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Childhood Obesity 2011

Childhood Obesity – 2011 Update of Legislative Policy Options

group of kidsUpdated February 2013

With one-third of American children overweight or obese and national health care spending on obesity nearing $150 billion annually, childhood obesity remains a pressing public health concern. Taxpayers fund about $60 billion of these costs through Medicare and Medicaid.  Recent research indicates that if obesity rates are reduced by as little as 5 percent, health care savings could exceed $29 billion.  Yet childhood obesity rates in the U.S. 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; 31.7 percent are either obese or overweight. In sheer numbers, more than 12 million American children and adolescents are obese and more than 23 million are either obese or overweight. The U.S. 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. 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, type 2 diabetes – are the first, second, third, and seventh 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. From 1987 to 2001, obesity-associated diseases accounted for 27 percent of the increases in U.S. medical costs. 

State legislatures continue to be active in considering policy options to make the healthy choice the easy choice and to help provide children with healthier foods and more opportunities for safe, enjoyable physical activity throughout childhood. The year of 2011 was an active year for state legislation on both nutrition and physical activity topics as reflected in the legislative summaries below. The Table of Contents below links to information to specific topics on this page.  More detailed topic information and bill summaries for 2011 follow the table.
 

TABLE OF CONTENTS

Body Mass Index (BMI) Legislation

Recess at School

Diabetes Screening and Management

School Nutrition Legislation

Insurance Coverage for Obesity Prevention and Treatment

School Wellness Policies

Joint Use Agreements for School Facilities

Task Forces, Commissions, or Studies

Nutrition Education

Taxes, Tax Exemptions and Tax Credits

Physical Activity or Physical Education in Schools

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

Preschool Obesity Prevention

 

 

 

 

50-State Legislation on Childhood Obesity Policy Options Enacted in 2011

State

School Nutrition

Nutrition Education

School Wellness

Physical Education, Physical Activity

Preschool Obesity Prevention

Task Forces, Studies

Alabama

 

 

 

X

 

 

Alaska

 

 

 

 

 

 

Arizona

 

 

 

 

 

 

Arkansas

 

X

 

 

 

 

California

X

 

 

 

 

 

Colorado

 

 

 

X

 

 

Connecticut

 

 

 

 

 

 

Delaware

 

 

 

 

 

Florida

X

 

 

 

 

 

Georgia

X

 

 

X

 

 

Hawaii

 

 

 

 

 

 

Idaho

 

 

 

 

 

 

Illinois

 

 

 

 

 

 

Indiana

 

 

 

 

 

 

Iowa

 

 

 

 

 

 

Kansas

 

 

 

 

 

 

Kentucky

 

 

 

 

 

X

Louisiana

X

X

 

 

 

 

Maine

X

 

 

X

 

 

Maryland

 

 

 

 

 

 

Massachusetts

X

 

 

 

 

 

Michigan

 

 

 

 

 

 

Minnesota

 

 

 

 

 

 

Mississippi

X

 

 

 

 

 

Missouri

 

 

 

 

 

 

Montana

 

 

 

 

 

 

Nebraska

 

 

 

 

 

 

Nevada

 

 

 

 

X

 

New Hampshire

 

 

 

 

 

 

New Jersey

 

 

 

 

 

 

New Mexico

X

 

 

 

 

 

New York

 

 

 

 

 

 

North Carolina

X

 

 

 

 

 

North Dakota

 

 

 

 

 

 

Ohio

 

 

 

 

 

 

Oklahoma

 

 

 

 

 

 

Oregon

 

 

 

 

 

 

Pennsylvania

X

 

 

 

 

 

Rhode Island

 

 

 

 

 

 

South Carolina

 

 

X

 

 

 

South Dakota

 

 

 

 

 

 

Tennessee

 

 

 

X

 

 

Texas

 

X

 

 

 

 

Utah

 

 

 

X

 

 

Vermont

 

 

X

 

 

 

Virginia

X

 

 

 

 

 

Washington

 

X

 

 

 

 

West Virginia

 

 

 

 

 

 

Wisconsin

 

 

 

 

 

 

Wyoming

 

 

 

 

 

 

District of Columbia

 

 

 

 

 

 

 

School Nutrition Legislation

In 2011, twelve states—California, Delaware, Florida, Georgia, Louisiana, Maine, Massachusetts, Mississippi, New Mexico, North Carolina, Pennsylvania and Virginia—enacted some type of school nutrition legislation, adopted resolutions related to school nutrition or authorized funding for school nutrition grants. These laws help ensure that students have access to healthier food and beverage options at school or encourage other community supports for child nutrition. They complement the federal Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296), which reauthorized the national School Lunch and School Breakfast programs; increased the School Lunch and School Breakfast per-meal reimbursement by 6 cents; and authorized the Secretary of Agriculture, without preempting stricter state standards, to set nutrition standards for all food products sold on school grounds during the day. Continuing areas of state legislation include not only increasing healthier school meal options, but also raising the quality of beverages and foods sold or consumed outside the regular school meals program as à la carte or snack items.  

Summaries of Enacted 2011 School Nutrition Legislation:

California
CA SB 87 (2011, enacted) - Includes Child Nutrition School Breakfast and Summer Food Service Program grants in the state’s budget for the 2011-2012 fiscal year.

Delaware
DE HB 3 (2011, enacted) Prohibits schools from serving or making available foods or beverages that contain industrially produced trans fat, including through vending machines, in school cafeterias or other school food service establishments.

Florida
FL HB 1312 (2011, enacted) - Transfers the Food and Nutrition Services Trust Fund in the Department of Education and all administrative authority for the state’s school meals program from the Department of Education to the Department of Agriculture and Consumer Services. It creates the 11-member Healthy Schools for Healthy Lives Council to advise the department on nutritional standards, nutrition education and prevention of childhood obesity. (The transfer of school food authority in the law follows legislation adopted in 2010 that created a Florida Farm Fresh Schools Program and Service to encourage schools and school districts to buy fresh and local food, and required the Department of Education to work with the Department of Agriculture and Consumer Services to recommend policies and rules for school food services to the State Board of Education.)

Georgia
GA HR 589 (2011, resolution adopted)
Creates Farm to School Day in Georgia on March 30, 2011.

GA SR 508 (2011, resolution adopted) - Commends Farm to School programs in Georgia.
 

Louisiana
LA HB 1 (2011, enacted) - Appropriates funds to conduct reviews of eligible school food and nutrition sponsors to ensure compliance with U.S. Department of Agriculture guidelines, among other budget provisions for FY 2012.

Maine
ME HB 398 (2011, enacted) - Authorizes the Department of Education to adopt standards that are consistent with federal school nutrition standards for foods and beverages sold on school grounds outside of school meal programs.

ME HB 778 (2011, enacted) - Provides funding for the federal School Nutrition Administration grant, among other appropriations for the FY 2012 and FY 2013 state budgets.

Massachusetts
MA HB 3535 (2011, enacted) - Appropriates $45,000 for the Virtual Gateway School Nutrition Program to directly certify children for free school meals and directly verify children for free or reduced-price meals, among other appropriations for the FY 2012 state budget.   

Mississippi
MS SB 2798 (2011, enacted) - Defines specific responsibilities for public school nurses to include supporting healthy food services programs; promoting healthy physical education, sports policies and practices; and implementing activities to promote health. It requires the Office of Healthy Schools in the Department of Education to provide resources to nurses in the Mary Kirkpatrick Haskell-Mary Sprayberry Public School Nurse Program to ensure that schools will be able to provide health education to support the Mississippi Comprehensive Health Framework, Mississippi Physical Education Framework, Wellness Policy and coordinated approach to school health. 

New Mexico
NM SB 144 (2011, enacted) - Requires free school breakfast programs for all elementary schools in which 85 percent or more of the students were eligible for free or reduced-price lunch during the prior school year.  It also authorizes all other school districts to establish school breakfast programs that are free to all students and permits other schools to serve breakfast after the bell during instructional time after the instructional day has begun.  

North Carolina
NC SB 415(2011, enacted) - Provides free school breakfasts for children who qualify for reduced-price meals at schools participating in the national school breakfast program. It requires the state Board of Education to report on public school nutrition programs operated by school districts under the jurisdiction of Child Nutrition Services in the Department of Public Instruction.

Pennsylvania
PA HB 1485 (2011, enacted) - Appropriates $3,327,000 from the state’s general fund to the School Nutrition Incentive Program, among other appropriations for the FY 2012 state budget. 

Virginia
VA HB 30, HB 1500 (2011, enacted) - Appropriates $2,054,253 for state-funded incentive programs to maximize federal school nutrition revenues and increase student participation in the school breakfast program. State incentive funds are designed to reimburse school districts for breakfast meals served that are in excess of the baseline established by the U.S. Department of Education. To qualify, school districts must certify that the incentive funds will supplement, not replace, existing funds provided by the local governing body. Funds may be used to reduce the per-meal price paid by students; reduce competitive food sales to improve the quality of nutritional offerings in schools; increase access to the school breakfast program; or develop programs to increase parent and student knowledge of good nutritional practices.

Additional policy approaches that states have considered to address childhood obesity in 2011 are reported below.  The listing of bills below may not be comprehensive, but provides an overview of other policy approaches considered during the 2011 legislative session.  Bill numbers are included, allowing for retrieval of the full bills for further information. 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.  

 

Body Mass Index (BMI) and Student Fitness Screening Legislation

Body mass index (BMI) 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.   Body mass index is widely accepted as a reliable indicator of body fat content and a screening tool for weight categories that can lead to health problems. The ease of measuring height and weight, without use of expensive equipment, makes BMI screening convenient and has led to policies in a number of states that require such screening at school where virtually all children can participate.

Legislation that requires individual student BMI measurement has been enacted in some states to help identify individual children with weight-related health risks. Aggregate BMI data reporting requirements are in place in other states to provide a picture of community health, monitor statewide obesity trends, or evaluate the results of programs intended to reduce or prevent obesity.   Individual BMI results generally are sent to parents in a confidential letter with suggestions for making healthy changes, which can help motivate families to adopt healthier habits. When screenings identify obesity-related health risks, such as type 2 diabetes, it is important to provide parents with information about how to seek further evaluation and appropriate follow-up Including BMI measurement as an element of a broader student fitness assessment has become a recent trend in state legislation.

In 2011, Michigan’s governor directed that information about body mass index be included in the Michigan Care Improvement Registry (MCIR), which tracks childhood immunization records. This rule change allows health care providers to report height and weight measurements to the registry, with the goal of increasing obesity screening rates and improving treatment of childhood obesity, which is significantly under-diagnosed in children.  

Although no state enacted BMI legislation in 2011, at least five states—Kentucky, Massachusetts, North Carolina, Nebraska and New York—introduced bills related to BMI screening or fitness assessment in 2011 that carried over into 2012 legislative sessions. 

Kentucky
KY SB 15 (2011 prefiled for 2012 as BR 165)- Would require the state board of education to create administrative regulations to include student body mass index percentile, height, and weight on preventative health care examination forms and to submit the aggregate data to the Department of Education without identifying individual students. 

Massachusetts
MA HB 1157 (2011 pending, carries over to 2012) - Would require school health screening tests ascertain body mass index and corresponding percentile of each student in grades one, four, seven, and ten, or, in the case of ungraded classrooms, by a student' s seventh, tenth, thirteenth and sixteenth birthday.

Michigan
In September 2011 Michigan’s governor directed Michigan Department of Community Health to incorporate information about body mass index into the Michigan Care Improvement Registry (MCIR), which tracks childhood immunization records. This rule change allows health care providers to report height and weight measurements on the registry, with the goal of increasing obesity screening rates and improving treatment of childhood obesity, which is significantly under-diagnosed in children. Another goal is to improve the quality of pediatric obesity care by highlighting the need for an annual screening of body mass index, which correlates with future obesity, hypertension, and diabetes. The rule applies only to persons under the age of 18, although the governor also stated his support for expanding the state’s registry to apply to persons of all ages, to give all Michiganders greater awareness of and control over the state of their own health. 

North Carolina
NC HB 334, SB 400 (2011 pending, both carry over to 2012) - Would require the State Board of Education to report on the results of fitness testing in each local school administrative unit.

Nebraska
NE SB 125 (2011 pending, carries over to 2012) - Would require the State Department of Education to annually provide parents with a written explanation of the possible health effects of body mass index, nutrition, and physical activity.

New York
NY AB 922 (2011 pending, carries over to 2012) - Would require schools to implement a method to measure, report, and analyze student body mass index data.

Ohio
OH HB 173 (2011 pending, carries over to 2012) - Would make schools' implementation of body mass index screenings elective, not required.

 

Diabetes Screening and Management at School 

As the number of obese and overweight children continues to rise, type 2 diabetes (formerly called adult-onset diabetes) is increasingly being diagnosed in schoolchildren. Screening for diabetes at school can help identify students at risk and, coupled with nutrition and physical activity policies, help prevent the actual onset of type 2 diabetes in children and reduce childhood obesity. There are two general types of state legislation related to diabetes in schoolchildren. Noninvasive diabetes risk screening at school has been enacted or proposed in a number of states as listed below. Although not preventive in nature, other states, responding to the needs of children already diagnosed with diabetes, are creating policies to facilitate diabetic care for students at school, such as requiring training for school personnel to provide diabetes care for students or limiting the liability of caregivers and schools that provide such care.

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 was replaced by statewide distribution of diabetes risk information to students commencing July 1, 2010 (California Education Code § 49452.7).

Student Diabetes Care – Counting legislation enacted in 2011, 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 Arkansas, Arizona, Florida, Illinois, 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. 

In 2011, Arkansas and Illinois passed legislation regarding school diabetes care by trained personnel. A Texas resolution recognized the economic savings and positive health impact of a community health worker diabetes outreach program in designated counties in the state with a high number of people with or at risk for diabetes. Diabetes legislation related to care, screening, risk analysis or testing of school-aged children was considered, and remains pending in 2012, in Pennsylvania and New York; and was considered, but not enacted, in Connecticut and Indiana.

Arkansas
AR HB 1447 (2011, enacted) - Authorizes the administration of Glucagon to a student who is suffering from Type I diabetes by trained volunteer school personnel designated as care providers in a plan developed under Section 504 of the Rehabilitation Act of 1973, as it existed on July 1, 2011, who have been trained by a licensed nurse employed by a school district or other healthcare professional.

Illinois
IL HB 1571 (2011, enacted) - Amends the Care of Students with Diabetes Act to require that in schools that have a student with diabetes, all school employees receive training, as part of a regular in-service training, in the basics of diabetes care, how to identify when a student with diabetes needs immediate or emergency medical attention, and whom to contact in the case of an emergency.

New York
NY AB 1320 (2011, pending carries over to 2012) - Would require that students with risk factors associated with type 2 diabetes, such as obesity, a family history of type 2 diabetes, or other risk factors be tested upon admission to public schools and periodically thereafter.

Pennsylvania
PA HB 431 (2011, pending carries over to 2012) - Would provide for providing for training additional school employees in diabetes care and treatment, for student diabetes medical management plans, for certain protections from liability so that school personnel can be prepared to provide diabetes care at school and all school-related activities in order for students with diabetes to be medically safe and to have the same access to educational opportunities as do all students in Pennsylvania.

Texas
TX SR 896 (2011, resolution adopted) - Recognizes documented economic savings and positive health impacts as a result of outreach to people in Cameron, Galveston, Nueces, and Webb Counties who have diabetes or are at risk of developing the disease; through a state program that employs certified community health workers to guide education, nutrition and physical activity interventions. Commends the program for achieving more than 39,000 contacts between September 2009 and November 2010.

 

Preschool Obesity Prevention

Obesity rates have doubled in the past 40 years among 2- to 5-year-old children. Twenty-one percent of children in that age group are overweight, and half of those are obese, according to recent reports from the Institute of Medicine and the Centers for Disease Control and Prevention. The Institute’s 2011 report, Early Childhood Obesity Prevention Policies, recommends that “national efforts to prevent obesity [give more] attention to infants, toddlers and preschool children,” and “support families’ efforts to prevent obesity and maintain healthy lifestyles.” Policies that promote the availability of healthy food, create safe play areas, and make other improvements in day care and preschool settings are aimed at establishing healthy habits early in life and providing healthier eating and physical activity options.

The national Childhood Obesity Task Force released an action plan, Solving the Problem of Childhood Obesity Within a Generation, in May 2010. The plan makes 70 specific recommendations, including offering nutritious food and ample opportunity for young children to be physically active in child care settings, while also involving parents and caregivers in prevention efforts. The Healthy, Hunger Free Kids Act of 2010 calls for a national study of physical activity opportunities and nutritional quality of all foods available to children in child care settings. In June 2011, Let’s Move Childcare, a national public-private partnership, was launched to provide resources and recognition for child care providers that establish healthier physical activity and nutrition practices. The General Services Administration, U.S. Department of Defense and Bright Horizons child care centers have committed to participate.

In recent years, state legislatures also have made efforts to stem early childhood obesity, including efforts to provide nutrition education and training for child care workers; include early childhood obesity prevention as a topic for consideration by legislatively created obesity councils or task forces on childhood obesity; include child care programs in school and community nutrition efforts; or set preschool beverage standards.California, Colorado, Massachusetts, North Carolina and Texas enacted relevant legislation during the previous two sessions. Nevada passed a bill in 2011. Because they have not previously been summarized under this topic heading, state legislative actions on preschool obesity prevention from 2009 and 2010, and one effort each from 2005 and 2007, are also summarized below. 

California
CA AB 2084 (2010, enacted) - Requires licensed child day care facilities to serve only low-fat (1 percent) or nonfat milk to children age two or older; to limit juice to one serving per day of 100 percent juice; and to make clean, safe drinking water readily available throughout the day. Sugar-sweetened beverages either natural or artificial are not allowed except for infant formula or complete balanced nutritional products designed for children.

CA AB 627 (2009, enacted, but vetoed) - Would have created 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. 

Colorado
CO SB 81(2010, enacted) - Includes preschools in the state’s efforts to promote consumption of healthy foods at schools and in state-regulated child care programs by encouraging increased use of local farm and ranch products in food service, in order to improve child nutrition and strengthen local and regional agricultural economies. It establishes a 13-member interagency farm-to-school task force to develop a state farm-to-school program. 

Illinois
IL HB 210 (2005, enacted) - Created a preschool interagency collaboration for nutrition and physical activity bydirecting the Illinois Early Learning Council, which coordinates existing programs and services for children from birth to age five, to expand upon existing early childhood programs and services, including those related to nutrition, nutrition education, and physical activity, in coordination with the state’s Interagency Nutrition Council. 

Kentucky
KY HCR 13 (2011, resolution adopted) - Establishes the Legislative Task Force on Childhood Obesity and directs its recommendations to the General Assembly to include, among others, strategies for addressing the problem of childhood obesity and encouraging healthy eating and increased physical activity among children through  (1) early childhood intervention; and at (2) child care facilities. 

Massachusetts
MA HB 4568 (2010, enacted) - Establishes a food policy council to develop recommendations to increase local food production and state acquisition of local products for schools, summer meals and for child care programs. 

Nevada
NV SCR 27 (2007, resolution adopted) - Encourages state agencies, school districts and organizations that provide nutrition education—especially to new and expectant parents and early childhood caregivers—to collaborate to educate Nevadans about healthy lifestyle choices.

NV SB 27 (2011, enacted) - Amends child care licensing standards to require that annual employee training include childhood obesity, nutrition and physical activity. 

North Carolina
NC HB 1726 (2010, enacted) - Requires the Child Care Commission to consult with the Division of Child Development in the Department of Health and Human Services in developing improved nutrition standards for child care facilities. Directs the division to study and recommend guidelines for increased physical activity levels in child care facilities.

NC HB 945 (2009, enacted) - Among other provisions in this bill creating a Legislative Task Force on Childhood Obesity, requires the task force recommend to the General Assembly strategies to address the problem of childhood obesity in early childhood and through child care facilities.

Texas
TX SB 395 (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. Requires the council to develop a 6-year early childhood nutrition and physical activity plan including measures to increase fruit and vegetable consumption among children under age 6; increase daily physical activity in early childhood care settings; increase awareness among parents of the benefits of breastfeeding, healthy eating and physical activity in children under age 6; facilitate the consumption of breast milk in early childhood care settings; decrease malnutrition and undernourishment among children under age 6; and educate parents and caretakers about the need for proper nutrition.

 

Insurance Coverage for Obesity Prevention and Treatment

Providing insurance coverage for obesity prevention can encourage patients to seek nutrition and physical activity counseling from health care providers. Studies have shown that health care providers can play an important role in promoting weight loss among their overweight 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 increase the effectiveness of health providers in this role, the First Lady’s “Let’s Move” initiative to address childhood obesity recommends that “health care providers have the necessary training and education to effectively prevent, diagnose, and treat obese and overweight children.”

State legislation in this category generally requires private insurers, public insurance programs such as Medicaid or SCHIP (State Children's Health Insurance Programs), or state employee health insurance programs to provide or strengthen obesity health insurance coverage. Some legislation specifically requires or encourages coverage for obesity prevention. State legislation does not always specifically refer to childhood obesity. Private insurance coverage for families, however, generally includes children, and some states specifically address insurance coverage for childhood obesity. In July 2004, Medicare recognized obesity as a medical condition, opening the door for greater coverage for obesity treatments.   Upon review, Medicare will now pay for anti-obesity interventions if scientific and medical evidence demonstrate their effectiveness. Medicaid and private insurers often follow Medicare coverage policy. Under Medicaid, states have flexibility to determine the scope of covered services within federal guidelines and can include obesity prevention and treatment as covered services.

A law requiring insurance coverage for obesity evaluation and management as a child wellness service was enacted in 2010 in Maryland. Laws or resolutions to strengthen or require coverage for obesity prevention as a part of wellness screening or obesity treatment were also considered, but not enacted, in 2010 in Mississippi, New Jersey and Washington. 

In 2011, a law establishing a pilot program for health insurance coverage for morbid obesity evaluation and treatment was enacted in 2011 in Arkansas. Legislation introduced in 2011 in Hawaii to require coverage for pediatric obesity management and prevention and to form a health department working group on childhood obesity remains pending and will be considered in the 2012 session. Recent enacted legislation from 2010 and 2011 is summarized below.

Arkansas
AR SB 66 (2011, enacted)- Establishes a pilot program for health plan coverage of morbid obesity diagnosis and treatment, and requires the state and public school employee health benefit plans to offer morbid obesity coverage that includes diagnosis and medical procedures.

Maryland 
MD HB 1017 (2010, enacted) – Requires individual, group, or blanket health insurance policies and nonprofit health service plans to cover visits for obesity evaluation and management as part of the minimum package of child wellness services required as part of family member coverage.

Joint Use Agreements for School Facilities

A joint-use agreement is a formal agreement between two separate entities—often a school district and a city or county government—that defines the roles, responsibilities, terms and conditions for the shared use of public property. Many communities lack safe places to exercise and play near where people live and work. Opening school fields, tracks, courts, playgrounds and gymnasiums to the public, when not in use by students, is a low-cost way not only to encourage more people to be physically active, but also to achieve maximum value for funds appropriated by legislatures for school facilities. Joint-use agreements allow town, city or county governments to work with school districts to share school facilities with the community and also address liability, staffing, maintenance, hours and cost-sharing issues.

In 2011, four states—Arkansas, Florida, Louisiana and Tennessee—enacted joint-use legislation to facilitate or encourage community use of school facilities for recreation. Additional Florida legislation and bills to permit use of public school facilities and grounds for physical fitness and recreation remain pending for consideration during 2012 in California, New Mexico, New York and Pennsylvania.  

Arkansas 
AR SB 211 (2011, enacted) - Appropriates $500,000 to the Department of Education Public School Fund Account for grants to local school districts to support school facility joint-use agreements.

Florida
FL HB 7207 (2011, enacted) - Establishes a process for determining where and how school board or local government facilities can be jointly used as part of growth management and community planning.

Louisiana
LA SCR 14 (2011, enacted) - Encourages city, parish and local public school boards to enter into joint-use agreements for school facilities to promote health benefits. It recognizes that physical inactivity can lead to obesity and type 2 diabetes; that many communities lack safe places to exercise; and that opening school fields, tracks, courts, playgrounds and gymnasiums to the public when not in use by students is a low-cost way to encourage more people to be physically active.

Tennessee
TN HB 1151 (2011, enacted) - Stipulates that, if a recreational activity is conducted pursuant to a recreational joint-use agreement, the local board of education or school official entering into the agreement does not incur greater liability than that provided under existing law, except for gross negligence or willful, wanton or malicious conduct. It also encourages local boards of education and school officials to require in a recreational joint-use agreement that the other party to the agreement maintain and provide proof of adequate liability and accident insurance coverage.

 

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. 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, Massachusetts, New Hampshire, Oklahoma, South Carolina, Texas, Vermont and West Virginia require some form of nutrition education in schools. Nutrition education that extends the benefits of nutrition education beyond schools to involve parents and the community—including hands-on nutrition education and growing, preparing or tasting healthy foods such as locally available fruits and vegetables—has been the focus of some recent nutrition education legislation. New legislation related to nutrition education in school curriculum, after school and for parents, was enacted in 2011 in Arkansas, Louisiana, Texas and Washington.

Arkansas
AR SB 138 (2011, enacted) - Defines activities that improve health and wellness, including nutrition education, to be part of youth development after-school programs. 

Louisiana
LA HB 194 (2011, enacted) - Requires printing nutrition education resource materials that contain core nutrition messages for households that receive Supplemental Nutrition Assistance Program (SNAP) benefits.   

Texas 
TX HB1(2011, enacted) - Requires a portion of appropriated funds be used for a nutrition education and outreach program or activities that improve low-income consumers' access to basic nutrition and healthy foods, among other state budget provisions for fiscal years 2012 and 2013.

Washington
WA HB 1302, SB 5122 (2011, enacted) - Includes nutrition education in defined wellness activities for health reform implementation purposes.

Physical Activity or Physical Education in Schools and Recess Legislation

Physical Activity or Physical Education in School

The first Physical Activity Guidelines for Americans, issued by the U.S. Department of Health and Human Services in October 2008, recommend 60 minutes of age-appropriate, enjoyable and varied daily, moderate-to-vigorous physical activity for children. Developed by experts in exercise science and public health, the Guidelines are based on research findings about the benefits of physical activity and recommended activity levels. For children, physical activity during the school day not only provides health benefits—such as strengthening the heart, muscles and bones—but studies show it can also increase academic achievement.

Before the Guidelines were issued, the National Association for Sport and Physical Education (NASPE) had recommended that all children from prekindergarten through grade 12 receive daily physical education taught by certified specialists, and that schools have appropriate class sizes, facilities and equipment. NASPE recommends 150 minutes per week of physical education for elementary school students and 225 minutes per week for middle and high school students, with qualified physical education teachers providing a developmentally appropriate program and a teacher-student ratio similar to other classroom settings. Excellent physical education programs nurture enjoyment of physical activity and set the stage for an active lifestyle in all children, regardless of athletic ability. 

Currently, almost 30 percent of children do not exercise even three days per week. Only 17 percent of high school students say they exercise the minimum recommended one hour daily. 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. Legislators have considered and enacted laws to support physical education programs in schools to bridge this gap. Although all 50 states have some type of statewide standards for physical education or physical activity at school (Colorado became the final state this year), their scope varies greatly. Policy approaches to increasing physical activity at school include setting physical education time standards at all grade levels, providing for daily physical education, and preserving recess time for physical activity.

Seven states—Alabama, Colorado, Georgia, Maine, Michigan, Tennessee and Utah—enacted legislation or adopted resolutions related to physical education or physical activity at school in 2011. Two of these laws—in Colorado and Tennessee—concerned reserving or requiring time for physical education or physical activity during the school day. Legislation to preserve time during the school day for recess, or to fund school recreational facilities for recess and physical education are pending for consideration in 2012 in California, Illinois and Oregon.

Alabama
AL SJR 55 (2011, resolution adopted) - Urges all state citizens to become involved in the “Let's Move in School” campaign to promote quality physical education programs in schools. It also recognizes the week of May 1-7, 2011, as physical education and sports week, and the month of May as physical fitness and sports month, to promote the knowledge, skills and values that can lead to a lifetime of physically active and healthy living. 

Colorado
CO HB 1069 (2011, enacted) - Requires 30 minutes of daily physical activity in elementary schools statewide. Physical activity may include physical education classes and recess time. 

Georgia
GA HR 466, SR 258 (2011, resolutions adopted) - Commends the Healthy Kids Challenge program and encourages all state schools to join the challenge and participate in fighting childhood obesity. It also recognizes March 3, 2011, as Healthy Kids Challenge Day. 

Maine
ME HB 939, LD 1280 (2011, enacted) - Implements the recommendations of a 2010 “PE4ME” legislative report and a pilot physical education project for elementary schools to demonstrate the value of implementing physical education and health education programs, and of reporting the health, fitness and academic performance of elementary school children. It authorizes funding to develop physical education programs for elementary schools and other plans to improve the health, nutrition and physical fitness of elementary school children. 

Tennessee
TN HB 9 (2011, enacted) - Establishes methods for monitoring compliance with the 90 minutes of required physical activity per week for elementary and secondary school students. The Office of Coordinated School Health in the Department of Education must report to the legislature by Aug. 1, 2012, on school district compliance with the law.

Utah
UT HCR 7 (2011, resolution adopted) - Supports policies that promote outdoor activities for children, in part because “childhood obesity rates in Utah and the nation are epidemic and outdoor activities can be an effective means to combating this major health concern.”

 

Recess Legislation Pending or Enacted as of December 2010

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. 

Colorado
Executive Proclamation (September 26, 2011) – Proclaims October 5, 2011 as Colorado Recess Day to promote recess that is otherwise being shortened or removed from school curriculum, and to recognize that children who play are less likely to suffer from obesity and related health problems such as diabetes and heart disease, do better in school and develop cognitive skills linked to academic performance and learn social skills that help them become happy, well-adjusted adults.

Illinois
IL SJR 80 (2009-2010, resolution adopted) - Creates the Recess in Schools Task Force within the State Board of Education and requires it to meet within 60 days of December 1, 2010. Directs the task force to examine the barriers facing schools in providing daily recess to every age-appropriate student and submit a final report to the General Assembly by January 1, 2011 with its recommendations for bringing recess back to the maximum number of students. Notes that studies have shown that children provided with recess are more focused, on-task, and able to concentrate on educational material than those who are not afforded a recess period and cognitive function improves when a child has the opportunity for physical exercise and active play. Also notes that obesity rates among children have skyrocketed in recent years, with one in three American children now being considered overweight or obese and that recess provides children with the opportunity for physical exercise during the school day. Adds that recess is essential for providing students with a less structured period of time in which to engage in social interactions and develop interpersonal relationships with peers.

IL HB 5035 (2009-2010, pending as of Dec. 2010) - Would require a daily mid-morning recess of at least ten minutes for students in grades kindergarten through grade 8. Would require school principals to direct that a recess be held indoors if the weather is inclement.

Massachusetts
MA HB 4459 (2010, enacted) – Includesstudy of time allotted, if any, for public school students to participate in recess each week. There is hereby established a commission on school nutrition and childhood obesity for the purpose of making an investigation and study of childhood obesity and effective programs promoting proper nutrition and exercise for the children. The commission shall conduct a comprehensive review of programs promoting proper nutrition for children at each stage of development, both inside and outside of the school setting. The commission’s review shall consider, but not be limited to: (1) current school district practices concerning nutrition and physical education in public schools, including, but not limited to, physical education course offerings, class duration and frequency and the physical space and time allotted, if any, for public school students to participate in recess each week.

Minnesota
MN SB 2908 (2010, enacted) – Among other provisions related to physical activity at school, encourages the state’s department of education to develop guidelines that school districts can adopt that promote quality recess practices and behaviors that engage all students, increase their activity levels, build social skills, and decrease behavioral issues.

New Jersey
NJ AB 1044 (2010, pending as of Dec. 2010) – Would establish a Task Force on Public School Student Recess to study benefits of student recess and make recommendations on advisability of mandatory recess in school districts. Would direct the task force to the task force to: examine current data, research, programs, and initiatives related to the physical, social, emotional, and intellectual benefits achieved by young students as a result of participation in school recess; identify effective strategies for schools that promote lifelong health and prepare children and youth for physically active lifestyles; examine the extent to which recess is provided to students in school districts across the State of New Jersey; and develop recommendations on the advisability of mandating daily recess in all school districts.
 
Recess legislation enacted previously, from 2005 through 2009 is summarized Recess legislation enacted previously, from 2005 through 2009 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 ten 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 twenty-minute daily recess, which shall be 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.  

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.

 

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. 

Encouraged by federal efforts and a potential penalty of withholding federal school lunch reimbursement funds, a number of states enacted legislation in previous sessions to support wellness policies or related school health efforts. State legislation has included approaches such as 1) encouraging or requiring local school districts to adopt wellness policies; 2) establishing state multidisciplinary wellness or school health advisory councils; 3) establishing a state office or clearinghouse to coordinate wellness activities or to be a repository for collecting local wellness policies and information; 4) directing local school districts to establish wellness councils with broad stakeholder participation; and 5) establishing mechanisms for state oversight of wellness policy implementation. Nearly all students now are covered by written school wellness policies. The policies vary in strength and completeness, however, and assessments of the implementation status range from nearly complete to inconsistent. State legislation, with or without referencing the federal requirement, has helped to fill the gaps or encourage implementation.

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 community stakeholders to encourage school wellness. In 2011, South Carolina adopted a resolution and Vermont enacted legislation to support school wellness policies or programs.   

South Carolina
SC HR 3789 (2011, enacted) - Acknowledges that overweight and obese children are at heightened risk for a number of chronic adult conditions, and urges state and private entities to implement policies and programs to help reduce overweight and obesity among youth.

Vermont
VT HB 202 (2011, enacted) - Includes school wellness programs as a component of the state’s unified, single-payer health system.

 

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

Legislation or resolutions have created obesity-related task forces, commissions, studies and other special programs in several states, both as an initial approach to state action and as a way to provide accountability through reports to the legislature. Task forces are sometimes charged with initiating specific programs to prevent obesity. Although the purposes and activities of task forces are not uniform, states often require representation on the task force of many stakeholders, not only legislators. Task forces also may be required to achieve specific goals or take specific actions in addition to studying a problem. Task force or commission efforts required by state legislation also may include reporting on the status of obesity prevention benchmarks.

Legislation on this topic was enacted in 2011 in Kentucky, which created a task force that met during the 2011 legislative interim and will provide recommendations to the legislature in 2012. North Carolina legislation to continue the state’s childhood obesity task force remains pending and will carry over to 2012. That task force, which served as the model for Kentucky’s efforts, resulted in enactment of five bills in 2010. The list below is meant to provide a sampling of state legislative efforts for obesity-related task forces and commissions and may not be completely comprehensive.

Florida
FL HB 1312 (2011, enacted) - Among other actions, creates an 11-member Healthy Schools for Healthy Lives Council.

Kentucky
KY HCR 13 (2011, resolution adopted) - Establishes the Legislative Task Force on Childhood Obesity and directs it to meet at least monthly during the 2011 interim and report its findings and recommendations to the legislature in 2012. The legislation directs the task force to study a variety of issues relating to childhood obesity including military readiness; and to recommend legislative strategies not only to address the problem of childhood obesity but also to encourage healthy eating and increased physical activity among children.

Louisiana
LA HCR 55 (2011, resolution adopted) - Requests the Office of Group Benefits to conduct a study on the financial benefits of establishing a program to address the high rate of obesity in Louisiana. Findings shall include but not be limited to the total number of state employees currently participating in the state employees group benefits program, annual expenditures on cardiovascular events, annual expenditures on open heart surgeries, annual expenditures on strokes and related rehabilitation, monthly expenditures on blood pressure medications, monthly expenditures on cholesterol medications, monthly expenditures on diabetic treatment and management medications, monthly expenditures on diabetic neuropathy treatment.

LA SR 134 (2011, resolution adopted) – Requests the Senate Committee on Health and Welfare to study the ongoing efforts of various groups to fight the childhood obesity epidemic and report by January 1, 2012, to the Senate Committee on Health and Welfare about the status of their ongoing efforts to curb the high incidence of childhood obesity.

North Carolina
NC SB 242, HB 218 same (2011, pending carryover) - North Carolina considered legislation to extend the life of its Legislative Task Force on Childhood Obesity for another year. The task force was responsible for sponsoring five bills that were enacted during the 2010 session. 

South Carolina
SC HR 3780 (2011, resolution adopted) - Acknowledges that overweight and obese children are at heightened risk for a number of chronic adult conditions; and urges appropriate state and private entities to implement policies and programs to help reduce overweight and obesity among the state's youth.

 

Taxes, Tax Credits, Tax Exemptions and Other Fiscal Incentives

States continue to consider fiscal options to encourage healthy lifestyles. Examples include offering tax credits for fitness or wellness choices; tax credits or other fiscal incentives for grocery store development or improvements that allow grocery retailers to offer fresh fruits and vegetables; or enacting or increasing taxes on foods and beverages that have minimal nutritional value in order to discourage their consumption or raise revenue.

California and the District of Columbia enacted legislation in these categories in 2011. California’s 2011 legislation includes a tax credit for farmers who donate fresh fruits and vegetables to food banks and creation of a California Healthy Food Financing Initiative. State legislatures in Illinois, Louisiana, New York and Pennsylvania have previously supported public-private partnerships to bring healthy food sellers into urban, suburban and rural communities currently lacking sufficient produce retailers. Not only can this help local diets, it also may give a boost to local economies. Grants, loans and tax credits are offered to grocery operators to build new full-service stores or improve existing facilities by adding refrigerated storage for fresh produce, for example. The District’s city council passed a bill in 2011 for fiscal incentives for a comprehensive grocery store development initiative. 

Legislation to impose a tax or fee or remove a tax exemption for soft drinks or sugary beverages was considered, but not enacted, in 2011 in at least ten states—California, Hawaii, Illinois, Mississippi, Oregon, Rhode Island, Texas, Utah, West Virginia and Vermont.   Vermont’s proposal will carry over to 2012 and would use the tax revenues for health programs, including creation of a healthy weight initiative that would fund purchase of fruits and vegetables by WIC and 3SquaresVT recipients; establish loans for small food retailers to purchase energy efficient refrigeration equipment for the sale of fruits and vegetables; provide electronic benefits transfer terminals to all Vermont farmers' markets as well as technical assistance, promotional support, and reimbursement to farmers' markets for transaction costs; subsidize school meals for low income Vermonters; and create a permanent and self-sustaining fund to support programs combating obesity. Virginia legislators proposed dedicating funds from an existing soft drink excise and litter tax to the state’s tourism fund. Colorado considered a bill to reinstate the state sales and use tax exemption for soft drinks that was repealed in 2010 but it did not pass. This listing is not intended to be comprehensive.

California
CA AB 152 (2011, enacted) - Creates a tax credit for qualified taxpayer-farmers equal to 10 percent of that would otherwise be included in inventory costs for the donation of fresh fruits or fresh vegetables to food banks located in California.   Authorizes the Department of Public Health to award grants and provide in-kind support to local governments, nonprofit organizations and local education agencies that encourage the sale and consumption of fresh fruits and vegetables; implement programs to prevent obesity; and promote healthy eating and access to nutritious food in underserved communities. 

CA AB 581(2011, enacted) - Creates a four-agency state council with a 21-member multidisciplinary advisory group to develop and implement a California Healthy Food Financing Initiative that will, among other activities, utilize federal, state, philanthropic, and private funds, for the purpose of expanding access to healthy foods in underserved communities and, to the extent practicable, to leverage other funding for the same purpose. Recognizes that health and economic benefits of the initiative are expected to include boosting a community’s physical health and well-being as well as its economic health by creating new jobs and opportunities in the areas of food distribution, retail sales and store management.

District of Columbia
DC LB 967(2011, enacted) - Requires the Mayor to establish a Grocery Store Development Program to attract grocery stores to underserved areas in the District of Columbia. As a condition of participating in the program, a grocery store must: (1) accept Supplemental Nutrition Assistance Program (SNAP) benefits; (2) apply to accept Women, Infants, and Children (WIC) benefits and accept WIC benefits, if eligible; and (3) sell fresh produce and healthy foods. The law also requires establishment of a Healthy Food Retail Program to expand access to healthy foods by providing assistance to corner stores, farmers markets, and other small food retailers. Participating program retailers are strongly encouraged to apply to accept SNAP and WIC benefits.

Nebraska
NE LB 200 (2011, enacted, but vetoed) - Would have provided $150,000 in each year of the next biennium to increase access to healthy food in low-income and high-poverty areas through a fresh foods financing initiative.


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. Additional support for legislative tracking is provided by the W.K. Kellogg Foundation. 

 

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