. Author manuscript; available in PMC: 2022 Sep 24.

Published in final edited form as: Am J Prev Med. 2015 Jul;49(1):102–111. doi: 10.1016/j.amepre.2015.03.032

Table 3.

Implementation and equity issues for four childhood obesity interventions in the United States: CHOICES.

Intervention	Quality of Evidence^a	Equity	Acceptability to stakeholders	Feasibility	Sustain-ability	Side effects	Social and Policy Norms
Sugar Sweetened Beverage Excise Tax²⁸ (SSB)	High quality RCT for children; moderate quality for adults	Neutral: Regressive tax, but health benefits, earmarking potential	Beverage industry opposition; national public opinion increasingly positive	Excise taxes common: very feasible	Likely; examples of other excise taxes like tobacco	Reduced diabetes, CVD independent of BMI	Substantial potential for shift in social norms with publicity surrounding successful implementation
Reduce Tax Subsidy of TV Advertising²⁹ (TV AD)	High quality RCT linking TV and BMI	Potential to reduce inequality as minority children watch more TV	Likely food, beverage, advertising industry opposition	Plausible feasibility; needs to be implemented and survive court challenge	Likely if implemented	Other media advertising may increase	Publicity concerning law could lead to increased support
Early Child and Education Policy Changes³¹ (ECE)	High/moderate quality RCTs linking SSB, TV, physical activity to BMI	Potential for reduced disparities with policy change and increased disparities due to family based settings	3 states already have so acceptable	States already regulate so feasible; cost a limiting factor	Yes but system for monitoring needed	Other effects on CVD, diabetes risk, dental health, as well as effects in the home and staff behaviors	Can increase awareness for issues among preschools
State Policy for Active Physical Education³⁰ (Active PE)	High quality RCT linking PA and BMI and moderate quality longitudinal study	Potential for negative effect on equity as only schools with PE can implement	Acceptable to policy-makers; teachers require training	Feasible with training for staff; cost major limiting factor	Likely but system for monitoring needed	Effects on fitness, reduced CVD health, class-room behavior, no harm to academic achievement	Can boost support for physical activity during school day

BMI, Body Mass Index; CVD, Cardiovascular Disease; RCT, Randomized Controlled Trial, SSB, Sugar-sweetened Beverage; TV, Television

Quality of evidence for the primary behavioral link to BMI, using GRADE rating.⁴⁰