Impact and cost-effectiveness of childcare center policy changes on BMI and healthcare costs in the United States

Introduction: Childcare facilities influence nutrition and physical activity behaviors, making them ideal for obesity prevention. We quantified the health and economic impact of a multi-component regulatory intervention in licensed U.S. childcare facilities. Methods: Using data from published research, we estimated the one-year costs and changes in body mass index (BMI) resulting from changes in beverage consumption, physical activity, and screen time viewing regulations among 6.2 million 3-5 year olds in childcare facilities. We used the U.S. Assessing Cost Effectiveness model to simulate the impact of one-year BMI changes in the 2005 U.S. population on lifetime healthcare expenditures and Disability-Adjusted Life Years (DALYs), assuming the maintenance of intervention effects. We simulated uncertainty intervals (UI) around outcomes and discounted outcomes at a 3.5% annual rate. Results: Regulatory changes would lead to children, on average, watching 28 hours less television, exercising for 58 more hours, and consuming four fewer 12-ounce servings of sugar-sweetened beverages annually. National implementation would lead to a one-year BMI decrease of 0.02 kg/m2 (95% UI: [0.01 kg/m2, 0.03 kg/m2]) and cost $6.4 million. Intervention effects were modeled to yield 4,470 (95% UI: [1,692, 8992]) lifetime DALYs averted in the total population. The intervention was cost saving, with a net cost of -$26.2 million (95% UI: [-$4.2 million, -$57.9 million]) over the population's lifetime. Effects were due to changes in sugar sweetened beverage consumption and screen time. The intervention would save $5 per intervention dollar spent. Discussion: Changing childcare facility regulations can improve health and reduce long-term healthcare expenditures.