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CHOICES Discussion Paper: Cost-Effective Strategies to Prevent Obesity & Improve Health Equity

The information in this discussion paper is intended only to provide educational information.


We face growing prevalence of children and adults with obesity in the United States, and widening disparities by race, ethnicity, geography, and income. This growth is driven by many forces, including the marketing of foods and beverages that increase obesity risk as well as deeply rooted social and economic determinants and structural racism. This discussion paper is designed to help public health professionals and community members identify feasible and cost-effective intervention strategies that can prevent future obesity cases among children while improving health equity. We provide examples of such strategies in localities throughout the United States. We build on previous findings in CHOICES briefs that describe how Learning Collaborative Partnerships with health departments and their community partners, together with the CHOICES team, have assessed the future impact of a range of strategies on cases of obesity prevented and health equity. In all cases, the strategies have strong evidence for effectiveness and include: sugary drink excise taxes in Denver, Hawaii, California, and West Virginia; a clinical strategy to treat children with obesity in Denver; an intervention to reduce excess TV viewing in Oklahoma. Projections are made using the CHOICES microsimulation model, taking into account effectiveness of the intervention, expected reach in the population, evidence for intervention cost, and other relevant local data. Definitions of groups experiencing disadvantage and inequities were developed with local decision-makers and community members. Projected effectiveness is expressed as cases of obesity prevented, and improvements in health equity as changes in risk relative to a reference population. These examples describe feasible and cost-effective strategies that can prevent future obesity cases and improve health equity.

Continue reading in the full discussion paper.

Suggested Citation

Gortmaker SL, Bleich SN, Kenney EL, Barrett JL, Ward ZJ, Long MW, Cradock AL. Cost-Effective Strategies to Prevent Obesity and Improve Health Equity. Harvard T. H. Chan School of Public Health, 2021. For further information, contact choicesproject@hsph.harvard.edu and visit www.choicesproject.org


Funded by The JPB Foundation (Grant No. 1085), the National Institutes of Health (Grant No. R01HL146625) and the Centers for Disease Control and Prevention (CDC) (Grant No. U48DP006376). This work is solely the responsibility of the authors and does not represent official views of the CDC, the NIH, or other agencies.

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