Childhood Obesity | 2010 Update of Legislative Policy Options

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Updated December 2010

Overview of 2009 childhood obesity legislation and policy options
Overview of 2008 childhood obesity legislation and policy options
Overview of 2007 childhood obesity legislation and policy options
Overview of 2006 childhood obesity legislation and policy options
Overview of 2005 childhood obesity legislation and policy options
Overview of 2003-2004 childhood obesity policy options

 

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.  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. Total annual obesity-attributable U.S. medical expenses were estimated at $147 billion for 2006, based on a study released by RTI and the Centers for Disease Control and Prevention in 2009.  Taxpayers fund about half of these costs through Medicare and Medicaid. 

In 2010, First Lady Michelle Obama announced “Let’s Move” a collaborative effort to address the obesity epidemic. Designed to promote healthy choices, increase healthy eating by improving school food quality and access to healthy, affordable food in communities and increase opportunities for a physically active lifestyle; the effort is underway to help children and adults achieve and maintain a healthy weight and reduce obesity-related chronic diseases.  

State legislatures also 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 2010 was an active year for state legislation on both nutrition and physical activity topics as reflected in the legislative summaries below. The table below links to information to specific topics on this page.  More detailed topic information and bill summaries for 2010 follow the table.

 

School Nutrition Legislation

Body Mass Index (BMI) Legislation

Diabetes Screening and Management

Insurance Coverage for Obesity Prevention and Treatment

Joint Use Agreements for School Facilities

Nutrition Education

 Physical Activity or Physical Education in Schools and Recess Legislation

 

Recess at School

School Wellness Policies

Task Forces, Commissions, or Studies

Taxes and Tax Credits

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

 

 

50-State Legislation on Childhood Obesity Policy Options Enacted in 2010

 State

School Nutrition 

Nutrition Education 

Body Mass Index (BMI) 

Physical Education,
Physical Activity or Recess 

Task Forces, Studies
or Other Special Programs 

Alabama 

 

 

 

 

 

Alaska 

 Enacted

 

 

 

 

Arizona 

 

 

 

 Enacted

 

Arkansas 

 

 

 

 

 

California 

 Enacted

 

 

 

 

Colorado 

Enacted

 

 

 

 

Connecticut 

 

 

 

 Enacted

 

District of Columbia

Enacted     Enacted  

Delaware 

 

 

 

 Enacted

 

Florida 

 Enacted

 

 

 

 

Georgia 

 

 

 

 

 

Hawaii 

 

 

 

 

 

Idaho 

 

 

 

 

 

Illinois 

 Enacted

Enacted 

Enacted 

 

 

Indiana 

 

 

 

 

 

Iowa 

 

 

 

 

 

Kansas 

 

 

 

 

 

Kentucky 

 

 

 

 

 

Louisiana 

 

 

 

 

 

Maine 

 

 

 

 

 

Maryland 

 

 

 

Enacted 

 

Massachusetts 

 Enacted

 

 

 

 

Michigan 

 

 

 

 

 

Minnesota 

 Enacted

 Enacted

 

 Enacted

 

Mississippi 

 Enacted

 Enacted

 

Enacted 

 

Missouri 

 

 

 

 

 

Montana 

 

 

 

 

 

Nebraska 

 

 

 

 

 

Nevada 

 

 

 

 

 

New Hampshire 

 

 

 

 

 

New Jersey 

 

 

 

 

 

New Mexico 

 

 

 

 Enacted

 

New York 

 

 Enacted

 

 

 

North Carolina

 Enacted

 

Enacted 

 

 Enacted

North Dakota 

 

 

 

 

 

Ohio 

 Enacted

 

 Enacted

 Enacted

 

Oklahoma 

 Enacted

 

 

 

 Enacted

Oregon 

 

 

 

 

 

Pennsylvania 

 Enacted

 

 

 

 

Rhode Island 

 

 

 

 

 

South Carolina

 

 

 

 Enacted

 

South Dakota 

 

 

 

 

 

Tennessee 

 

 

 

 

 

Texas 

 

 

 

 

 

Utah 

 

 

 

 

 

Vermont 

 Enacted

 

 

 

 

Virginia 

Enacted 

 

 

 

 

Washington 

 

 

 

 

 

West Virginia 

 

 

 

 

 

Wisconsin 

 Enacted

 

 

 

 

Wyoming                      

 

 

 

 

 

Data Source:  National Conference of State Legislatures, 2010

 

 

School Nutrition Legislation

Legislatures were very active on the topic of school nutrition in 2010. Twelve states and the District of Columbia enacted some type of school nutrition legislation, including Alaska, California, Colorado, Florida, Illinois, Massachusetts, Mississippi, North Carolina, Oklahoma, Ohio, Vermont and Virginia. These laws establish new or additional policies designed to help ensure that students have access to healthier food and beverage options at school or encourage other community supports for child nutrition. This includes two states, California and North Carolina, that enacted legislation designed to help improve nutrition in early childhood or day care programs. Legislation included not only healthier school meal options, but also addressed school beverages and foods sold or consumed outside of the regular school meals program as à la carte or snack items.  

Summaries of Enacted 2010 School Nutrition Legislation:

Alaska
AK HB 70 (2010, enacted) - Establishes a farm-to-school program in the Department of Natural Resources; with provisions related to school gardens, greenhouses and farms.

California
CA SB 1413 (2010, enacted) -Requires school districts to provide access to free, fresh drinking water during meal times in school food service areas by July 1, 2011. Allows school districts to comply by, among other means, providing cups and containers of water or soliciting or receiving donated bottled water. Provides a mechanism for a school district to state that it is unable to comply with this requirement due to fiscal constraints or health and safety concerns, by resolution publicly noticed on at least two consecutive meeting agendas and approved by at least a majority of the governing school board.

CA SB 1255 (2010, proposed) - Would have removed electrolyte replacement beverages from those beverages that can be sold at schools at specified times and restricted the sale of electrolyte replacement beverages in middle, junior, and high schools to specified times before and after school, beginning July 1, 2011.

CA AB 2084 (2010, enacted) -Requires licensed child day care facilities to serve only low-fat (1 percent) milk or nonfat milk to children two years of age or older; to limit juice to not more than one serving per day of 100-percent juice; and to serve no beverages with added sweeteners, either natural or artificial, except for infant formula or complete balanced nutritional products designed for children. Also requires child day care facilities to make clean, safe drinking water readily available throughout the day.

Colorado
CO HB 1335 (2010, enacted)- Creates a board of cooperative services (BOCES) Healthy Food Grant Program in the Department of Education to make grants available to BOCES that maintain, equip, and operate food-service facilities. Authorizes BOCES to maintain, equip, and operate a food-service facility as a school food authority. Requires each BOCES that receives a grant from the program to procure and distribute to schools of its constituent school districts only food and beverages that satisfy certain nutritional standards.

CO SB 81(2010, enacted)- Promotes 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, especially in the school meals program, to improve child nutrition and strengthen local and regional agricultural economies. Establishes a 13-member interagency farm-to-school task force to develop a state farm-to-school program.

District of Columbia
DC B 564(2010, enacted)- The Healthy Schools Act creates a comprehensive program to promote healthy eating and active living in schools. Provisions related to school nutrition establish local nutritional standards for school meals, healthy vending, fundraising, marketing and prize requirements in public schools; require public schools to participate in federal meal programs whenever possible; require schools to solicit feedback about healthy meals, provide public disclosure of ingredients, origin of fruits and vegetables, and the nutritional content of school meals; and allow at least 30 minutes to eat lunch. Establishes a farm-to-school program and creates a preference and a financial incentive to serve locally grown, unprocessed foods in schools and requires an annual report and recommendations on farm-to school initiatives. Requires teaching about the benefits of fresh, local foods. Creates a school gardens program to issue grants to support the development of school gardens; requires a report and recommendations about school gardens; and permits the sale and consumption of food grown in school gardens. Funds certain programs and requirements.

Florida
FL SB 140, FL HB 1619 (2010, enacted) - Creates a Florida Farm Fresh Schools Program and Service in the state’s department of education and requires the department to work with the state’s department of agriculture and consumer services to recommend policies and rules for school food services to the State Board of Education to encourage schools and school districts in to buy fresh and local food and to provide outreach services regarding the benefits of fresh food products.

Illinois
IL SB 615 (2010, enacted)- Requires the Department of Agriculture to establish, and make available on its website, a geo-coded electronic database to facilitate the purchase of fresh produce and food products by schools. The database must contain information necessary for schools to identify and contact agricultural producers that are interested in supplying schools with fresh produce and food products.

IL SB 3706 (2010, enacted)- Requires the State Board of Education to develop and maintain a nutrition and physical activity best practices database containing policies implemented by local school districts designed to improve nutrition and physical activity

Massachusetts
MA HB 4459, MA SB 2322 (2010, enacted)- Directs the state’s department of public health to establish healthy standards for snacks and beverages sold in school vending machines, school stores, and cafeteria à la carte lines. These standards must be in accord with scientific guidelines that encourage greater consumption of water, low- and non-fat milk, and juice; reduced fat and sugar in snacks; and increased consumption of fresh fruits and vegetables. By the 2012 – 2013 school year, the law requires schools to offer drinking water, fruits and vegetables wherever food is being sold on school campuses. Makes it easier for schools to purchase directly from Massachusetts farmers in order to support the state’s agricultural economy and help schools access local healthy produce. Establishes a Commission on Childhood Obesity to develop a coordinated statewide plan to implement the program.

MA HB 4568 (2010, enacted)- Establishes a food policy council to develop recommendations to advance food system goals of increased local food production, state subsidies, and, among other goals, increased state purchasing of local products for schools, summer meals, and child care programs.

Minnesota
MN SB 2908 (2010, enacted)- Makes changes to school district health and wellness provisions; requires a school district to post its wellness policy on its Web site. Also makes changes to physical education standards and provides for rewards to schools that implement policies relating to student physical activities and healthy food choices.

Mississippi
MS HB 1078 (2010, enacted)- Requires the State Department of Education, as part of the state’s Healthier Schools Initiative to provide financial incentives to schools receiving recognition through the program for promotion of good nutrition and physical activity. Requires local school districts to include relevant information on their web sites and to provide technical assistance. Requires review of program applications by the state’s department of agriculture.

MS HB 1079 (2010, enacted)- Requires the Office of Healthy Schools in the Department of Education to provide comprehensive training on food service practices to specified personnel in local school districts.

North Carolina
NC HB 1726(2010, enacted)- Requires the state’s Child Care Commission to consult with the state’s Division of Child Development in the Department of Health and Human Services, to develop improved nutrition standards for child care facilities. Directs the Division to study and recommend guidelines for increased levels of physical activity in child care facilities. Directs the Division of Public Health to work with other entities to examine and make recommendations for improving nutrition standards in child care facilities, all as recommended by the Legislative Task Force on Childhood Obesity.

NC SB 1152, HB 1777 (2010, enacted) - Authorizes the state’s Joint Legislative Program Evaluation Oversight Committee to direct the Program Evaluation Division to study indirect costs under child nutrition programs, as recommended by the Legislative Task Force on Childhood Obesity.

NC HB 1832 (2010, enacted) - Establishes a position in the North Carolina Department of Agriculture to facilitate the farm to school program to provide technical assistance to increase the amount of North Carolina produce purchased by schools.

Ohio
OH SB 210 (2010, enacted) - Among other provisions related to school nutrition and health, establishes nutrition standards for certain school foods and beverages.

Oklahoma
OK HB 2774 (2010, enacted) - Requires the Department of Health to create a program to certify communities and schools that promote wellness, encourage adoption of healthy behaviors, and establish safe and supportive environments. It establishes a Healthy Communities Advisory Committee and a Healthy Schools Advisory Committee to help the department develop criteria for certification. Certified communities and schools are eligible for grant awards ranging from $2,500-$10,000 for use in achieving the act’s objectives.

OK SR 77 (2010, resolution adopted) - Encourages schools to offer healthy snacks for children's health.

Pennsylvania
PA HB 174 (2010, enacted)Provides for food safety standards to include school cafeterias. Requires schools and organized camps to cooperate in conducting cafeteria health and safety inspections and to participate in inspection services and training programs.

PA SB 1419 (2010, proposed)Would have required school foods and beverages sold at all locations on school campuses and throughout the school day to comply with USDA standards.

Vermont
VT HB 408(2010, enacted)- Among other provisions related to nutrition improvement, requires schools in districts receiving 21st Century Community Learning Center grant funds to financially assist organizations operating after-school programs to help access funding for meals and snacks through federal nutrition programs. It also requires the Department for Children and Families and the Department of Education to continue to improve the direct certification process to make children eligible for school breakfast, lunch and summer meals programs.

Virginia
VA HB 1607, VA SB 414(2010, enacted) - Requires the State Board of Education, in cooperation with the Department of Health, to create and periodically update regulations setting nutritional guidelines for all competitive foods sold or served to students during regular school hours. The standards must be adopted from either the Alliance for a Healthier Generation's guidelines or those of the Institute of Medicine as the initial statewide standard for competitive foods.

Wisconsin
WI AB 746, SB 536 (2010 enacted) - Promotes use of locally grown food in school meals and snacks and creates a Farm to School Council in the state’s Department of Agriculture, Trade and Consumer Protection to administer a Farm to School Program and allocate program grants to school districts, nonprofit organizations, farmers, and any other entities for the creation and expansion of farm to school programs. Grants rule-making authority for the administration of these programs.

Additional policy approaches that states have considered to address childhood obesity in 2010 include farm to school programs at both the state and local level, nutrition education or wellness initiatives in schools, body mass index measurement and reporting the information confidentially to parents, improving physical education programs or providing opportunities for physical activity or recess during the school day, providing information on the nutrition content of school foods, and addressing the needs of diabetic students, among others. The listing of bills below may not be comprehensive, but provides an overview of other policy approaches considered during the 2010 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) Legislation and Student Fitness Screening 

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, and 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 recent trend in state legislation is to include BMI measurement as an element of a broader student fitness assessment; both parents and legislators may be more receptive to multi-component fitness assessments.

In 2010, at least three states—Illinois, North Carolina and Ohio—enacted legislation related to student fitness assessment or BMI screening. North Carolina’s legislation requires the development of a fitness assessment for students. Ohio passed broad legislation related to school nutrition and health that includes a requirement for periodic BMI screening of students. Other legislation related to BMI screening and reporting was considered, but not enacted, in 2010 in Mississippi, New Hampshire and New York. 

Illinois
IL SB 3706 (2010, enacted)- Requires the State Board of Education to develop and maintain a nutrition and physical activity best practices database containing, among other information, the results of any wellness-related fitness testing done by local school districts.

North Carolina
NC HB 1757(2010, enacted)- Requires the State Board of Education to develop guidelines for evidence-based fitness testing for students in public schools statewide in grades kindergarten through eight.

Ohio
OH SB 210 (2010, enacted) - Among other provisions related to school nutrition and health, requires periodic body mass index measurements for public school students.

 

Diabetes Screening and Management at School 

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

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 – Including legislation enacted in 2010, 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, 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 2010, Alabama and Oklahoma passed resolutions designating diabetes awareness days or weeks, with Alabama’s resolution directed specifically to schools. In addition, Florida and Illinois enacted legislation to provide for diabetes care or self-care at school, or to permit medication administration by, or liability protections for, school personnel who provide care for students with diabetes. Diabetes legislation related to care, screening, risk analysis or testing of school-aged children was considered, but not enacted, in 2010 in California, Michigan and New York.

Alabama
AL HJR 463 (2010, resolution adopted) - Declares the week of November 8 through November 12, 2010, Diabetes Awareness Week in Alabama public schools.

Florida
FL HB 747 (2010, enacted) - Authorizes students with diabetes to carry equipment and supplies to manage their diabetes while in school, at school-sponsored activities, or in transit to and from school or school-sponsored activities with written authorization from the student’s parent and physician. Indemnifies school districts, county health departments, public-private partners, and the employees and volunteers of those entities against any future claims related to students’ use of diabetes supplies and equipment. The legislation also requires the State Board of Education, in cooperation with the Department of Health, to adopt rules to encourage every school in which a student with diabetes is enrolled to have personnel trained in routine and emergency diabetes care, and to protect other students from unauthorized use of diabetes medications or supplies.

Illinois
IL HB 6065, IL SB 3822 (2010, enacted)- Requires a parent or guardian to submit a diabetes care plan for a student with diabetes who seeks assistance with diabetes care at school. Authorizes delegated care aides to assist a student with diabetes in accordance with the care plan, and provides training for all school employees in schools that have a student with diabetes on how to identify when a student with diabetes needs immediate or emergency medical attention, and whom to contact in an emergency.

Oklahoma
OK SCR 34, (2010, resolution adopted)- Designates November 14, 2010 as Diabetes Awareness Day in Oklahoma.

 

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 both obesity prevention and treatment. 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. 

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

When communities lack safe, adequate places for children and their families to exercise and play, school facilities may offer recre­ational opportunities. Gymnasiums, playgrounds, fields, courts, tracks and other sports facilities can provide opportunities for community physical activity when they are not in use by students. Concerns about costs, vandalism, security, maintenance, and liability in the event of injury may discourage school districts from opening their facilities to the public after school hours in many locations. These concerns can often be addressed, however, through what are known as joint use agreements that allow cities, counties, and town governments to partner with school districts to allow recreational use of schools’ recreation facilities by community members. A joint use agreement is a formal agreement between two separate government entities—often a school district and a city or county—that defines the terms and conditions for the shared use of public property. It may address liability concerns, staffing, maintenance, hours and other concerns.

This topic was not covered in last year’s report, so enacted legislation for both 2009 and 2010 is reported below. State legislation can encourage joint use agreements as a means to open school facilities to the community for after-hours physical activity and state legislatures can also provide fiscal resources for this purpose. Arkansas appropriated $1,000,000 for joint use of school facilities in both 2009 and 2010. California authorized school districts to enter into agreements for buildings to be used jointly by districts and local government agencies in 2009 and considered additional legislation related to use of school facilities for community recreation. In 2009-2010, state legislation to encourage or explore joint use of school facilities for physical activity was also enacted in North Carolina and Washington as summarized below; and was considered in Indiana and Texas.

Arkansas 
AR SB 120 (2010, enacted), SB 291 (2009, enacted)Among other grants and aid to local school districts and special programs for the department of education, each bill appropriates $1 million for school facility joint use support.

California
CA AB 1080 (2009, enacted) - Specifically authorizes a school district to enter into leases and agreements relating to real property and buildings to be used jointly by the district and a local governmental agency.

North Carolina
NC HB 1471(2010, enacted) - Directs the State Board of Education to encourage local boards of education to enter into agreements with local governments and other entities regarding the joint use of their facilities by the local community for physical activity.  Recommends that joint use agreements delineate opportunities, guidelines, and the roles and responsibilities of the parties, including responsibilities for maintenance and liability.

Washington
WA HB 1216 (2009, enacted) - Among other provisions in this appropriations bill, convenes a definitions work group on the joint use of public school facilities. The work group was required to report its findings and recommendations to the appropriate committees of the legislature by January 1, 2010.

 

Nutrition Education

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

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

Existing laws in California, Colorado, Indiana, Louisiana, Maine, Massachusetts, New Hampshire, Oklahoma, South Carolina, Texas, Vermont and West Virginia require some form of nutrition education in schools. New legislation related to nutrition education as a component of health and wellness, both in schools and in broader community programs, was enacted in 2010 in Illinois, Minnesota and Mississippi.

Illinois
IL SB 3158 (2010, enacted) - Authorizes the Department of Human Services to create a Commission to End Hunger responsible for developing an action plan every two years with the goal of improving nutrition and ending hunger in the state. Promoting health and wellness through nutrition education, coordination of services, and access to nutrition programs is one opportunity to help Illinois residents achieve food security.  The commission must identify all funding sources that can be used to improve nutrition and end hunger and make funding recommendations; identify barriers to achieve its goals; promote public-private partnerships; and develop benchmarks to indicate success. In creating the commission, the legislation acknowledges that school nutrition programs are underutilized in Illinois with the state ranking last in providing free and reduced school breakfasts, and that increasing school breakfast participation to 60 percent would yield the state an additional $42,655,714 in federal funds and result in 189,668 additional children receiving breakfast each day.

Minnesota
MN HB 3055, MN SB 2098 (2010, enacted) - Among other criteria for the state’s Healthy Kids Awards Program, provides for awards to programs that seek to integrate nutrition education and healthy food and beverage choices throughout the school environment, including classrooms, cafeteria, vending, school stores and fund-raising efforts.

Mississippi
MS HB 1078 (2010, enacted)- Requires the Office of Healthy Schools in the Department of Education to develop and implement a Healthier Schools Initiative, which includes financial incentives to schools receiving recognition for promoting good nutrition. Awards range from $2,000-$8,000 per school for use in staff training needed to meet healthy eating, nutrition education and physical education guidelines, and provide nutrition education to students.  

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

 

Physical Activity or Physical Education in Schools and Recess Legislation

Forty-nine states—every state except Colorado—require some physical education in schools statewide, but the scope of the requirement varies greatly. As a result, states continue to refine and strengthen their laws pertaining to physical education and physical activity at school, including preserving time for recess during the school day. 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. Examples of all of these approaches can be found in 2010 state legislation. 

For children, physical activity during the school day provides not only health benefits—such as strengthening the heart, muscles and bones—but can also increase academic achievement. A total of 60 minutes of daily, moderate-to-vigorous physical activity for children that is age-appropriate, enjoyable and varied is recommended by the Physical Activity Guidelines for Americans, issued by the U.S. Department of Health and Human Services in October 2008. Currently, almost 30 percent of children do not exercise even three days per week and only 17 percent of high school students say they exercise the minimally recommended one hour daily. To help meet the goal, the National Association for Sport and Physical Education recommends 150 minutes a week of instructed physical education for elementary school kids and 225 minutes a week for older students. Only a handful of states meet those goals, according to Education Week, but state legislatures have been active on this topic in 2010.

At least ten states and the District of Columbia enacted legislation concerning physical education or physical activity at school in 2010. Four of these bills—in the District of Columbia, Minnesota, Oklahoma and Ohio—concerned reserving or requiring time for physical education or physical activity during the school day.

Arizona
AZ HB 2080 (2010, enacted) - Provides flexibility in meeting physical education requirements by allowing students with chronic health problems to participate in regular physical education classes to the extent their health permits.

Connecticut
CT SB 438 (2010, enacted) - Among other education reform provisions, requires one credit of physical education for high school graduation, unless there is a medical exception.
 
Delaware
DE HB 328 (2010, enacted) – Requires free and appropriate education in compliance with federal law for students with disabilities, including instruction in physical education.

District of Columbia
DC B 564 (2010, enacted) - The Healthy Schools Act creates a comprehensive program to promote healthy eating and active living in schools.  Among many other provisions related to obesity prevention, it establishes minimum levels of physical education and physical activity in schools; and provides exemptions for students with disabilities, students with other diagnosed health problems, or schools that lack the facilities. It also provides schools with equal access to recreation facilities. 

Maryland
MD HB 334, SB 256 (2010, enacted) - Directs the state’s department of education to adopt regulations requiring public schools that are newly constructed or completely renovated on or after January  1, 2013, to include a gymnasium and adequate support space for physical education instruction, and to adopt guidelines for use of facilities for physical education programs.

Minnesota
MN SB 2908, HB 3055 (2010, enacted) -  Among other provisions related to school nutrition and physical activity, encourages the state’s Department of Education to include physical education classes, school district physical education standards, and local physical education graduation requirements as part of Minnesota’s common course catalogue.  Encourages the department to develop guidelines promoting quality school recess practices.  Requires the adoption of the most recent National Association for Sport and Physical Education standards for physical education in grades kindergarten through 12; and establishes a healthy kids awards program to reward schools that implement policies and practices that create opportunities for students to be physically active and make healthy food choices throughout the day.

Mississippi
MS HB 1078 (2010, enacted) - Requires the Office of Healthy Schools in the state’s Department of Education to develop and implement a Healthier Schools Initiative, which includes financial incentives to schools receiving recognition that promote good nutrition and physical activity.  Awards range from $2,000-$8,000 per school for use in staff training needed to meet healthy eating, nutrition education and physical education guidelines.

New Mexico
NM HB 44 (2010, enacted)
– Requires one unit of physical education for high school graduation beginning with the 2012-2013 school year.

North Carolina
NC SB 900 (2010, enacted) – Provides for studies by the Legislative Research Commission, statutory oversight committees and commissions, and other agencies, committees, and commissions; among them, a study of physical education and physical activity in schools.

Ohio
OH SB 210 (2010, enacted)
– Among other provisions intended to create healthy schools, requires daily physical activity for public school students; creates a school district physical education pilot program;  and requires physical education teacher certification.

Oklahoma
OK SB 1876 (2010, enacted) - Requires public elementary schools to provide physical education or exercise programs for a minimum of an average of 60 minutes each week, not including recess, to students in full-day kindergarten and grades one through five. Also requires an average of sixty minutes each week of physical activity for the same students. Strongly encourages districts to provide physical education for students in grades six through 12, including at least a 20-minute daily recess. Specifies certain components to be included in physical education curriculum and requires the State Board of Education to include certain knowledge and skills in Priority Academic Student Skills for physical education.

 

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. As a result, a number of states have enacted legislation to promote physical activity at school by encouraging or requiring school recess time. Illinois, Massachusetts, Minnesota and New Jersey enacted school recess legislation in 2010. 
 

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 requires school principals to direct that a recess be held indoors if the weather is inclement.

Massachusetts
MA HB 4459 (2010, enacted) – Includes study 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 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. In 2010, the District of Columbia, Minnesota, Mississippi and Oklahoma enacted legislation to support school wellness policies or programs, or to reward healthy school efforts statewide.    Florida and New York also considered, but did not enact, school wellness legislation in 2010. Statewide legislation to support wellness policies or related school health efforts enacted in Maryland in 2009 is also included below for informational purposes. Legislators also have acted on individual policies that are part of school wellness goals, such as improving the nutritional quality of school foods, providing greater opportunities for physical activity, ensuring that adequate nutrition education is part of the school curriculum and designing task force efforts by multiple stakeholders in the community to encourage school wellness efforts as discussed in other sections of this page. 

District of Columbia
DC LB 564(2010, enacted) – Establishes a Healthy Schools Act that, among other provisions, requires local wellness policies to be promoted and shared, and requires information regarding health programs, nutrition programs, physical and health education programs, and wellness policies to be reported to the State Superintendent of Education.

Minnesota
MN SB 2908 (2010, enacted) – Among other provisions, requires local school districts to post the current local school wellness policy on their website effective August 1, 2010. Also encourages the state’s department of education to develop guidelines that school districts can adopt that promote quality recess practices; requires the adoption of the most recent National Association for Sport and Physical Education standards for physical education in grades kindergarten through 12; and establishes a healthy kids awards program to reward kindergarten through grade 12 schools that implement policies and practices that create opportunities for students to be physically active and make healthy food choices throughout the day.

Mississippi
MS HB 1078(2010, enacted) – Creates a Healthier School Initiative and requires the Department of Education to provide financial incentives to schools receiving recognition through the program for, among other requirements, promotion of good nutrition and physical activity. It requires schools that receive awards for meeting the Healthier U.S. Schools Challenge to have in place a local school wellness policy which supports the initiative and affirms that the school plays a critical role in promoting student health, preventing childhood obesity, and combating problems associated with poor nutrition and physical inactivity. 

Oklahoma
OK HB 2774(2010, enacted) – Directs the Department of Health to establish and maintain a program for the voluntary certification of schools that promote wellness, encourage the adoption of healthy behaviors, and establish safe and supportive environments according to criteria in the Center for Disease Control and Prevention’s Coordinated School Health Program model.

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

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

Legislation or resolutions to create obesity-related task forces, commissions, studies, strategic plans or other special programs was enacted in at least two states—North Carolina and Oklahoma—and the District of Columbia in 2010. These obesity-related task forces, commissions, studies and other special programs serve both as an initial approach to state action and as a way to provide accountability through reports to the legislature. Specific programs to prevent obesity may also be initiated through task forces. States often require representation on the task force of many sectors and stakeholders, not just legislators. In addition, task forces may be required to achieve specific goals or take specific actions in addition to studying different approaches to addressing obesity. Task force or commission efforts required by state legislation also may include reporting on a state’s initial benchmark status on obesity prevention and wellness. 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.

District of Columbia
DC LB 564(2010, enacted) – Among other provisions contained in the comprehensive Healthy Schools Act, establishes a Healthy Youth and Schools Commission, and requires it to submit an annual report and recommendations to promote the healthy eating and active living objectives of the act.

North Carolina
NC HB 1827, SB 1153(2010, enacted) – Reestablishes the Legislative Task Force on Childhood Obesity to study and make recommendations to the General Assembly regarding strategies to address childhood obesity and encourage healthy eating and increased physical activity among children. Topics for consideration include early childhood interventions; childcare facilities; before and after school programs; physical education and physical activity at school; higher nutrition standards; comprehensive nutrition education; and increased access to recreational facilities. The task force must report its finding and recommendations to the General Assembly in 2011 and 2012.

Oklahoma
OK HB 2774(2010, enacted) – Creates the Healthy Communities Advisory Committee and a Healthy Schools Advisory Committee to help the Department of Health develop criteria for the voluntary certification of communities and schools that promote wellness, encourage the adoption of healthy behaviors, and establish safe and supportive environments.

 

Taxes and Tax Credits

States continue to consider fiscal options to encourage healthy lifestyles. Examples include tax credits for fitness or wellness choices; tax credits or other fiscal encouragements 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 to discourage their consumption or raise revenue. In 2010, Mississippi enacted legislation that provides a sales tax credit for local foods sold at farmers’ markets. The District of Columbia enacted a sales tax on certain soft drinks at the retail level to fund a healthy schools initiative. The Washington Legislature passed a sales tax on candy and bottled water, and an excise tax on certain carbonated beverages; that legislation was overturned by voters, however, on the November ballot. A tax exemption on soft drinks and candy was eliminated in Colorado. Legislation to impose a tax or remove a tax exemption for soft drinks was considered, but not enacted, in 11 other states—Arizona, California, Hawaii, Kansas, Massachusetts, Michigan, Mississippi, New Hampshire, Rhode Island, South Carolina and Vermont.  Enacted legislation is summarized below. This listing is not intended to be comprehensive.

Colorado
CO HB 1191 (2010, enacted) –
Removes a food sales tax exemption from soft drinks and candy.

District of Columbia
DC Budget Bill (2010, enacted) – Adds artificially and sugar-sweetened beverages to those items subject to the general 6 percent sales tax to help fund the District’s healthy schools programs. 

Mississippi
MS HB 1566(2010, enacted) – Exempts from the state sales tax on food, products grown, made or processed in Mississippi that are sold at farmers’ markets and are certified by the Department of Agriculture and Commerce. 

Tennessee
TN SB 255, HB 2657 (2010, enacted)-Extends the temporary tax on bottles of soft drinks and barrels of beer for an additional six years to June 30, 2016, to fund programs for the prevention and collection of litter.

Washington
WA SB 6143 (2010, enacted, but overturned by voters through Initiative 1107) - As part of a more comprehensive revenue package, provided for new taxes on bottled water, candy and gum, beer and carbonated beverages effective in May, June and July 2010. The taxes were repealed by voters through Washington ballot initiative 1107 in November 2010, effective December 1, 2010.


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.