Version 2.0 [Last updated 11/01/2022]
About
The CHOICES National Action Kit provides a menu of strategies with good evidence that they can reduce excess weight gain, improve nutrition and physical activity environments, and promote related health behaviors. The CHOICES team has projected the national population reach, impact on health, implementation costs, health care cost savings, and health equity (when relevant data is available) for effective policies and programs that can be used in schools, early care and out-of-school settings, communities, and clinics. The kit allows you to compare up to four strategies at a time to help inform your organization’s decision-making around promoting healthy weight. Learn more about our methods.
Individuals whose work focuses on promoting healthy weight, healthy eating, and active living in the United States can use the kit to:
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- Compare strategies to understand differences among them in the numbers of people they reach, implementation costs, impact on health, cost-effectiveness, and health equity (when relevant data are available)
- Compare strategies that influence key health behaviors (like reducing sugary drink consumption) or by age group within a given setting or across settings.
- Understand implementation considerations for each strategy (e.g., the potential policy mechanisms that could be used or the activities and resources that are required for implementation)
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Information & Frequently Asked Questions
Background Information
Why does CHOICES focus on children?
Why does CHOICES focus on obesity and BMI?
Methods
How did CHOICES choose these strategies?
What is not included in the CHOICES model?
Results
What metrics does CHOICES report and what do they mean?
How do I interpret modeling projections?
What is needed to implement these strategies?
Why are some of the values in the results table noted as “cost-saving”?
How can I share the results of a comparison?
How can I apply national model results to my state or local area?
What other details should I consider when prioritizing strategies to promote healthy weight with decision-makers and key partners?
General
Why does the Action Kit ask for my personal information?
Do you need help using the Action Kit?
Background Information
Why does CHOICES focus on children?
Having excess weight has clear implications for health and health care costs. According to our recent research (Ward et al., N Engl J Med, 2017), more than half of today’s children will have obesity when they are adults. People with obesity are at an increased risk for an array of serious diseases and health conditions, including heart disease, type 2 diabetes, asthma, cancer, and reduced quality of life. Children with obesity are more likely to have obesity when they are adults, so early prevention is key.
Adults with obesity and severe obesity incur on average about $2,000 and $3,000 each year in additional health care costs, respectively. Children with obesity also incur more health care costs than children without obesity (about $100 and $300 annually for children with obesity and severe obesity, respectively).
Why does CHOICES focus on obesity and BMI?
Excess body weight is associated with reduced quality of life, many chronic diseases, and early death. Obesity is a chronic health condition recognized by the National Institutes of Health, the American Medical Association, Medicare, and Medicaid. Obesity is a category of excess weight defined by body mass index (BMI), which is calculated as the ratio of a person’s weight (kg) to their height squared (m2). BMI is used to define obesity for adults and children aged 2 years and older. CHOICES uses a wide array of data sources on obesity and BMI to evaluate the cost-effectiveness of policies and programs aimed at promoting a healthy weight across all age groups and BMI levels.
NOTE: While the term “obesity” and BMI as a measurement are used widely in medical and scientific research, they are not always the most appropriate terms to use, especially depending on the audience. Using the word obesity can promote stigma, blame, and may unintentionally reinforce misconceptions about the condition. BMI is not a perfect measure of an individual’s health but is a useful and widely available measure for studying and assessing excess weight gain in populations. We use these terms in certain places throughout this tool, our site, and our work when sharing direct findings from our research. We use destigmatizing language whenever possible. Always consider your audience first when selecting terms and developing messaging.
References
Centers for Disease Control and Prevention. Overweight & Obesity: Consequences of Obesity. Accessed May 16, 2022. https://www.cdc.gov/obesity/basics/consequences.html
Methods
How did CHOICES choose these strategies?
The strategies presented in the CHOICES National Action Kit come from a menu of strategies that our team, in consultation with key partners and our expert advisory group, has identified as having high-quality evaluations and strong evidence for effectiveness for
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- reducing excess weight gain and/or
- improving behavioral risk factors for excess weight (such as reduced sugary drink intake, increased physical activity, and/or decreased screen time).
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CHOICES has published cost-effectiveness results for each of these strategies in peer-reviewed journals (Kenney et al., Child Obes, 2021, Kenney et al., Obesity (Silver Spring), 2019, Sharifi et al., Pediatrics, 2017, Cradock et al.,Prev Med, 2016, Gortmaker et al., Health Aff, 2015). Additional strategies will be added to the kit once CHOICES model results have been published. Learn more about our methods.
How does CHOICES project impacts of strategies on population health?
CHOICES projects the impacts of strategies on population health using a computer model of the U.S. population that projects BMI changes and health outcomes over time. CHOICES uses information on the economic costs and health effects of interventions based on structured reviews of evidence and available data. Learn more about our methods.
What is not included in the CHOICES model?
The CHOICES team recognizes that many of these strategies will have additional benefits beyond helping individuals achieve a healthy weight. The health behaviors that CHOICES strategies address impact additional outcomes that are important for children’s well-being.
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- Reducing sugary drink consumption can prevent type 2 diabetes (independent of changes in body weight), as well as tooth decay.
- Increasing children’s physical activity will likely also have positive benefits related to improved bone health, aerobic and muscular fitness, cognition, and academic performance. Learn more about increasing children’s physical activity.
- Decreasing noneducational screen time can leave more time to develop important skills and can improve adolescents’ social-emotional skills and sleep.
- Increasing water intake is a critical way to ensure proper hydration.
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CHOICES measures changes in these health behaviors. We do not measure changes in outcomes not related to healthy weight because it is beyond the scope of the CHOICES model. CHOICES cost-effectiveness measures can be used along with other key considerations about feasibility and impacts in a local context to prioritize strategies to promote a healthier weight among children.
Results
What metrics does CHOICES report and what do they mean?
CHOICES reports multiple metrics for the available strategies in this tool. See the CHOICES National Action Kit Modeled Outcomes Glossary for a list and description of the metrics reported in this tool. Effects of strategies on health behaviors related to weight are reported when the strategy aims to improve a health behavior and data are available to quantify improvements in health behavior. Health behaviors that some strategies focus on include:
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- Sugary drink intake
- Physical activity
- Time spent watching TV
- Water intake
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How do I interpret modeling projections?
Modeling projections are made for a particular model period. This is the timeframe for which individuals in the model are followed to make projections of future impacts. In the CHOICES model, results are typically estimated for a 10-year period which covers a recent or the current year and projects 10 years into the future. As new data become available, the model inputs and assumptions may change over time, and new simulations may update the model period to be more relevant for current decision makers. In the past, the CHOICES model was often updated every one to two years to reflect the most recent available data. However, as the COVID-19 pandemic interrupted the data collection activities of various sources that the CHOICES model uses, more recent data are limited. As new data become available in the future, the model will be updated to account for the impact of the pandemic.
What is needed to implement these strategies?
To learn more about the activities, resources, and leadership needed for implementation of each strategy, click “More Info” in the results table and then select “Download PDF” under the “Strategy Profile” header. The strategy profiles have information that could be useful for planning and prioritization purposes.
Why are some of the values in the results table noted as “cost-saving”?
In most cases, a strategy is reported as “cost-saving” because projections show that health care costs saved due to reductions in excess weight would be greater than the implementation costs. Cost-saving interventions are relatively uncommon and hold special interest decision makers. Exceptions are noted in the footnotes and detailed strategy descriptions that can be accessed by clicking on “More Info” in the results table.
How can I share the results of a comparison?
You can export your comparison of strategies as a PDF. You can then either print or electronically share the comparison with others to aid in decision-making related to strategies to promote healthy weight.
How can I apply national model results to my state or local area?
National model results can be used to compare the impacts of strategies and to identify strategies that could be the best value for money in your state or local area. National results do not show how many people could be reached by a strategy in your area alone, and they do not account for potential differences in how a strategy might be implemented in your area. However, comparing national strategy results can inform decision-making in your state or local area. Here are some examples.
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- Compare “Population Reach” of multiple strategies to see which might reach the most people in your area.
- Compare “Obesity Prevented”, “Child Obesity Prevented”, or “Obesity Years Prevented” of multiple strategies to see which might have the biggest impact on levels of excess weight in your area.
- Compare “Intervention Cost per Person” of multiple strategies to see which might be the least expensive to implement per person in your area.
- Compare “Health Care Costs Saved per $1 Invested” of multiple strategies to see which might be cost-saving or save the most in future health care costs per dollar invested in your area.
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What other details should I consider when prioritizing strategies to promote healthy weight with decision-makers and key partners?
The CHOICES team projects the impacts of strategies on overall population health. In addition to the cost-effectiveness measures described in the CHOICES model, you might also consider:
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- What will interest organizations/people who are part of an area’s efforts to promote healthy weight
- Whether organizations/people who would be implementing a particular strategy can participate in the decision-making process
- Whether those who have the authority to make a change or provide information to inform decision-making are involved in considering the information about a particular strategy
- Whether it would make sense to pair one strategy with another during decision-making – for example, pairing a strategy that has the potential to generate revenue, such as a sugary drink excise tax, with a strategy that requires an investment, such as one in an early care setting
- What is the effect of the strategy on health equity?
- How could the strategy improve racial/ethnic and/or socioeconomic health equity in the population?
- Is there equity in access to, or utilization of, the specific strategy? For example, consider whether only individuals with high income will be able to access the strategy.
- How acceptable is the strategy?
- Is the strategy acceptable to the various individuals and groups affected by the strategy (children and adolescents, parents and caregivers, teachers, the general community, third-party funders, health service providers, government, and the private sector)?
- Do key groups that would be implementing the strategy see it positively?
- Are there examples of successful implementation?
- How feasible is the strategy?
- Is there expertise available to support implementing the strategy on a state or local scale?
- How much will the strategy cost, and who will have to pay to implement?
- What is the time scale for implementation?
- How sustainable is the strategy?
- How much ongoing funding support is required?
- How much community empowerment, capacity building, and level of policy support is likely to be achieved?
- What is the likelihood of required changes in behaviors, practices, and attitudes being achieved on an ongoing basis?
- Are there side effects or unintended consequences of the strategy?
- What are the both the positive and negative impacts of this strategy on:
- other health outcomes (e.g., anxiety/depression stemming from stigmatization)?
- environmental outcomes (e.g., less pollution/congestion)?
- other economic consequences (e.g., impact on industry)?
- What are the both the positive and negative impacts of this strategy on:
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Some of our partners have taken steps to implement the strategies that they’ve modeled with us:
General
Why does the Action Kit ask for my personal information?
After you have selected strategies and clicked the “Build Comparison” button, you will be asked to share some information. This helps the CHOICES team know who is using the tool (organization type) and where a user is from (location). The provision of any additional information is optional.
Do you need help using the Action Kit?
Contact the CHOICES team at choicesproject@hsph.harvard.edu with any questions.
Contributors
Funding
This work has been supported by grants from The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention, or other funders.