Childhood obesity public policy

Directly to directly to a to z directly to directly to page directly to site ight and obesity policy end on c disease state policy tracking database currently contains state-level legislation and regulation pertaining to nutrition, physical activity and obesity. It allows users to conduct searches by state, year, bill number, status, and health care and education policy review [pdf-4. Considers early care and education (ece) an important setting to implement childhood obesity prevention strategies. This policy review is intended to help educate public health practitioners, child care providers, and decision-makers about the current conditions that exist in their state and inform future efforts to prevent obesity in this setting. The report identifies potential actions in ece programs to prevent obesity, provides state-specific child care demographics, and highlights enacted state legislation and current licensing regulation that impact the nutrition and physical activity environments in ece y communities: what local governments can do to reduce and prevent obesity[ppt-8. Presentation, developed for use by local government staff, makes the case for investing in cdc's recommended community strategies and measurements to prevent obesity in the united states. It highlights how local governments can be part of the solution and provides specific examples of policy, systems and environmental approaches to creating healthier communities. Powerpoint last reviewed: august 19, last updated: august 19, on of nutrition, physical activity, and obesity, national center for chronic disease prevention and health directly to directly to a to z directly to directly to page directly to site ight and obesity policy end on c disease state policy tracking database currently contains state-level legislation and regulation pertaining to nutrition, physical activity and obesity. Powerpoint last reviewed: august 19, last updated: august 19, on of nutrition, physical activity, and obesity, national center for chronic disease prevention and health ncbi web site requires javascript to tionresourceshow toabout ncbi accesskeysmy ncbisign in to ncbisign l listhhs author j prev med. Barclay), hartford, connecticut; changelab solutions (ashe), oakland, california; los angeles county department of public health (teutsch, retired), los angeles, california; american heart association (sanchez), dallas, texas; community and family medicine and global health (story), duke university, durham, north carolina; and brown school and division of public health sciences (brownson), washington university in st. P@ information ► copyright and license information ►copyright notice and disclaimerthe publisher's final edited version of this article is available at am j prev medsee other articles in pmc that cite the published ctbackgroundchildhood obesity prevalence remains high in the u.

Information is needed about federal policies that could reduce childhood obesity rates and by how eto estimate the impact of three federal policies on childhood obesity prevalence in 2032, after 20 years of scriteria were used to select the three following policies to reduce childhood obesity from 26 recommended policies: afterschool physical activity programs, a $0. For each policy, the literature was reviewed from january 2000 through july 2012 to find evidence of effectiveness and create average effect sizes. In 2012, a markov microsimulation model estimated each policy’s impact on diet or physical activity, and then bmi, in a simulated school-aged population in sthe microsimulation predicted that afterschool physical activity programs would reduce obesity the most among children aged 6–12 years (1. All three policies would reduce obesity more among blacks and hispanics than whites, with the ssb excise tax reducing obesity disparities the sionsall three policies would reduce childhood obesity prevalence by 2032. Ounce ssb excise tax is the best uctionalthough recent data suggest that childhood obesity has plateaued or begun to decline, prevalence remains high. Further, obese adolescents tend to remain obese as adults,5,6 making childhood the ideal time to prevent obesity. For these reasons, policymakers are interested in effective programs and policies to reduce childhood and localities are increasingly using laws, regulations, and other policy tools to promote healthy eating and physical activity (pa). However, federal policies can reach larger populations and fund programs that benefit populations at risk for obesity, and thus play an essential role in improving public health. Information is needed about which federal policies could reduce childhood obesity rates and by how much. The purpose of this study is to estimate the impact of three federal policies on childhood obesity prevalence in 2032, after 20 years of sthe methods used in this analysis are summarized below; see the appendix for more details. Williamstown ma) examined how three federal policies affect obesity-related behaviors (pa and diet), bmi, and obesity prevalence in a simulated school-aged u.

Obesity and overweight were determined by comparing bmi values from the model to bmi values from cdc growth charts. The current cdc definitions of obesity (bmi at or above the 95th percentile for age and sex) and overweight (bmi at or above the 85th percentile and below the 95th percentile for age and sex) were used. The relative bmi remains constant until a policy intervention causes it to trend downward to a new level consistent with expected changes in behavior from the intervention. Each policy was introduced in the model , a systematic process was used to search and review the literature on 26 recommended policies for preventing childhood obesity. Senior authors (rb, ma, es, ms, and st) narrowed the list to three policies in a two-step process using multiple criteria, including effectiveness, potential reach into the general population and high-risk groups, feasibility, acceptability, precision of information for modeling, and potential impact on childhood obesity. These policies target key obesity-related behaviors through the federal policy mechanisms of appropriation, taxation, and regulation. Federal policies to reduce childhood obesityestimating effect sizespubmed and journal article references were searched from january 2000 through july 2012 to find effectiveness data for the three policies and create average effect sizes. A systematic strategy and policy definition limited the scope of the literature search and identified key data elements for the population groups targeted by each policy. Owing to the varied nature of evidence, the general process to determine each policy’s average effect size was modified as needed. The policy was modeled such that all programs were offered to all youth for the entire year. The modeled intervention combined individual interventions using sample sizes and demographic breakdowns as weighting -sweetened beverage excise taxno well-controlled trials were found that directly assessed an excise tax’s impact on youth ssb consumption or the relationship between ssb consumption and childhood obesity.

Few studies quantified the impact of an ssb tax or price increase on childhood obesity prevalence and those that did were based on econometric forecasts. The policy’s impact on obesity resulted from reduced consumption of sugar and total calories, assuming complete substitution with a zero-calorie beverage. Although the policy targets children, the analysis included adolescents to show that the effect continues into adolescence. The policy’s impact on obesity was modeled through dietary change (reduced sugar, carbohydrates, fat, and total calories). A meal meeting the 2012 national school lunch program standards was assumed to be substituted for each fast food meal not eaten, which would result in an average of 504 fewer calories and 94 fewer grams of sugar consumed per stable 3 summarizes baseline obesity rates and behaviors for the simulated school-aged population. 3baseline weight and behavior distributions of simulated populationtable 4 summarizes each policy’s predicted impact on pa or diet in 2032. The policy would reduce consumption in children more than adolescents because children consumed more fast food at baseline and thus would have a greater potential for 4change in childhood obesity-related behaviors in 2032table 5 summarizes the policies’ potential impact on rates of overweight and obesity in 2032. The microsimulation predicted that disparities would decrease for black and hispanic adolescents, with obesity decreasing by 2. The predicted impact of afterschool pa programs on disparities reflects higher baseline rates of obesity among blacks and hispanics and the non-linear relationship between behavior change and bmi. For children, afterschool pa programs would have the largest impact on obesity of the three 5change in childhood weight distributions in 2032for adolescents, the $0. Ounce ssb excise tax had the largest predicted overall impact on obesity, resulting in a 2.

This was due to two factors: compared to blacks and hispanics, whites had higher income levels and are therefore less affected by a price increase, and had a lower baseline rate of child-directed ban on fast food tv advertising has the greatest predicted behavioral impact, but would reduce obesity prevalence the least. This is due to the substitution effect and the policy’s narrow focus on fast food. Although its predicted impact on obesity is small, the large behavioral result shows that tv advertising affects what children eat. Although this policy targets children aged 12 years and younger, it would also reduce obesity in adolescents because their baseline consumption of fast food is decreased because of less exposure to advertising as appendix describes the key univariate results of a sensitivity sionthis microsimulation analysis suggests that long-term implementation of three federal policies could reduce childhood obesity in the u. The use of microsimulation contributes to the childhood obesity literature because behavior change can be modeled over time in the simulated population. This approach differs from models that derive estimates from population-level trends, and provides valuable information as to how policies may impact known disparities in health behaviors and obesity in different the ssb and fast food advertising policies, this study’s effect sizes are consistent with, but smaller than, prior work owing to the use of microsimulation, narrower policy definitions, and different assumptions. The difference between the regular state sales tax and the higher soda tax) would correspond to a 20% reduction of the excess bmi gain seen between the third and fifth grades if the tax impact is ing to the present study, a ban on child-directed fast food tv advertising would reduce obesity among children and adolescents by nearly 1 percentage point in 2032. The model of veerman and colleagues39 predicts that a ban on all tv food advertising would reduce obesity prevalence among u. The bans in both studies are much broader than in this three policies could reduce childhood obesity prevalence, particularly among blacks and hispanics, who have higher rates of obesity than whites, thus demonstrating that federal policy could alter the childhood obesity epidemic. Although the microsimulation predicts that each policy would reduce obesity in children and adolescents, the $0. It would also reduce obesity among adults who consume ssbs, does not require substantial federal funding to implement (unlike the afterschool policy), and would not face the legal hurdles that new regulations often encounter.

However, over the long timeframe included in this analysis, the infeasible may become feasible as the evidence base for these policies grows and changes in public knowledge increase calls for stronger governmental action. In the meantime, the findings support state- and local-level action to enact ssb excise taxes, promote pa in afterschool settings, and reduce marketing and advertising of unhealthy foods and beverages in public tionsthis study has several limitations. Modeling childhood obesity is challenging and others believe attempts should stop at energy balance owing to insufficient data on the association between changes in behaviors and changes in bmi z-scores. We agree that the challenges are significant, but attempts to examine policy impact on childhood obesity have relevance. For instance, substituting a caloric beverage, rather than a zero-calorie beverage, can reduce the ssb policy’s estimated impact by over 60%. In this analysis, policies were assessed independently, but to reverse the childhood obesity epidemic, a comprehensive set of national policies would need to be sionsthe three federal policies in this analysis could each reduce childhood obesity prevalence by 2032. Ounce ssb excise tax is the best option given its ability to generate revenue for additional obesity prevention activities and reduce obesity among ssb-consuming ledgmentsthe authors thank jud richland, mph, for conceptualizing this work and developing the proposal; ana lindsay, drph, mph, for contributing to policy selection; dana mcgree for providing administrative and project management support; and sheena de freitas, mph and amanda asgeirsson, mph for their research work of each author was supported entirely by the aetna ixthis appendix provides detailed information about the methods used in this analysis. In this study, the obesity-related behavior microsimulation model (orb) evaluated policies to reduce or prevent obesity in children and adolescents. The model is designed to examine how the policies affect obesity-related behaviors (physical activity and diet), and in turn, how changes in these behaviors affect bmi and obesity model was developed with treeage 2012 to track the state (age, diet, physical activity, body mass index (bmi), and health status) of simulated individuals over time. Note: other was omitted from the results because it is impossible to draw policy conclusions when race is unknown). The other behavioral factors (physical activity and dietary factors), which are the target of the modeled policy interventions, are further conditioned upon initial bmi.

Behavioral factors were conditioned upon bmi in order to sharpen focus upon each policy’s impact upon rates of childhood progression youth obesity is a relative concept. Thus, obesity and obesity risk are determined by comparing a youth’s bmi to standardized bmi growth charts using standardized percentiles. The centers for disease control and prevention define childhood obesity as a bmi at or above the 95th percentile for age and sex, and overweight as a bmi that is at or above the 85th percentile and below the 95th percentile for age and microsimulation reflects this growth pattern by modeling the change in bmi over time in terms of percentiles of the standardized bmi distribution conditioned upon agent age, sex, ethnicity, physical activity, and diet. Each cycle, bmi, or more precisely bmi percentile, is adjusted according to age-, sex-, and ethnicity-based trends, as well as changes in diet and physical activity attributable to the policy intervention. 2-year-old, non-hispanic, white males), it corresponds to the 89th percentile of the population-wide distribution represented by the cdc bmi growth ix figure 2bmi growth and policy impactat age 3, his bmi decreases to 18. This process is repeated until age 18 and, assuming no significant behavioral changes, results in the bmi path shown by the black, triangled dotted line reflects the impact of a modeled policy intervention. Selecting the policies once the microsimulation model had been adapted for this study, a comprehensive list of obesity prevention policies was developed and then narrowed in a two-stage process to the final three , policy recommendations to improve nutrition, increase physical activity, or promote breastfeeding were collected. Yale rudd center, changelab solutions, the center for science in the public interest), federal task forces (the community preventive services task force, the white house task force on childhood obesity), and entities such as the institute of medicine. Thomas was also used to search for recently introduced federal legislation that pertained to children’s nutrition, physical activity, or obesity. For each of the 26 policies, the literature was briefly reviewed to better understand the policy, identify possible federal policy mechanisms, and provide a rating for each criterion to be used in the selection process. Advertising of unhealthy foods to children and e funding for communities to build or make improvements to public parks, playgrounds, and other safe spaces for youth to be physically e states and metropolitan planning organizations to adopt “complete streets” principles into all federally-funded transportation then and expand federally-funded afterschool programs to promote physical a 1-cent-per-ounce excise tax on sugar-sweetened beverages, and earmark revenue for obesity prevention strategies in high risk se students’ fruit and vegetable consumption by expanding federal programs, such as the fresh fruit and vegetable program and the department of defense fresh fruit and vegetable briefs were then written to summarize additional research conducted on the 7 policies.

Each issue brief contained pertinent history and background information, plus a rating for the same criteria as those used to select the 7 policies, with the addition of acceptability (to the general public and policymakers), precision of information for modeling, and potential impact on childhood obesity. The afterschool policy was selected because it had the strongest evidence of effectiveness, due to a large number of intervention studies. The sugar-sweetened beverage excise tax had also been well-studied and would have very broad reach into both the general population and populations at-risk for obesity. The policy to regulate advertising, although controversial, was selected to address the known negative influence of advertising on children’s diets. Although this policy posed challenges, it was selected to illustrate what could happen if the federal government regulated advertising of unhealthy foods to . Estimating policy impact once the final three policies were selected, each one was defined and a boolean search strategy was developed using key search terms specific to each policy. The policy definitions clarified the scope of the literature search, the key data elements that were to be abstracted from identified published manuscripts, and the population groups targeted by the policy. There were considerable differences in the literature base for each policy, and the development of interventions is discussed on a policy-by-policy chool physical activity key search terms included “activity,” “physical,” “fitness,” “school,” “children,” and “adolescen*. Obesity effect sizes were reported as average change in bmi, average weight loss, and percentage sample shift in obesity category (normal, overweight, and obese). As mentioned in the manuscript, the evidence base linking tax policy to sugar-sweetened beverage consumption consists of well-controlled econometric studies. To develop a reliable estimate of the policy’s impact, a two-step approach was used.

Consistent with the approach to assess the impact of an excise tax on sugar-sweetened beverages, a two-step approach was followed when examining the impact of reduced food advertising on obesity. Sensitivity analysis appendix table 9 summarizes key univariate results for a sensitivity analysis on changes in obesity from the three policies, given different values for model parameters. For afterschool pa programs, three factors influenced changes in childhood obesity rates: baseline pa level, the intervention’s intensity (indicated by a percentage change in overall physical activity level), and participants’ adherence to the program. Obesity rates fell more under the following model assumptions: lower baseline physical activity, higher program intensity, and higher program adherence. The ssb excise tax and fast food television advertising ban, which affect obesity through dietary change, were sensitive to changes in baseline diet and assumptions regarding the composition of the ssb or fast food meal. For the excise tax, obesity rates fell more under the following assumptions: more baseline servings of ssbs and greater price sensitivity. For the advertising policy, obesity rates were most sensitive to the average number of fast food servings per ix table 1agent-level parameters within the modelagent-levelparameterconditioningfactorspopulationdistributiontime ofinitializationfixed orvariablesource forbaselineagen/an/amodelintroductionvariableu. It in a separate windowappendix table 6articles used to develop the relationship between price and ssb consumptionauthor(s)journalinfopopulation orsettingintervention orpolicyoutcome measuresand resultsstudy design & analysisandreyeva t,chaloupka fj,brownell kdprev med. Censuspopulationprojectionfrom 2007 -2015a penny-per-ounceexcise tax on allssbsa 24% decrease in ssbconsumptionused data available from consumer reports todevelop a model to estimate the revenue whichcan be generated from an excise eva t, longmw, brownell kdam j publichealth. Aggregatemeasure for all ssbs)systematic review of studies on priceelasticities of different foods, including jp, chandraa, mcmanus kd,williett wcam j publichealth. 8(4):a74high schoolstudents inboston, maschool districtpolicy restrictingsales of ssbs inboston schoolschange in dailyconsumption of ssbsquasi-experimental evaluation.

Results fromthe boston youth survey taken by 2,033 publichigh school students feb-april '04 and feb-april '06 were compared to national trends asreported in the '03-'04 and '05-'06 sena s,capps o jrhealth econ. Children2-19 and adults20+a 20% specificexcise tax on ssbsthat is completelypassed onto theconsumer (a 20%price increase)change in calories,predicted weight loss amongadults over 10-yr period,and predicted change inadult prevalence ofoverweight and obesityover a 10-yr period analysis used nielsen homescan data (1998-2007) and nhanes (2003-2006). Childrenand adults20% price increaseon caloricallysweetenedbeverages thatconsumers are aware ofbeverage consumption,calories, weight loss, bmi,prevalence ofoverweight/obesityadults: avg reduction of 37calories per day, 3. 29(5):1052-1058students whowere involvedin the earlychildhoodlongitudinalstudy -kindergarten(ecls-k) cohort studyexisting state-levelsales tax rates forsoda purchased atgrocery taxes did notnecessarily apply toother ation between sodatax and bmi, drinksconsumed per week anddrinks bought at schoolextrapolating effects to an18% differential soda taxwould correspond to a −0. 1view it in a separate windowappendix table 9sensitivity analysismodel parameterschange in obesity rateunder differentassumptionsmodel and policy assumptionsbaselinevaluerange (+/−)for sensitivityanalysis+sensitivityvalue− sensitivityvalueafterschool physical activityphysical activity level (mets)1902. Centers for disease control and prevention vital signs: obesity among low-income, preschool-aged children--united states, 2008-2011. Prevalence of obesity and trends in body mass index among us children and adolescents, 1999-2010. Measuring health disparities: trends in racial-ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the united states, 2001-2010. Patterns and predictors of enactment of state childhood obesity legislation in the united states: 2006-2009. Barlow se, expert committee expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity.

Other questions concern the extent to which parents and other community members are responsible for providing children a safe environment and whether childhood obesity can be considered a child protection problem (similar to child abuse) needing societal intervention (11). Of application of the frameworkwe present 3 examples of policy interventions for childhood obesity to illustrate the application of these frameworks in light of the ethical issues explored in this calorie labelingin 2008, no place in the united states required restaurants to post calorie labels. Thus, menu calorie labeling alone may not be effective, and communities considering this policy intervention would be well advised to consider the role of personal autonomy in implementing such drink taxforty states and many cities levy taxes on low-nutrition foods (12). In schoolsthe united states has built a public education system on the principle that no child should be denied the right to an education on the basis of socioeconomics or other challenges, yet when a child becomes obese, that child struggles to achieve academic success because of stigma, depression or anxiety, or absenteeism (18). The ethical responsibility of schools to limit soft drink sales and provide healthy meals and opportunities for physical activity and to combat the other adverse consequences of childhood obesity affecting education (20) must also be national school lunch program now serves more than 30 million students (approximately 60% of attendees) daily. Thus, again, a stand-alone intervention may be ineffective, and the policy interventions planned for school settings must consider these competing stewardship role of the state gives special attention to disadvantaged populations. Children with functional limitations and learning disabilities are more than twice as likely to be obese as other children, and children from families with low socioeconomic status are at higher risk for obesity (22). Parents, schools, health care settings, and communities all have a role in ensuring that the risk for obesity among children with special needs is no greater than for other children (13). Review of research protocols typically emphasizes informed consent and confidentiality, the standard in most research regarding health-policy interventions for human behavior. Collection of papers supports the claim that the nature of evaluation research — testing a single intervention, often during the formative stage of implementation — may mislead policy makers and the public about the efficacy of achieving sustainable reform. If one focuses on a single isolated intervention and holds other factors constant (as if that were possible), the policy change may appear to be ineffective.

When evaluations of individual policies (eg, menu labels, soft drink taxes, and removal of competitive foods in schools) fall short of anticipated benefits, does this imply that we are promoting the wrong policies or that no single intervention is likely to be successful in reversing the rates of childhood obesity? A similar approach may be the most promising means of systematically addressing childhood advancement and impact of policy evaluations of simultaneous interventions face 2 challenges. Evidence-based approaches (those informed by the best available scientific evidence and reflecting community preferences and feasibility) are more likely to be effective at addressing causes of childhood obesity, interventions, and policies that may work to confront those causes, in a manner acceptable to the community affected (24). Second, the separation of powers in the us legislative system, with its multiple veto points, combined with dedicated interest-group resistance to any attempts to regulate food or beverage policies, makes approval of passing even a single program difficult, much less a multifaceted, coordinated national approach to childhood the urgency of the childhood obesity problem and the difficulty of personal-responsibility approaches (25), the public policy arena is the most promising response. Yet, in the united states, the time-honored policy-making practices of incrementalism are proving inadequate for the present crisis (26). For public policy to enable a response, barriers to simultaneous interventions, a new view of the role of the state, and attention to the ethical issues raised in this collection of articles will be ledgmentsthis article highlights ideas generated and conclusions reached at the symposium on ethical issues in interventions for childhood obesity, sponsored by the robert wood johnson foundation and data for solutions, inc.