A middle school–based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy cafeteria foods, and peer-led education, increased participation in school lunch programs and selection of fruit dishes, and reduced snack sales.

Cost and Cost-Effectiveness of Students for Nutrition and Exercise (SNaX)

Published in: Academic Pediatrics, v. 16, no. 3, Apr. 2016, p. 247-253

Posted on RAND.org on April 28, 2016

by Joseph A. Ladapo, Laura M. Bogart, David J. Klein, Burton O. Cowgill, Kimberly E. Uyeda, David G. Binkle, Elizabeth R. Stevens, Mark A. Schuster

Research Questions

  1. Does Students for Nutrition and eXercise (SNaX), a 5-week middle school-based obesity-prevention intervention, improve students' diet?
  2. Is it cost effective?

OBJECTIVE: To examine the cost and cost-effectiveness of implementing Students for Nutrition and eXercise (SNaX), a 5-week middle school–based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. METHODS: Five intervention and 5 control middle schools (mean enrollment, 1520 students) from the Los Angeles Unified School District participated in a randomized controlled trial of SNaX. Acquisition costs for materials and time and wage data for employees involved in implementing the program were used to estimate fixed and variable costs. Cost-effectiveness was determined using the ratio of variable costs to program efficacy outcomes. RESULTS: The costs of implementing the program over 5 weeks were $5433.26 per school in fixed costs and $2.11 per student in variable costs, equaling a total cost of $8637.17 per school, or $0.23 per student per day. This investment yielded significant increases in the proportion of students served fruit and lunch and a significant decrease in the proportion of students buying snacks. The cost-effectiveness of the program, per student over 5 weeks, was $1.20 per additional fruit served during meals, $8.43 per additional full-priced lunch served, $2.11 per additional reduced-price/free lunch served, and $1.69 per reduction in snacks sold. CONCLUSIONS: SNaX demonstrated the feasibility and cost-effectiveness of a middle school–based obesity-prevention intervention combining school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education. Its cost is modest and unlikely to be a significant barrier to adoption for many schools considering its implementation.

Key Findings

  • The program, which combined school-wide environmental changes, multimedia, encouragement to eat healthy school cafeteria foods, and peer-led education, significantly increased the proportion of students who chose fruit dishes in the school cafeteria and who participated in school lunch programs.
  • It reduced the proportion of students buying snacks.
  • Program aims were achieved at a cost of less than $0.25 per student per day.
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