BACKGROUND:Evidence suggests that providing children with water on school lunch lines promotes healthy weight and is cost-effective. OBJECTIVE:Estimate reach, cost, cost-effectiveness, and impact on weight status and obesity-related health equity of a strategy to install chilled, filtered water dispensers on school lunch lines in Massachusetts' schools. DESIGN:A cost-effectiveness analysis was conducted in 2022-2023 using the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model (2020-2029), estimates from published studies, publicly available national and state surveillance, programmatic, administrative data, and experts' assumptions. PARTICIPANTS/SETTING:Schools participating in Massachusetts' school drinking water lead testing program with elevated lead concentrations in areas with disproportionate health risks MAIN OUTCOME MEASURES: Reach, cost, cost per quality-adjusted life year (QALY) gained, and cases of obesity prevented overall and by income, race, and ethnicity STATISTICAL ANALYSES: Means and 95% uncertainty intervals (UIs) for outcomes were estimated by running the model 1000 times, accounting for uncertainty from data sources and population projections. RESULTS:This strategy is projected to improve drinking water access for 265 000 (95% UI, 259 000-273 000) students in 304 schools, prevent 525 (95% UI, 192-880) cases of childhood obesity in 2029, cost $4.48/student/year (95% UI, $3.54-$5.43) to implement, and is likely cost-effective ($72 700 (95% UI, $40 000-$234 000) per QALY). Larger projected reductions in obesity prevalence for Hispanic/Latino and Black students compared with white students were observed (7.2 [95% UI, 5.2-10.3], and 4.7 [95% UI, 2.9-7.4], respectively), and among students from families with lowest incomes (<130% Federal Poverty Level) compared with the highest incomes (>350% Federal Poverty Level) (2.6 [95% UI, 1.9-3.5]). CONCLUSIONS:A strategy to provide chilled, filtered water dispensers on lunch lines in Massachusetts schools is projected to improve school nutrition environments, increase water consumption, prevent excess weight gain, improve health equity, and be cost-effective.

INTRODUCTION:Excluding sugar-sweetened beverages from eligible purchases in the Supplemental Nutrition Assistance Program has been proposed as a strategy to improve diet quality and health. This study estimates the cost-effectiveness of this policy and its potential impact on health equity. METHODS:The Childhood Obesity Intervention Cost-Effectiveness Study microsimulation and systematic review process was used in 2024 to estimate the potential impact of excluding sugar-sweetened beverages from Supplemental Nutrition Assistance Program-eligible purchases over a 10-year period (2023-2032) for the U.S. POPULATION:Health outcomes related to excess weight, costs, and relative changes in obesity prevalence by income, race, and ethnicity groups in 2032 were estimated. RESULTS:The policy is projected to be cost-saving, prevent 279,000 cases of obesity (95% uncertainty interval=149,000-446,000), and contribute 115,000 (95% uncertainty interval=60,100-187,000) quality-adjusted life years gained over 10 years among Supplemental Nutrition Assistance Program participants. The policy could save an estimated $2.75 billion in healthcare costs related to excess weight over 10 years, resulting in $3.35 in healthcare cost savings per dollar spent on implementation. Reductions in obesity prevalence were estimated to be 3.5 times greater among individuals with income ≤130% of the federal poverty level than the overall mean and 3-3.5 times greater among non-Hispanic Black and Hispanic individuals than among non-Hispanic White individuals. CONCLUSIONS:Excluding sugar-sweetened beverages from Supplemental Nutrition Assistance Program-eligible purchases could be a cost-saving strategy to improve health and health equity between income, racial, and ethnic groups. The U.S. Department of Agriculture could use pilot studies to test the real-world effects of excluding sugar-sweetened beverages from the Supplemental Nutrition Assistance Program.

BACKGROUND:Although fatal food-induced anaphylaxis is rare, adolescence is the period of highest risk. However, we lack strong estimates of the incidence of food allergic reactions among adolescents. OBJECTIVE:To estimate the incidence of food allergic and anaphylactic reactions among adolescents with food allergy who have a prescription for epinephrine. METHODS:As part of a cohort study that was embedded in a randomized trial to promote safe food allergy management, we followed adolescents aged 15 to 19 years with food allergy and a current prescription for epinephrine for a period of 15 months in 2019 to 2020. At monthly intervals, participants were asked, through text message check-ins, whether they had experienced a food allergic reaction due to accidental exposure to food allergens in the past month. RESULTS:Among the cohort of 131 adolescents, 112 answered at least 1 of the 15 monthly check-ins. Together, these respondents contributed 742 person-months of follow-up data of a total possible 1680 person-months. In the 15-month study period, the incidence of food allergic reactions among adolescents with food allergy was 34.0 events per 100 person-years (95% CI: 21.0-51.9). The incidence of food allergic reactions meeting the criteria for anaphylaxis was 16.2 events per 100 person-years (95% CI: 7.8-29.7). CONCLUSION:Data on the incidence of food allergic reactions can help set expectations for safe food allergy management for adolescents and their families, and can help inform discussions between patients, families, and physicians regarding different treatment options available and their associated risks and benefits. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03284372.

Background The evidence-based nutrition standards of the Healthy, Hunger-Free Kids Act of 2010 significantly improved school meal nutrition, yet little is known about how school food authorities (SFAs) were supported to translate the standards into practice in schools. Objective This study tested whether or not 2 implementation supports, SFA receipt of training/technical assistance (TA) and purchase of new equipment, for implementing the nutrition standards were associated with the nutritional quality of school lunches. Design This study used a cross-sectional design. Participants/setting The study sample included 365 SFAs derived from the US Department of Agriculture's School Nutrition and Meal Cost Study (2014 to 2015 school year), the only national data of school nutrition environments since the Healthy, Hunger-Free Kids Act of 2010. Main outcome measures Implementation supports included reported participation in training/TA and the purchase of new equipment between the 2012 to 2013 (year of policy adoption) and 2014 to 2015 school years. The primary outcome, nutritional quality of school lunches served, was defined as low/high Healthy Eating Index 2010 scores during the 2014 to 2015 school year. Secondary implementation supports included the number of areas covered by training/TA, the adequacy of training/TA, and the degree of implementation challenges. Statistical analyses Multivariable-adjusted logistic regression models assessed if receipt of implementation supports was associated with lunch Healthy Eating Index 2010 scores. Results The median lunch Healthy Eating Index 2010 score was 81.7 (95% CI 80.4 to 82.9). Most SFAs (78.4%, 95% CI 72.0% to 85.0%) reported having participated in training/ TA and one-third (33.8%, 95% CI 24.4% to 43.2%) reported having purchased new equipment-neither were associated with the odds of having higher Healthy Eating Index 2010 scores for lunches served at the time of data collection. Conclusions Many SFAs accessed implementation supports to adopt the nutrition standards. Information on dose, quality, and nutrition-related impact of implementation supports using measures of change are needed to determine how best to support SFAs with implementation of new nutrition standards. J Acad Nutr Diet. 2025;125(5):666-673.

Introduction The US has required chain food establishments—including supermarkets—to display calorie labels on prepared (i.e., ready-to-eat) foods since 2018. Implementation of this supermarket calorie labeling policy reduced purchases of prepared foods from supermarkets, but it remains unknown whether the policy is cost-effective. Methods In 2023-2024, this study applied the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model to estimate the effects of the supermarket calorie labeling policy on health, costs, and cost-effectiveness over 10 years (2018-2027) for the US population. The model projected benefits overall and among racial, ethnic, and income subgroups. Sensitivity analyses varied assumptions about the extent to which consumers replace calorie reductions from prepared foods with calories from other sources (i.e., caloric compensation). Results From 2018-2027, the supermarket calorie labeling policy was projected to save $348 million in healthcare costs (95% Uncertainty Interval [UI]: $263-426 million), prevent 21,700 cases of obesity (95% UI: 18,200-25,400), including 3,890 cases of childhood obesity (95% UI: 2,680-5,120), and lead to 15,100 quality-adjusted life years (QALYs) gained across the US population (95% UI: 10,900-20,500). The policy was projected to prevent cases of obesity and childhood obesity across all racial, ethnic, and income groups. The policy was projected to be cost-saving when assuming low and moderate caloric compensation and cost-effective when assuming very high caloric compensation. Conclusions A policy requiring calorie labels on prepared foods in supermarkets was projected to be cost-saving or cost-effective and lead to reductions in obesity across all racial, ethnic, and income groups.

Childhood Obesity Prevention Although new weight-loss drugs are important, scholars and policymakers shouldn't lose sight of population-level strategies that can prevent excess weight gain and obesity among children in the first place.

Subsidized meals provided through the National School Breakfast and Lunch programs are an important source of daily nutrition for millions of students across the United States. Aging school infrastructure has led some districts to rely on pre-packaged meals to feed students over the past few decades. It is unclear how investments in infrastructure upgrades that would enable on-site scratch cooking in schools might influence student selection and consumption of school meals. The aim of this study was to assess changes in student selection and consumption of school lunches following a conversion from pre-packaged meals to lunches prepared on-site, the introduction of salad bars on the lunch line, and removal of flavored milk offerings. Quasi-experimental difference-in-difference analysis of pre/post direct observation weighed plate waste measurements collected in Fall 2018 and Spring 2019 from 595 3rd-5th graders at eight elementary schools (four intervention, four controls) in a large urban school district in New England. Descriptive statistics and mixed-model linear regressions controlling for grade, sex, intervention, and observations nested within individual were used to examine changes in meal component selection and consumption. Student selection and consumption of vegetables increased by 31 grams (95%CI 18g – 43g) (equivalent to ∼3.25 carrot sticks or grape tomatoes) in intervention schools relative to controls, while student selection and consumption of milk decreased by 46g (95%CI 18g – 43g) (∼1/5 of an 8 ounce milk carton). Entrée and fruit selection and consumption did not change significantly. Removal of flavored milk may lead to an initial decline in milk selection and consumption. Increased offerings of fresh unpackaged vegetables can increase student acceptance and consumption. T32 HL098048/HL/NHLBI NIH HHS/United States.

Introduction: Amid the successes of local sugar-sweetened beverage (SSB) taxes, interest in statewide policies has grown. This study evaluated the cost effectiveness of a hypothetical 2-cent-perounce excise tax in California and its implications for population health and health equity. Methods: Using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model, tax impacts on health, health equity, and cost effectiveness over 10 years in California were projected, both overall and stratified by race/ethnicity and income. Expanding on previous models, differences in the effect of intake of SSBs on weight by BMI category were incorporated. Costing was performed in 2020, and analyses were conducted in 2021-2022. Results: The tax is projected to save $4.55 billion in healthcare costs, prevent 266,000 obesity cases in 2032, and gain 114,000 quality-adjusted life years. Cost-effectiveness metrics, including cost/ quality-adjusted life year gained, were cost saving. Spending on SSBs was projected to decrease by $33 per adult and $26 per child overall in the first year. Reductions in obesity prevalence for Black and Hispanic Californians were 1.8 times larger than for White Californians, and reductions for adults with lowest incomes (<130% Federal Poverty Level) were 1.4 times the reduction among those with highest incomes (>350% Federal Poverty Level). The tax is projected to save $112 in obesity-related healthcare costs per $1 invested. Conclusions: A state-wide SSB tax in California would be cost saving, lead to reductions in obesity and improvement in SSB-related health equity, and lead to overall improvements in population health. The policy would generate more than $1.6 billion in state tax revenue annually that can also be used to improve health equity.Am J Prev Med 2024;66(1):94-103. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

INTRODUCTION:Amid national efforts to align priorities for nutrition and food assistance programs, little is known about the implementation of community-led efforts for children. This study aimed to estimate U.S. public school participation in weekend backpack programs (WBPs), to document program structure, and to consider characteristics of programs with more nutritious food offerings. METHODS:The prevalence of WBP participation in 2022 was estimated using a state-stratified, random sample of n=413 public schools. Administrators from WBPs at 49 schools completed measures of implementation characteristics and nutritional quality of foods offered. In 2022-2023, using a multivariable-adjusted linear regression model, the authors explored the association between hypothesized implementation characteristics and Healthy Eating Index-2015 scores of foods provided. RESULTS:Half of public schools (53.7%, 95% CI: 46.8%, 60.7%) in the national sample reported participating in WBPs. Many WBPs in the subsample were affiliated with anti-hunger organizations (41%), led by school counselors and volunteers (55%), and funded by grants (51%). WBPs spent an average of $0.56 (sd=$0.36) per item. Foods provided averaged a Healthy Eating Index-2015 score of 58.4 (sd=12.3), similar to children's average diets. About half of WBPs (41%) reported accessing nutrition resources. CONCLUSIONS:Despite the decentralized structure and absence of dedicated funding mechanisms, WBPs were common in our national sample of schools, suggesting widespread perceptions of unmet food needs and extensive efforts from community members to mitigate weekend hunger. Further research on food procurement methods and program impacts on child nutrition outcomes is needed to advance national priorities for nutrition and food security.

Introduction: Calorie labeling of standard menu items has been implemented at large restaurant chains across the U.S. since 2018. The objective of this study was to evaluate the cost effectiveness of calorie labeling at large U.S. fast-food chains. Methods: This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost effectiveness over a 10-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022. Results: Calorie labeling is estimated to be cost saving; prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval=518,000; 586,000), including 41,500 (95% uncertainty interval=33,700; 50,800) cases of childhood obesity; and save $22.60 in healthcare costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126 and 185 cases per 100,000 people) and all income groups (range between 152 and 186 cases per 100,000 people). Conclusions: Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants. Am J Prev Med 2024;66(1):128-137. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Background Despite federal regulations limiting saturated fat and sodium levels on a weekly average basis, daily nutrient content of school meals in the United States is not regulated, leading to potential large fluctuations and intake well in excess of dietary recommendations. Objective To assess the daily prevalence of potential public elementary school meal combinations that were high in saturated fat and sodium (using cutoffs based on the US Department of Agriculture weekly average reimbursable meal thresholds), and to identify saturated fat and sodium thresholds for entrees to limit full meals exceeding those cutoffs. Design Cross-sectional. Participants and setting Four weeks of publicly available public elementary school (kindergarten through grade five) breakfast and lunch menus with associated nutrition data were collected from a national stratified random sample of 128 school districts during fall 2019. Main outcome measures Percent of meal combinations exceeding the saturated fat and Target 1 sodium thresholds were calculated, as well as thresholds for saturated fat and sodium levels in breakfast and lunch entrees. Statistical analyses Descriptive statistics and logistic regression were used to examine the odds of alignment with sodium and saturated fat US Department of Agriculture thresholds. Results The prevalence of elementary breakfast and lunch meal combinations that were high in sodium was on average 11% and 12.4%, respectively, and for saturated fat was 10.6% and 34%, respectively. Entrees above certain thresholds (>= 400 and >= 1,000 mg sodium and >= 4.5 and >= 6 g saturated fat for breakfast and lunch, respectively) had a higher odds of producing a reimbursable meal that was high in sodium and saturated fat. Conclusions There is widespread availability of high-saturated fat and sodium elementary school meal combinations on a daily basis. Daily thresholds, in addition to weekly nutrient thresholds, as well as limits on sodium and saturated fat for entrees, may therefore be needed to prevent daily excess intake of saturated fat and sodium among elementary students.

ObjectiveThe objective of this study is to estimate health-related quality of life (HRQoL) by continuous BMI by age, sex, and demographic group in the United States.MethodsWe estimated HRQoL (overall and by domain) by continuous BMI using SF-6D (Short-Form Six-Dimension) data from 182,778 respondents ages 18 years and older from the repeated cross-sectional Medical Expenditure Panel Survey (MEPS) 2008 to 2016. We adjusted for BMI self-report bias and for potential confounding between BMI and HRQoL.ResultsWe found an inverse J-shaped curve of HRQoL by BMI, with lower values for female individuals and the highest health utilities occurring at BMI of 20.4 kg/m2 (95% CI: 20.32-20.48) for female individuals and 26.5 kg/m2 (95% CI: 26.45-26.55) for male individuals. By BMI category, excess weight contributed to HRQoL loss of 0.0349 for obesity overall, rising to 0.0724 for class III obesity. By domain, pain was the largest cause of HRQoL loss for obesity (26%), followed by role limitations (22%).ConclusionsHRQoL is lower for people with excess body weight across a broad range of ages and BMI levels, especially at high levels of BMI, with pain being the largest driver of HRQoL loss. These findings highlight the importance of promoting a healthy weight for the entire population while also targeting efforts to prevent extreme weight gain over the life course.

BACKGROUND AND OBJECTIVES: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prevents food insecurity and supports nutrition for more than 3 million low-income young children. Our objectives were to determine the cost-effectiveness of changes to WIC’s nutrition standards in 2009 for preventing obesity and to estimate impacts on socioeconomic and racial/ethnic inequities. METHODS: We conducted a cost-effectiveness analysis to estimate impacts from 2010 through 2019 of the 2009 WIC food package change on obesity risk for children aged 2 to 4 years participating in WIC. Microsimulation models estimated the cases of obesity prevented in 2019 and costs per quality-adjusted-life year gained. RESULTS: An estimated 14.0 million 2- to 4-year old US children (95% uncertainty interval (UI), 13.7–14.2 million) were reached by the updated WIC nutrition standards from 2010 through 2019. In 2019, an estimated 62 700 (95% UI, 53 900–71 100) cases of childhood obesity were prevented, entirely among children from households with low incomes, leading to improved health equity. The update was estimated to cost $10 600 per quality-adjusted-life year gained (95% UI, $9760–$11 700). If WIC had reached all eligible children, more than twice as many cases of childhood obesity would have been prevented. CONCLUSIONS: Updates to WIC’s nutrition standards for young children in 2009 were estimated to be highly cost-effective for preventing childhood obesity and contributed to reducing socioeconomic and racial/ethnic inequities in obesity prevalence. Improving nutrition policies for young children can be a sound public health investment; future research should explore how to improve access to them.

Background: Although interventions to change nutrition policies, systems, and environments (PSE) for children are generally cost effective for preventing childhood obesity, existing evidence suggests that nutrition education curricula, without accompanying PSE changes, are more commonly implemented. Objectives: This study aimed to estimate the societal costs and potential for cost-effectiveness of 3 nutrition education curricula frequently implemented in United States public schools for childhood obesity prevention. Methods: In 2021, we searched for nutrition education curricula in the Supplemental Nutrition Assistance Program (SNAP)-Ed Toolkit, a catalog of interventions for obesity prevention coordinated by the federal government. Standard costing methodologies estimated the societal costs from 2023 to 2032 of nationwide implementation of each identified curriculum. Using the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) microsimulation model, which projects the costs, health care costs saved, and cases of obesity prevented for childhood obesity prevention interventions, we conducted threshold analyses for each curriculum, estimating the cost per quality-adjusted life-year for a range of hypothetical effects on child BMI to determine how large of an effect each curriculum would need to have to meet a cost-effectiveness threshold of $150,000 per quality-adjusted life-year. Results: Three nutrition education curricula without PSE were identified from SNAP-Ed; none had evidence of an impact on obesity risk. From 2023 to 2032, the estimated implementation costs of the curricula nationwide ranged from $1.80 billion (95% upper interval: $1.79, $1.82 billion) to $3.48 billion (95% upper interval: $3.44, $3.51 billion). Each curriculum would have to reduce average child BMI by 0.10 kg/m2 or more-an effect size that has not been reported by any of the 3 curricula, or by more comprehensive existing prevention programs-to be considered cost effective at this threshold. Conclusions: SNAP-Ed-endorsed nutrition education curricula alone are unlikely to be cost effective for preventing childhood obesity. Continued efforts to implement interventions with strong evidence for effectiveness, including PSE approaches, are needed.

OBJECTIVE:The objective of this study was to project the cost-effectiveness of implementing the Healthy Weight Clinic (HWC), a primary care-based intervention for 6- to 12-year-old children with overweight or obesity, at federally qualified health centers (FQHCs) nationally. METHODS:We estimated intervention costs from a health care sector and societal perspective and used BMI change estimates from the HWC trial. Our microsimulation of national HWC implementation among all FQHCs from 2023 to 2032 estimated cost per child and per quality-adjusted life year (QALY) gained and projected impact on obesity prevalence by race and ethnicity. Probabilistic sensitivity analyses assessed uncertainty around estimates. RESULTS:National implementation is projected to reach 888,000 children over 10 years, with a mean intervention cost of $456 (95% uncertainty interval [UI]: $409-$506) per child to the health care sector and $211 (95% UI: $175-$251) to families (e.g., time participating). Assuming effect maintenance, national implementation could result in 2070 (95% UI: 859-3220) QALYs gained and save $14.6 million (95% UI: $5.6-$23.5 million) in health care costs over 10 years, yielding a net cost of $278,000 (95% CI: $177,000-$679,000) per QALY gained. We project greater reductions in obesity prevalence among Hispanic/Latino and Black versus White populations. CONCLUSIONS:The HWC is relatively low-cost per child and projected to reduce obesity disparities if implemented nationally in FQHCs.

Introduction Adults with severe obesity are at increased risk for poor metabolic health and may need more intensive clinical and community supports. The prevalence of severe obesity is underestimated from self-reported weight and height data. We examined severe obesity prevalence among US adults by sociodemographic characteristics and by state after adjusting for self-report bias. Methods Using a validated bias-correction method, we adjusted self-reported body mass index (BMI) data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) by using measured data from the National Health and Nutrition Examination Survey. We compared bias-corrected prevalence of severe obesity (BMI ≥40) with self-reported estimates by sociodemographic characteristics and state. Results Self-reported BRFSS data significantly underestimated the prevalence of severe obesity compared with bias-corrected estimates. In 2020, 8.8% of adults had severe obesity based on the bias-corrected estimates, whereas 5.3% of adults had severe obesity based on self-reported data. Women had a significantly higher prevalence of bias-corrected severe obesity (11.1%) than men (6.5%). State-level prevalence of bias-corrected severe obesity ranged from 5.5% (Massachusetts) to 13.2% (West Virginia). Based on bias-corrected estimates, 16 states had a prevalence of severe obesity greater than 10%, a level not seen in the self-reported estimates. Conclusion Self-reported BRFSS data underestimated the overall prevalence of severe obesity by 40% (5.3% vs 8.8%). Accurate state-level estimates of severe obesity can help public health and health care decision makers prioritize and plan to implement effective prevention and treatment strategies for people who are at high risk for poor metabolic health.

Abstract This chapter emphasizes the enormous potential schools hold for impacting population health. Considering the constant presence of school in children’s lives for over 12 years, it is important to conduct research and plan programs that can work together across the life course to promote health and seek to understand how schools can help to link children to services beyond the school walls. A large gap between the evidence for effectiveness of school-based health interventions and the types of programs, policies, and services that currently influence the lives of children must be addressed. Future school-based dissemination and implementation research cannot overestimate the importance of developing strategies that are compatible with the primary aims of schools: promoting learning through reading, writing, math, and so on. Equally important is considering policy and environmental change strategies at the national, state, and district levels to promote health within schools.

We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps' What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a "WWFH intervention" rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.