Childhood obesity is epidemic in the United States, and a leading cause of diabetes, cardiovascular heart
disease, cancer, and other chronic conditions. Disparities in childhood obesity prevalence are found across US
states and by age, gender, socioeconomic status, and race/ethnicity. Interventions with effectiveness to reduce
childhood obesity have been developed, but little is known about their overall impact on obesity and
subsequent chronic disease, their cost-effectiveness, and their potential to reduce health disparities. Our
team’s preliminary work in developing cost-effectiveness simulation models of leading preventive and
treatment interventions for childhood obesity (e.g. excise taxes on sugar sweetened beverages) has
documented dramatic differences in population health impact and cost-effectiveness. But what is not known is
the impact of these preventive health interventions on reducing health disparities and cost-effectiveness of the
interventions in the context of intersectional health disparities. The planned research will build on our team’s
prior work in developing accurate simulation models of the growth of BMI by gender and race/ethnicity over the
life course. We aim to develop a microsimulation model to project the 10- and 30-year national impact of six
widely studied and effective childhood obesity preventive and treatment interventions, evaluating cases of
obesity prevented, cost-effectiveness metrics, chronic disease, and disparities metrics in outcome by
race/ethnicity. Secondarily, we will test impacts at the intersection of race/ethnicity and place among six states:
West Virginia, New York, Mississippi, Washington, Alaska, and Hawaii, with the goal of identifying interventions
that can both cost-effectively improve population health and reduce racial/ethnic disparities in obesity and
future chronic disease. Our specific aims: 1) Systematically evaluate evidence for effect, reach, obesity risk
factors, costs and implementation – and differences in these characteristics – of six effective interventions for
reducing obesity in children. 2) Develop a microsimulation model to accurately project nationally, over 10 and
30 years, the impact on obesity, chronic disease, cost-effectiveness and racial/ethnic disparities of the six
interventions, accounting for effectiveness, reach, obesity risks, implementation and uncertainty. 3) Adapt the
microsimulation model to six states and project the cost-effectiveness, impact on obesity, chronic disease, and
impact on racial/ethnic disparities of the six interventions, accounting for local characteristics including
effectiveness, reach, obesity risks, implementation, and accounting for uncertainty. Decision makers have
limited resources to use in reducing obesity prevalence. While there is evidence for effective preventive and
treatment interventions, there is limited cost-effectiveness analysis. If successful, this project will create a new
paradigm for evaluating obesity interventions, emphasizing cost-effectiveness, population health impact, and
health disparities metrics, providing decision makers with the tools to identify cost-effective interventions that
reduce health disparities while improving overall population health.