The objective of this report was to present new findings related to the costs and the efficiency of interventions aimed at tackling the rapid rise in the obesity epidemic by improving diets and increasing physical activity in low-income and middle-income countries. Governments in countries at different levels have implemented different public health strategies that use interventions such as school-based health promotion interventions, worksite health promotion interventions, mass media health promotion campaigns, counselling of individuals at risk in primary care, fiscal measures affecting the price of fruits and vegetables and foods high in fat, regulation of food advertising to children, and compulsory food labelling. It has been observed that interventions targeting adults start to generate health effects immediately after their implementation, and benefits are even faster for interventions that target high-risk individuals and age groups, such as primary-care-based counselling. Conversely, interventions targeting children, including regulation of food advertising and school-based health promotion, are unlikely to have any meaningful effects within populations for at least 40-50 years. Analyses presented in this report have shown that fiscal measures are consistently cost-saving in all low-income and middle-income settings and generate the largest health effects in both 20 years and 50 years. Food labelling is also cost-saving in many settings, but with smaller health effects than for fiscal measures. Regulation of food advertising to children and mass media health promotion campaigns have very favourable cost-effectiveness ratios. Worksite health-promotion initiatives also have good cost-effectiveness, with quicker health returns than those for advertising regulation. Physician counselling of individuals at risk in primary care is one of the most effective interventions. In addition, a multiple-intervention strategy would achieve substantially larger health gains than would individual interventions, often with an even more favourable cost-effectiveness profile. Thus, these findings suggest that several population-based prevention policies can be expected to generate much needed health gains while entirely or very largely paying for themselves through their reduction of future healthcare costs. These policies include health information and communication strategies that improve population awareness and behaviour about the benefits of healthy eating and physical activity. In their editorial comment, Beaglehole R and Horton R underlined the fact that even if there are science-based evidence of health gains and proven cost-effectiveness of preventive interventions for chronic disease, there is limited action in low- and middle-income countries where the obesity epidemic is rapidly rising. They therefore support the findings of the present report that showed the cost-effectiveness of implementing a package of measures to tackle unhealthy diets, physical inactivity, and obesity.
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