Development and Validation of a Conceptual Epidemiological and Economic Model for Predicting Obesity in Low- and Middle-Income Countries: A Systematic Review and Meta-Synthesis–Informed Approach

Abstract Background Model-based epidemiologic and economic evaluations are widely accepted as decision-making tools. However, unlike in high income countries, there is little experience of healthcare policies based on evidence of obesity model in low- and middle-income countries (LMICs). The aim of this study was to develop and validate a conceptual epidemiological and economic model to predict obesity in LMICs. Methods The study was conducted in two phases consisting of a systematic review to identify relevant evidence, followed by a Delphi panel to achieve expert consensus. The systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out on MEDLINE, CINHAL and AMED, PubMed, and The Cochrane library and EconLit databases for publications in English from inception to December 2, 2024. Economic evaluation studies where they described an economic model of adult patients with/without obesity in which obesity progression was evaluated were eligible. Title and abstract, full text screening, and data extraction were conducted. Thematic analysis was applied to identify key domains, and this was helpful to develop a conceptual model of obesity in LMICs. The conceptual model was subsequently validated through a Delphi process involving expert consensus to ensure its relevance, completeness, and applicability. Results A total of 825 studies were identified, of which 31 met the inclusion criteria in the meta-synthesis. The model type of the included studies was Markov model (n = 23), decision tree (n = 2), discrete event simulation (n = 4), and combination of Markov model and decision tree (n = 2). These studies were published between 1997 to 2024 and were developed based on cohort and patient data. Six health states which include diabetes (n = 19), stoke (n = 14), cardiovascular (n = 14), normal weight (n = 10), overweight (n = 9), and obesity (n = 8) were thematically identified and validated. Conclusions This is the first study to develop and validate a conceptual epidemiological and economic model to predict obesity in LMICs. The model can be used to predict the prevalence and the economic burden associated with obesity to inform healthcare decisions to facilitate resource allocation for prevention and management of the condition in LMICs. Therefore, practitioners and policy makers are to be aware that adopting the model may help reduce the prevalence of obesity and the significant economic burden associated with the condition in resource limited settings such as LMICs.