Brief – The Cost-Effectiveness of Interventions for Reducing Obesity among Young Children through Healthy Eating, Physical Activity, and Screen Time

A new brief from the CHOICES Project at the Harvard T. H. Chan School of Public Health in partnership with Healthy Eating Research (HER) provides an overview on the evidence thus far for the strategies with the lowest cost for the most health impact to prevent obesity in the places where very young children live, learn, and play.

The brief also discusses the need for further evidence on the obesity impact of programs for very young children.

Little girl holding a spoon - The text says: Which strategies provide the most value for money spent to reduce early childhood obesity?Preventing obesity in the early years, before poor diet and physical activity behaviors become entrenched and related chronic diseases develop, is an important public health action goal. While there is a clear need for early intervention, identifying what should be done is a harder task.

Researchers with the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Project reviewed what is known so far about the health impact and cost-effectiveness of different strategies to prevent obesity in young children (ages 0-5). The CHOICES Project works to identify the childhood obesity interventions that are the best value for money.

Some of the key findings from the study included:

    • To conduct cost-effectiveness analysis of a strategy, strong evidence for how much that strategy can reduce the risk of obesity for children, such as reducing excess weight gain and improving dietary intake and physical activity, is needed.
    • We need more evidence on the obesity impact of programs for young children to know whether they offer the best value for the money invested.
    • According to recent CHOICES research, more than half of today’s children will have obesity when they are adults if new cost-effective interventions are not initiated.
    • To see immediate cost savings, invest in strategies such as sugary drink taxes or other strategies that impact adults; however, we must invest in children in order to slow the rise of obesity prevalence.
    • Based on what is currently known regarding strong evidence for impact on health, the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) is the best value for money spent among strategies that focus on young children in early care and education settings, but it will require upfront investment.
    • No single strategy will solve the childhood obesity epidemic; instead, multiple interventions, across multiple settings and at many levels of influence (local, state, federal) will need to be applied together.

More research with strong evidence for effectiveness that uses rigorous measures and study designs is urgently needed in order to better inform stakeholders’ options when it comes to childhood obesity prevention. Additionally, this review also highlights that policymakers and advocates should be realistic about the likely short-term financial implications of early childhood obesity prevention interventions. Recognizing that it may be more important to focus on the best long-term value, broadly defined, for money invested, rather than on whether or not an intervention results in immediate financial returns, is essential.

The report was funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation.

Kenney E, Cradock A, Resch S, Giles C, Gortmaker S. The Cost-Effectiveness of Interventions for Reducing Obesity among Young Children through Healthy Eating, Physical Activity, and Screen Time. Durham, NC: Healthy Eating Research; 2019. Available at: Address correspondence to Erica Kenney, ScD, MPH at