Federal programs to prevent obesity

Wallace and colleagues described an initiative implemented in 4 rural western counties in Tennessee that engaged community residents in activities to reduce obesity and used a PSE framework and a community-based participatory approach 9. Evaluators conducted various assessments focus groups, audits, pedometer monitoring, and mapping to determine the number of community members potentially served as a result of the initiative and how the initiative affected attitudes and behaviors. The authors reported improvements in physical activity and healthy eating among participating community members.

Castillo and colleagues described how needs assessments were used to identify components of a PSE-centered initiative implemented in 4 communities in Hidalgo County, Texas, to increase access to physical activity and healthy foods The needs assessments identified gaps in active living infrastructure for physical activity and recommended individuals to help establish local community coalitions.

The program successes demonstrated that community-driven PSE interventions can be a strategy in establishing long-term solutions for obesity prevention. This special collection in Preventing Chronic Disease describes approaches to improve the nutrition and physical activity environments in rural areas that have a high prevalence of adult obesity. Articles in this collection support the approaches of previous studies on interventions to improve health outcomes, such as the use of tailored community-based participatory approaches and a focus on using PSE when improving the nutrition environment and opportunities for physical activity in communities.

The collection provides examples of community interventions that aim to increase the healthfulness of food and access to physical activity, such as improving healthy food options in retail outlets 7 , creating opportunities for physical activity through local organizations 5 , and collaborating with nontraditional public health partners, such as CES 4— The approaches described in this collection may provide organizations and community-based programs ideas for implementation of future work to improve the nutrition and physical activity environments in rural areas with a high prevalence of obesity.

The findings from HOP influenced the approach and expectations of the subsequent HOP funding period, which began in , and other cooperative agreements funded by CDC. CDC continues in its expectation that state and local recipients engage coalitions through community-based participatory approaches, use the results of community needs assessments to drive the selection of interventions, and tailor approaches to meet the unique needs of priority populations and communities.

Other funding organizations addressing obesity may consider these approaches for implementation of future community-level work. The authors thank the HOP recipients whose collective efforts contributed to the findings presented in this essay.

This essay was supported by CDC cooperative agreements no. Contents of this essay are solely the responsibility of the authors and do not necessarily represent the official views of CDC or the US Department of Health and Human Services. As this review reveals, virtually all of the peer-reviewed scientific literature published between January and March focused on policies affecting school environments. Interestingly and in contrast to the literature from prior years [ 67 ], more studies focused on PA and PE-related policy changes as compared to other changes to the school environment.

What makes this particularly noteworthy is that literature from prior years heavily influenced the enactment of federal legislation that, for the first time, provided the U. Department of Agriculture with the authority to establish nationwide standards governing snack foods and beverages sold in schools [ 68 ].

And, while the studies reviewed herein illustrate that state and school district policies can influence school PE and PA environments, they alone are not sufficient to change the rates of child and adolescent PA to meet the national recommendations of 60 minutes of daily PA [ 69 ].

Currently, there are no federal standards governing PA or PE in schools and, historically, federal PA-related guidelines have not been subject to regular scientific updates. And, on March 13, , U. Senators Tom Harkin and Roger Wicker introduced bipartisan legislation to require a year cycle for review and updating of the Physical Activity Guidelines for Americans , with mid-course reviews to be conducted during each cycle to highlight best practices and continuing issues in the PA-related arena [ 71 ].

Finally, schools are only one piece of the complex web of influences affecting the obesogenic environment within which young Americans live, work and play [ 14 ]. Thus, it is important for policy makers to start to look beyond schools by focusing on broader population-based strategies that aim to improve all aspects of society, particularly given that school-level changes alone are insufficient for addressing the obesity problem in this country.

The IOM has released two reports in recent years that specifically identify a range of policy strategies that may be considered by state, local and school district governments [ 11 , 14 ]. I also would like to acknowledge the research assistance provided by Christina Sansone and Yuka Asada.

Compliance with Ethics Guidelines. Jamie F. He has received payment for manuscript preparation from Healthy Eating Research at the University of Minnesota for a research synthesis on competitive food and beverage policies. Human and Animal Rights and Informed Consent. This article does not contain any studies with human or animal subjects performed by any of the authors. Papers of particular interest, published recently, have been higlighted as:.

National Center for Biotechnology Information , U. Curr Obes Rep. Author manuscript; available in PMC Sep 1. Author information Copyright and License information Disclaimer. Copyright notice. See other articles in PMC that cite the published article. Abstract Obesity is a complex problem requiring large-scale, population-based solutions. Keywords: Obesity, public policy, state and local governments, policy impact, prevention.

Introduction Obesity rates in the U. Table 1 Representative examples of state and local public policy a strategies b related to obesity prevention. Policy strategy b sorted alphabetically within environment Jurisdiction s c where policy may be adopted Published studies of policy influence, —13 Child care environments 1.

Nutrition standards for foods and beverages served in child care settings S No 2. Physical activity standards for child care settings S No Food and beverage environments 1. Incentivizing food purchasing subsidies, vouchers [ 18 ] S, L No 4. Licensing restrictions on retail outlets selling certain foods and beverages [ 33 ] L No 5.

Minimum age restrictions on purchase of certain beverages e. Nutrition standards for foods sold in public places e. Restrictions on retail food outlet e. Insurance including Medicaid coverage for weight management counseling and programming S No Messaging and marketing environment 1. Complete streets policies [ 18 ] S, L No 2. Farm-to-school policies S, SD Yes [ 61 ] 4. Healthy food marketing on school property [ 36 ] S, SD No 5. Physical education teacher and physical educator qualifications [ 18 ] S, SD Yes [ 49 ] 7.

School food service director qualifications S, SD Yes [ 49 ] School siting policies [ 25 ] S, SD No Strategies to improve the school meal environment S, SD Yes [ 49 ]. Open in a separate window. Although not exhaustive, the list is intended to be representative of the broad range of state and local obesity prevention-related policy strategies.

Results As noted in Table 1 column 3 , with the exception of a few studies reporting the influence of menu labeling policies or tax policies, virtually all studies published between January 1, and March 1, have focused on the school environment. Focus on School Environments The recent literature primarily focused on the influence of PE and PA-related policies as well as snack food and beverage policies.

Association with PA Levels The results of studies examining the association between policies and youth PA levels were mixed. Association with Youth Obesity The two studies to examine the relationship between state PE and recess-related laws on youth obesity reported mixed results. Association with Snack Food and Beverage Environments Four studies examined policy impacts on objectively measured or administrator-reported changes to the snack food and beverage environments in schools, collectively reporting mixed results.

Influence on of Snack Food and Beverage Policies on School Revenues Two studies examined the influence of policy-related changes to snack food and beverage availability on school revenues. Conclusions State and school district governments, in particular, have been at the forefront of enacting obesity-related policy interventions in the United States.

References 1. Katz DL. Childhood obesity trends in Mind, matter, and message. Child Obes. Prevalence of obesity in the United States, — Accessed 22 Mar. Robert Wood Johnson Foundation. Declining childhood obesity rates—where are we seeing the most progress? Cawley J, Meyerhoefer C. The medical care costs of obesity: An instrumental variables approach.

J Health Econ. Indirect costs of obesity: a review of the current literature. Obes Rev. Hammond RA, Levine R. The economic impact of obesity in the United States.

Diabetes Metab Syndr Obes. Supplemental Nutrition Assistance Program. SNAP to Skills. Farmers Market Nutrition Program. Seniors Farmers' Market Nutrition Program. Child Nutrition Programs. Summer Food Service Program. It outlines strategies to help start community activities. HHS sponsored the development of a Healthy People Toolkit to provide guidance, technical tools, and resources to groups as they develop and sustain a successful plan of action.

The Toolkit is organized around common elements of health planning and improvement and provides useful tips for getting started. The Blueprint for Action , which was developed by health and scientific experts from 14 Federal agencies and 23 health care professional organizations, offers action steps for the health care system, families, the community, researchers, and the workplace to better focus attention on the importance of breastfeeding.

HHS, the U. They have developed Breastfeeding in the United States: A National Agenda , which is a strategic plan to protect, promote, and support breastfeeding.

The National Institutes of Health NIH Pathways research fosters culturally appropriate healthy eating practices and increased physical activity among American Indian children, their families, food service staff, and physical education and classroom teachers.

NIH and the National Recreation and Park Association have developed the Hearts N' Parks program, which will create national dissemination magnet sites for implementing activities encouraging healthy eating and physical activity. NIH has developed a health awareness campaign called Sisters Together: Move More, Eat Better to encourage African American women in Boston to maintain or achieve a healthier weight by increasing their physical activity and eating healthy foods.

NIH is currently expanding this program to other sites. The program promotes health awareness, with major emphasis on assisting elders in weight loss, participation in exercise programs, improvement of diet, and smoking cessation. The Office on Women's Health has developed the Girls and Obesity Initiative , serving to identify existing government obesity programs and to adapt these programs toward gender-specific guidance for girls.

This project will achieve its goals through the integration of research, education, and innovative approaches to help children achieve healthy weights. The project will test a number of program interventions designed to reduce the prevalence of childhood overweight and obesity in various populations. Both quantitative and qualitative methodologies will be employed in determining the most appropriate and effective program intervention for a specific population.