CHOICES Childhood Obesity National Action Kit

Instructional information & FAQ


About the CHOICES Childhood Obesity National Action Kit
Why does the CHOICES Project focus on childhood obesity?
How did the CHOICES team choose these strategies?
How does the CHOICES team categorize the strategies?
How can I use the kit?
How can I share the results of a comparison I’ve built?
Why does the kit ask for my information?
Are these results specific to my state or geographic area?
Why are some of the values in the results table noted as “cost-saving”?
What is not included in the CHOICES model?
What are other things I should consider when prioritizing childhood obesity prevention strategies with decision-makers and stakeholders?
What are implications of implementing the strategy that I should also consider?
Help
Developers

About the CHOICES Childhood Obesity National Action Kit

The CHOICES team has projected the national population reach, impact on health, implementation costs, and health care cost savings for 14 effective strategies that can be used in multiple settings – including schools, early care and out of school time, communities, and clinical. This kit provides a menu of strategies with good evidence that they can reduce obesity and/or the behavioral risks for obesity. The kit allows you to compare up to four strategies at a time within or across settings to see national results to help inform your organization’s decision-making related to childhood obesity prevention. Learn more about CHOICES methods.

Please note: The words “strategy” and “intervention” are used interchangeably throughout the Action Kit, its associated pages, across the CHOICES website, and among CHOICES published products and materials. Please note that, in the context of CHOICES and its work, these two words are synonymous.

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Why does the CHOICES Project focus on childhood obesity?

According to our recent study from the New England Journal of Medicine (Ward et al., 2017), more than half of today’s children will have obesity when they are adults. We must focus on obesity prevention strategies that are shown to improve population health and projected to reduce health care costs at national, state, and local levels. Children with obesity are more likely to have obesity when they are adults, so early prevention is key.

Adults with obesity incur on average just over $1,000 each year in additional health care costs. Children with obesity also incur more health care costs than children without obesity (about $200 annually). Having obesity has clear implications for health and health care costs.

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How did the CHOICES team choose these strategies?

The CHOICES team evaluates strategies that have clear evidence for effectiveness and impact on health, and follows specific criteria when selecting strategies to model. These strategies are just a fraction of the many strategies currently being implemented in communities. The CHOICES model centers on existing data that document the effectiveness of a strategy and its impact on obesity. Some strategies do not have these necessary effectiveness data that enable evaluation using the CHOICES model.

The strategies presented in the CHOICES Childhood Obesity National Action Kit come from a menu of over 40 strategies that our team, in consultation with expert stakeholders, has identified as having had high quality research completed regarding their:

• Impact on reduction of excess weight gain and/or

• Improvement of the behavioral risk factors for obesity (such as increased physical activity, decreased screen time, and/or reduction in sugary drink intake).

CHOICES has published cost-effectiveness results for each of these strategies in peer-reviewed journals (Sharifi et al., 2017, Cradock et al., 2016, Gortmaker et al., 2015). Additional strategies will be added to the kit once their CHOICES model results have been published.

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How does the CHOICES team categorize the strategies?

CHOICES categorizes strategies by the settings in which they take place. Our team currently has strategies within four settings:

• School settings

• Early care and out of school time settings

• Community settings (including government & transportation)

• Clinical settings

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How can I use the kit?

This kit is a great starting place for states, cities, and counties to use when making decisions related to strategies to implement to reduce childhood obesity. The relative impact and cost-effectiveness of these strategies in comparison with each other are likely to be very similar at the state or local levels, even though these strategies are scaled to national implementation and results are for the nation.

The kit can be used in several ways:

The kit can be used to compare the relative cost-effectiveness of the strategies that CHOICES has evaluated:

• Users can compare up to four strategies at one time to get a sense of how they differ in terms of impact on health (both at an individual and population level), population reach, implementation cost, and cost-effectiveness

• Users can determine which strategies give the biggest bang for the buck

• Users can compare strategies within a given setting or across settings by a focus health behavior (like reducing sugary drink consumption) or by age group.

The kit can be used to inform strategy implementation planning. Each strategy description highlights considerations for implementing the strategy that can be applicable at the local, state, or national level – such as what potential policy mechanisms could be used or what resources and activities are required.

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How can I share the results?

This kit is a great starting place for states, cities, and counties to use when making decisions related to strategies to implement to reduce childhood obesity. The relative impact and cost-effectiveness of these strategies in comparison with each other are likely to be very similar at the state or local levels, even though these strategies are scaled to national implementation and results are for the nation.

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Why does the kit ask for my information?

After you have selected strategies and clicked the “Build Comparison” button, you will be presented with a brief form asking to capture some information about you. The purpose of this is that the CHOICES team would like to know who is using this tool (organization type) and where a user is from (location). The provision of any additional information is optional.

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Are these results specific to my state or geographic area?

All results presented assume national-level implementation and are not specific to any specific user’s state, county, city, or geographic area.

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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 obesity-related health care costs saved would be greater than implementation costs. Exceptions are noted in the detailed strategy description that can be accessed by clicking on “More Info” in the results table. For example, for the “New opportunities for healthy afterschool programs” strategy, some results are “cost -saving” because implementing the strategy is more efficient (i.e., costs less) than the status quo.

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What is not included in the CHOICES model?

The CHOICES model looks at obesity as a health outcome as well as obesity-related health care costs. The CHOICES team recognizes that many of these strategies will have additional benefits beyond helping individuals achieve a healthy weight. The CHOICES researchers have compiled some estimates regarding type 2 diabetes prevention and the prevention of tooth decay for strategies that can reduce sugary drink consumption. Strategies that increase children’s physical activity will likely also have positive benefits related to improved bone health, aerobic and muscular fitness, cognition, and academic performance. The quantification of these outcomes are beyond the scope of the CHOICES model but are important outcomes for children’s education and well-being.

There are other considerations besides cost-effectiveness measures that are important when prioritizing strategies for childhood obesity prevention and determining their implementation and impacts in a local context.

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What are other things I should consider when prioritizing childhood obesity prevention strategies with decision-makers and stakeholders?

In addition to the cost-effectiveness measures described in the CHOICES model, you might also consider:

•  What is of interest to organizations/people that are at the table as part of an area’s obesity reduction efforts

• Whether organizations/people who would be responsible for implementation of a particular strategy are already or can participate in the decision-making process

• Whether those who have authority to make a change or give information to others who have that authority as part of the decision-making process are involved with 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 requires an investment, such as in an early care setting, with a strategy that has potential to generate revenue, such as a sugary drink tax

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What are implications of implementing the strategy that I should also consider?

• What is the effect of the strategy on equity in terms of implementation? 
How does the strategy impact inequity in access to, or utilization of, the specific strategy? Consider, for example, whether only highly educated individuals will be able to access the strategy. Could there be unintended consequences where services might become more expensive as a result of the strategy?

• What is the effect of the strategy on health disparities?
Considering potential inequities in implementation or access to the strategy (or reductions in inequity), how could the strategy impact racial/ethnic and/or socioeconomic inequity in the population distribution of obesity, levels of physical activity, or health status?

• 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, or are there examples of successful implementation?

• How feasible is the strategy?
Consider factors such as the availability of appropriate expertise to implement the strategy on a state or local scale, the potential size of the financial commitment, and the time scale for implementation.

• How sustainable is the strategy?
Consider the durability of the strategy, thinking about factors such as the level of ongoing funding support required; the community empowerment and capacity building and level of policy support likely to be achieved; and 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?
Consider both positive and negative impacts, such as other health consequences (e.g., anxiety/depression stemming from stigmatization), environmental consequences (e.g., less pollution/congestion), social capital (e.g., from empowered communities or improved social networks), increased household costs, or other economic consequences (e.g., impact on industry).

Some of our partners have implement strategies that they’ve modeled with us:

Example of a strategy implemented at the state level
Example of a strategy implemented at the local level

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Need help using the CHOICES Childhood Obesity National Action Kit?

For general assistance in using the CHOICES Childhood Obesity National Action Kit, please contact the CHOICES Project at mknox@hsph.harvard.edu. For technical questions regarding how the CHOICES model projects the health impact, population reach, implementation cost, and/or cost-effectiveness of strategies to reduce childhood obesity, please refer to our publications or contact Katie Giles at cgiles@hsph.harvard.edu.

 

More about the Developers of the CHOICES Childhood Obesity National Action Kit

The CHOICES Childhood Obesity National Action Kit was developed by the CHOICES Project team, specifically Katie Giles and Molly Knox– under the leadership of Dr. Steven Gortmaker and Dr. Angie Cradock – and in partnership with Burness and Alley Interactive. The JPB Foundation provided funding for the development of the CHOICES Childhood Obesity National Action Kit.