Date of Award

Summer 8-15-2015

Author's School

Graduate School of Arts and Sciences

Author's Department


Degree Name

Doctor of Philosophy (PhD)

Degree Type



Introduction: Pediatric overweight and obesity is a public health crisis, affecting one third of children and over two thirds of adults in the United States (US). The US Preventive Services Task Force (USPSTF) recommends screening for obesity and offering intensive or specialty lifestyle intervention or referral. Recent analyses revealed a family-based social facilitation weight loss maintenance intervention delivered at high intensity (“SFM-High”) resulted in significantly greater change in children’s percent overweight at 1-year compared to lower intensity conditions (Wilfley et al., in preparation). Thus, the purpose of this dissertation is to conduct the first cost-effectiveness analysis of the recommended treatment strategy, SFM-High, compared to standard care for obesity (i.e., no treatment control, “NTC”) with a lifetime horizon. It was hypothesized that SFM-High would be cost-effective for the treatment of obesity in children and parents. Methods: Using TreeAge software, two cost-effectiveness decision trees were built to evaluate the incremental cost effectiveness of SFM-High (N=59 parent-child dyads) compared to NTC for the treatment of obesity. The incremental costs of SFM-High compared to NTC were divided by the incremental effectiveness to estimate the incremental cost-effectiveness ratio (ICER), which provides a metric for the resources required (i.e., dollars) to obtain a unit of effectiveness (i.e., life years gained). If a treatment is considered dominant, it is less costly and more effective than the comparative strategy. Results: The ICER for treating children with SFM-High compared to NTC was $17,877 per life year gained. The ICER for treating adults with SFM-High compared to NTC was dominant. Approximating the cost-effectiveness of treating children and parents using the family-based SFM-High intervention showed that the ICERs for treating the child and treating the parent were dominant compared to NTC. Conclusions: Results of the present analyses show that the family-based SFM-High intervention is cost-saving for the treatment of obesity in children and parents. As such, the present results provide an important, initial quantification of the costs and benefits of obesity intervention, offer preliminary optimism regarding the cost savings of a family-based social-facilitation weight loss maintenance intervention approach, and indicate areas for future study.


English (en)

Chair and Committee

Denise E Wilfley

Committee Members

Brian D Carpenter, Su-Hsin Chang, Leonard Green, Thomas F Oltmanns, Ramesh Raghavan,


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