Impact of Public Health Interventions on Obesity and Type 2 Diabetes Prevention: A Simulation Study

Introduction: Little is known about what interventions worked or did not work in slowing the obesity epidemic. The long-term comparative effectiveness of environmental and behavioral public health interventions for obesity and type 2 diabetes prevention over an individual's life course is relatively unexplored. The potential impact and long-term collective effectiveness of environmental and behavioral interventions on obesity and type 2 diabetes throughout the life course was evaluated. Methods: The Virtual Los Angeles Obesity Model developed in 2016 was used to estimate the incidence and prevalence of obesity and type 2 diabetes under current and hypothetical interventions among 98,000 individuals born in 2009 and followed from birth to age 65 years. Analyses were performed in 2016 and completed in 2018. Results: The 48-year risk of type 2 diabetes was 0.533 (95% CI=0.446, 0.629) under the natural course, 0.451 (95% CI=0.334, 0.570) under the physical activity intervention, and 0.443 (95% CI=0.389, 0.495) under the fast-food intervention. The 64-year risk of obesity was 0.892 (95% CI=0.879, 0.903) under the natural course, 0.876 (95% CI=0.850, 0.899) under the physical activity intervention, and 0.864 (95% CI=0.856, 0.873) under the fast-food intervention. The other interventions had little or no long-term effects. When all the interventions were applied, the population risk ratios were 0.942 (95% CI=0.914, 0.967) and 0.634 (95% CI=0.484, 0.845) for obesity and type 2 diabetes, respectively. Conclusions: Implementing health interventions continuously throughout the life span and in combination with other interventions could substantially halt the obesity and the type 2 diabetes epidemics. (C) 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.