Childhood Obesity | An Overview of Policy Options in 2003-2004
Obesity is epidemic in the United States. In the past two decades, rates of overweight and obesity have doubled for children and tripled in adolescents. The percentage of overweight among children and youth has climbed to the 15 percent range. Being overweight or obese increases risk for the top U.S. causes of death and disability including heart disease, stroke, cancer, and diabetes. Across the country, obesity carried a $117 billion price tag in 2000, accounting for 9 percent of the nation’s total health care costs. The Centers for Disease Control and Prevention estimates that if current obesity trends continue, one-third of all children, and one-half of African-American and Hispanic children, born in 2000 will develop diabetes.
Fortunately, much can be done to prevent costly obesity-related health problems. State legislators have begun to aim prevention efforts at obesity risk factors that begin in childhood—such as poor nutrition, physical inactivity, and the increase in children diagnosed with Type 2 diabetes.
Childhood obesity legislation proposed or enacted in 2003 and 2004 is summarized and organized below into the general categories of:
Advertising to Children – Nutritional Standards
Availability of Nutritious Groceries
Body Mass Index Measurement and Reporting to Parents
Diabetes Screening and Management
Insurance Coverage for Obesity Prevention and Treatment
Nutrition Education
Nutrition Standards in Schools
Obesity Prevention and Education
Physical Education or Physical Activity in Schools
Raising Awareness
Task Forces, Commissions, or Studies
Taxes on Foods or Beverages with Minimal Nutritional Value
Bill numbers are included, allowing for retrieval of the full bills for further information.
The proposed legislation has not become law, unless otherwise noted. This document is a work in progress and may not be comprehensive. It is intended as an overview of policy options and not as an endorsement or recommendation of any specific legislation. If you have questions, find errors or omissions; please contact the author as listed below.
Advertising to Children – Noting that children view an estimated 40,000 commercials each year, 50 percent of which advertise food products, California legislators enacted a resolution asking for responsible food and beverage marketing to children. Legislators found that studies show that food advertising and marketing result in more favorable attitudes, preferences and behaviors toward advertised products and that children’s food preferences are influenced by television food advertising.
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California
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CA SJR 29, Resolution Chapter 140 (2004) (enacted)
Calls upon the Federal Trade Commission to develop and implement nutrition standards for foods and beverages advertised to children and to ensure that equal time is given during television programs that have a significant youth audience to encourage fruit and vegetable consumption and physical activity. Calls upon the food industry and food marketers in California to adhere to voluntary guidelines, developed by experts, for responsible food and beverage advertising to children.
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Availability of Nutritious Groceries – Studies show that living in communities without adequate access to supermarkets limits nutritious food choices and my contribute to long-term health problems, such as diabetes or heart disease, and diet-related deaths at a rate higher than the population as a whole. Pennsylvania legislators passed a resolution calling for a report on the shortage of supermarkets in urban and underserved areas. With bipartisan legislative sponsorship, an economic development program to bring more supermarkets into underserved communities has followed.
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Pennsylvania
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PA HR 13 (2003) (enacted)
Directs the Committee on Health and Human Services to investigate and consider problems associated with lack of supermarkets in urban and underserved communities in Pennsylvania and to report to the legislature within eight months.
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Pennsylvania
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PA SB 1026 (2004) (enacted)
Provides economic development financing that may be used, among other purposes, to encourage the development of supermarkets in underserved areas throughout the state, including urban and rural communities.
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Body Mass Index Measurement and Reporting to Parents – In 2003, Arkansas became the first state to require schools to annually provide parents with information about student body mass index as part of each student’s report card, including an explanation of possible health effects of body mass index, nutrition, and physical activity.
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Arkansas
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AR HB1583, Act 1220 (2003) (enacted)
Creates a 15-member Child Health Advisory Committee and requires the Committee to develop nutrition and physical activity standards and policy recommendations for Arkansas schools. Earmarks up to five percent of Health Master Settlement Agreement funds for model or pilot programs created under this Act. Prohibits food and beverage vending machine access for elementary students. Beginning with the 2003-2004 school year, requires reporting student body mass index to parents annually in student report cards. Requires annual evaluation and progress reports on effectiveness. Requires development of local policies to integrate nutrition and physical activity into school curriculum.
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Diabetes Screening and Management –Bills to require screening, risk analysis or testing of school children for diabetes were enacted in 2003 in California and Illinois, and introduced in New York. Noninvasive screening of school children is aimed at promoting an earlier response to prevent or respond to type 2 diabetes. Legislation aimed at improving care and diabetes management for children with diabetes in school or daycare settings was introduced in California, Illinois, Massachusetts, New Jersey, Pennsylvania, Tennessee, Vermont, and Virginia.
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California
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CA AB 766 (2003) (enacted)
Requires inexpensive, noninvasive clinical screening of school pupils for type 2 diabetes and notification to the parents or guardian of children found to be at an elevated risk for diabetes.
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Illinois
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IL SB 1081 (2003) (enacted)
Requires that a noninvasive diabetes screening be included in health examinations for school children.
IL HB 4154 (2004)
Would create the Care of Students with Diabetes Act.
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Pennsylvania
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PA HB 1510 (2003)
Would require training of designated school employees in the care needed for students with diabetes, and planning for diabetes treatment while at school.
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New Jersey
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NJ SB 2684 (2003) and NJ AB 3663 (2003)
Both bills would have required certain school employees to be trained in diabetes care and the use of medical management plans in schools for students with diabetes.
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New York
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NY AB 9176 (2003)
Would require a diabetes risk analysis and, if necessary, testing for all children entering public school and periodically thereafter.
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Tennessee
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TN SB 2122 (2004)
Would allow public and private schools to train school personnel to assist students with diabetes care and would require departments of health and education to develop guidelines for student diabetes care. Would limit liability for individuals who provided reasonable care within those guidelines.
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Vermont
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VT HB 81 (2003)
Bill related to emergency administration of glucagon to a student with diabetes.
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Virginia
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VA HB 2146 (2003)
Would have directed the Board of Education to develop guidelines for school boards for the development and implementation of individual diabetes care plans for public school students at the written request of the student's parent.
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Insurance Coverage for Obesity Prevention and Treatment – Legislation mandating health insurance coverage for obesity reduction treatments and prevention programs for children and adolescents was introduced in 2004 in Hawaii and Maryland. In addition, legislators in Hawaii requested the state auditor’s office to assess the social and financial effects of requiring health insurers to cover obesity reduction programs for children and adolescents.
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Hawaii
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HI HB 2105 (2004) and HI SB 2601 (2004)
Would require health insurance coverage for obesity reduction treatment and prevention programs for children and adolescents.
HI HCR 5 (2003) and HI SCR 16 (2003)
Requests the state auditor to assess the social and financial effects of requiring health insurance coverage of obesity reduction programs for children and adolescents.
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Maryland
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MD HB 340 (2004)
Would have required health insurers to cover obesity reduction programs for children and adolescents as part of the minimum child wellness services package.
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Nutrition Education – Legislators have taken a variety of approaches to encourage nutrition education for children, youth and parents, beginning with prenatal education and continuing through the school years. Many believe that with better information, children and their families will make better nutritional choices.
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California
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CA SB 875 (2003) (enacted)
Requires the state health department (pending funding availability) to provide expectant and new parents with an educational brochure about maintaining healthy lifestyles and preventing chronic disease.
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Connecticut
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CT HB 5344 (2004) (enacted)
Requires schools to offer students a daily lunch period of at least 20 minutes and to include a daily recess period for physical exercise for all full day students. Requires schools to offer nutritious, low-fat foods and drink and fresh or dried fruit at all times when students can purchase food or drink during the regular school day.
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Illinois
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IL HR 593 (2004)
Urges the U.S. Department of Agriculture to update nutritional labels for foods distributed through the WIC program every 10 years.
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Maine
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ME HB 113 (2003)
Proposed helping schools promote public health and address childhood obesity.
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Minnesota
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MN HB 51A (2003)
Would have included nutrition education as part of a comprehensive bill for early childhood, family, and K-12 education.
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North Carolina
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NC HB 881 (2003)
Would have appropriated funds to pay a bonus to child nutrition personnel in the public schools.
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Pennsylvania
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PA HR 770 (2004) (enacted)
Urges the United States Department of Agriculture to reconsider its recent policy change relating to Pennsylvania's Nutrition Education Program and to recognize that food provided to low-income households may properly be considered nutrition education when used to reinforce or replicate a nutrition lesson.
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Rhode Island
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RI HB 5597 (2003)
Would have required the department of health to establish programs to encourage physical exercise and proper nutrition in children.
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Nurition Standards in Schools – Proposals for ensuring more healthy food and beverage choices for school children were also considered in many states in 2003 and 2004. Options being considered include demonstration projects, the development of school nutrition policies or standards at the state or local level, and guidelines for how school foods can meet standards or prohibit the sale of foods with high sugar or fat content. States have considered prohibiting the sale of foods competitive with the School Breakfast Program or National School Lunch Program and at directing state boards of education to adopt nutrition standards for public schools throughout the state. (Note: For a discussion focused specifically on vending machines in schools and recent legislation, see the NCSL website at: http://www.ncsl.org/programs/health/vending.htm.)
Special note on regulatory action: In Texas, a Public School Nutrition Policy became effective August 1, 2004 under the auspices of the state’s Agriculture Commissioner, whom the governor authorized to administer the state’s National School Lunch Program, School Breakfast Program, and After School Snack Program. Texas’ policy limits the number of grams of fat and sugar that schoolchildren may be served each week and phases in an elimination of deep-fat frying for preparation of meals, snacks, and a la carte items. The policy also limits sales of foods that compete with the breakfast, lunch, and snack programs and schools can lose federal reimbursement up to $1.20 at breakfast and $2.19 at lunch in federal reimbursements for each meal lost to competitive food sales. The chair of the state’s Joint Interim Study Committee on Nutrition and Health in Public Schools has lauded the policy as supportive to legislative efforts to curb obesity among public school children through better nutritional choices.
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California
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CA SB 167 (2003)
Encourages day care providers to provide children with only nutritious foods and beverages.
CA SB 677 (2003) (enacted)
California’s Childhood Obesity Prevention Act restricts on the sale of food items in schools, contingent on the appropriation of funding for certain nutritional purposes, and prohibits the sale of certain beverages to elementary and middle school students, except at specified school events.
CA SB 1566 (2004)
Would have restricted the sale of certain food items at high schools. Would have deleted the funding contingency for restrictions on the sale of food items in elementary schools. Would have revised provisions relating to the sale of beverages and food items at elementary, middle, or junior high schools and would have made middle schools participating in that pilot program eligible for reimbursement.
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Colorado
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CO SB 103 (2004) (enacted)
Encourages school boards to include nutritious choices in vending machines and to phase in higher nutritional standards as contracts. Urges each school district to adopt a policy requiring at least 50 percent of vending machine items to meet nutritional standards by the 2006-2007 school year.
CO HB 1158 (2004)
Would have established school nutrition integrity policies.
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Florida
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FL SB 306 (2004)
A proposed Childhood Obesity Prevention Act would have provided nutritional standards for food available to children on school campuses and sold for fundraising purposes and imposed fines against school superintendents or other supervisory personnel for violations
FL SB 256 (New Bill 2004, Prefiled for 2005)
Would provide nutritional standards for food available to children at school and food sold for fundraising purposes. Would require each school's child nutrition program to approve all food sold on campus or for fundraising purposes and would authorize the state’s Agriculture and Consumer Services Department to fine food manufacturers, processors, packers, or distributors for misrepresentations.
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Hawaii
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HI HB 1428 (2004)
Would establish a three-year school nutrition demonstration project to reduce obesity and improve the health of children.
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Illinois
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IL HR 593 (2004)
Urges the U.S. Department of Agriculture to update nutritional labels for foods distributed through the WIC program every 10 years.
IL HB 4834 (2004)
Would require each school board in the state to establish a school district office of nutrition to help prevent childhood obesity.
IL HR 595 (2004)
Urges the state board of education to develop guidelines for how schools can meet standards for saturated fat in school meals and provide healthy meal alternatives.
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Kentucky
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KY HB 148 (2004)
Would prohibit the sale of certain foods with high sugar or fat content in schools and prohibit the sale of foods competitive with the School Breakfast Program or National School Lunch Program.
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Louisiana
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LA SB 871, Act 734 (2004) (enacted)
Establishes and provides awards for schools with outstanding physical activity and nutrition programs (subject to funding), provides for selecting school systems for participation, and for program development.
LA HR 20 (2004) (enacted)
Requests the state Department of Education to develop school menus containing foods that will foster lifelong healthy eating habits and particularly foods containing marine-source long chain Omega-3 fatty acids.
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Minnesota
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MN HB 3191 (2003-04)
Would provide for healthy a la carte options for children in Minnesota's school lunch program.
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Tennessee |
TN HB 2783 (2004) (enacted)
Requires the state board of education, cooperating with the department of education and department of health to establish minimum nutritional standards for individual food items sold or offered for sale to students in grades K-8.
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Washington
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WA SB 5436 (2004) (enacted)
Requires the state’s school directors association, with the office of the superintendent of public instruction, the department of health, and others to develop a model policy regarding access to nutritious foods and opportunities for developmentally appropriate exercise by January 1, 2005. Each school district's board of directors is then to establish its own policy by August 1, 2005.
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Obesity Prevention and Education – States with legislative proposals calling for childhood obesity prevention or education initiatives included Hawaii, Illinois, and New York. Illinois considered a proposal to appropriate $500,000 for a grant to the Cook County Department of Public Health to establish a childhood obesity prevention education and awareness program, and a separate proposal for the state Department of Public Health to establish the same type of program for children and adolescents, especially for populations with high rates of obesity and obesity-related health complications. Legislation in New York would have established a Childhood Obesity Prevention program within the Department of Health to prevent and reduce childhood and adolescent obesity and created a fund for the program by taxing certain foods with minimal nutritional value and video sales or rentals.
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Hawaii
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HB 1891 (2003-2004) and SB 2147 (2003-2004)
Would have established a childhood obesity prevention and education initiative.
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Illinois
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IL SB 2279 (2004)
Would establish and fund a childhood obesity prevention and education program in Cook County.
IL SB 2742 (2004)
Would direct the state’s Department of Public Health to establish an obesity prevention and education program for children and adolescents, especially for populations with high rates of obesity and obesity-related health complications. Would require the Department to periodically collect and analyze information to (i) determine the prevalence of childhood obesity in the State and (ii) evaluate the effectiveness of the program. Would authorize the Department, subject to appropriation, to make grants for community-based projects targeted at populations at high risk for childhood obesity
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New York
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NY AB 2800, SB 2045 (2004)
Would have established a Childhood Obesity Prevention program within the Department of Health funded by a tax on foods with minimal nutritional value and on the sale or rental of video movies or games.
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Physical Education or Physical Activity in Schools – Forty-eight states have some type of physical education requirement, but only Illinois currently requires daily physical education for school children and waivers can be granted. Recent proposed legislation has focused on refining or increasing physical education requirements or encouraging positive physical activity programs for students at recess or other opportunities for physical activity at school.
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Connecticut
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CT HB 5344 (2004) (enacted)
Requires schools to offer students a daily recess period for physical exercise for all full day students.
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Rhode Island
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HB 5597 (2003)
Would have encouraged physical exercise for children.
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Louisiana
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LA SB 871, Act 734 (2004) (enacted)
Establishes and provides awards for schools with outstanding physical activity and nutrition programs (subject to funding), provides for selecting school systems for participation, and for program development.
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Massachusetts
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MA HB (Bill number unavailable, Introduced 11-04 by Representative Le Duc and Senator McGee)
Would reinstate physical education, which was mandatory until 1996, as a requirement in school curricula in Massachusetts in order to respond to the increase in childhood obesity.
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Vermont
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SB 241 (2004)
Would define physical education as a daily program of moderate to vigorous physical activity.
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Raising Awareness – Efforts to raise public awareness of childhood obesity, its impact, and positive efforts to respond to the problem included declarations by legislatures in California, Illinois, and Colorado.
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California
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CA ACR 70 (2003)
Declares “YEAH!: Youth Eating and Acting Healthy! Children’s Fitness Week 2003”.
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Colorado
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CO SCR 03-045 (2003) (enacted)
Creates Colorado “Walking Wednesday” urging parents and children to walk to school together each Wednesday.
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Illinois
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IL 594 (2003)
Urges Congress to strengthen and improve the National School Lunch Program and Child Nutrition Program.
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Task Forces, Commissions, or Studies – Many states have proposed or established childhood obesity task forces or commissions, or planned for further study of the issue.
States with established task forces as of 2002 included Arkansas, Maine, New York, Texas, and Rhode Island. New Jersey legislatively established an obesity prevention task force in 2003. States with legislative proposals to create childhood obesity task forces, commissions or studies in 2003-2004 included Illinois, a proposed Maine study focusing specifically on childhood obesity and methods to decrease healthcare costs, and Nebraska, New Mexico, Rhode Island, and West Virginia.
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Illinois
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IL HB 478 (2003) and HB 3942 (2004)
Would have created a section of the School Code related to the study of childhood obesity. HB 3942 would have required school boards to publish each school's lunch menu and the nutrition content, including calories, of each meal item, and required a comprehensive school health education program.
IL HJR 49 (2003-2004)
Urged the governor to convene a Summit on Children’s Nutritional Health and Well-Being.
IL HB 3969 (2004)
Would have created the Children's Nutritional Health Act and the Commission on the Status of Children’s Nutritional Health consisting of members appointed by the legislative leaders and the Executive Branch for the purpose of tracking the status of children's nutritional health and developing ongoing policy initiatives to address issues concerning children's nutritional health.
IL HR 147 (2003) (enacted)
Directs the Department of Public Health, in conjunction with the State Board of Education, to conduct a sugar consumption study to determine the effects of sugar consumption as it relates to the overall health of school children.
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Maine
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ME LR 602 (2004)
Proposed a Maine study focusing on childhood obesity and methods to decrease healthcare costs.
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Nebraska
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Nebraska LR 186 (2003)
Proposed an interim study by the Health and Human Services Committee of the legislature to examine the causes and effects of obesity on young people and recommend policy options for the state to combat childhood obesity.
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New Jersey |
New Jersey (2003) (enacted) (P.L. 2003, Chapter 303)
Establishes an obesity prevention task force.
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New Mexico
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New Mexico HM 28 (2004) (enacted)
Requests the Legislative Education Study Committee to study childhood obesity, including nutrition and physical education, and the impact of foods and beverages offered in public schools.
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Rhode Island
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Rhode Island SB 1201 (2003)
Would create a special Senate commission to make recommendations on school age child and youth obesity prevention.
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W. Virginia
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WV HCR 8 (2004) (enacted)
Requests the joint committee on government and finance to conduct a study on the childhood obesity epidemic in West Virginia and its relationship to chronic disease, poor nutrition, and inadequate exercise.
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Taxes on Certain Foods or Beverages with Minimal Nutritional Value – A New York bill introduced in 2003 (AB 9145) proposed an additional tax on certain food and drink items and on the sale or rental of video and computer games, commercials, and analog or digital video movies; and would have directed moneys from the tax to the Childhood Obesity Prevention Program Fund.
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New York
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NY AB 9145 (2003)
Would have imposed additional tax on certain food and beverage items and on the sale or rental of video and computer games and movies and directed the revenues to a Childhood Obesity Prevention Program Fund.
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Information catalogued and written by:
Amy P. Winterfeld, JD
Program Principal
Health Program
National Conference of State Legislatures
7700 East First Place
Denver, CO 80230
303-364-7700
amy.winterfeld@ncsl.org