broader array of costs may provide a more accurate picture. This paper brings together a review of the health economics literature on the costs to families attending child weight management programmes with qualitative data from families participating in a programme to manage child overweight and obesity.
  
  
  METHODS
  A search identified economic evaluation studies of lifestyle interventions in childhood obesity. The qualitative work drew on interviews with families who attended a weight management intervention in three UK regions.
  
  
  RESULTS
  We identified four cost-effectiveness analyses that include information on costs to families. These were categorised as direct (e.g. monetary) and indirect (e.g. time) costs. Our analysis of qualitative data demonstrated that, for families who attended the programme, costs were associated both with participation on the scheme and with maintaining a healthy lifestyle afterwards. Respondents reported three kinds of cost: time-related, social/emotional and monetary.
  
  
  CONCLUSIONS
  Societal approaches to measuring cost-effectiveness provide a framework for assessing the monetary and non-monetary costs borne by participants attending treatment programmes. From this perspective, all costs should be considered in any analysis of cost-effectiveness. Our data suggest that family costs are important, and may act as a barrier to the uptake, completion and maintenance of behaviours to reduce child obesity. These findings have implications for the development and implementation of child weight initiatives in particular, in relation to reducing inequalities in health.
authors: School of Health and Social Care, Teesside University, Borough Road, Middlesbrough, United Kingdom.
authors: Lisa
authors: L
authors: Arai
authors: Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, United Kingdom.
authors: Monica
authors: M
authors: Panca
authors: Department of Applied Health Research, University College London, 1-19 Torrington Place, London, United Kingdom.
authors: Steve
authors: S
authors: Morris
authors: School of Health Sciences, City University London, Northampton Square, London, United Kingdom.
authors: Katherine
authors: K
authors: Curtis-Tyler
authors: School for Policy Studies, University of Bristol, Bristol, United Kingdom.
authors: Patricia J
authors: PJ
authors: Lucas
authors: University College London Institute of Child Health, London, United Kingdom.
authors: Helen M
authors: HM
authors: Roberts
mesh_terms: D001835:Body Weight; D003362:Cost-Benefit Analysis; D004032:Diet / Q000191:economics; D005069:Evaluation Studies as Topic; D006801:Humans; D063766:Pediatric Obesity / Q000178:diet therapy* / Q000191:economics / Q000473:pathology; D013997:Time Factors