• Elena Milkovska and Pieter Hm van Baal.
• Erasmus School of Health Policy & Management (ESHPM), Department of Health Economics, Erasmus University Rotterdam, the Netherlands. Electronic address: milkovska@eshpm.eur.nl.
• Prev Med. 2023 Oct 1; 175: 107700107700.

ObjectiveBulgarian government efforts to tackle obesity are focused mainly on guidelines affecting children. However, it is unclear whether targeting children for obesity-related health policies yields better long-term health outcomes as opposed to changing the risk of obesity in adulthood. This study aims to evaluate where policy efforts should be directed to alleviate the health burden associated with obesity.MethodsWe compare the impact on population health of two simulated scenarios when (a) the prevalence of obesity upon entering adulthood is lowered; (b) the risk of getting an unhealthy weight as an adult is reduced. Additionally, we run (c) combinations of the two and (d) childhood obesity prevention on the one hand, and worsening (increasing) obesity incidence later in adulthood on the other.ResultsOur findings show that obesogenic environmental changes throughout adulthood have a stronger effect on life expectancy (LE), diabetes-free life expectancy (DFLE) and type 2 diabetes prevalence outcomes compared to lowering the proportion of individuals with obesity during adolescence. Nevertheless, a sizable reduction in the number of young adults with unhealthy weight has the potential to recover years of LE/DFLE that would be lost if the risk of obesity in adulthood would continue to grow in time.ConclusionsThe two types of policies' (a-b) effects are not equivalent in strength and the best way forward is dependent on future obesity incidence trends.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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