BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth Kendrin R. Sonneville, ScD, RD, Michael W. Long, ScD, Zachary J. Ward, MPH, Stephen C. Resch, PhD, Y. Claire Wang, MD, ScD, Jennifer L. Pomeranz, JD, MPH, Marj L. Moodie, DrPH, Rob Carter, PhD, Gary Sacks, PhD, Boyd A. Swinburn, MD, MBChB, Steven L. Gortmaker, PhD Introduction: Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2–19 years. Methods: We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015–2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. Results: We estimated the intervention would reduce an aggregate 2.13 million (95% UI¼0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI¼$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI¼$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI¼1,752, 7,489) quality- adjusted life-years. Conclusions: Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures. (Am J Prev Med 2015;49(1):124–134) & 2015 American Journal of Preventive Medicine Introduction C hildren and adolescents view thousands of food- related TV ads each year. 1 These ads include extensive promotion of nutritionally poor foods and beverages that are high in calories; contain signifi- cant amounts of sodium, saturated fat, and added sugars; and are low in nutrients. 2–4 In 2009, food marketers spent $633 million on youth-directed TV in the U.S. 5 Despite changes in TV viewing platforms and adverti- sing expenditures, TV remains the predominant medium to reach youth, accounting for 35% of total youth- directed expenditures. 5 Children are particularly vulner- able to persuasive messages because of their inability to identify persuasive intent, 6 and exposure to TV food From the Department of Nutritional Sciences (Sonneville), School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Social and Behavioral Sciences (Long, Gortmaker), Center for Health Decision Science (Ward, Resch), Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Health Policy and Management (Wang), Mailman School of Public Health, Columbia University, New York, New York; Department of Public Health (Pomeranz), Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania; Deakin Health Economics (Moodie, Carter); and the WHO Collaborating Centre for Obesity Prevention (Sacks, Swinburn), Deakin University, Melbourne, Victoria, Australia Address correspondence to: Kendrin R. Sonneville, ScD, RD, Depart- ment of Nutritional Sciences, University of Michigan School of Public Health, 6634 Tower, 1415 Washington Heights, Ann Arbor MI 48109- 2029. E-mail: kendrins@umich.edu. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2015.02.026 124 Am J Prev Med 2015;49(1):124–134 & 2015 American Journal of Preventive Medicine  Published by Elsevier Inc.