State's public health initiatives address nutrition, obesity, and physical education: over the past three years, the media, food and beverage industry, public health advocates, and federal and state policymakers have devoted significant attention to the growing American obesity epidemic

Healthcare Financial Management, Sept, 2004 by Carla I. Plaza

This epidemic, especially among American youth, has emerged as a leading public health concern with high costs associated with treating overweight and obese individuals.

Several recent studies contain troubling statistics. In 2001, the Centers for Disease Control and Prevention (CDC) reported that the percentage of children ages 6 to n who are overweight more than doubled between 1980 and 2000, and that the percentage of teenagers who are overweight more than tripled during the same period. Separate studies in JAMA concluded that poor diet and physical inactivity would most likely be the leading preventable cause of mortality in the next few years. Obesity prevalence increased in every state and in both genders across all age, race, and socioeconomic groups, the JAMA studies concluded.

State policymakers are taking action to trim the nation's growing waistlines, and are relying on national studies and their states' task forces and commissions for guidance. In 2004, lawmakers mostly focused on preventive action--addressing obesity and health for schoolchildren by regulating snack foods, school lunches, and physical activity. Yet in some states, state policymakers also considered placing the onus for poor health decisions on citizens by limiting their ability to pursue obesity-related lawsuits.

Creating Healthier School Environments

State legislators are focused on combating youth obesity because molding healthy behaviors at an early age is easier than changing established adult lifestyles. Creating an environment where healthy food choices are readily available to schoolchildren is a high priority in this effort. To this end, schools are seen as effective venues to promote and educate children on issues concerning health and nutrition. Hundreds of bills introduced in 40 states attempt to create a healthier, more active school environment for children and adolescents. The issue of foods and beverages sold in competition with school breakfast and lunch programs continues to be a popular avenue for state legislators to address this issue.

Following California's lead, several states adopted policies to establish explicit school nutrition standards that limit the items available to students during the school day. Last year, Arkansas banned in school access to vending machines. Colorado lawmakers enacted a measure encouraging school boards to adopt policies, by July 1, 2004, that require at least 50 percent of the items sold through vending machines to meet specific nutritional standards. In Tennessee, the State Board of Education is required to develop rules by the 2006-07 school year that establish mini mum nutritional standards for competitive food items sold. And in Texas, the Department of Agriculture released its Public School Nutrition Policy, effective August 1, 2004, for schools participating in federal child nutrition programs.

Along with state government, local school boards have also taken action. Schools in Philadelphia, New York City, and Los Angeles can no longer sell soda; and in Chicago, schools now face restrictions on what items they can sell in vending machines.

Strengthening Physical and Health Education Curriculums

To further foster healthy habits, legislators are also turning to policy initiatives that are either setting standards or increasing requirements for health and physical education curricula. Some of the initiatives policymakers are considering include:

* Developing, as part of the course curriculum, physical and health education programs

* Requiring students to participate in physical and health education programs

* Increasing the number of minutes of physical education classes

* Requiring year-round or daily physical education courses

Because there is no federal standard or mandate regarding physical or health education, the programs being implemented by state and local boards of education vary widely. Although lawmakers introduced several measures this year that would set statewide standards, many of these measures stalled because implementation costs and a growing emphasis on academic standards made it difficult for bill sponsors to gain support. Several measures were signed into law, but only Louisiana set specific requirements for health or physical education classes. Legislation enacted in New Hampshire and Washington requires that an advisory committee or the Department of Education develop a model policy on physical education requirements for schools. In New Mexico, a study was commissioned to determine the effect of the lack of physical and health education classes provided in schools.

Measuring BMI

Some states are examining the idea of measuring each student's body mass index (BMI). In 2003, Arkansas Governor Mike Huckabee signed legislation that requires schools to send parents health report cards, along with academic reports, which would provide information on a student's health status, specifically the student's BMI. Of the 450,000 students attending Arkansas' public schools, 22 percent are considered overweight and 18 percent are at risk for being overweight.