Topic: Prevention & Treatment

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 for an accessible version of this report.

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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Coffee Chat: An Action Kit for Prevention: Prioritizing Cost-Effective and Equitable Healthy Eating and Physical Activity Strategies

Posted on November 16, 2023

In this coffee chat hosted by the CHOICES Community of Practice, Dr. Steven Gortmaker, Principal Investigator of the CHOICES Project at the Harvard T.H. Chan School of Public Health, highlights the new features available in the Action Kit 2.0, including more detailed information on costs and health equity impacts. Dr. Gortmaker also discusses how this information can be helpful for planning and prioritization purposes to ensure responsible investments to improve child health, nutrition, physical activity, and health equity.

View the resource round-up from this coffee chat

Download the November 2023 coffee chat presentation slides

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Strategy Profile: Electronic Decision Support for Pediatric Medical Providers

Posted on April 28, 2022

Toddler girl laughing while doctor examines

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.

  • 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

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

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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CHOICES Web Forum: How a clinical strategy in Denver could improve health and address health equity

Posted on October 13, 2021

The CHOICES Project at the Harvard T.H. Chan School of Public Health hosted this virtual Web Forum on July 14, 2021. Key leaders in the field discussed how cost-effectiveness analysis can be a useful decision-making tool to prioritize strategies that promote healthy eating, active living, and health equity.

Moderator:

  • William Dietz, MD, PhD, Director, Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health, The George Washington University

Panelists:

  • Captain Heidi Blanck, PhD, MS, Branch Chief, Chronic Disease Nutrition/Obesity, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention
  • Jennifer Moreland, MPH, Chronic Disease Manager, Denver Public Health –
  • Elsie Taveras, MD, MPH, Chief Community Health Equity Officer, Mass General Brigham, Executive Director, Kraft Center for Community Health at MGH, Conrad Taff Endowed Professor, Harvard Medical School

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Stories from the Field: Denver Takes Action to Promote Healthy Child Weight

Posted on November 30, 2020

The information in this Story from the Field is intended only to provide educational information.

In this story from the field, partners at Denver Health worked with the CHOICES Team to see what might happen if they made changes to their electronic medical record systems to prompt pediatric medical providers to recognize children with too much weight for their health during well-child visits, and provide follow-up supportive care, education, and educational messages to families.

Identifying Priorities in Denver

Two departments of Denver Health – Denver Public Health and Community Health Services – identified healthy weight as a goal of their local Community Health Improvement Plan to address local population health priorities. Many partners had several ongoing initiatives to ensure that Denver’s children did not have too much weight for their health. As the health care provider for one-third of Denver’s children, Denver Health recognized its potential to reach more families by undertaking additional actions within its health system. Evidence suggests that racial, ethnic, and low-income groups in U.S. communities tend to have greater exposure to negative environmental influences and less access to protective factors, making maintaining a healthy weight more challenging.

Gathering Information for Action

In 2017, partners in Denver teamed up with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project at the Harvard T.H. Chan School of Public Health’s Learning Collaborative Partnership. The CHOICES Project works with health agencies to create new evidence to inform decision-making. Using local data, health agencies learn how to apply evaluations of effectiveness, reach, and cost to understand the relative cost-effectiveness of strategies to prevent and treat childhood obesity.

Strategy Selection

The Denver Learning Collaborative Partnership Team attended a CHOICES training and reviewed strategies to find best-value-for-money options for preventing children from having too much weight for health. One approach seemed particularly relevant: The Study of Technology to Accelerate Research (STAR), a clinical strategy that had been shown effective in a randomized trial.1

The Intervention

STAR uses decision support tools in the Epic electronic medical record system to help the health care team recognize and engage supports for children at annual well-child visits. Families receive education and can opt to receive text messages on healthy habits, like increasing physical activity and adopting healthier nutrition practices.

The Change Needed

While Denver Health had many pieces for STAR already in place, they would need several adjustments. Denver Health needed to modify its health record protocol to include diagnosis, screening, and decision support prompts for children with a BMI at or above 85%. Denver Health could build on its existing text messaging system and develop materials to provide relevant education and resources to parents and families, and then ensure training opportunities for pediatricians.

Steps Taken for Implementation

  • Interviewed clinicians to build engagement and incorporate feedback in Epic modifications to include decision support tools and prompts to help identify and manage children with too much weight for health

  • Surveyed families to inform educational content and text message program

  • Modified Epic to include decision support tools

  • Trained the health care team on the changes in Epic and the available resources for families

Helping Change Happen

Through the CHOICES Learning Collaborative Partnership, the CHOICES Team works with local stakeholders to make projections about what may happen if they implement a program or policy. Here they calculated that STAR could reach 19,400 children in Denver over ten years and prevent 300 children from having too much weight for their health. For every dollar spent implementing STAR, $0.78 would be saved in health care costs because more children would have a healthier weight.2 This strategy is projected to both improve overall population health, as well as reduce disparities in too much weight for health among children. What’s more, this information gave Denver Health data to support a grant application for strategy implementation. With leadership support and funding, Denver Health was well positioned to begin implementing components from STAR in 2019.

Impact & Lessons Learned

Since 2019:
An info graphic that states: "11 Denver health clinics implementing the strategy," and "8 Denver health training materials created."

With the STAR clinical strategy, it was so feasible compared to other strategies, and when looking at our entire budget, it is a drop in the overall bucket of funding.” – Jennifer Moreland, Chronic Disease Manager, Denver Public Health

References

  1. Taveras E., Marshall R., Kleinman KP, Gillman MW, Hacker K…Simon SR. (2015). Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care: A Cluster-Randomized Clinical Trial, JAMA Pediatrics, 169(6):535-542

  2. Moreland J, Rosen J, Kraus E, Reiner J, Gortmaker S, Giles C, Ward Z. Denver: Study of Technology to Advance 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.

Suggested Citation:

CHOICES Stories from the Field: Denver Takes Action to Promote Healthy Child Weight. Denver Public Health, a Department of Denver Health, Denver, CO, and the CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; October 2020.

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Cost-Effectiveness Analysis & Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US

Posted on August 13, 2019

The CHOICES team partnered with the Maine-Harvard Prevention Research Center and the Maine Obesity Policy Committee to evaluate two state-level obesity prevention strategies– a sugar-sweetened beverage (SSB) excise tax and a policy removing SSBs as SNAP-eligible products. Both policies were estimated to save society more than they cost to implement. However, the SNAP restriction raised greater equity concerns among stakeholders.

Long MW, Polacsek M, Bruno P, Giles CM, Ward ZJ, Cradock AL, Gortmaker SL. Cost-Effectiveness Analysis and Stakeholder Evaluation of 2 Obesity Prevention Policies in Maine, US. J Nutr Educ Behav. 2019 Aug [Epub ahead of print], pii: S1499-4046(19)30922-4.

Obesity prevention is a priority item for many policymakers at the state level. The goal of this study was to not only predict the health impact of two obesity prevention policies in Maine, but also to gauge stakeholder interest and level of support for these policies.

Two obesity prevention policies were focused on:

– A $0.01/ounce sugar-sweetened beverage (SSB) excise tax for the state of Maine
– A Supplemental Nutrition Assistance Program (SNAP) policy that would not allow SSBs to be bought using SNAP money (SNAP SSB restriction policy)

The stakeholder engagement process developed over more than 10 years as a result of a relationship between the Maine Obesity Policy Committee (Maine OPC) and the Maine-Harvard Prevention Research Center (MHPRC). The Maine OPC consists of individuals from the Maine Public Health Association, American Heart Association of Maine, American Cancer Society, the State Department of Health and Human Services, legislators, lobbyists, and health systems. The stakeholder interview process was conducted in two phases: Phase 1 in 2013 focused on an SSB excise tax and Phase 2 in 2016 focused on a SNAP SSB restriction policy.

The study authors also measured the health impact of these two policies on a virtual population that was developed for the state of Maine. The CHOICES model was used to project these policies’ impact on obesity prevalence and health care costs over 10 years (2017-2027).

The results from the CHOICES model showed the potential for both health improvement and cost-savings. In particular:

Metric*

$0.01/ounce SSB excise tax

SNAP SSB restriction policy
Health care cost savings
 $78.3 million $15.3 million
Quality-adjusted life years (QALYs) saved
 3,560 749

*For metric definitions, please visit the CHOICES Modeled Outputs Glossary

Study authors noted mixed levels of support for each policy by Maine stakeholders, with less support for the SNAP SSB restriction policy. Opposition to the SNAP restriction policy was based on concern that SNAP recipients were being unfairly targeted and stigmatized. This study used strategic science thinking to inform obesity prevention policy in Maine by strengthening the capacity of existing stakeholder groups and local applied researchers to integrate advanced cost-effectiveness modeling into their already well-developed policy input process. Results of the modeling were presented to the state’s legislature, which was holding hearings on a proposed SSB tax. This study points to the need for stronger, long-term partnerships between local public health researchers, cost-effectiveness modeling groups, and local policy stakeholder groups.

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Brief: Study of Technology to Accelerate Research (STAR) in Denver

Posted on December 6, 2018

Toddler girl laughing while doctor examines

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

This brief summarizes findings from a CHOICES Learning Collaborative Partnership model of implementation of the “Study of Technology to Accelerate Research” (STAR) intervention in Denver Health pediatric primary care settings. Denver STAR leverages electronic health record (EHR) decision support tools to facilitate the diagnosis and management of childhood obesity during well-child care visits.

The Issue

Over the past four decades, childhood obesity has tripled.1 Health care costs for treating obesity-related health conditions are high, costing $147 billion in 2008.2 Interventions in clinical settings that aim to manage childhood obesity have the potential to help children lead healthier lives, reduce obesity prevalence in adulthood, and reduce health care costs.3

In Denver, 13.9% of 2-12 years old seen at Denver Health clinics have obesity. Although time-intensive counseling to improve dietary intake and physical activity is recommended, these interventions are often time consuming, resource intensive, and difficult to implement and sustain.3,4 Leveraging existing EHRs to facilitate childhood obesity diagnosis and management, and engaging families through direct-to-parent communications, is a promising clinical strategy to reduce the prevalence of childhood obesity at a relatively low cost.

About STAR

The Denver STAR intervention leverages EHR decision support tools, operated by EPIC software, to promote recognition of pediatric obesity and facilitate recommended screening and management during pediatric well-child care visits. In addition, the Denver STAR intervention includes direct-to-parent communications in which parents receive text messages to support behavior change for their children. Families would also have access to a webpage that shares local health and wellness resources. Primary Care Physicians (PCPS) who see pediatric patients at Denver Health clinics would be trained in the EHR changes and motivational interviewing techniques to facilitate weight management discussions with the patients and families. Evidence obtained in a cluster randomized controlled trial showed that STAR helped to prevent excess weight gain compared to usual care.4

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of the implementation of STAR within pediatric primary care practices in Denver Health with the costs and outcomes associated with not implementing STAR over a 10 year time period (2017-2027). The approach assumes that all Denver Health pediatric primary care clinics would implement STAR. We assume that all children ages 2- 12 with obesity (BMI > 95th percentile) who visit Denver Health clinics for well-child visits would benefit from the intervention.

Implementing STAR in Denver Health pediatric primary care settings is an investment in the future. By the end of 2027:
Infographic: 19,400 children reached and 303 cases of childhood obesity prevented by 2027 at $32.80 per child

Conclusions and Implications

Every child deserves a healthy start in life. This includes developing innovative clinical strategies that can be feasibly implemented to improve the quality of care for childhood obesity in pediatric primary care settings. By leveraging EHR tools managed by EPIC, Denver STAR is a scalable intervention that can be feasibly implemented in all Denver Health primary care clinics. The intervention is expected to reach 19,400 children over 10 years and would prevent 303 cases of childhood obesity in the final year of the model.

Denver STAR is a good buy as it is likely to have a high magnitude of effect on improving children’s health at a relatively low cost per child. For every $1 spent on implementing Denver STAR, a projected $0.78 would be saved in obesity-related health care costs. Denver STAR also supports institutional policies by collecting reportable data for Healthcare Effectiveness Data and Information Set (HEDIS) performance measures.

Denver STAR intervention is projected to both improve overall population health, as well as reduce disparities in childhood obesity. The modeled implementation of STAR in Denver Health, a health system that predominantly serves a higher proportion of racial/ethnic minority groups, is projected to result in significant health benefits among Hispanic and Black populations in Denver.

Evidence is growing about how to help children achieve a healthy weight. Interventions such as Denver STAR, which is evidence-based, feasible to implement, and relatively low cost, can improve the quality of care of childhood obesity in pediatric primary care.

References

  1. Fryar CD, Carroll MD, Ogden CL, Prevalence of overweight and obesity among children and adolescents: United States, 1963-1965 through 2011-2012. Atlanta, GA: National Center for Health Statistics, 2014.
  2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs. 2009;28(5).
  3. Sharifi, M., Franz, C., Horan, C. M., Giles, C. M., Long, M. W., Ward, Z. J., … & Taveras, E. M. Cost-Effectiveness of a Clinical Childhood Obesity Intervention. Pediatrics. 2017, e20162998.
  4. Taveras E., Marshall R., Kleinman KP, Gillman MW, Hacker K….Simon SR. (2015). Comparative Effectiveness of Childhood Obesity Interventions in Pediatric Primary Care: A Cluster-Randomized Clinical Trial, JAMA Pediatrics, 169(6):535-542
Suggested Citation:

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. For more information, please visit www.choicesproject.org

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 Denver Public Health and Denver Health 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. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the funder.

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Cost-Effectiveness of a Clinical Childhood Obesity Intervention

Posted on November 1, 2017

A CHOICES study estimates that the national implementation of an intervention focused on electronic health record (EHR)-based decision support for primary care providers and self-guided behavior change support for parents is likely a more cost-effective approach to treating children with obesity than previous clinical interventions reporting cost 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.

Over 12 million children and adolescents in the United States have obesity (17% of the population). The results of this study demonstrate that taking advantage of electronic health record (EHR) systems may be among the “best value for money” strategies currently tested for pediatric obesity treatment.

A child and doctor smiling“It is clear that the most cost-effective strategies for preventing new cases of obesity are population-level approaches like taxes and school-based policies,” said Mona Sharifi, lead author and Assistant Professor of Pediatrics at the Yale School of Medicine. “However, we need additional and different strategies to support the approximately 12 million children who already have obesity and are at highest risk for health complications and obesity in adulthood. Our study suggests that using the electronic health record to help primary care pediatricians deliver higher quality care for children with obesity may be relatively low hanging fruit among clinical interventions in terms of cost-effectiveness.”

The Study of Technology to Accelerate Research (STAR)1 involved modifications to existing EHR systems to facilitate childhood obesity management in pediatric primary care by prompting diagnosis as well as providing decision support and electronic resources for evaluation, management, and follow-up care. Evidence obtained in a cluster randomized controlled trial showed that STAR helped to prevent excess weight gain compared to usual care.

The CHOICES study of STAR offers an opportunity to both inform clinicians and policymakers about what investment would be required to adopt STAR in pediatric practices across the country and evaluate the cost-effectiveness and population impact of the intervention, if implemented nationally over 10 years from 2015-2025. Some of the key outcomes include:

  • Cases of obesity averted in 2025: 43,000
  • Life-years with obesity averted (2015-2025): 226,000
  • Cost per BMI unit reduced: $237
  • Mean BMI unit reduction: -0.5
  • 10-year reach: 2 million
  • Total health care costs saved (over 10 years): $64 million
  • 10-year net cost (the cost of implementation minus the health care cost saved): $175 million
  • Cost per child: $119

As more pediatric practices adopt fully functional EHRs (fueled by federal goals and incentives), the results indicate even greater reach and population health benefits, even if implementation is limited to large practices.

Overall, there is evidence that STAR can reduce the prevalence of childhood obesity by focusing on high-risk children, providing electronic decision support for pediatricians, and supplying self-guided behavior change strategies for parents to utilize outside of the clinical setting. Limited cost effectiveness information on other similar clinical interventions indicates that STAR is likely to have a higher magnitude of effect on improving children’s health at a lower cost per child.

STAR is one of 13 interventions that have been evaluated using CHOICES methods. While many strategies focused on preventing childhood obesity are more cost-effective than STAR, the projected impact of the STAR intervention on the prevalence of obesity is high and intervention costs are low when compared with other clinical interventions focused on treatment of obesity, such as bariatric surgery.

References:

  • Taveras EM, Marshall R, Kleinman KP, et al. Comparative effectiveness of childhood obesity interventions in pediatric primary care: A cluster-randomized clinical trial. (link: https://www.ncbi.nlm.nih.gov/pubmed/25895016) JAMA Pediatr. 2015;169(6):535-542.

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Three Interventions That Reduce Childhood Obesity Are Projected to Save More Than They Cost to Implement

Posted on December 1, 2015

A CHOICES paper identifying cost-effective nutrition interventions with broad population reach highlights the importance of primary prevention for policy makers aiming to reduce childhood obesity.

Gortmaker SL, Claire Wang Y, 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, 34, no. 11 (2015):1304-1311.

Graph of impact of interventions outlined in article

Reused with permission from Project HOPE/Health Affairs. The published article is archived and available online at www.healthaffairs.org.

The United States will not be able to treat its way out of the obesity epidemic with current clinical practice. Instead, reversing the tide of obesity will require expanded investment in primary prevention, focusing on a combination of interventions with broad population reach, proven individual effectiveness, and low cost of implementation.

This study is the first of its kind to estimate the cost effectiveness of a wide variety of nutrition interventions high on the obesity policy agenda—documenting their potential reach, comparative effectiveness, implementation cost, and cost-effectiveness. Researchers identified three interventions that would more than pay for themselves by reducing healthcare costs related to obesity: an excise tax on sugar-sweetened beverages; elimination of the tax subsidy for advertising unhealthy food to children; and nutrition standards for food and drinks sold in schools outside of school meals. Implemented nationally, these interventions would prevent 576,000, 129,100, and 345,000 cases of childhood obesity, respectively, in 2025. The projected net savings to society in obesity-related health care costs for each dollar spent would be $30.78, $32.53, and $4.56, respectively.

Additional interventions modeled include restaurant menu calorie labeling, increased access to adolescent bariatric surgery, improved early care and education, and nutrition standards for school meals. The study points out that the improvements in nutrition standards for both school meals and foods and beverages sold outside of meals through current Smart Snacks in School regulation make the Healthy, Hunger-Free Kids Act of 2010 one of the most important national obesity prevention policy achievements in recent decades.

Though researchers analyzed interventions separately, no strategy on its own would be sufficient to reverse the obesity epidemic. The study also emphasizes the importance of obesity prevention that spans across multiple settings throughout the life course. While childhood interventions are necessary to reduce obesity during the early years of life and ensure that children enter into adulthood at a healthy weight, it is critical that environments spanning the life course continue to support healthy eating and drinking behaviors.

“Policy makers looking to reverse the childhood obesity epidemic and reduce long-term obesity prevalence need to focus on implementing cost-effective preventive interventions that reach a large percentage of our nation’s children,” says lead investigator of the CHOICES Project, Dr. Steve Gortmaker, who also serves as a Professor of the Practice of Health Sociology and the Director of the Prevention Research Center on Nutrition and Physical Activity at the Harvard T.H. Chan School of Public Health.

The study notes that interventions affecting both children and adults are particularly attractive, since near-term health care cost savings can be achieved by reducing adult obesity, while laying the ground work for long-term cost savings by reducing childhood obesity. The sugar-sweetened beverage excise tax, for example, would save $14.2 billion in net costs over the course of the decade, primarily due to reductions in adult health care costs.

Interventions that can achieve near-term health cost savings among adults and reduce childhood obesity offer policy makers an opportunity to make long-term investments in children’s health while generating short-term returns.

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