Setting: Clinical

Coffee Chat: Exploring Opportunities to Disseminate Evidence-Based Clinical Practices for Promoting Healthy Child Weight

Posted on June 26, 2025

In this coffee chat hosted by the CHOICES Community of Practice, Lauren Fiechtner, Director of Nutrition, Pediatric Gastroenterology and General Academic Pediatrics at Mass General for Children, Associate Professor at Harvard Medical School, and Senior Health and Research Advisor at the Greater Boston Food Bank, shared an overview of the Healthy Weight Clinic program for children and adolescents, including a discussion of implementation success stories throughout the US as well as tools and resources available through the program.

View the resource round-up from this coffee chat

Download the June 2025 coffee chat presentation slides

Disclaimer: Our guest speakers share their own perspectives and do not speak for Harvard.

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Strategy Profile: Healthy Weight Clinic at Federally-Qualified Health Centers

Posted on February 4, 2025

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

Engaging families of children ages 6-12 with overweight or obesity in a multidisciplinary, primary care-based weight management program (Healthy Weight Clinic) at Federally-Qualified Health Centers.

What population benefits?

Children ages 6-12 years old with overweight or obesity (BMI > 85th percentile) who receive care at a Federally-Qualified Health Center and enroll in a Healthy Weight Clinic program when referred by their primary care provider.

What are the estimated benefits?

Relative to not implementing the strategy
Increase nutrition and physical activity health-promoting behaviors and, as a result, promote healthy child weight.

What activities and resources are needed?

Activities	Resources	Who Leads?
Train pediatric primary care providers in weight management practices	• Time for Healthy Weight Clinic pediatrician and support staff (community health worker or registered dietitian) and supervising nurse to prepare and attend training • Time for pediatric primary care providers to attend training on the Healthy Weight Clinic, referral process, and text message campaign • Time for pediatric medical assistants and community health workers to attend training in proper protocol to take height and weight measurements • Food costs to offer with trainings	Healthy Weight Clinic pediatrician
Set up internal referral system to refer patients to the Healthy Weight Clinic program	• Time for technician to add internal referral to the electronic health record system	Electronic health record system technician
Develop and maintain a text message and email campaign to send families educational tips and local nutrition and physical activity resources to support healthy behaviors	• Mobile platform cost • Time for community health workers to set up the text message program, tailor messages and resources to the community, enroll participants, and respond to patients’ messages	Healthy Weight Clinic community health worker
Track referrals to the Healthy Weight Clinic program and conduct outreach to engage families referred	• Time for community health worker to review referrals to the Healthy Weight Clinic program and to make initial outreach phone call to families	Healthy Weight Clinic community health worker
Train multidisciplinary care team on how to deliver the Healthy Weight Clinic program components	• Time for pediatric primary care provider to lead the training • Time for the Healthy Weight Clinic team (pediatric primary care provider, registered dietician, and community health worker) to attend the training • Training material costs • Food and drink costs	Healthy Weight Clinic pediatrician
Deliver Healthy Weight Clinic program for enrolled children and families in individual and group visits	• Time for the Healthy Weight Clinic team to conduct individual and group visits with enrolled participants • Time for community health workers and registered dieticians to call families between visits • Time for community health workers to schedule patients and prepare for visits • Food and drink costs	Healthy Weight Clinic team
Participate in the Healthy Weight Clinic program	• Time for parents/guardians of children enrolled in the Healthy Weight Clinic to attend individual and group visits and engage in phone calls with providers • Transportation costs for families to attend visits • Cost of childcare for families with other children not participating in the program	Families
Develop Healthy Weight Clinic promotional materials (posters, signs, and handouts)	• Time for community health worker to develop and tailor promotional materials to their community • Material printing costs	Healthy Weight Clinic community health worker
Conduct quality assurance observations of the Healthy Weight Clinic individual and group visits	• Time for a Healthy Weight Clinic supervisor to conduct observations	Healthy Weight Clinic supervisor

FOR ADDITIONAL INFORMATION
Sharifi M, Fiechtner LG, Barrett JL, et al. Cost-effectiveness of a primary care-based Healthy Weight Clinic compared with usual care. Obesity (Silver Spring). 2024;32(9):1734-1744. doi:10.1002/oby.24111

Browse more CHOICES research briefs & reports in the CHOICES Resource Library.

Suggested Citation

CHOICES Strategy Profile: Healthy Weight Clinic at Federally-Qualified Health Centers. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2025.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. 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.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Strategy Profile: Increased Access to Adolescent Bariatric Surgery

Posted on September 10, 2024

Fourfold increase in the use of bariatric surgery among eligible adolescents ages 13-19.

What population benefits?

Adolescents ages 13-19 with a body mass index (BMI) of at least 40 kg/m².

What are the estimated benefits?

Relative to not implementing the strategy
Reduce excess weight.

What activities and resources are needed?

Activities	Resources	Who Leads?
Evaluate adolescents and provide diagnostic testing in advance of surgery	• Costs of outpatient visits for pre-operative evaluation of eligible adolescents by cardiology, pulmonary, endocrine, and gastroenterology clinicians • Costs of diagnostic testing, including laboratory tests, imaging, procedures, and sleep study	Hospital
Admit adolescents to hospital and perform surgery	• Costs of hospital admission • Physician fees • Costs of operating room procedures	Hospital

FOR ADDITIONAL INFORMATION
Gortmaker SL, Wang YC, Long MW, Giles CM, Ward ZJ, Barrett JL, Kenney EL, Sonneville KR, Afzal AS, Resch SC, Cradock AL. Three interventions that reduce childhood obesity are projected to save more than they cost to implement. Health Aff (Millwood). 2015 Nov;34(11):1932-9. doi: 10.1377/hlthaff.2015.0631. Supplemental Appendix with strategy details available at: https://www.healthaffairs.org/doi/suppl/10.1377/hlthaff.2015.0631/suppl_file/2015-0631_gortmaker_appendix.pdf

Pratt JSA, Browne A, Browne NT, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis. 2018 Jul;14(7):882-901. doi: 10.1016/j. soard.2018.03.019.
Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023 Feb 1;151(2):e2022060640. doi: 10.1542/peds.2022-060640.
Browse more CHOICES research briefs & reports in the CHOICES Resource Library.

Suggested Citation

CHOICES Strategy Profile: Increased Access to Adolescent Bariatric Surgery. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2024.

Funding

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Cost-Effectiveness of a Primary Care-Based Healthy Weight Clinic Compared with Usual Care

Posted on August 28, 2024

This study determines the cost-effectiveness of implementing the Healthy Weight Clinic, a primary care-based intervention for 6- to 12-year-old children with overweight or obesity, at federally qualified health centers nationally.

Sharifi M, Fiechtner LG, Barrett JL, O’Connor G, Perkins M, Reiner JF, Luo M, Taveras EM, Gortmaker SL. Cost-effectiveness of a primary care-based Healthy Weight Clinic compared with usual care. Obesity. 2024 Sep;32(9):1734-1744. doi: 10.1002/oby.24111.

Abstract

Objective

The objective of this study was to project the cost-effectiveness of implementing the Healthy Weight Clinic (HWC), a primary care-based intervention for 6- to 12-year-old children with overweight or obesity, at federally qualified health centers (FQHCs) nationally.

Methods

We estimated intervention costs from a health care sector and societal perspective and used BMI change estimates from the HWC trial. Our microsimulation of national HWC implementation among all FQHCs from 2023 to 2032 estimated cost per child and per quality-adjusted life year (QALY) gained and projected impact on obesity prevalence by race and ethnicity. Probabilistic sensitivity analyses assessed uncertainty around estimates.

Results

National implementation is projected to reach 888,000 children over 10 years, with a mean intervention cost of $456 (95% uncertainty interval [UI]: $409–$506) per child to the health care sector and $211 (95% UI: $175–$251) to families (e.g., time participating). Assuming effect maintenance, national implementation could result in 2070 (95% UI: 859–3220) QALYs gained and save $14.6 million (95% UI: $5.6–$23.5 million) in health care costs over 10 years, yielding a net cost of $278,000 (95% CI: $177,000–$679,000) per QALY gained. We project greater reductions in obesity prevalence among Hispanic/Latino and Black versus White populations.

Conclusions

The HWC is relatively low-cost per child and projected to reduce obesity disparities if implemented nationally in FQHCs.

Funding

National Heart, Lung, and Blood Institute, Grant/Award Numbers: R01HL151603, K24HL159680, R01HL146625; National Institute on Minority Health and Health Disparities, Grant/Award Number: R01MD014853; Agency for Healthcare Research and Quality, Grant/Award Number: K08HS024332; Eunice Kennedy Shriver National Institute of Child Health and Human Development, Grant/Award Number: K23HD090222; National Center for Chronic Disease Prevention and Health Promotion, Grant/Award Numbers: U18DP006259, U48DP006376; National Institute of Diabetes and Digestive and Kidney Diseases, Grant/Award Number: K24DK105989; The JPB Foundation, Grant/Award Number: 1085.

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Strategy Report: Electronic Decision Support for Pediatric Medical Providers

Posted on December 12, 2023

Toddler girl laughing while doctor examines

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: Electronic Decision Support for Pediatric Medical Providers Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

Acknowledgments

We thank the following members of the CHOICES Project team for their contributions: Molly Garrone, Banapsha Rahman, Ya Xuan Sun, Shilpi Agarwal, Ana Paula Bonner Septien, Jenny Reiner, Matt Lee, Zach Ward.

Funding

This work is supported by the National Institutes of Health (R01HL146625), 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. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

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Strategy Report: Home Visits to Reduce TV Time

Posted on December 7, 2023

Mom and daughter meeting with counselor at home, while daughter is looking at a handheld screen

Overview

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu with any accessibility questions.

Suggested Citation

CHOICES National Action Kit: Home Visits to Reduce TV Time Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

Acknowledgments

Funding

For further information, contact choicesproject@hsph.harvard.edu

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Exploring the Cost-Effectiveness of Strategies to Improve Child Health in Boston, MA

Posted on November 13, 2023

The information in this brief is intended only to provide educational information.

The CHOICES Project at the Harvard T.H. Chan School of Public Health and the Boston Public Health Commission (BPHC) worked together as part of the Massachusetts-CHOICES Project (2019 – 2024), a training, technical assistance, and modeling initiative, to develop a playbook of strategies to promote healthy weight and advance health equity in addition to studying how cost-effectiveness metrics are used by partners throughout the state.

Methods & Strategies Modeled

Using CHOICES cost-effectiveness analysis and local data, the BPHC team worked with CHOICES to create a virtual population that mirrors the current population of Boston, MA. Then, the teams examined the expected costs, health outcomes, and health care costs saved if the following strategies were implemented in Boston, Massachusetts over a 10-year timeframe (2020-2029):

• Reducing Screen Time in Early Child Care Settings
• More Movement Program in Early Child Care Settings
• Home Visits to Reduce Screen Time
• Movement Breaks in the Classroom
• Creating Healthier Afterschool Environments (OSNAP)

Reducing Screen Time in Early Child Care Settings

The strategy to reduce screen time in early child care settings involves providing voluntary training to early child care educators and resources to families to limit noneducational television time at child care and home. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators, offering ongoing support and technical assistance, and providing parents with educational materials that may lead to reducing screen time in young children.^1,2

Helping educators to implement practices shown to be effective in reducing television time can help the children in Boston’s early education and care settings engage in fewer minutes of screen time.

Additional Key Findings

If a strategy to reduce screen time in early child care settings was implemented in Boston, 125 cases of obesity would be prevented in 2029, saving $138,000 in health care costs over 10 years.

In addition, this strategy would train and provide technical assistance to early childhood educators on reducing screen time. In the initial training series, this strategy would provide additional skills training and professional development for 1,380 educators and more opportunities to reduce screen time in 570 (100%) child care programs serving 3-5 year olds.

To learn more about this strategy, read the research brief.

Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: Reducing Screen Time in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.

References

1. Mendoza JA, Baranowski T, Jaramillo S, et al. Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial. American Journal of Preventive Medicine. 2016;50(5):584-592.<
2. Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Archives of Pediatrics and Adolescent Medicine. 2004;158(2):170-176.

More Movement Program in Early Child Care Settings

The more movement program provides training opportunities and resources for early child care educators to implement actions in their programs to encourage physical activity. This strategy could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators in physical activity curricula, provide resources and instructional materials, and support technical assistance opportunities that may lead to higher physical activity levels among young children.^1,2

Helping educators implement practices shown to be effective in increasing physical activity can help the children in Boston’s early education and care settings to move more.

Additional Key Findings

If the more movement program in early child care settings was implemented in Boston, 94 cases of obesity would be prevented in 2029, saving $104,000 in health care costs over 10 years. Besides promoting a healthy weight, increasing physical activity is linked to improved bone and muscular health and better gross motor skills in young children.^3-5

In addition, this strategy would train and provide technical assistance to early childhood educators. In the initial training series, the more movement program would provide additional skills training and professional development for 1,380 educators and more physical activity promotion opportunities in 570 (100%) child care programs serving 3-5 year olds.

To learn more about this strategy, read the research brief.

Bovenzi M, Carter S, Sabir M, Bolton AA, Barrett JL, Reiner JF, Cradock AL, Gortmaker SL. Boston, MA: More Movement Program in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2023.

References

1. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity (Silver Spring). 2011;19(5):994-1003.
2. Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. American Journal of Preventive Medicine. 2016 Feb;50(2):136-44.
3. U.S. Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Dept of Health and Human Services; 2018. Accessed Jul 23, 2021. https://health.gov /sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf
4. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Medicine & Science in Sports & Exercise. 06 2019;51(6):1282-1291.
5. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism. Aug 2012;37(4):773-92.

Home Visits to Reduce Screen Time

The home visits to reduce screen time strategy aims to reduce the amount of screen time viewed at home by young children. Community health workers would provide counseling and resources on strategies to limit children’s screen time to children and families who participate in home visiting programs.

Through professional development training opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.¹

Additional Key Findings

If the home visits to reduce screen time strategy was implemented in Boston, 60 cases of childhood obesity would be prevented in 2029. Besides promoting a healthy weight, this strategy may also benefit children in other ways. Providing children and their families with strategies to move away from their screens allows for more time for activities like reading and active play.

By training and equipping 119 community health workers annually by ensuring that everyone has access to what they need to grow up healthy and strong, this strategy could help reach those families and children that may be at higher risk of having or developing obesity. Children in households with low income could see greater health benefits from this strategy.¹

To learn more about this strategy, read the research brief.

Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023.

References

1. Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. Mar 2008;162(3):239-45. doi:10.1001/archpediatrics.2007.45

Movement Breaks in the Classroom

Movement breaks in the classroom is a strategy to promote physical activity during the school day by incorporating five-to-10-minute movement breaks in K-5 public elementary school classrooms. To implement the movement breaks strategy in Boston, teachers, Wellness Champions, and staff would receive training, equipment, and materials to incorporate short activity breaks in the classroom to help children move more.^1,2

This aligns with Boston Public School’s (BPS) Physical Education and Physical Activity Policy that requires schools to offer physical activity opportunities during the school day,³as well as BPS’ Whole School, Whole Community, Whole Child approach, which supports students’ holistic health by promoting positive classroom environments that foster physical activity and learning.

Additional Key Findings

If movement breaks were incorporated into classrooms in Boston, 37 cases of childhood obesity would be prevented in 2029 and save $35,300 in health care costs related to excess weight over 10 years.

By training and equipping over 600 teachers and other school staff yearly to incorporate movement breaks in the classroom, this strategy could help all Boston Public Schools cultivate a positive school climate and improve social emotional learning.⁴ Participation in movement breaks are associated with students spending more time on task,⁵ and teachers report that students are more engaged, supportive of each other, and responsive to teacher instructions after participating in a movement break.⁶

To learn more about this strategy, read the research brief.

Carter J, Greene J, Neeraja S, Bovenzi, M, Sabir M, Carter S, Bolton AA, Barrett JL, Reiner JR, Cradock AL, Gortmaker SL. Boston, MA: Movement Breaks in the Classroom {Issue Brief}. Boston Public Schools, Boston Public Health Commission, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; August 2022.

References

1. Erwin HE, Beighle A, Morgan CF, Noland M. Effect of a low-cost, teacher-directed classroom intervention on elementary students’ physical activity. J Sch Health. 2011;81(8):455-461.
2. Murtagh E, Mulvihill M, Markey O. Bizzy Break! The effect of a classroom-based activity break on in-school physical activity levels of primary school children. Pediatr Exerc Sci. 2013;25(2):300-307.
3. Boston Public Schools. Physical Education & Physical Activity Policy. 2020:8. Superintendent’s Circular. https://drive.google.com/file/d/1rSGwpFaa4LsPKxjhdsHxz2IaXg3ZFVtE/view?usp=embed_facebook
4. School-Based Physical Activity Improves the Social and Emotional Climate for Learning. Centers for Disease Control and Prevention,. Accessed March 9, 2022. https://www.cdc.gov/healthyschools/school_based_pa_se_sel.htm
5. The Community Preventive Services Task Force. Physical Activity: Classroom-based Physical Activity Break Interventions. The Community Guide. 2021:8.
Campbell AL, Lassiter JW. Teacher perceptions of facilitators and barriers to implementing classroom physical activity breaks. J Educ Res. 2020;113(2):108-119

Creating Healthier Afterschool Environments (OSNAP)

The Out of School Nutrition and Physical Activity (OSNAP) initiative helps afterschool programs improve practices and policies that increase physical activity and consumption of healthy snacks.

To implement this initiative, the Boston Public Health Commission would provide professional development opportunities for afterschool program leaders serving students in grades K-5. Afterschool staff leaders would participate in three learning collaborative sessions and receive technical assistance to assess¹ and modify their programs’ practices and policies² to meet the OSNAP nutrition and physical activity goals.

Additional Key Findings

If the OSNAP initiative was implemented in Boston, 37 cases of obesity would be prevented in 2029. It is also projected to be cost-effective at commonly accepted thresholds³ based on net population health improvement related to excess weight ($72,100 per quality-adjusted life year gained).

This strategy may also support children’s health in a variety of other ways. Regular physical activity, healthy eating, and adequate hydration can improve children’s mental and emotional well-being and their heart, lung, and bone health.⁴ These healthy behaviors can also strengthen students’ attention, memory,^5,6 and cognitive functioning,⁵ all important components for learning and academic performance.

To learn more about this strategy, read the research brief.

Carter S, Bovenzi M, Clarke J, Bolton AA, Reiner JF, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Creating Healthier Afterschool Environments (OSNAP) {Issue Brief}. Boston Public Health Commission, Massachusetts, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; July 2023.

References

1. Lee RM, Emmons KM, Okechukwu CA, Barrett JL, Kenney EL, Cradock AL, Giles CM, deBlois ME, Gortmaker SL. Validity of a practitioner-administered observational tool to measure physical activity, nutrition, and screen time in school-age programs. Int J Behav Nutr Phys Act. 2014 Nov 28;11:145. doi: 10.1186/s12966-014-0145-5.
2. Kenney EL, Giles CM, deBlois ME, Gortmaker SL, Chinfatt S, Cradock AL. Improving nutrition and physical activity policies in afterschool programs: results from a group-randomized controlled trial. Prev Med. 2014;66:159-166. doi:10.1016/j.ypmed.2014.06.011
3. Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness–the curious resilience of the $50,000-per-QALY threshold. New England Journal of Medicine. 2014 Aug 28;371(9):796-7. DOI: 10.1056/NEJMp1405158. PMID: 25162885.
4. Health Benefits of Physical Activity for Children. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/health-benefits-of-physical-activity-for-children.html. Published Jan 12, 2022. Updated 2022-01-12T05:06:09Z. Accessed Dec 7, 2022.
5. Childhood Nutrition Facts. Centers for Disease Control and Prevention. https://web.archive.org/web/20241116072100/https://www.cdc.gov/healthyschools/nutrition/facts.htm. Published 2022. Updated 2022-08-05T03:49:26Z. Accessed Dec 12, 2022.
6. Blanding N. Afterschool Programs in Boston, MA, Expand Opportunities for Obesity Prevention. Centers for Disease Control and Prevention; 2016. http://nccd.cdc.gov/nccdsuccessstories

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This document was developed at the Harvard T.H. Chan School of Public Health through the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This document is intended for educational use only. This work is supported by 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.

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Strategy Profile: Home Visits to Reduce TV Time

Posted on September 15, 2023

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

Home visits to reduce TV time is a program to disseminate a screen time managing device to families through a home visiting program to reduce screen time among children ages 4-7.

What population benefits?

Children ages 4-7 with BMI >75th percentile who receive home visits.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce child daily television time which can help improve dietary intake and, in turn, promote healthy child weight.

What activities and resources are needed?

Activities	Resources	Who Leads?
Coordinate the training rollout	• Time for the director to coordinate the trainings	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program
Train community health workers who would implement the program	• Time for community health workers to receive trainings • Travel costs • Material costs	Home Visiting Program Coordinator
Train registered nurses about referring children to home visits to reduce screen time	• Time for registered nurses to receive trainings • Travel costs	Home Visiting Program Coordinator
Purchase program materials	• TV control device cost • Posters cost • Incentives for children cost	Home Visiting Programs
Coordinate patient referrals and provide counseling during home visits	• Time for registered nurses to recruit and refer patients • Time for community health workers to implement	Community health center registered nurses & community health workers

Strategy Modification

Some state and local health agencies added to this strategy by teaching about parental controls on other screen devices (e.g., tablets, smart phones, etc.). This could help parents limit all types of screen time for their children, not just on the television. This would require additional training and materials for families.

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.

Selected CHOICES research brief including cost-effectiveness metrics:

Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023. Available at: https://choicesproject.org/publications/brief-home-visits-screen-time

Browse more CHOICES research briefs & reports in the CHOICES Resource Library.
Explore and compare this strategy with other strategies on the CHOICES National Action Kit.

Suggested Citation

CHOICES Strategy Profile: Home Visits to Reduce TV Time. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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Brief: Home Visits to Reduce Screen Time in Boston, MA

Posted on May 31, 2022

The information in this brief is intended only to provide educational information.

A version of this brief was published in May 2022. This brief was updated in February 2023 to reflect revised projections for Boston’s population.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining a strategy to reduce the amount of screen time viewed at home by young children in Boston, MA. Community health workers would provide counseling and resources on strategies to limit children’s screen time to children and families who participate in home visiting programs.

The Issue

In 2017, three in 10 first graders in Boston had overweight or obesity.¹ Access to healthy foods, beverages, and opportunities to participate in regular physical activity are key priorities for communities in supporting children growing up at a healthy weight. However, not all families have access to the same resources.

Limiting children’s screen time is also a high priority for communities.² Food companies use television to market unhealthy foods and drinks to children, which can increase children’s food intake and their risk for excess weight gain.³ Moreover, food companies have disproportionately marketed fast food and sugary drinks to Black and Hispanic youth⁴ and children from lower income households watch more screen media than their peers,⁵ putting them at greater risk for unfavorable health outcomes.

Helping families manage screen time can promote a healthy weight and advance health equity. Home visiting programs engage community health workers to improve health behaviors and reduce the risk of chronic diseases for families with children. Home visiting programs specifically support children who are exposed to conditions that could negatively impact their health.⁶

About the Home Visits to Reduce Screen Time Strategy

This strategy supports the Boston Public Health Commission’s goal of preventing obesity and chronic disease using a health equity lens while also building and maintaining partnerships with home visiting programs across Boston. Through professional development trainings opportunities, community health workers would learn ways to support families and children in limiting their screen time. During a home visit, community health workers would share the importance of appropriate screen time limits and provide strategies and tools for families to use, including a screen time management device. Integrating this strategy through existing home visiting programs could help more children manage their screen time and grow up at a healthy weight.⁷

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes over a 10-year time horizon (2020-2030) of implementing the home visits to limit screen time strategy with the costs and outcomes associated with not implementing the program.

Implementing the home visits to reduce screen time strategy is an investment in the future. By the end of 2030:

Conclusions and Implications

Incorporating counseling and providing resources to limit screen time through existing home visiting programs could reach 3,320 children ages 4-7. Over 10 years, we project that children whose families participated in the program would watch nearly two fewer hours of screen time per day, on average. This strategy could also prevent 60 cases of childhood obesity in 2030, saving $44,600 in health care costs related to excess weight over 10 years. It would cost $540 per child.

Community health workers play an important role in building healthier communities and promoting health equity. By training and equipping 119 community health workers annually by ensuring that everyone has access to what they need to grow up healthy and strong, this strategy could help reach those families and children that may be at higher risk of having or developing obesity. Children in households with low income could see greater health benefits from this strategy.⁷

In addition to promoting healthy weight, this strategy may also benefit children in other ways. Too much screen time can negatively impact children’s sleep and social wellbeing.⁸ Providing children and their families with strategies to move away from their screens allows for more time for developmentally appropriate activities like reading and active play. Strategies families can use to limit online video viewing and mobile device use may be particularly important as screen time from these sources has increased dramatically in recent years.⁵

Working with community health workers in Boston’s existing home visiting programs will help families build a foundation for overall health and wellbeing. These preventive strategies play a critical role in helping children establish healthy habits early on in life.

References

School Health Services, Dept of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. School Health Services, Dept of Public Health; 2020. Accessed Feb 22, 2022. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017
Healthy People 2030: Building a healthier future for all. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. Accessed Feb 4, 2022. https://health.gov/healthypeople
Russell SJ, Croker H, Viner RM. The effect of screen advertising on children’s dietary intake: A systematic review and meta-analysis. Obes Rev. 2019;20(4):554-568. doi:10.1111/obr.12812
UConn Rudd Center for Food Policy & Obesity. Fast Food Advertising: Billions in spending, continued high exposure by youth. 2021. Fast Food Fact, UConn Rudd Center for Food Policy & Obesity. https://www.fastfoodmarketing.org/media/FACTS%20Summary%20FINAL%206.15.pdf
Rideout V, Robb MB. The Common Sense Census: Media Use by Kids Age Zero to Eight. 2020. Common Sense Census. https://www.commonsensemedia.org/research/the-common-sense-census-media-use-by-kids-age-zero-to-eight-2020
Duffee JH, Mendelsohn AL, Kuo AA, Legano LA, Earls MF. Early Childhood Home Visiting. Pediatrics. Sep 2017;140(3). doi:10.1542/peds.2017-2150
Epstein LH, Roemmich JN, Robinson JL, et al. A randomized trial of the effects of reducing television viewing and computer use on body mass index in young children. Arch Pediatr Adolesc Med. Mar 2008;162(3):239-45. doi:10.1001/archpediatrics.2007.45
Tremblay MS, LeBlanc AG, Kho ME, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. Sep 21 2011;8:98. doi:10.1186/1479-5868-8-98

Suggested Citation:

Carter S, Bovenzi M, Sabir M, Bolton AA, Reiner JR, Barrett JL, Cradock AL, Gortmaker SL. Boston, MA: Home Visits to Reduce Screen Time {Issue Brief}. Boston Public Health Commission, Boston, MA, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; February 2023. For more information, please visit www.choicesproject.org

A version of this brief was published in May 2022. This brief was updated in February 2023 to reflect revised projections for Boston’s population.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by 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.

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Strategy Profile: Electronic Decision Support for Pediatric Medical Providers

Posted on April 28, 2022

Promoting recognition and recommended management of obesity among children ages 6-12 through electronic decision supports for pediatric medical providers during well-child visits.

What population benefits?

Children ages 6-12 years old with obesity (BMI>95th percentile) who are being seen by primary care providers with fully-functioning electronic health records systems.

What are the estimated benefits?

Relative to not implementing the strategy
Increase nutrition and physical activity health-promoting behaviors and, as a result, promote healthy child weight.

What activities and resources are needed?

Activities	Resources	Who Leads?
Oversee and implement electronic decision support for pediatric medical providers	• Time for health system project coordinator to develop content for website, project dissemination plan, and training materials	Health system project coordinator
Modify electronic health record system to prompt providers to recognize and manage obesity at clinics	• Time for electronic health record system staff to update electronic health record system	Electronic health record system staff
Develop and maintain a website to share local nutrition and physical activity resources to support healthy behaviors	• Time to develop and maintain the website	Health system website developer and staff
Train in motivational interviewing and electronic health system changes and provide performance feedback to primary care providers	• Time for health system project coordinator and/ or electronic health records system manager to lead trainings and to provide performance feedback to primary care providers • Time for primary care providers to attend trainings • Training material costs • Food costs to offer with trainings	Health system project coordinator, electronic health records system manager, practice coach, and/or operations manager
Develop and deliver direct-to-parent communications	• Time for the health systems project coordinator to develop content for communications materials for families • Costs for printing and mailing materials	Health systems project coordinator
Additional time in clinics by primary care providers	• Additional time for primary care clinicians to spend with patients in office	Primary care clinicians
Material costs for primary care offices	• Costs for printing posters to be displayed in primary care offices	Health system

Strategy Modification

Some state and local health agencies replaced parent mailings with text messages, following a strategy modification that was shown to be effective in a research study. In the text messaging scenario, this strategy could reach children ages 2-12 and we estimate BMI would decrease (-0.3 units or about -1.24 lbs for a 9-year-old of average height). If a text messaging platform already exists in clinics, this could be less expensive than parent mailings.

FOR ADDITIONAL INFORMATION
Sharifi M, Franz C, Horan CM, Giles C, Long M, Ward Z, Resch S, Marshall R, Gortmaker S, Taveras E. Cost-Effectiveness of a Clinical Childhood Obesity Intervention. Pediatrics. 2017; 140(5): e20162998.

Selected CHOICES research brief including cost-effectiveness metrics:
Moreland J, Rosen J, Kraus E, Reiner J, Gortmaker S, Giles C, Ward Z. Denver: Study of Technology to Accelerate Research (STAR) {Issue Brief}. Denver Public Health and Denver Health, Denver, CO, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; July 2018. Available at: https://choicesproject.org/publications/brief-star-denver

Browse more CHOICES research briefs & reports in the CHOICES Resource Library.
Explore and compare this strategy with other strategies on the CHOICES National Action Kit.

Suggested Citation

CHOICES Strategy Profile: Electronic Decision Support for Pediatric Medical Providers. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; April 2022.

Funding

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

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