¶ STATE GOVERNMENT AFFAIRS ISSUE BRIEF
Legislative Strategies to Address Childhood Obesity
Overview
According to the AAP policy statement, “Prevention of Pediatric Overweight and Obesity,”
15.3 percent of 6- to 11- year-olds and 15.5 percent of 12- to 19-year-olds are overweight or
obese. Obesity is associated with significant health problems in the pediatric age group and is an
important early risk factor for much of adult morbidity and mortality. And, childhood obesity is
associated with such medical conditions as type 2 diabetes, hypertension, depression, and
asthma.
A national study found that over 300,000 deaths in the US in 2000 were related to poor diet and
physical inactivity. Only tobacco use caused more deaths (435,000). And while most of the
major preventable causes of death showed declines or little change since 1990, deaths due to
poor diet and physical inactivity increased.
(http://www.hhs.gov/news/press/2004pres/20040309.html)
According to another study that analyzed national costs attribut ed to both overweight (BMI 25–
29.9) and obesity (BMI greater than 30), medical expenses accounted for 9.1 percent of total US
medical expenditures in 1998 and may have reached as high as $78.5 billion ($92.6 billion in
2002 dollars). (www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm)
Approximately half of those costs were paid by Medicaid and Medicare.
These grim statistics have caught the attention of state policymakers from both a public health
perspective and from a budgetary perspective. In the 2004 legislative sessions, 39 states
considered bills that target obesity. This legislative trend is expected to continue in 2005.
AAP Recommendations
In the AAP policy statement, “Prevention of Pediatric Overweight and Obesity,” the Academy
makes several recommendations for state policymakers to help them to reduce the childhood
obesity rates in their states. State officials could:
· Ensure that foods that are nutrient rich and palatable, yet low in excess energy from
added sugars and fat, are readily available to parents, school and child care food services,
and others responsible for feeding children
Division of State Government Affairs ¶ 800.433.9016, x 7799 ¶ stgov@aap.org
2
· Discourage advertising and promotion of energy-dense, nutrient-poor food products to
children
· Limit the sales and promotion of carbonated beverages, along with other foods and
beverages of little nutritional value in schools
· Encourage school districts to decrease their dependence on vend ing machines, snack
bars, and school stores for school revenue
· Incorporate physical education programs into their state required curricula that emphasize
personal fitness - as opposed to physical education limited to a few team sports
· Encourage communities and schools to develop needed counseling services, physical
activity opportunities, and strategies to reinforce the gains made in the clinical
management of childhood obesity
· Ensure that there is adequate health care coverage for preventive and treatment services
for all children – including treatments for obese and overweight children
· Ensure that there is adequate public and private insurance reimbursement for the
treatment of childhood obesity. This is crucial because inadequate reimbursement is a
disincentive for physicians to develop prevention and treatment programs. This
disincentive presents a significant barrier to families seeking professional care
In another AAP policy statement, “Soft Drinks in Schools,” the AAP focuses on the effect that
soft drink availability in schools is having on the obesity epidemic. In the US, children’s daily
food selections are excessively high in discretionary or added fat and sugar. Such fats and sugars
account for 40 percent of children’s daily energy intake, and sweetened and/or soft drinks
constitute the primary source of these added sugars in the daily diets of children. Because so
many schools depend on revenue from soft drink vending sales to fund extra-curricular activities
and other discretionary spending, there is a lot of opposition to legislative efforts to limit these
sales. The AAP policy statement includes the following recommendations:
· Pediatricians should advocate for the removal of soft drinks and sweetened beverages in
schools, educate schools on the health impact of soft drink consumption, and encourage
schools to replace soft drinks with healthier choices
· Pediatricians should also work with schools in developing healthy nutritional policies and
ensure that the first priority of school nutritional policies is the health of students
· The decision- making process that schools use to enter into vending machine contracts
should be open to public scrutiny and input
· In instances where schools have an existing contract with soft drink vendors, policies
should be set in place so that soft drinks are not sold in competition with or as a part of
the school lunch program
· Additionally, access to vending machines containing soft drinks should be restricted
during the lunch hour, and healthy choices should be made available in addition to soft
drinks
The AAP also advocates for physical activity in school as another way to address the obesity
epidemic. In the AAP policy statement, “Physical Fitness and Activity in Schools,” the AAP
recommends that schools should implement the following:
· Comprehensive, preferably daily, physical education for children in grades kindergarten
through 12
3
· Comprehensive health education for children in grades kindergarten through 12
· Commitment of adequate resources, including program funding, personnel, safe
equipment, and facilities
· The use of appropriately trained physical education specialists and appropriately trained
teachers for physical and health education classes, respectively
· Physical activity instruction and programs that meet the needs and interests of all
students, including those with illness, injury, and developmental disability, as well as
those with obesity, sedentary lifestyles, or a disinterest in traditional team or competitive
sports
Current State Laws
School Nutrition Legislation
Arkansas House Bill 1583 (2003)
Arkansas is the first state to enact a sweeping piece of childhood obesity/school nutrition
legislation. In 2003, Arkansas legislators enacted House Bill (HB) 1583 (link below). The law’s
provisions include:
· The creation of a state Child Health Advisory Committee which shall include a member
of the AAP-Arkansas Chapter
· The Committee shall develop nutrition and physical activity standards and policy
recommendations focusing on: 1) foods sold individually in school cafeterias,
2) competitive foods offered at schools through vending machines and school stores,
3) professional development of food service staff, 4) expenditure of funds from
competitive food and beverage contracts, 5) physical education and activity, 6) systems to
ensure implementation of the recommendations, and 7) monitoring and evaluation of the
systems
· Starting with the 2003/2004 school year, every school district shall: 1) prohibit in-school
access by elementary school students to vending machines offering food and beverages
2) disclose to parents the financial relationship between the school and competitive food
and beverage companies; 3) require schools to disclose to parents an annual body mass
index (BMI) percentile by age for each student; 4) require schools to explain annually to
parents the health implications of BMI, nutrition and physical activity
· For the 2004/2005 school year, the state shall require each school district to form a school
nutrition and physical activity advisory committee. The goal of the committee is to help
raise awareness of the importance of physical activity and nutrition. It will also help to
implement the state recommendations on these issues at the local level
The Arkansas law can be found at the end of this document and online at:
www.arkleg.state.ar.us/ftproot/acts/2003/public/act1220.pdf (pdf file/5 pages).
California Senate Bill 677(2003)
California also enacted legislation that will ensure that only healthy beverages are sold on
elementary, middle, and junior high school campuses, beginning on July 1, 2004. California’s
law can be found at:
www.leginfo.ca.gov/pub/bill/sen/sb_0651-0700/sb_677_bill_20030917_chaptered.html
4
Daily Physical Education
States are also considering physical education bills as a way to influence the obesity epidemic.
Forty-eight states require physical education classes for students at various grade levels, but most
do not require them to be held on a daily basis. Only South Dakota and Washington do not
require physical education at all. Currently, Illinois is the only state with a law that requires daily
physical education for students in public schools. If you would like a copy of the Illinois law,
105 Illinois Compiled Statutes (ICS) 5/27-5, please contact the AAP Division of State
Government Affairs at 800/433-9016, ext 7799 or at stgov@aap.org.
Louisiana enacted legislation in 2003 requiring quality daily physical activity in public schools
for kindergarten through sixth grade. The Louisiana law, Act 814, can be viewed online at:
www.legis.state.la.us/leg_docs/03RS/CVT2/OUT/0000KT2Y.PDF
Texas has also enacted legislation that calls on the state department of education to author
regulations requiring daily physical education in Texas public schools for grades kindergarten
through sixth grade. Please contact the AAP Division of State Government Affairs if you would
like the text of the Texas statute, §28.002(k)(1).
Insurance Mandates
A few states have considered private insurer mandates for the coverage of obesity treatment.
Maryland requires insurers to provide coverage for the treatment of morbid obesity through
gastric bypass surgery or other surgical procedure recognized by the National Institutes of Health
(NIH). Georgia, Indiana, and Virginia require private insurers to offer policies that include
such treatments, but the insurers are able to charge more for the policies.
2004 State Legislation
In 2004, 39 states (Alabama, California, Colorado, Connecticut, Delaware, Florida, Georgia,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland,
Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey,
New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island,
South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington, West
Virginia, and Wisconsin) considered bills that address childhood obesity. The bills take a
variety of approaches, including:
· prohibiting or limiting the sale of junk food or carbonated beverages on school campuses
· encouraging healthy eating in schools
· including obesity prevention materials in school health curricula
· encouraging physical education/activity in schools
· requiring BMI measurement of students
· creating state or local commissions to investigate solutions to the issue
· mandating reimbursement by insurers for obesity prevention, treatment and counseling
Of the 2004 bills, the following were enacted:
· Alabama Senate Joint Resolution (SJR) 97 urges schools to provide instruction on
healthy lifestyle choices including programs for physical education.
5
· Colorado SB 103 encourages school districts to implement a policy that requires vending
machines to carry at least 50 percent healthy food and beverage items.
· Connecticut HB 5344 requires minimum time limits for school recess and lunch breaks.
It also requires schools to make healthy foods and beverages available to students.
· Florida SB 2372 requires the department of health to undertake certain actions to
promote healthy lifestyles and body weight. Such requirements include working with the
department of education to promote education programs in Florida schools that provide
an awareness of the benefits of physical activity and nutrition standards.
· Illinois SB 2940 amends the school health act to require health examinations to include
obesity information.
· Louisiana SB 871 provides for the establishment and implementation of a pilot program
in schools to establish a baseline assessment of the physical fitness of students.
· New Hampshire HB 1352 requires school districts to adopt policies recommending that
all pupils participate in developmentally appropriate daily physical activity, exercise, or
physical education as a way to minimize the health risks created by chronic inactivity,
childhood obesity, and other related health problems.
· New York SB 6738 provides for the creation of school district nutrition advisory
committees. Each committee is encouraged to study all facets of the school district’s
nutrition policies and to report back on the effectiveness of such policies.
· Oklahoma SB 1627 is the Healthy and Fit Kids Act of 2004. It provides for the
establishment of healthy and fit school advisory committees. Each committee shall study
and make recommendations to the school principal regarding health education, physical
education and physical activity, and nutrition and health services.
· Tennessee HB 2783 requires the board of education to establish minimum nutritional
standards for individual food items sold or offered to pupils in pre-kindergarten through
8th grade.
· Vermont HB 272 requires the state to publicize physical activity programs to local
school districts. It encourages school districts to address pupil fitness.
· Washington SB 5436 requires the development of a model policy regarding access to
nutritious foods for students.
Advocacy Considerations
USDA Standards for National School Lunch and Breakfast Program
The federal government encourages schools to limit the sale of non- nutritious foods. This is
accomplished through the US Department of Agriculture (USDA) standards for “competitive
foods.” Schools taking part in the USDA National School Lunch and Breakfast Program follow
these standards – or similar guidelines established by their state department of education. Under
the USDA standards, competitive foods are either foods of “minimal nutritional value” or foods
offered for individual sale, such as candy and chewing gum. Under the USDA standards,
competitive foods are not reimbursable. The USDA regulations are limited in scope, so states are
taking action to limit the sale of non-nutritious foods and carbonated beverages in schools.
The following link provides information on school lunch guidelines in each state:
www.fns.usda.gov/cnd/Lunch/CompetitiveFoods/state_policies_2002.htm
6
CDC State Level Programs
The US Centers for Disease Control and Prevention (CDC) has supported state programs to
encourage nutrition and fitness in 28 states (Arizona, Arkansas, Colorado, Florida, Georgia,
Illinois, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana,
New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island,
South Carolina, South Dakota, Texas, Vermont, Washington, West Virginia, and
Wisconsin). The CDC’s target interventions are:
· Increase in physical activity
· Reduction in television viewing
· Increase in consumption of fruits and vegetables
· Increase in breastfeeding
If your chapter is in one of these 28 states, you may wish to establish a relationship with the state
official in charge of the CDC program. The CDC program is titled, the “State-based Nutrition
and Physical Activity Program to Prevent Chronic Diseases, Including Obesity.” For more
information, please see the following Web page:
www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm
The American Council on Fitness and Nutrition
The American Council on Fitness and Nutrition (ACFN) is the snack food and soda pop
industry-supported group that is very active in state legislatures on obesity and nutrition issues.
The ACFN supports:
· Nutrition education
· Physical education
· Community programs
· Industry self-regulation
The ACFN opposes:
· Regressive taxes
· Restrictions on food sales
· Advertising regulations
· Government regulation
The ACFN also supports local control of these issues for school districts. Industry has substantial
influence with legislators and has done a good job of defeating bills that include issues that it
opposes, so chapters should be aware of their efforts.
Resources
AAP Overweight and Obesity Web Site
www.aap.org/obesity/
7
AAP Policy Statement: Prevention of Pediatric Overweight and Obesity
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424
AAP Policy Statement: Soft Drinks in Schools
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/1/152
AAP Policy Statement: Physical Fitness and Activity in Schools
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;105/5/1156
National Conference of State Legislatures Obesity Prevention Web site
www.ncsl.org/programs/health/phypubs.htm
The National Center for Chronic Disease Prevention and Health Promotion Web Site
www.cdc.gov/nccdphp/dnpa/obesity/index.htm
California Center for Public Health Advocacy Unfit and Overweight Children Web Site
www.publichealthadvocacy.org/policy_briefs/overweight_and_unfit.html
US Department of Agriculture Food and Nutrition Service Web site
www.fns.usda.gov/cnd/
Center for Science in the Public Interest: School Foods Tool Kit
http://cspinet.org/schoolfood/index.html
American Obesity Association
www.obesity.org
National Governors Association Issue Briefs on Obesity Prevention
www.nga.org/center/divisions/1,1188,C_ISSUE_BRIEF^D_3878,00.html
and,
www.nga.org/center/divisions/1,1188,C_ISSUE_BRIEF^D_5109,00.html
Updated 1/05