Childhood Obesity | 2009 Update of Legislative Policy Options

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Updated January 2010

With one-third of American children overweight or obese and national health care spending related to obesity approaching $150 billion annually, childhood obesity remains a pressing public health concern.  First lady Michelle Obama recently unveiled a campaign called Let’s Move to address the obesity epidemic. Childhood obesity rates in the United States have nearly tripled over the past three decades, and today an estimated 16.9 percent of U.S. children and adolescents ages 2 to 19 are obese, and 31.7 percent are obese or overweight. More than 12 million American children and adolescents are obese and more than 23 million are either obese or overweight. This childhood obesity epidemic also poses a national security challenge, as obesity has become one of the most common disqualifiers for military service.

Obese children and teenagers are at greater risk for developing serious chronic diseases such as type 2 diabetes, heart disease, high blood pressure, cancer and other health conditions including asthma, sleep apnea, and psychosocial effects such as decreased self-esteem. In one large study, 61 percent of overweight 5- to 10-year-olds already had at least one risk factor for heart disease, and 26 percent had two or more risk factors for the disease. There is a 70 percent chance that an overweight adolescent will be overweight or obese as an adult.

By adulthood, obesity-associated chronic diseases – heart disease, some cancers, stroke, diabetes–are the first, second, third and sixth leading U.S. causes of death. Moreover, obesity is costly. Among children and adolescents, annual hospital costs related to obesity were $127 million during 1997–1999 up from $35 million during 1979–1981. Annual obesity-attributable U.S. medical expenses were estimated to be as high as $147 billion in 2006, based on a study released by RTI and the Centers for Disease Control and Prevention in 2009. Taxpayers fund about half of this through Medicare and Medicaid. 

Fortunately, healthy eating and a physically active lifestyle can help children and adults achieve and maintain a healthy weight and reduce obesity-related chronic diseases. In 2009, legislatures continued to be active in considering policy options to make the healthy choice the easy choice and to help provide children with a healthier diet and more exercise beginning in childhood.

The table below links to specific topics on this page. 
Detailed information and bill summaries for the variety of policy approaches considered in 2009 follows the table.

 

 

Body Mass Index (BMI) Legislation

Diabetes Screening and Management

Insurance Coverage for Obesity Prevention and Treatment

Nutrition Education

Physical Activity or Physical Education in Schools

Recess at School

School Nutrition Legislation

 

School Wellness Policies

 

Task Forces, Commissions, or Studies

 

Taxes and Tax Credits

 

Other links for NCSL resources on legislative and
policy options to address obesity

 

 

 

 

 

50-State Legislation on Childhood Obesity Policy Options Enacted in 2009

 State

School Nutrition 

Nutrition Education 

Body Mass Index (BMI) 

Physical Education,
Physical Activity or Recess 

Task Forces, Studies
or Other Special Programs 

Alabama 

 

Enacted

 

 

 

Alaska 

 

 

 

 

 

Arizona 

 

 

 

 

 

Arkansas 

Enacted

 

 

 

 

California 

 Enacted

 

 

 

 

Colorado 

Enacted

 

 

 

 

Connecticut 

 

 

 

 

 

Delaware 

 

 

 

 

 

Florida 

 

 

 

 

 

Georgia 

 

 

 

 

 

Hawaii 

 

 

 

 

 

Idaho 

 

 

 

 

 

Illinois 

 

 

 

 

 Enacted

Indiana 

 

 

 

 

 

Iowa 

 

 

 

 

 

Kansas 

 

 

 

 

 

Kentucky 

 

 

 

 

 

Louisiana 

 Enacted

 

 Enacted

 Enacted

 

Maine 

 

 

 Enacted

 Enacted

 

Maryland 

 

 

 

 

 

Massachusetts 

 

 Enacted

 

 

 

Michigan 

 

 

 

 

 

Minnesota 

 

 

 

 

 

Mississippi 

 

 

 

 

 

Missouri 

 

 

 

 

 

Montana 

 

 

 

 

 

Nebraska 

 

 

 

 

 

Nevada 

 

 

 

 

 

New Hampshire 

 

 

 

 

 

New Jersey 

 

 

 

 

 

New Mexico 

 

 

 

 

 

New York 

 

 

 Enacted

 

 

North Carolina

 Enacted

 

 Enacted

 

 Enacted

North Dakota 

 

 

 

 

 Enacted

Ohio 

 

 

 

 

 

Oklahoma 

 

 

 

 

 

Oregon 

 

 

 

 Enacted

 

Pennsylvania 

 

 

 

 

 

Rhode Island 

 

 

 

 

 

South Carolina

 

 

 

 

 

South Dakota 

 

 

 

 

 

Tennessee 

 

 

 

 

 

Texas 

 

 

 

 Enacted

 Enacted

Utah 

 Enacted

 

 

 

 Enacted

Vermont 

 

 

 

 

 

Virginia 

 Enacted

 

 

 

 

Washington 

 Enacted

 

 

 Enacted

 

West Virginia 

 

 

 

 

 

Wisconsin 

 

 

 

 

 

Wyoming                      

 

 

 

 

 

Data Source:  National Conference of State Legislatures, 2009       

 

The listing of bills below may not be comprehensive, but provides an overview of other policy approaches considered during the 2009 legislative session.  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 not intended as an endorsement or recommendation of any specific legislation but as an overview of state policy actions.  

School Nutrition Legislation

In 2009, at least eight states enacted some type of school nutrition legislation. These laws establish new or additional policies designed to help ensure that students have access to healthier food and beverage options at school, or encourage other community supports for child nutrition. This includes two states that adopted school nutrition resolutions calling for specific federal action or acknowledging community nutrition programs. Legislation from 2009 for healthier school meals remained pending at the close of 2009 in at least eight states—Massachusetts, Michigan, New York, North Carolina, Oklahoma, Pennsylvania, Tennessee and Wisconsin. A new area for state legislation is state efforts aimed at improving the quality of meals served in early childhood programs and daycare settings. In addition, state efforts to improve or expand participation in federal school meals programs provide opportunities to improve the nutritional quality of school foods for children who participate in these programs.

Summaries of Enacted 2009 Legislation

School Nutrition Legislation:

Arkansas
AR SB 374 and SB 724 (2009, enacted)
- Appropriates $1.5 million to the Department of Human Services, Division of Child Care and Early Childhood Education, for operating expenses for after school and summer program grants for low income and rural school districts. The bills include funding for nutrition and physical activity components.

California
CA AB 627 (2009, enacted but vetoed) - Would have established a pilot program for licensed child care centers and child day care homes selected by the Department of Education that participate in the federal Child and Adult Care Food Program to implement nutrition and physical activity standards in exchange for a higher state meal reimbursement rate, contingent on the availability of non-general fund revenue.

CA SB 1c (2009, enacted) - As part of the state's budget bill for fiscal year 2010, appropriates $1,017,000 for Child Nutrition School Breakfast and Summer Food Service Program grants.

Colorado
CO SB 33 (2009, enacted)
- Expands the list of students who qualify to receive a free lunch to include children enrolled in public school early childhood education programs who are eligible to receive a reduced-cost lunch under the federal National School Lunch Act. The bill eliminates the reduced price that these eligible students would otherwise pay for school lunches. It directs the general assembly to annually appropriate not less than $850,000 and not more than $1.5 million to the Department of Education to provide lunches at no charge.

CO SB 259 (2009, enacted) - As part of the state's budget bill for fiscal year 2010, appropriates $850,000 for the Child Nutrition School Lunch Protection Program; $2,472,644 for Colorado's state match for the federal School Lunch Program; and $500,000 for the School Breakfast Program.

CO SJM 2 (2009, enacted) - Calls upon Congress to reauthorize the "Child Nutrition and WIC Reauthorization Act of 2004" in 2009 to prevent its expiration on September 30, 2009. (Editor’s note - Subsequent legislation enacted by the U.S. Congress extended federal child nutrition programs for one year.)

Louisiana
LA HB 1 (2009, enacted)
- Among other items, sets standards for nutritious meals. The bill sets performance indicators for the School Food and Nutrition Program and for child and adult care food and nutrition activities to ensure that nutritious meals are served to children. 

LA HB 193 (2009, enacted) - Authorizes the Board of Elementary and Secondary education to promulgate rules and regulations to implement United States Department of Agriculture nutrition programs. The bill requires the Department of Education to implement the nutrition programs pursuant to such rules and regulations. It allows the department to conduct studies regarding methods of improving and expanding nutrition programs and promoting nutritional education in the schools, and also authorizes the state department to conduct appraisals of the nutritive benefits of nutrition programs and report its findings and recommendations to the governor.

LA HB 767 (2009, enacted) - Revises nutrition standards for beverages sold in public high schools. The bill states that beverages offered for sale to high school students will be comprised of bottled water; no-calorie or low-calorie beverages that contain up to 10 calories per eight ounces; up to 12 ounce servings of beverages that contain 100 percent fruit juice with no added sweeteners and up to 120 calories per eight ounces; up to 12 ounce servings of any other beverage that contains no more than 66 calories per eight ounces; or low-fat milk, skim milk and nondairy milk. It requires that at least 50 percent of non-milk beverages be water and no-calorie or low-calorie options that contain up to 10 calories per eight ounces.

North Carolina
NC SB 1067 (2009, enacted)
- Establishes the Sustainable Local Food Advisory Council to distribute revenue from local food sales within communities and conduct an assessment of foods served under school breakfast and lunch programs. The bill establishes a study of other healthy eating policy options, including making local food available under public assistance programs; food stamp use at farmers' markets; and promoting urban and backyard gardens.

Texas
TX SB 395 and HB 4629 (2009, enacted)
- Creates the Early Childhood Health and Nutrition Interagency Council to assess the health of children, the significance of nutrition and physical activity in the development of children, and the existence of nutrition and physical activity requirements and practices in early childhood care settings. The council membership includes a representative of the Health and Human Services Commission; the Department of State Health Services; the Texas Workforce Commission; the Department of Agriculture; the Texas Education Agency; the Department of Family and Protective Services; and the Texas AgriLife Extension Service. The bills require the council to develop an early childhood nutrition and physical activity plan with a recommended timeline for implementation over a six-year period. The plan must include measures to increase fruit and vegetable consumption among children under the age of six; increase daily physical activity in early childhood care settings; increase awareness among parents of the benefits of breast-feeding, healthy eating and physical activity in children under the age of six; facilitate the consumption of breast milk in early childhood care settings; decrease malnutrition and undernourishment among children under the age of six; and educate parents and caretakers about the need for proper nutrition.

Vermont
VT HB 192 (2009, enacted)
- Uses a portion of American Recovery and Reinvestment Act funds to encourage the consumption of local Vermont foods by establishing a milk and meat pilot program that will encourage purchasing local milk and meat for school meals. The bill also provides technical assistance to schools to help maximize the use of local fruits and vegetables.

Virginia
VA SJR 392 (2009, enacted)
- Designates the week that begins the first Sunday in March in 2009, and in each succeeding year, as National School Breakfast Week in Virginia.

Other school nutrition policy actions: 

Farm-to-school Policies - Policies that make it easier for school food services to purchase local fresh foods for student meals and snacks are a new approach that is gaining momentum in many states. Statewide farm-to-school programs provide students with fresh food, increase their knowledge of nutrition and agriculture, and offer new markets for local agriculture.  Most of the statewide farm-to-school programs in at least 19 states were created legislatively with bipartisan support. In addition, more than 2,000 local farm-to-school programs operate in 39 states. NCSL's database for healthy community design and access to healthy foods lists farm-to-school legislation for 2009.

♦ School Wellness Policies - Beginning with the 2006-2007 school year, federal law requires all schools participating in federal school meals programs--nearly every school district in the country--to develop a local school wellness policy.  Policies must include nutrition guidelines for all foods available on school campuses during the school day, with the goal of promoting student health and reducing childhood obesity.  State legislation continues to foster collaboration in the development of local wellness policies. (The federal law is the Child Nutrition and WIC Reauthorization Act of 2004, Public Law 108 - 265.)  See below for a summary of state legislation on school wellness policies.

Additional policy approaches that states have considered to address childhood obesity in 2009 include nutrition education or wellness initiatives in schools, body mass index measurement and reporting the information confidentially to parents, enchancing physical education programs or providing opportunities for physical activity or recess during the school day, providing information on the nutrition content of school foods, and addressing the needs of diabetic students.  
 

Body Mass Index (BMI) Legislation and Student Fitness Screening 

Among the proposed approaches to address obesity is student body mass index measurement. Body mass index is a measure of whether a person’s weight is healthy in proportion to height. For children, the calculations also take into consideration age and gender to account for “baby fat.” Body mass index is widely accepted as a reliable indicator of body fat content and a screening tool for weight categories that may lead to health problems. The ease of measuring height and weight, without using expensive equipment, makes body mass index screening convenient. Schools provide a convenient screening site because virtually all children can participate. Screenings at schools can help motivate families to adopt healthier habits that can reduce childhood obesity, especially when results are clearly explained to parents and suggestions for making healthy changes are communicated. When obesity-related health risks are identified, screening reports also should provide parents with information about how to seek further evaluation and appropriate follow-up.

In 2009, at least four states enacted legislation related to student body mass index (BMI) or fitness screening, including Louisiana, Maine, New York and North Carolina. Of those states, New York appropriated $2 million for expenses related to reporting body mass index on school physical forms. North Carolina passed legislation to allocate public health discretionary funds based, in part, on the body mass index of public school students. Legislation for student BMI screening remains pending in Ohio and Oklahoma; Mississippi considered but did not enact student body mass index reporting requirements in 2009.

Louisiana 
LA SB 309 (2009, enacted) - Provides for health-related fitness assessments to determine physical fitness levels of students in schools to reduce childhood obesity, including baseline measures of fitness and body mass index, and measurement of the effectiveness of interventions. The bill expands a pilot program to provide for statewide implementation focused on school systems with high poverty levels.

Maine
ME HB 255 (2009, enacted) - Requires creation of a schedule and protocol for trained screeners and school nurses to collect BMI data from children and report it to the Department of Health and Human Services, Maine Center for Disease Control and Prevention in an aggregate format only that does not identify individual students. The bill allows for student exemptions if the parent or guardian objects on religious or philosophical grounds. It stipulates that BMI data is confidential and not subject to disclosure. Data collection and reporting is contingent upon availability of federal funds.

New York
NY AB 154 (2009, enacted) -
Appropriates funds for the Department of Health and Mental Hygiene, including $2 million for services and expenses, including grants, for reporting body mass index on school physical forms. The bill also allocates $1 million from the federal American Recovery and Reinvestment Act of 2009 to support community coalitions for obesity prevention to plan and create environmental and policy changes that support access to sustainable, healthy and affordable food, and safe environments for physical activity.

North Carolina 
NC SB 202 (2009, enacted) - Appropriates funds for public health programs based on a formula that takes into consideration the body mass index of public school students, in addition to other factors such as population (including percent of minorities), per capita income, rates of infant mortality, teenage pregnancy, tobacco use, cancer, heart disease, diabetes and stroke.

As of December 2008, states that have required some type of student BMI reporting are Arkansas, California (pilot program for diabetes risk assessment that included BMI measurement was replaced by statewide distribution of diabetes risk information in 2008), Delaware (piloting BMI as part of student fitness testing), Florida, Illinois, Iowa (pilot program to track student height and weight), Missouri (required aggregate screening results), New York (requires school entry health certificates to include information about the student's body mass index), Pennsylvania, South Carolina (phasing in student fitness testing), Tennessee, Texas (screening as part of a student risk assessment program for Type 2 diabetes in selected regions of the state) and West Virginia.  Some of these state requirements are aggregate BMI data reporting requirements, rather than requirements for individual BMI reports to parents. The Arkansas, California, Delaware, Missouri, South Carolina, Tennessee and West Virginia requirements were enacted legislatively. In Pennsylvania and Florida, state health departments require measuring BMI as part of annual student growth screenings. Arkansas was the first state to enact BMI legislation in Act 1220 of 2003. In 2007, legislation was enacted to change the frequency of BMI screening from annual to every other year and allow parents to submit a written refusal for their child to participate in BMI screening to the child's school. California enacted legislation in 2003 (AB 766, Cal. Ed. Code §49452.6) that required non-invasive screening of 7th grade female and 8th grade male students for type 2 diabetes risk including measurement of body mass index as one of four diabetes risk factors. The pilot program was renewed to 2008 when it was replaced by statewide distribution of diabetes risk information. 

 

Diabetes Screening and Management at School 

There are two general types of state legislation to address diabetes in schoolchildren. Recognizing that rising childhood obesity rates put children at risk for type 2 diabetes, some states have begun non-invasive risk screening for type 2 diabetes in school children. Other states, responding to the needs of children already diagnosed with diabetes, are creating policies to facilitate diabetic care for students at school and to limit the liability of caregivers and schools that provide such care. 

In 2009, New Jersey enacted legislation for student diabetes care at school, and Nevada passed a resolution with recommendation for school resources to manage diabetes. In addition, at least six states—Connecticut, Florida, Illinois, Michigan, New York and Pennsylvania—considered legislation to require non-invasive screening, risk analysis or testing of schoolchildren for diabetes; provide for student diabetes care or self-care at school; or permit medication administration by, or liability protections for, school personnel providing care for diabetic students.

Student Diabetes Risk Screening - Existing law requires non-invasive student diabetes risk screening as a regional pilot program in Texas and statewide in Illinois.  California legislation that required non-invasive screening of students in specific pilot locations for risk of type 2 diabetes was in effect 2003-2008 (California Education Code § 49452.6); the law expired in 2008 but will be replaced by statewide distribution of diabetes risk information to students commencing July 1, 2010 (California Education Code § 49452.7).

Student Diabetes Care – Counting New Jersey legislation enacted in 2009, existing law now provides for student diabetes care or self-care at school or permits medication administration by, and/or liability protections for, school personnel responding to diabetic students in Arizona, Indiana, Nebraska, New Jersey, Tennessee, Texas, Rhode Island, Utah, West Virginia and Virginia.  A California lawsuit settled in August 2007 interprets federal laws that guarantee equal educational opportunities for children with disabilities to require schools to have personnel trained and available to assist diabetic students.  Enacted 2009 legislation is summarized below.

New Jersey
NJ SB 2426, substituted by similar AB 267 (2009, enacted) -
Recognizes that in order to manage diabetes, students with diabetes must have access to the means to balance food, medications and physical activity at school and at school-related activities. The law authorizes a parent or guardian to request the use of individualized health care plans for a student with diabetes and provides for the emergency administration of glucagon for certain students.

Nevada
NV SCR 20, (2009, resolution adopted) -
Acknowledges the positive effects that the Nevada Diabetes Resource Directory and the Recommendations For Management of Children with Diabetes in School  from the Nevada Diabetes Association for Children and Adults will have in reducing the incidence of diabetes by promoting community awareness. In honor of these efforts, the resolution designated March 25, 2009, as Diabetes Awareness Day in Nevada. 

 

Insurance Coverage for Obesity Prevention and Treatment

Studies have shown that health-care providers can play an important role in promoting weight loss among their overweight and obese patients. Guidelines recommend that physicians identify obese patients and counsel them on weight management, using a personalized approach, as physician manner and timing when discussing weight management issues are important to avoid unintended consequences. Laws requiring insurance coverage for obesity prevention or treatment or resolutions encouraging these options were enacted in 2009 in Connecticut, Mississippi, Utah and Virginia. Much of the new legislation strengthens coverage for obesity prevention or treatment (especially for the morbidly obese). Existing Maryland law requires insurers to cover morbid obesity treatment, including surgery, while Georgia, Indiana and Virginia require private insurers to offer general coverage for morbid obesity as an option.  Some legislation proposed in this category has been specifically aimed at addressing childhood obesity, for example, Illinois legislation proposed in 2007 would have established a weight loss and management pilot program in partnership with a private entity specializing in weight loss and weight control for individuals enrolled in the state's Covering ALL KIDS health insurance program or the Medicaid program, while other laws would cover children under their parents’ health insurance.  As of July 2004, Medicare began to recognize obesity as a medical condition, opening the door to greater coverage for obesity treatments demonstrated as scientifically effective. Enacted 2009 legislation is summarized below.

Connecticut 
CT HB 6600 (2009, enacted) - Establishes the SustiNet Health Insurance Plan, a self-insured health care delivery plan subject to coverage mandates and use review of group health insurance. Among other plan services, it provides for coverage of mental and behavioral health services, including tobacco cessation services, substance abuse treatment services and services that prevent and treat obesity, at parity with coverage for physical health services.

Mississippi 
MS HB 1530 (2009, enacted) - Provides for the treatment and management of obesity and related conditions through various methods, including the use of bariatric surgery as a treatment option. The bill charges the State and School Employees Health Insurance Management Board, through the State and School Employees Health Insurance Plan, with responsibility for managing the program. Criteria for patients to be eligible for bariatric surgery include a body mass index of greater than 40, or greater than 35 with two co-morbidities such as diabetes, hypertension, gastroesophageal reflux disease, sleep apnea or asthma.

Utah 
UT SCR 4 (2009, resolution adopted) - Designates September 2009 as Obesity Awareness Month and September 5, 2009, as Walk from Obesity Day, and requests health care providers to increase coverage of treatments for the overweight and the obese, including surgical procedures, in order to prevent increased future health care costs to the state and to businesses.

Virginia 
VA SB 1351 and HB 2557 (2009, enacted) - Both bills establish insurance coverage for diabetes prevention and obesity treatment as part of the state's health insurance program for state employees. Such insurance must include coverage for equipment, supplies and outpatient self-management training and education, including medical nutrition therapy, treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and noninsulin-using diabetes if prescribed by a healthcare professional. Diabetes outpatient self-management training and education must be provided by a certified, registered or licensed health care professional to qualify for coverage. The bills also require the state's health insurance program for state employees to offer coverage for treatment of morbid obesity through gastric bypass surgery or other methods recognized by the National Institutes of Health as effective for long-term reversal of morbid obesity.

 

Nutrition Education

Many states have school health education requirements, but inclusion of nutrition education as a specific component of health education varies. To address this, legislators in some states have considered and enacted bills that specifically require nutrition education to be a component of the school health curriculum or that require school personnel to receive training about child nutrition. Hands-on nutrition education that involves growing, preparing or tasting healthy foods such as locally available fruits and vegetables has been the focus of some recent nutrition education legislation.

A U.S. Department of Agriculture-contracted review of 217 studies found that nutrition education is a significant factor in improving dietary practices when behavior change is the goal and educational strategies are designed with those goals as a purpose. Another study concluded that nutrition education programs of longer duration, with more contact hours and more components—such as parent involvement and changes in school meals—result in more positive outcomes.

Existing laws in California, Colorado, Indiana, Louisiana, Maine, New Hampshire, Oklahoma, South Carolina, Texas, Vermont and West Virginia require some form of nutrition education in schools. New legislation related to nutrition education was enacted in 2009 in Alabama (a resolution commending a nutrition education program) and Massachusetts. Legislation to encourage expanded nutrition education was carried over from 2009 to 2010 in New York.

Alabama 
AL HJR 238 (2009, resolution adopted) - Commends the Junior League of Montgomery, Alabama for sponsoring the Kids in the Kitchen program, an initiative that is designed to empower youth to make healthy lifestyle choices by engaging them in preparation of healthy meals, nutrition education and demonstrations in partnership with local organizations, chefs and nutritionists. The initiative's overarching goal is to reverse the growth of childhood obesity and its associated health issues.

Massachusetts
MA HB 4149 (2009, enacted) -
As part of a general appropriations bill for fiscal year 2010, incorporates obesity prevention programs, including nutrition and wellness programs, into school curricula to address nutrition and lifestyle habits needed for healthy development.

New York 
NY SB 4153 (2009, proposed, carry over to 2010) - Among other provisions, would require that nutrition education be integrated into school curriculum.

 

Physical Activity or Physical Education in Schools and Recess Legislation

Forty-nine states—every state except Colorado—require some physical education in schools, but the scope of the requirement varies greatly. As a result, states continue to refine and strengthen their laws pertaining to physical education and physical activity at school, including preserving time for recess during the school day. Both the cost of physical education programs and an emphasis on academics have sometimes been considered barriers to increasing physical education in schools, but recognition is growing that physical activity during the school day can increase student achievement. In 2009, at least four states enacted physical education or physical activity legislation or resolutions, including Louisiana, Maine, Oregon and Texas. 

Louisiana
LA HB 400 (2009, enacted) -
Requires public schools to provide at least 30 minutes of physical activity each school day for students in grades seven and eight. The bill also authorizes the establishment of a local school health advisory councils.

Maine
ME HB 983, LD 1407 (2009, enacted) -
Requires the commissioner of education to conduct an assessment of the physical education capacities of elementary schools and to report its findings to the Legislature's Joint Standing Committee on Education and Cultural Affairs. The bill also establishes the Obesity and Chronic Disease Fund in the Department of Education.

Oregon
OR HB 2544 (2009, enacted)
- Expands physical education and physical activity opportunities for students by creating an environmental literacy task force and directs the task force to develop environmental education curricula and an environmental literacy plan. The basis for this approach is a recognition in the bill of studies showing time spent outdoors for learning during the school day is critical to the intellectual, emotional and physical health of students and that providing students with quality opportunities to directly experience the natural world can improve students' overall academic performance, self-esteem, personal responsibility, community involvement, personal health and understanding of nature.

Texas
TX SB 1 (2009, enacted)
- Among other appropriations, provides grants for in-school physical education and fitness programs for students in grades six through eight. Eligibility criteria include advancing the goal of reducing childhood obesity and type 2 diabetes in school districts that have proportionately high numbers of economically disadvantaged students.
 

School Recess Legislation Enacted in 2005-2009 

States also have considered legislation to preserve time for physical activity during the school day through recess.  Both the cost of physical education programs and an emphasis on academics have sometimes been considered barriers to increasing physical education in schools but recognition is growing that physical activity during the school day can increase student achievement. Washington enacted a bill in 2009 calling for a study and report to the Legislature concerning the availability of recess during the school day in elementary schools. 

Washington
WA SB 5551 (2009, enacted) -
Requires the Office of the Superintendent of Public Instruction to collaborate with the statewide parent-teacher organization in conducting a survey of elementary schools to determine the current availability of recess for students and perceptions of the importance of recess in schools. The rationale for the survey is a legislative finding that as childhood obesity rates rise, it is important to ensure that children have the time for physical activity because insufficient physical activity and excessive calories consumed are critical factors in the increase in overweight and obese children. The bill further requires the survey to include questions about daily recess time, whether recess time has increased or decreased, whether there is recess in inclement weather, and whether teachers can keep students from participating in recess for academic or disciplinary reasons. The office must report its findings to the legislature.

Recess legislation enacted previously, from 2005 through 2008 is summarized below. 

Arkansas
AR HR 1023 (2007, resolution adopted)
- Urges school districts to provide a mid-morning and mid-afternoon recess of at least 10 minutes to all students in kindergarten through grade six.  Recognizes that recess creates a supportive environment for children and allows them to incorporate regular physical activity into their daily lives; recess provides children with discretionary time and opportunities to engage in physical activities that lead to healthy bodies and enjoyment of movement; recess results in enhanced cognitive abilities and facilitates improved attention in the classroom; recess is an essential component in the development of interpersonal communication skills, as it provides an unstructured environment in which children can interact with one another; and recess is an avenue for creativity which in turn leads to the ability to think "outside the box" and develop stronger thinking skills.

Connecticut
CT Senate Substitute Bill 204, (2006, enacted, Public Act 06-44)
- Requires the Connecticut Department of Education to develop guidelines for addressing the physical health needs of students that include, among other things, plans for engaging students in daily physical exercise during regular school hours.  (Note - the bill doesn't use the word "recess" or specify a certain number of minutes.)

Indiana
IN SB 111 (2006, enacted, Public Law 54)
- Beginning with the 2006-2007 school year, requires the governing body of each school corporation to provide daily physical activity for students in elementary school. The physical activity must be consistent with the curriculum and programs developed under IC 20-19-3-6 and may include the use of recess. On a day when there is inclement weather or unplanned circumstances have shortened the school day, the school corporation may provide physical activity alternatives or elect not to provide physical activity.

New Jersey
NJ AB 1601, SB 226 (2008-2009, pending, identical) -
Both bills would establish a task force to study the benefits of student recess and make recommendations on the advisability of mandatory recess in school districts.

Oklahoma
OK HB 1186 (2008, enacted, Chapter 118)
- Beginning with the 2008-2009 school year, requires school boards, as a condition of accreditation for public elementary schools, to provide students in full-day kindergarten and grades one through five an average of 60 minutes each week of physical activity. Allows for this physical activity to include, but not be limited to, physical education, exercise programs, fitness breaks, recess, and classroom activities, and wellness and nutrition education. Each school district board of education shall determine the specific activities and means of compliance with the requirements, giving consideration to the recommendations of each school's Healthy and Fit Schools Advisory Committee to the school principal.

OK HB 1601 (2007, enacted - OS 70-11-103.9) - Creates the Fit Kids Physical Education Task Force regarding school physical education. Also strongly encourages school districts to incorporate physical activity into the school day by providing to students in full-day kindergarten and grades one through five at least a 20 minute daily recess, in addition to the 60 minutes of required physical education, and by allowing all students brief physical activity breaks throughout the day, physical activity clubs and special events.

South Carolina
SC HB 3499 (2005, enacted, Act 102) -
As part of bill phasing in physical education standards statewide, provides that each elementary school shall designate a physical education teacher to serve as its physical education activity director. The physical education activity director shall plan and coordinate opportunities for additional physical activity for students that exceed the designated weekly student physical education instruction times that may include, but not be limited to, before, during and after school dance instruction, fitness trail programs, intramural programs, bicycling programs, walking programs, recess and activities designed to promote physical activity opportunities in the classroom.

Texas
TX SB 42 (2005, enacted) - Encourages school districts to promote physical activity for children through classroom curricula for health and physical education.  Allows the state board of education, by rule, to require students in kindergarten to grade nine to participate in up to 30 minutes of daily physical activity as part of a school district's physical education curriculum, through structured activity or during a school's daily recess.  

 

School Wellness Policies

The federal Child Nutrition and WIC Reauthorization Act of 2004 (Public Law 108-265) required each local school district participating in the National School Lunch and Breakfast programs to establish a local wellness policy by the beginning of the 2006-2007 school year. School districts were required to involve a broad group of stakeholders to develop wellness policies and set goals for nutrition education, physical activity, campus food provision and other school-based activities designed to promote student wellness. The act also required plans for measuring policy implementation. In 2009, statewide legislation to support wellness policies or related school health efforts was enacted in Maryland. Legislators also have acted on individual policies that are part of school wellness goals, such as improving the nutritional quality of school foods, providing greater opportunities for physical activity, ensuring that adequate nutrition education is part of the school curriculum and designing task force efforts by multiple stakeholders in the community to encourage school wellness efforts as discussed in other sections of this page. 

Maryland
MD HB 1264 and SB 879 (2009, enacted) -
Authorizes local school systems to develop and implement wellness policy implementation and monitoring plans. The plans must be used to establish baseline student data for health-related components of physical fitness to assist students in developing personal physical fitness plans and encouraging appropriate intervention for students with unhealthy physical fitness levels. The plans also must identify effective practices to improve student health-related issues and encourage partnerships with health agencies to address student health-related issues. Each plan must include policy goals, activities, expected outcomes and measurements for physical activity and physical education. The Department of Education must distribute effective wellness policy practices for physical activity and education to local school systems. The bills also establish a wellness advisory council.
 

Task Forces, Commissions, Studies, Grants and Other Special Programs

Legislation or resolutions to create obesity-related task forces, commissions, studies, strategic plans or other special programs were enacted in at least five states in 2009—Illinois, North Carolina, North Dakota, Texas and Utah. As of December 2009, creation of a childhood obesity task force remains pending in Massachusetts. The list below is meant to provide a sampling of state legislative efforts and may not be completely comprehensive.

Illinois
IL HB 3767 (2009, enacted)
- The Obesity Prevention Initiative Act requires the Department of Public Health to organize public hearings on the health effects and costs of obesity and the need to address the obesity epidemic. The bill authorizes the department to award grants to non-profit organizations or local public health departments as part of a statewide education campaign.

North Carolina
NC HB 945 (2009, enacted)
- Among other study measures for 2009, creates a Legislative Task Force on Childhood Obesity composed of six members of the House of Representatives and six members of the Senate. The bill requires the task force to study issues relating to childhood obesity and to consider and recommend to the General Assembly strategies for addressing the problem of childhood obesity and encouraging healthy eating and increased physical activity among children, including interventions in early childhood and through childcare facilities.

North Dakota
ND SB 2333 (2009, enacted)
- Creates regional public health networks and a Regional Public Health Network Task Force. The bill requires the regional public health networks to prepare an annual plan for public health services and submit the plan to the state health officer for approval. Public health services are defined to include school health and nutrition along with physical activity, diabetes, cardiovascular health and chronic disease. The task force must submit the results of any studies it conducts to the Legislative Council

Texas
TX SB 870 (2009, enacted)
- Creates an obesity prevention pilot program designed to decrease the rate of obesity, improve nutritional choices and increase physical activity levels of child health plan program enrollees and Medicaid recipients. The bill directs the Department of State Health Services to implement the pilot program for a period of at least 24 months in one or more health care service regions in this state, focusing on areas that have residents at higher than average risk of obesity. In developing the program, the department must identify measurable goals and specific strategies for achieving those goals.

Utah
UT HB 188 (2009, enacted)
- Requires multiple actions to achieve health system reform including developing strategies to promote health and wellness and highlight the health risks associated with obesity and sedentary lifestyles.

 

Taxes and Tax Credits

States continue to consider various fiscal options to encourage healthy lifestyles. In 2009, states considered tax credits for fitness or wellness choices, as well as taxing foods and beverages with minimal nutritional value and, in a few states, directing the revenues to fund obesity or health-related services or programs. Legislation enacted in three states includes a sales tax on candy in Maine; creation of a specialty license plate to fund safe routes to school in Texas; and allowing exposition districts to tax candy, prepared foods and soft drinks in Wisconsin. Taxes on soft drinks at the retail level or excise taxes on soft drink ingredients such as soft drink syrup, powders or other base products used to produce liquid soft drinks were proposed, but not enacted, in at least 12 other states in 2009, including Arizona, Hawaii, Illinois, Maine, Massachusetts, Maryland, Michigan, New Mexico, New York, Rhode Island, South Dakota and Washington. Maine voters in November 2008 overturned a law enacted in April 2008 that imposed a tax on syrup used to make soda in restaurants, bottled soft drinks, beer and wine, and on claims paid by insurance companies, and directed the tax revenues to pay for the Dirigo Health Choices program, a government-sponsored health insurance program. Enacted legislation is summarized below. This listing is not intended to be comprehensive.

Maine
ME LD 1495 (2009, enacted)
- Among other tax reform items, raises the retail sales tax from 7 percent to 8.5 percent for all prepared foods sold in the state. The bill adds candy to the definition of prepared foods and defines candy to be a preparation of sugar, honey or other natural or artificial sweeteners in combination with chocolate, fruits, nuts or other ingredients or flavorings in the form of bars, drops or pieces that does not contain flour or require refrigeration.

Texas
TX SB 161 and HB 1834 (2009, enacted)
- Creates a specialty license plate to generate revenue to be used by the Texas Education Agency to support the Safe Routes to School Program.

Wisconsin
WI SB 62 (2009, enacted)
- Among other state government financing revisions related to creating business enterprise and jobs, authorizes a local exposition district to impose a retail sales tax on the sale of candy, prepared foods or soft drinks. The bill defines soft drink as a beverage that contains less than 0.5 percent alcohol and that contains natural or artificial sweeteners. A soft drink does not include a beverage that contains milk or milk products; soy, rice or similar milk substitutes, or more than 50 percent vegetable or fruit juice by volume.


Other links for NCSL resources on legislative and policy options to address obesity are:
NCSL healthy community design legislative database
NCSL's trans fat and menu labeling legislation web page

Please contact Amy Winterfeld, NCSL, Health Program, to report any comments or corrections to this document.

Support for this web page is provided in part by the Robert Wood Johnson Foundation as part of its Leadership for Healthy Communities national program.