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Childhood Obesity Legislation 2013

Childhood Obesity Legislation - 2013 Update of Policy Options

3/1/2014

Overall obesity rates remain high and obesity prevalence among children and youth ages 2 to 19 and adults in the United States has not changed significantly between 2003-2004 and 2011-2012, according to the Centers for Disease Control and Prevention (CDC).

Currently, 17 percent of American youth are obese, a figure that continues to reflect that childhood obesity rates in the United States have nearly tripled in the past 30 years. Counting both obese and overweight, 31.7 percent of American children and adolescents are affected by this epidemic. In sheer numbers, more than 12 million American children and adolescents are obese and more than 23 million are either obese or overweight. For very young children, however, there are signs of progress. Data from CDC’s National Health and Nutrition Examination Survey (NHANES) released in February 2014 show a decline in obesity prevalence in children ages 2 to 5, from nearly 14 percent in 2003-2004, to just over 12 percent in 2009-2010, to a little more than 8 percent in 2011-2012.

Overall health care spending on obesity continues to significantly burden the nation, however, and the most recent research data available estimate obesity-related health care costs at nearly $150 billion annually. Taxpayers fund about half of these costs, at approximately $60 billion, through Medicare and Medicaid.  Childhood obesity also poses a national security challenge, as obesity has become one of the most common disqualifiers for military service; affecting 25 percent of those who apply to serve.

Obese children and teenagers also remain at greater risk for developing serious chronic diseases including 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. An overweight adolescent has a 70 percent chance of being 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.

Many policy options can help prevent and reduce childhood obesity.  This page reports policies enacted or adopted by state legislatures in 2013 and classifies them by the policy approaches listed in the table below.

Body Mass Index (BMI) or Student Fitness Screening at School Diabetes Screening and Management at School
Insurance Coverage for Obesity Prevention and Treatment Joint or Cooperative Use Agreements for School Facilities
Physical Activity or Physical Education in Schools and School Recess Legislation Raising Awareness
School Nutrition Legislation School Wellness Policies
Task Forces, Commissions, Studies, Grants and Other Special Programs

Taxes, Tax Credits, Tax Exemptions and Other Fiscal Incentives


50-State Legislation on Childhood Obesity Policy Options Enacted in 2013

State

School Nutrition

Physical Education, Physical Activity
 

School Wellness

Joint-Shared Use Agreements

Insurance Coverage for Obesity

Task Forces, Studies

Alabama

           

Alaska

         

X

Arizona

           

Arkansas

X

X

 

X

   

California

X

   

X

   

Colorado

X

       

X

Connecticut

         

X

Delaware

           

Florida

X

         

Georgia

X

       

X

Hawaii

X

       

X

Idaho

       

X

 

Illinois

 

X

       

Indiana

           

Iowa

           

Kansas

X

         

Kentucky

           

Louisiana

X

       

X

Maine

X

         

Maryland

           

Massachusetts

X

 

X

     

Michigan

X

         

Minnesota

           

Mississippi

X

       

X

Missouri

X

         

Montana

X

         

Nebraska

           

Nevada

X

         

New Hampshire

           

New Jersey

           

New Mexico

           

New York

           

North Carolina

X

X

       

North Dakota

           

Ohio

 

X

       

Oklahoma

X

         

Oregon

X

       

X

Pennsylvania

         

X

Rhode Island

X

 

X

     

South Carolina

X

X

     

X

South Dakota

           

Tennessee

           

Texas

X

         

Utah

         

X

Vermont

           

Virginia

   

X

     

Washington

           

West Virginia

X

         

Wisconsin

           

Wyoming

           

District of Columbia

           

 


School Nutrition Legislation

States have continued to actively innovate in the area of school nutrition policies by enacting legislation and adopting resolutions that both complement and supplement federal efforts to implement the Healthy, Hunger-Free Kids Act of 2010 (P.L. 111-296) and other policies that make nutritious foods available to school children throughout the school day. In 2014, 22 states—Arkansas, California, Colorado, Florida, Georgia, Hawaii, Kansas, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Texas and West Virginia—enacted some type of school nutrition legislation or adopted school nutrition resolutions. These laws help ensure students have access to healthier food and beverage options at school or encourage other community supports for child nutrition. An area that drew the attention of legislators in many states in 2014 was wider access to a nutritious school breakfast to help children start the day ready to learn. 

Summaries of Enacted 2013 School Nutrition Legislation

Arkansas
AR SB 428 (2013, enacted) – As part of the general school improvement appropriation, creates a pilot program for breakfast nutritional programs in public schools and provides $1 million funding for the pilot.

AR SB 1051 (2013, enacted) – As part of a new Whole Child Recognition Program launched by the legislation, provides for working group efforts to reinforce healthy eating patterns by offering students nutritious and fresh food choices as part of both routine food services, and special programming and events.

California
CA AB 626 (2013, enacted) –
Requires California after-school programs to certify that they provide a nutritious snack, meal or both and, in high schools, a physical activity element.  Allows the use of school cafeteria funds for central food processing expenditures, for the cost of housing and equipping cafeterias, and for the cost of providing drinking water in cafeterias. Extends to 1/2 hour before and after the school day the existing school nutrition standards that prohibit selling less nutritious food items or beverages, or food containing trans fat at school.  Requires compliance monitoring. Provides for nutrition pilot program participation.

CA AB 290 (2013, enacted) – Requires that as a condition of licensure on or after January 1, 2015 through the California Child Day Care Act, in addition to any other required training, at least one director or teacher at each day care center and each family day care home licensee who provides care, complete as a part of their minimum of 15 hours of health and safety training, at least one hour of childhood nutrition training as part of the preventive health practices course.

Colorado
CO HB 1006 (2013, enacted) – Creates the Breakfast After the Bell Nutrition Program to offer free breakfast to students in public schools that have a specified percentage of students who are eligible for free or reduced-cost lunch under the School Lunch Program. Requires participating schools to comply with nutrition standards and meal patterns for school breakfasts established by the federal Healthy, Hunger-Free Kids Act of 2010 and related federal regulations.

CO SB 153 (2013, enacted) – Continues Colorado’s interagency farm-to-school coordination task force indefinitely. Adds task force members from colleges or universities, a school principal or teacher, and a school food services management representative from higher education. Makes tracking progress a group task and requires the task force to report its progress, findings, and recommendations to the education committees of the house of representatives and the senate, the senate agriculture and natural resources committee, and the house agriculture, livestock, and natural resources committee, or any successor committees, by February 1, 2015 and every February 1 every two years thereafter.

Florida
FL SB 1500 (2013, enacted) – Among other appropriations to aid local governments, provides $1,067,958,003 to the school lunch program from the Food and Nutrition Services Trust Fund.

Georgia
GA HB 17 (2013, pending, carryover to 2014) -
Would create a Farm to School program in Georgia to promote the sale of Georgia grown farm products by schools in the state, including creation of a database of farmers interested in selling agricultural products to schools.

GA HR 558, GA SR 430 (2013, resolutions adopted) – Commends school districts participating in the Farm to School 5 Million Meals Campaign and recognize that Georgia agencies, schools, parents, students, farmers, and communities are collaborating and working together to reduce childhood obesity. Recognizes that farm to school programs represent an innovative opportunity for a comprehensive approach that seeks to improve child nutrition, thus improving academic performance, and that also provides local market opportunities for Georgia farmers.

GA HB 105 (2013, enacted) – Among other appropriations, provides nutrition funding of $597,481,435, including $574,888,212 in federal funds and grants and $22,593,223 in state funds, to provide leadership, training, technical assistance, and resources, so local program personnel can deliver meals that support nutritional well-being and performance at school and comply with federal standards.

Hawaii
HI HR 184 (2013, pending, carryover to 2014) -
Would declare October as Farm to School month in Hawaii and request the department of education and the department of agriculture to cooperate to create and implement a farm to school program in public schools in the state.

Kansas
KS SB 171 (2013, enacted) – Appropriates school food assistance funding of $2,510,486.

Louisiana
LA HB 214 (2013, enacted) - Encourages public school governing authorities to create partnerships for the purpose of increasing parental involvement in schools; including encouraging participation in parenting classes that educate parents about, among other topics, the importance of sleep and good nutrition in school performance. Public school governing authorities and the state’s department of education are to identify available funding sources for these classes.

LA HB 1 (2013, enacted) – As part of annual appropriations, provides that at least 90% of the meals offered/served by school food services will meet USDA standards for the Child Nutrition Program (National School Lunch/School Breakfast Program), and provides for performance indicators to ensure that nutritious meals are served to children who receive federally reimbursable lunch or breakfast, such as sponsor reviews and quantities served.

Maine
ME HB 1079 (2013, enacted) –
Funds, among other items, an update to the school nutrition web-based computer system.

Massachusetts – Nutrition Education
MA HB 3538 (2013, enacted) –
Among other items, this appropriations bill provides for incorporating obesity prevention programs, including nutrition and wellness programs, into school curricula to address the nutrition and lifestyle habits needed for healthy development. Also provides funding to increase participation in the summer meals program and universal school breakfast program. Requires that $200,000 more than the amount spent in fiscal year 2013 be expended for the universal school breakfast program in which all children in schools receiving funds under the program are provided free, nutritious breakfasts. Pays for the state share of the National School Lunch program in the amount of $5,426,986.

Michigan
MI HB 4228 (2013, enacted) – Provides funding for Michigan schools including an allocation for 2013-2014 of all available federal funding, estimated at $460,000,000.00 for the national school lunch program and allocating an amount not to exceed $5,625,000.00 for 2013-2014 to school districts for school breakfast.  Requires a purchasing preference for the school lunch and breakfast programs for food that is grown or produced by Michigan businesses if it is competitively priced and of comparable quality.

Mississippi
MS HB 718 (2013, enacted) - Creates an Interagency Farm to School Council and requires it to meet at least quarterly, starting no later than August 1, 2013. Directs the Council to facilitate purchase and use of locally grown and raised agricultural products in school meals in order to improve the quality of food served in schools. Also encourages community organizations, restaurants, grocery retail stores and other local organizations and businesses to purchase more local agricultural products. Defines local agricultural products as food products grown on Mississippi farms or gardens including, but not limited to, fruits, vegetables, and nuts grown in Mississippi, meat, poultry, eggs, dairy, fish, seafood and other aquatic products produced in Mississippi, and products processed into value-added products that are grown or produced in Mississippi. Supports the state economy by generating new income for Mississippi farmers. Provides for multi-sector membership, duties and purposes of the Council. Requires an annual report from the Council to the legislature beginning January 1, 2015. Sunsets the Council’s existence as of July 1, 2015.

MS SB 2073 (2013, enacted) - Promotes local purchasing of perishable supplies or food for school lunch programs among other state agency food programs by authorizing certified purchasing offices to include the location of a bidder's local office and inventory in the best value calculation.

Missouri
MO HB 2 (2013, enacted)
– Appropriates $3,412,15 from the state’s general revenue fund to the Department of Elementary and Secondary Education for the School Food Services Program to reimburse schools for school food programs.

MO HB 14 (2013, enacted) - Appropriates $16,000,000 to the Department of Elementary and Secondary Education For the School Food Services Program to reimburse schools from Federal Funds for school food programs.

Montana
MT HB 4 (2013, enacted) – Directs all remaining fiscal year 2013 federal budget amendment authority for the fiscal year 2011 specialty crop block grant program to develop efficiencies in food processing for rural farm-to-school programs through school food nutrition service cooperative agreements and authorizes them to continue into federal fiscal year 2014.

Nevada
NV AB 337 (2013, enacted)
– Encourages public schools to establish and participate in farm to school programs to promote fruit and vegetable consumption.

NV SB 466 (2013, enacted) - Transfers authority over school nutrition programs from the state’s department of education to the director of the state’s department of agriculture.

North Carolina
NC HB 57, NC SB 193 (same, 2013, enacted) – Prohibits local school administrative units from assessing indirect costs to a school’s child nutrition program unless the program is financially solvent with a minimum of one month's operating balance. Also provides that the North Carolina Procurement Alliance shall promote optimal pricing for child nutrition program food and supplies.

Oklahoma
OK HB 1418 (2013, enacted) – Requires the state’s department of education to develop rules to prevent food waste in public school cafeterias and policies to redistribute leftover school foods to students in need. Allows the department to seek ways to receive packaged or nonperishable food and fresh foods such as fruits and vegetables to distribute to students in need without requiring school cafeterias to provide overnight storage.

Oregon
OR HB 2649 (2013, enacted) – Resets requirements for the state’s education department regarding grant funds awarded to encourage the purchase of healthy school foods to require that at least 80 percent of funds be used to purchase Oregon grown foods for schools and at least 10 percent to fund food-based, agriculture-based or garden-based educational activities.

Rhode Island
RI HB 6291 (2013, enacted) –
Provides that local school health and wellness subcommittees shall be responsible for, but not limited to, developing policies, strategies, and implementation plans that promote purchasing and serving locally grown fruits, vegetables and dairy products in schools.

RI SB 513 (2013, enacted) - Promotes purchasing and serving locally grown fruits, vegetables and dairy products to children in Rhode Island schools.

South Carolina
SC SB 191 (2013, enacted) – Establishes a voluntary program in the state’s department of agriculture to link local farms to school districts and other institutions to provide students and adults with fresh and minimally processed farm foods for meals and snacks. Encourages the integration of nutritional and agricultural education into school curriculum through hands-on learning opportunities, such as farm visits, cooking demonstrations, and school gardens. Recognizes that the program will strengthen local economies; create jobs; open a substantial new market for farmers; and provide beginning farmers with a consistent and secure customer base.  Allows the department to seek grants and private funding for the program and requires the department to create a program website.

SC HB 3710 (2013, enacted) – Among other measures to address obesity in this appropriations bill, requires school districts to report to the state health department information regarding their progress towards meeting provisions of the Student Health and Fitness Act of 2005 including efforts to promote healthy eating patterns; assessment of school district health education programs; snacks in vending machines; and health curriculum. Gives the health department authority to collect, compile and assess state and school districts’ progress in meeting these goals, with the overarching goal of facilitating an environment that decreases body mass index in the state.

Texas
TX SB 376 (2013, enacted) -
Requires school districts or open-enrollment charter schools that participate in the national school breakfast program, in which a specified percentage of the students qualify for a free or reduced-price breakfast, to offer a free breakfast to each student.

TX HCR 101, TX HCR 99 (2013, resolutions adopted) – Resolutions congratulate Burnet Consolidated Independent School District  for earning a HealthierUS School Challenge Gold Award of Distinction from the U.S. Department of Agriculture, a voluntary national certification initiative  designed to encourage schools to improve the quality of food served in school cafeterias and provide nutrition education as well as to promote physical education and other opportunities for physical activity for students. Recognizes the district's food service department and its director for outstanding contributions to this achievement.

West Virginia
WV SB 663 (2013, enacted)
– Creates a Feed to Achieve program that requires school breakfast and lunch to be available for all students in order to improve nutrition and health of the state's children. Encourages development of community gardens and farm to school programs. Provides for public-private funding of the school breakfast program and requires an annual audit of donations of private funds.

Wisconsin
WI AB 40 (2013, enacted) – Among other provisions in the state budget, appropriates $250,000 for farm to school grants.


Body Mass Index (BMI) or Student Fitness Screening at School 

Body mass index (BMI) is a measure of a person’s weight 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 BMI 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. A number of states include BMI measurement as an element of a broader student fitness assessment.

At the close of 2013 legislative sessions, legislation related to student body mass index measurement remained pending to carry over for 2014 legislative sessions in Massachusetts, New York and Oklahoma.  In three states, Mississippi, Montana and New Jersey, student BMI measurement was proposed but not enacted in 2013; while a measure to repeal student body mass index measurement failed in Arkansas in 2013. South Carolina legislators enacted an appropriations bill giving the state health department authority to collect data to assess the progress of schools in creating an environment to decrease BMI.

Massachusetts
MA HB 2634 (2013, pending, carry over)
– Would require, among other items as part of childhood obesity prevention program, measuring body mass index percentile of each student by trained school personnel or others approved by the Department, and in accordance with guidelines of the Department in grades one, four, seven, and ten, or, in the case of ungraded classrooms, by a student's seventh, tenth, thirteenth and sixteenth birthday.

MA HB 2024 (2013, pending, carryover) – Would prohibit the department of public health from collecting data on student height and weight or calculating the body mass index of a student.

New Jersey
NJ AB 4245, NJ SB 111 (same) (2013, proposed, not enacted)
-  Would have required boards of education to calculate body mass index for students in first, fourth, seventh, and tenth grades.

New York
NY AB 2517, AB 2565, S2363, S2437 (similar)  (2013, proposed, pending, carryover )
– Would require schools to measure, report and analyze body mass index (BMI) and weight status category of its students.

Oklahoma
OK HB 1670 (2013, proposed, pending, carryover)
– As part of a new RIGHTTRACK act, would require   the opportunity to attend health and wellness school assemblies as a tool in educating and identifying children who may be at risk for poor nutrition, and to provide health and wellness education with materials from the Centers for Disease Control and Prevention that provide information about healthy foods, body mass index (BMI) and exercise. At the health and wellness assemblies, calculation of BMI would be available as a tool in screening and identifying students who may be at risk for poor nutrition and parents or guardians of a student whose BMI is measured would receive a confidential health report including the result of the student's BMI screening, along with basic educational information explaining the results.

South Carolina
SC HB 3710 (2013, enacted)
– Among other measures to address obesity in this appropriations bill, requires school districts to report to the state health department information regarding their progress towards meeting provisions of the Student Health and Fitness Act of 2005, specifically: the average number of minutes students exercise weekly; results of the South Carolina Physical Education Assessment; efforts to promote healthy eating patterns; assessment of school district health education programs; snacks in vending machines; and health curriculum. Gives the health department authority to collect, compile and assess state and school districts’ progress in meeting these goals, with the overarching goal of facilitating an environment that decreases body mass index in the state.


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. Although not preventive in nature, a number of states, responding to the needs of children already diagnosed with diabetes, have created policies to facilitate care for students with diabetes, such as requiring training for school personnel to provide diabetes care for school children or limiting the liability of caregivers and schools that provide such care. In 2013, the states of Arizona, Arkansas and Missouri enacted laws that refined or described requirements for volunteer school personnel, with appropriate training by medical personnel, to provide school diabetes care.

Another approach has been to provide non-invasive screening for diabetes at school to help identify students at risk. Together with nutrition and physical activity policies, such screening can help prevent the actual onset of type 2 diabetes in children and may reduce childhood obesity as well. The two general types of state legislation related to diabetes in schoolchildren are summarized below, followed by summaries of enacted 2013 legislation on this topic. 

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 2012-2013, 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, Arkansas, Connecticut, Florida, Georgia, Illinois, Indiana, Missouri, 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. Alabama adopted a legislative resolution in 2012 to study training school personnel to provide care to students with diabetes.

Arizona
AZ HB 2042 (2013, enacted) – Allows schools to designate two or more school employees to serve as voluntary diabetes care assistants. Subject to final approval of the voluntary diabetes care assistants by the parent or guardian, the assistants may administer insulin, assist the pupil with self-administration of insulin, or administer glucagon in an emergency situation. The volunteer diabetes care assistant must provide the school with a written statement signed by a licensed health professional stating that the voluntary diabetes care assistant has received proper training, including training about techniques for determining the proper insulin dose based on standing orders from the pupil’s physician. Requires a pupil’s parent to provide all diabetes equipment and supplies.

Arkansas
AR SB 361 (2013, enacted) -
Allows school volunteers, who have received signed parental permission and have completed required training, to administer glucagon to students with diabetes in accord with a student’s plan under Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 701 et seq., as of July 1, 2013.

Missouri
MO HB 675 (2013, enacted) –
Directs the state’s department of education, in consultation with the department of health and senior services, the American Diabetes Association, American Association of Diabetes Educators, School Nurses Association, Diabetes Control Program, and the state board of nursing to develop guidelines for training to a minimum of three volunteer school employees at each school attended by a student with diabetes about diabetes care. Requires the school nurse or another health care professional with diabetes expertise to provide follow-up training and supervision as needed to the volunteers.  Allows trained school personnel to administer glucagon or insulin or to assist a student in administering insulin through the insulin delivery system the student uses. Requires the parent or guardian of a student with diabetes who seeks diabetes care at school to submit a diabetes medical management plan to the school.


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 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 recommended 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. State legislation may also specifically require or encourage coverage for obesity prevention. Although insurance coverage laws do not always specifically refer to childhood obesity, private insurance coverage for families generally includes children, and some states do 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.

In 2013, Idaho adopted a legislative resolution recognizing the potential value of covering nutrition counseling by registered dieticians to prevent or reduce obesity.

Idaho
ID HCR 19 (2013, resolution adopted)
– Observes that nearly 62% of Idaho's adult residents are overweight or obese due to poor nutrition and physical inactivity, putting them at risk for costly chronic diseases, such as diabetes, heart disease and obesity-related cancers. States that a five percent reduction in average body mass index (BMI) of Idaho's citizens could lead to health care savings of more than $1 billion in ten years and $3 billion in 20 years. Resolves that by providing medical nutrition therapy and professional nutrition counseling by registered dietitians in conjunction with existing services covered by insurance carriers, there will be a significant positive impact on BMI and chronic disease and significant health care cost savings in Idaho.


Joint or Cooperative Use Agreements for School Facilities

When communities, urban neighborhoods or rural towns 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 to provide opportunities for people to be physically active. Community access also helps to achieve maximum value for funds appropriated by legislatures for school facilities. Joint or cooperative use agreements are formal agreements between two separate entities—often a school district and a city or county government—that define the roles, responsibilities, terms and conditions for the shared use of public property.  These agreements often address matters such as liability, staffing, maintenance, hours and cost-sharing issues. Creation of or enhanced access to places for physical activity is “strongly recommended” by the Guide to Community Preventive Services, an initiative of the Centers for Disease Control and Prevention that reviews research evidence on population-based approaches to health, because of its “effectiveness in increasing physical activity and improving physical fitness among adults.”

In 2013, three states—Arkansas, California, and Florida—enacted joint-use legislation to facilitate or encourage shared community use of school facilities for recreation.

Arkansas
AR SB 1062 (2013, enacted) – Allows the use of public school facilities for community activities to promote the public health and well-being of school communities by providing that, at times other than the regular instructional school day, a school district may permit members of the community to use school land or facilities for community purposes, including social and civic events, recreation, health and wellness activities. Provides that school districts may charge a fee to offset the cost of community use of school facilities and may also accept gifts, grants or donations from the private sector, local government and the federal government and may enter into joint use agreements with other public or private entities or nonprofit organizations for shared use and responsibility of school land or a public school facility.

AR SB 233 (2013, enacted) – Among other education budget items, appropriates $500,000 to support joint use of school facilities.

California
CA AB 1359 (2013, enacted)
– As part of planning for approval of a tentative or parcel subdivision map to include dedicated park and recreation land, provides that a city, county, or other local agency to which park land or fees in lieu of land are conveyed or paid may enter into a joint or shared use agreement with one or more other public districts in the jurisdiction, including, but not limited to, a school district or community college district, in order to provide access to park or recreational facilities to residents of subdivisions with fewer than three acres of park area per 1,000 members of the population.

Florida
FL HB 277, FL SB 396 (similar) (2013, introduced; 2014, pending)
– Finds that greater access to recreation and sports facilities is needed to reduce the impact of obesity on personal health and health care expenditures. For that purpose, would give school districts discretion to enter into joint-use agreements with local governments or private organizations or to adopt public access policies for indoor or outdoor recreation and sports facilities on public school property. Observes that joint-use agreements or public access policies content should specify the facilities to be used, dates and times of use, and terms and conditions governing use of the facilities and may also include provisions for liability insurance coverage and indemnification of the school district. Authorizes school districts to enter into joint-use agreements or adopt public access policies; provides immunity from liability except for gross negligence or intentional misconduct.


Physical Activity or Physical Education in Schools and School Recess Legislation

The first national 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. A research review by the Centers for Disease Control and Prevention (CDC) concluded that physical activity during the school day not only provides health benefits—such as strengthening the heart, muscles and bones—but also increases students’ 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 P.E. 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 can 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. 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, 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, ensuring that P.E. is taught by qualified instructors, and preserving recess time for physical activity.

At least five states—Arkansas, Illinois, North Carolina, Ohio and South Carolina—enacted legislation or adopted resolutions related to physical education or physical activity at school in 2013, with Arkansas’ directing consideration of a requirement for a daily, 20 minute school recess for elementary and middle school students. Two additional states, Massachusetts and New York, had proposed 2013 physical education legislation that remained pending and carried over to 2014.

Arkansas
AR SB 1051 (2013, enacted) –
Launches a Whole Child Recognition Program  to create a framework for recognizing community and state efforts to ensure all children receive comprehensive support of the whole community. Requests that the Whole Child working group consider how to provide elementary and middle school students with a dailty recess of at least 20 minutes;  provide quality physical education instruction; offer opportunities for elementary, middle, and high school students of all abilities to participate in a wide variety of intramural and extracurricular activities that provide them with positive physical, social, and emotional experiences; and integrate movement into lessons and across the school day. Also provides for efforts to reinforce healthy eating patterns by offering students nutritious and fresh food choices as part of both routine food services, and special programming and events.

Illinois
IL HR 24 (2013, resolution adopted) – Recognizing that p
oor diet and lack of exercise are the two main causes of childhood obesity, urges school teachers and administrators statewide to promote 60 minutes of daily physical activity for schoolchildren so they will enjoy healthier, active lifestyles and urges parents and their children to embrace better nutritional education to further build healthier lifestyles.

Massachusetts
MA HB 2634 (2013, proposed, carryover)
– As part of proposed legislation to create a program to reduce childhood obesity, would require that if a school does not teach formal physical education classes daily, all students shall have at least 30 minutes of daily physical activity performed in the classroom or during recess.

MA HB 478 (2013, proposed, carryover) – Would require physical education for students in all grades in public and charter schools. For students in grades K-8 would require a minimum of 30 minutes of daily of moderate to vigorous physical activity that could be completed through regular physical education, physical activities, recess, classroom energizers or other curriculum based physical education activity programs. Would also establish a Healthy Kids Award program to reward K-12 schools that implement policies and practices that create opportunities for students to be physically active and make healthy food choices available throughout the school day.

New York
NY SB 135 (2013, proposed, carryover) – States that the United States is confronting a devastating obesity epidemic and that the primary causes of childhood obesity are lack of physical activity and poor diet and that the epidemic will cost billions more dollars if left un-reversed. In response, would direct the commissioner of education to create a pilot program to improve physical education and physical activity programs in at least ten public elementary, middle or high schools in the state, or more if there is interest and funding available, to participate in a two year pilot program aimed at improving physical education and physical activity programs.  Seventy-five percent of the schools selected would be located in New York City and the remainder be selected based upon applications for participation in the pilot program from schools where: (1) at least 50% of the students qualify for federal free and reduced lunches; (2) school facilities and/or resources to implement a physical education program are limited; and (3) the school would be able to provide a "site coordinator" including but not limited to a member of the facility or member of a parent/teacher organization. The bill also notes that student-teacher ratios for physical education in New York City are an estimated 730 to 1, and although New York state requires physical fitness education in schools, many schools have difficulties implementing the requirements due to limited funding and/or space.

NY AB 2517 (2013, proposed, pending) – Would require physical education for all pupils age eight years and older, including those with disabilities or in alternative education programs in all elementary and secondary schools under the direction of the commissioner of education as the state’s board of regents may determine, with the goal of developing students’ character, citizenship, overall physical fitness and good health. Where feasible, would include daily physical exercise or activity. Would require a minimum of one hundred twenty minutes per week in physical education, exercise or activity for secondary school pupils.  Would allow regents to provide for a two-year phase-in schedule for daily physical education in elementary schools.

NY SB 2374 (2013, proposed, pending) – This omnibus obesity and respiratory illness reduction act would, among other provisions, allow the board of regents to provide in its rules that the physical education instruction requirement for all students enrolled in elementary and secondary school grades shall, where feasible, include daily physical exercise or activity, including students with disabling conditions and those in alternative education programs. Would require secondary school students to participate in physical education, exercise or activity for a minimum of one hundred twenty minutes during each school week. Would allow board of regents to provide in its rules for a two-year phase-in schedule for daily physical education in elementary schools. Would require instruction about the long term health risks associated with obesity and methods for preventing and reducing obesity, including good nutrition and regular exercise, as an integral part of required health, science, or physical education courses. Would also require after-school programs to present some form of educational instruction or academic material, or promote physical education. Includes additional provisions on school nutrition.

North Carolina
NC SB 402 (2013, enacted) – Among other provisions in this appropriations bill, provides for promoting healthy physical education, sports policies, and practices.

Ohio
OH HB 59 (2013, enacted)
– Among appropriations for the biennium beginning July 1, 2013, and ending on June 30, 2015, funds physical education in schools. Reaffirms requirement for one-half unit of physical education for high school graduation, allows school districts to grant physical education credit for participation for two full seasons in interscholastic athletics, marching band or cheerleading; or in ROTC for two full years. Schools established as science, technology, engineering and mathematics pilot programs must provide at least thirty minutes of moderate to rigorous physical activity each school day or at least one hundred fifty minutes of moderate to rigorous physical activity each week, exclusive of recess. A school sponsored physical activity before or after the regular school day at which attendance can be verified meets the physical activity requirement. Requires physical education teachers to hold a valid license. Requires an annual report, as prescribed by the department, of how the districts or schools have implemented the thirty minutes of daily physical activity requirement and the financial costs of implementation.

South Carolina
SC HB 3710 (2013, enacted) – Among other measures to address obesity in this appropriations bill, requires school districts to report to the state health department information regarding their progress towards meeting provisions of the Student Health and Fitness Act of 2005, specifically: the average number of minutes students exercise weekly; results of the South Carolina Physical Education Assessment; efforts to promote healthy eating patterns; assessment of school district health education programs; snacks in vending machines; and health curriculum. Gives the health department authority to collect, compile and assess state and school districts’ progress in meeting these goals, with the overarching goal of facilitating an environment that decreases body mass index in the state.


Raising Awareness 

States continue to adopt legislative resolutions to raise public awareness of childhood obesity and of policy options to address it. A sample of resolutions from 2013 are summarized below.

Idaho
ID HCR 19 (2013, resolution adopted) – States legislative findings that poor nutrition and physical inactivity are putting Idahoans at risk for costly chronic diseases, such as diabetes, heart disease and obesity-related cancers; and that a reduction of 5 percent in the average Body Mass Index of Idaho's citizens could lead to health care savings of more than one billion dollars in ten years and three billion dollars in twenty years. Encourages the inclusion wellness classes and nutrition services provided by registered dietitians as an integral component in the prevention and treatment of chronic disease.

Louisiana
LA HB 214 (2013, enacted) - Encourages public school governing authorities to create partnerships for the purpose of increasing parental involvement in schools; including encouraging participation in parenting classes that educate parents about, among other topics, the importance of sleep and good nutrition in school performance. Public school governing authorities and the state’s department of education are to identify available funding sources for these classes.

North Carolina
NC SB 402 (2013, enacted)
– Among other appropriations, funds programs promoting wellness, physical activity, and health education programming for North Carolinians.

Tennessee
TN HJR 514 (2013, resolution adopted) -
Recognizes the Robertson County Family YMCA for being named the Robertson County Chamber of Commerce Business of the Year and as a leader in the community in the Chamber's effort to facilitate mentoring and after school and wellness programs to address social and education issues to improve the quality of life in Robertson County.

Texas
TX HCR 101, TX HCR 99 (2013, resolutions adopted) – Resolutions congratulate Burnet Consolidated Independent School District  for earning a HealthierUS School Challenge Gold Award of Distinction from the U.S. Department of Agriculture, a voluntary national certification initiative  designed to encourage schools to improve the quality of food served in school cafeterias and provide nutrition education as well as to promote physical education and other opportunities for physical activity for students. Recognizes the district's food service department and its director for outstanding contributions to this achievement.

Utah
UT HCR 2 (2013, resolution adopted) - Recognizes obesity as a significant public health and economic issue in Utah. Expresses support for improving the health and lifestyles of adults and children in Utah by promoting activities that encourage healthy weight; and supports policies that promote increased access to healthy food and physical activity.


School Wellness Policies

Beginning with the 2006-2007 school year, federal law required each local school district participating in the National School Lunch and Breakfast programs to establish a local wellness policy. Most school districts wrote wellness policies but the policies varied in strength and completeness. Assessments of wellness policy implementation status reported that some policies were nearly complete but others were inconsistent. State legislation, with or without referencing the federal requirement, has helped to fill the gaps or encourage policy implementation. With implementation of the Healthy, Hunger Free Kids Act of 2010, wellness policy requirements have become more robust.  States have continued to enact policies that complement federal school wellness policy efforts.

In 2013, Massachusetts, Rhode Island and Virginia enacted legislation to strengthen school-based health and wellness programs. Massachusetts provided funding for incorporating nutrition and wellness into school curriculum, Rhode Island added wellness duties related to serving local produce and dairy products in schools and Virginia took a school wellness approach to school physical fitness programs and school curriculum.

Massachusetts
MA HB 3401 (2013, enacted)
– Among other appropriations items, provides for incorporating obesity prevention programs, including nutrition and wellness programs into school curriculum to address nutrition and lifestyle habits needed for healthy development.

MA SB 246 (2013, proposed, carry over) – Would provide for physical activity goals to be incorporated into school wellness plans, including those for charter schools.

Rhode Island
RI HB 6291, RI SB 513 (2013, enacted, similar) –
Both laws provide that local school health and wellness subcommittees shall be responsible, among other matters, for, developing policies, strategies, and implementation plans to promote purchasing and serving locally grown fruits, vegetables and dairy products in schools.

Virginia
VA HB 2028 (2013, enacted)
– Among other provisions related to school instructional programs, requires local school boards to incorporate into school wellness policies a goal for the implementation of a program of physical fitness available to all students for at least 150 minutes per week on average during the regular school year. Allows those programs to include any combination of physical education classes, extracurricular athletics, or other programs and physical activities deemed appropriate by the local school board.


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

State legislatures were active in 2013 in creating obesity-related legislative task forces, commissions, councils, programs, studies, working groups or the like.  
Eleven states enacted legislation or adopted resolutions in 2013 to launch or continue these types of initiatives, including the states of Alaska, Colorado, Connecticut, Georgia,

Hawaii, Louisiana, Mississippi, Oregon, Pennsylvania, South Carolina and Utah.

In addition, an Executive Order in the state of Washington creates a new, comprehensive healthier food service policy for all state agencies.

Alaska
AK HCR 1 (2013, resolution adopted)
- Establishes a state food resource development working group to work with the Alaska Food Policy Council to identify resources and set policies to build a strong and sustainable healthy food system in the state.

Colorado
CO SB 153 (2013, enacted) – Continues the existence of, and adds new representatives to, Colorado’s Farm-to-School Coordination Task Force. Makes tracking progress a group task and requires the task force to report its progress, findings, and recommendations to the education committees of the house of representatives and the senate, the senate agriculture and natural resources committee, and the house agriculture, livestock, and natural resources committee, or any successor committees, by February 1, 2015 and every February 1 every two years thereafter.

Connecticut
CT HB 6525 (2013, enacted)
– Establishes a multidisciplinary task force commencing October 1, 2013, to: (1) gather and maintain current information regarding childhood obesity that can be used to better understand the impact of obesity on children's health; (2) examine nutrition standards for all food procured by the state; (3) explore ways to increase physical activity in children; (4) recommend the implementation of a pilot program through one local or regional board of education to schedule recess before lunch in elementary school; and (5) advise the legislature and governor about how to coordinate and administer state programs that may reduce childhood obesity. Requires the task force to submit a report to the legislature’s joint committee on children by October 1, 2014.

Georgia
GA HB 298 (2013, enacted)
– Creates a multidisciplinary Agricultural Commodity Commission for Georgia Grown Products to study and promote the marketing of Georgia grown products.  Provides for public hearings and marketing orders by the commission. Authorizes the commission to levy assessments on producers or processors utilizing the Georgia grown trademark. Allows the commission to accept private donations.

Hawaii
HI HCR 23 (2013, resolution adopted)
- Requests formation of a task force to develop recommendations for improving obesity prevention-related services and counseling in accordance with the implementation of the federal Patient Protection and Affordable Care Act (federal health reform). Directs the task force to (1) Assess gaps in healthcare providers' ability to prevent obesity and provide treatment for obesity-related services and counseling; (2) Investigate providers' reimbursement options for the provision of these services; (3) Educate providers about these reimbursement options; and (4) Encourage providers' utilization of reimbursement options. Also instructs the task force to 1) Research how other states are implementing obesity prevention reimbursement practices; (2) Develop recommendations for increasing the provision of obesity-related services and counseling by healthcare providers through additional International Classification of Diseases, Ninth Edition and Tenth Edition codes, training and education, or other strategies; and (3) Submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2014. Dissolves the task force on June 30, 2014.

Louisiana
LA SR 5 (2013, enacted)
– Requires the state’s department of education to study public schools’ compliance with state law that requires physical activity in schools and its effectiveness in combating obesity. Directs the department to submit a written report to the Louisiana Senate Select Committee on Women and Children on or before December 31, 2013 and requires the Select Committee to hold a public meeting on the report before March 1, 2014. Recognizes the need for targeted intervention strategies that address and produce sustained results among African-American children battling obesity and that reduce childhood obesity by the development of and the support of sustainable programs to combat childhood obesity.

Mississippi
MS HB 718 (2013, enacted)
–  Creates a Mississippi Farm to School Interagency Council to help facilitate procurement and use of locally grown and locally raised agricultural products in school meals in order to improve the quality of school food statewide.

Oregon
OR HB 2992 (2013, enacted)
– Authorizes the Oregon Health Authority to operate both a Farm Direct Nutrition Program and a Senior Farm Direct Nutrition Program to help enable participants in the Women, Infants and Children nutrition program and low-income seniors to purchase fresh produce at farmers markets or roadside stands.

Pennsylvania
PA HR 243 (2013, resolution adopted)
- Directs the Joint State Government Commission to establish a multidisciplinary advisory committee to conduct a comprehensive study of childhood obesity, to propose strategies for healthier eating and physical activity for children and to report to the House of Representatives with its findings, recommendations and legislation within 12 months.  Notes that the Pennsylvania Department of Health reports that 32.6 percent of children in kindergarten through grade six and 34.1 percent of children in grades seven through twelve in the state are overweight or obese.

South Carolina
SC HB 3710 (2013, enacted) –
Among other measures to address obesity in this appropriations bill, creates a statewide collaborative effort to “fight against obesity in South Carolina.” Names the Department of Health and Environmental Control, because it is charged with addressing public health of South Carolina’s citizens, as the convener and coordinator of efforts to address obesity in the state. Recognizes that the obesity epidemic also requires behavioral, educational, systemic, medical, and community involvement,  and directs other  state agencies to use their best efforts to cooperate with the requests of the health department and its partners to facilitate an environment that decreases body mass index, including the Department of Education; Department of Health and Human Services; Department of Social Services; Department of Mental Health; Medical University of South Carolina; University of South Carolina Arnold School of Public Health; Department of Parks, Recreation & Tourism; Department of Commerce; Department of Transportation; and Commission for the Blind.

Utah
UT HJR 20 (2013, resolution adopted)
- Among Legislative Management Committee items that may be assigned to interim committees for study and to make recommendations for legislative action, includes the topic of obesity and policies that could be implemented by state and local governments, in partnership with the private sector, to effectively support healthy lifestyle choices and reduce obesity.

UT HCR 2 (2013, enacted, signed by governor) - Recognizes obesity as a significant public health and economic issue in Utah and urges support of policy development to address the obesity problem in Utah and promote public awareness of the adverse affects of obesity on individual health. Expresses support for improving the health and lifestyles of adults and children by promoting activities to encourage healthy weight.

Washington
WA Executive Order 13-06 (issued October 30, 2013) -
Establishes a comprehensive food service policy for the state, requiring all executive agencies to adopt the Washington State Healthy Nutrition Guidelines and to fully implement the guidelines by the end of 2016.


Taxes, Tax Credits, Tax Exemptions and Other Fiscal Incentives

States continue to consider fiscal options to encourage healthy lifestyles. In 2013, an additional state, Oregon, provided for tax relief for donations to food banks, A few states proposed or enacted taxes on foods or beverages with less nutritional value in order to discourage their consumption and/or raise revenue. Mississippi authorized a city to tax prepared foods and direct the revenues to fund a citywide parks and recreation plan. Massachusetts and Rhode Island considered proposals to tax candy, soft drinks or sugar sweetened beverages to provide funding for childhood obesity prevention efforts but neither was enacted in 2013 although both proposals carried over to 2014. Community or school programs for wellness and prevention and other evidence-based obesity prevention programs would be funded by these proposed taxes.

Massachusetts
MA HB 2634 (2013, proposed, carryover)
– Would create a program to reduce childhood obesity funded by revenues from taxes on candies, confectionaries and soft drinks. The fund shall consist of revenues collected by the commonwealth including: (1) any revenue from appropriations or other monies authorized by the general court and specifically designated to be credited to the fund; (2) all monies received by the commonwealth as excises upon the sale of candy, confectionary, or soft drinks as defined by the provisions of chapter 64H; (3) any fines and penalties allocated to the fund under the General Laws; (4) any funds from public and private sources such as gifts, grants and donations to further community-based prevention activities; (5) any interest earned on such revenues; and (6) any funds provided from other sources.

Mississippi
MS SB 2921 (2013, enacted)
– Authorizes the city of Pascagoula to levy a tax upon the gross proceeds derived from the sale of prepared foods by restaurants and caterers in the city; provides that the city may utilize the revenue from the tax to implement a comprehensive parks and recreation master plan adopted by the city and for related purposes.

Oregon
OR HB 2788 (2013, enacted)
- Includes donating food to a local food bank or school as a “farm use” for purposes of property tax special assessment.

Rhode Island
RI HB 5228 (2013, proposed, carryover) -
Would impose a tax on distributors, manufacturers and wholesalers of sugar-sweetened beverages, and direct the revenue to establish and fund a prevention and wellness trust fund and advisory board.


Other links for NCSL resources on legislative and policy options to address obesity are:
NCSL’s Leadership for Healthy Communities Web Page

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

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

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