Postdoctoral Scholar Stanford University School of Medicine Palo Alto, California, United States
Background: Childhood overweight and obesity (OWOB) represent a healthcare burden estimated at $237 USD per capita per year. Primary care intervention for childhood obesity costs range from $246 to $641 per child per year. Sugar-sweetened beverages (SSB) are major contributors to OWOB. While school policies have restricted SSB availability, inadequate provision of free potable and appealing water persists. We conducted a cluster-randomized clinical trial in 26 elementary schools serving low-income populations to examine the impact of Water First, a school-based water promotion and access intervention, on changes in child OWOB. Water stations with cups were installed in cafeterias and high-traffic areas in schools. Fourth-grade students and teachers received reusable water bottles, lessons, and educational materials. The 10-month intervention was associated with lower odds of OWOB in the intervention group compared with the control group (OR 0.1; 95% CI: 0.03–0.7). Objective: To evaluate the feasibility of scaling up the intervention in other school settings, we assessed the costs of the intervention per school and participant. Design/Methods: We systematically captured the incremental costs of the intervention in three study schools with an average of 110 4th-grade students per school in the 2018-2019 academic year. We quantified the resources used for each activity: 1) Change in school environment, such as water station installations, cups, and promotional posters; 2) Individual-level activities, such as lessons, educational and promotional materials, and reusable water bottles; and 3) Meetings and other activities with key personal (principals, food service employees, teachers, and research staff). Key personnel completed a weekly survey detailing their time spent on intervention-related tasks. Unit costs were derived from invoices of purchased products, and labor costs were determined using the 2018-2019 California wages from the Bureau of Labor Statistics. Results: On average, the intervention cost was $9,199 per school and $83.6 per student: $17.50 for changes in the school environment, $61.4 for individual-level intervention, and $4.7 for planning and other activities.
Conclusion(s): Given the high economic burden of childhood OWOB on healthcare systems, we found that a simple intervention, such as providing and promoting free, safe, and appealing water to students at school, is a promising alternative to costly primary care interventions. This approach could help to prevent the incidence of OWOB and reduce the burden of childhood OWOB on healthcare systems.
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