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Modeling the Cost-Effectiveness of Child Care Policy Changes in the U.S. 

CHOICES researchers found that implementing a multi-component regulatory policy in US childcare facilities would lead children to watch less TV, get more physical activity, and consume fewer sugary drinks, serving as a cost-effective strategy in reducing the childhood obesity epidemic.

Wright DR, Kenney EL, Giles CM, Long MW, Ward ZJ, Resch SC, Moodie ML, Carter RC, Wang YC, Sacks G, Swinburn BA, Gortmaker SL, Cradock AL. Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S. Am J Prev Med. 2015 Jul;49(1):135-47. doi: 10.1016/j.amepre.2015.03.016.

Risk factors for obesity, including dietary habits, physical activity, and screen time behaviors develop in early childhood, persisting into late childhood and even into adulthood. Long-term habits are hard to change during adulthood, highlighting the importance of early intervention for obesity prevention. With nearly 70 percent of American preschool-aged children in out-of-home child care facilities, the setting serves as an ideal intervention target.

Children playing in daycare“Full day childcare programs are an educational environment responsible for providing children with snacks, meals, and daily opportunities for physical activity,” says lead author, Davene Wright, PhD, an Assistant Professor in the Department of Pediatrics at the University of Washington School of Medicine. “Many childcare programs fail to meet best practice standards for nutrition, physical activity, and screen time viewing. When 20 percent of preschool-aged children in the US are currently overweight or obese, this sector should be a key target for policy regulations to aid in the development of lifelong healthy behaviors.”

The study developed a hypothetical state-level regulatory policy intervention with three components:

  • The beverage component stipulated that water be made freely available throughout the program day, that sugar-sweetened beverages (SSBs) be replaced with water, that 100% juice be limited to 6 ounces per child per day, and that whole milk be replaced with reduced-fat milk.
  • The physical activity component required programs to provide opportunities for at least 90 minutes of moderate and vigorous physical activity (MVPA) over the course of the program day for children in full-time care.
  • The screen time component specified that television and computer time be educational in nature and limited to 30 minutes per week.

By using a simulation model, researchers found that these regulatory changes would reach 3.8 million US preschool-aged children, resulting in 21 hours of less screen time, 5 hours more of MVPA, 588 fewer ounces of whole milk, and 40 fewer ounces of SSBs annually per child. Implementation would cost $7.4 million annually, and result in 0.02 fewer BMI units per child at a cost of $58 per BMI unit avoided. Over a 10-year period, these effects would result in net healthcare cost savings of $372 million.

This is the first study to examine the potential economic impact of a multi-component child care-based obesity policy intervention. These regulations could have a small but meaningful impact on short-term BMI at a low cost, with promising potential to be cost-saving within only 10 years. This analysis provides important new information to policymakers regarding the benefits to the health of our nation’s children, and the substantial savings to healthcare expenditures that could be achieved.

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