1. State Actions on Childhood Overweight and Obesity– Update for 2005 By Amy Winterfeld, JD Program Principal Health Program National Conference of State Legislatures amy.winterfeld@ncsl.org

2. 2 Obesity – Fast Facts  Obesity is epidemic in the U.S. and cost $117 billion in 2000.  Obesity increased 60 percent among U.S. adults in the last 10 years.  59 million U.S. adults are obese.  Obesity-associated chronic diseases – heart disease, some cancers, stroke, diabetes – are the 1 st, 2 nd, 3 rd, & 6 th leading U.S. causes of death.

3. 3 Obesity & Children’s Health  16 percent of U.S. children and adolescents age 6-19 are overweight (9 million children).  Since 1980, obesity has doubled for children and tripled for adolescents.  The number of children diagnosed with type 2 diabetes (formerly “adult onset diabetes”) has increased.  Other health consequences of obesity for children may include:

4. 4 Obesity – Factors Driving Policy  Obesity-attributable U. S. medical expenses were estimated at $75 billion for 2003.  Taxpayers fund about half of this through Medicare and Medicaid.  Healthy eating and a physically active lifestyle can help children and adults achieve and maintain a healthy weight and may reduce or prevent obesity-related medical costs and chronic diseases.

5. 5 State Medical Obesity Costs in Millions of Dollars Source: Obesity Research, Volume 12, No. 1, January 2004

6. 6 Obesity – Legislative Responses  Nutrition Topics Nutrition Standards in Schools Nutrition Education Measurement of Student Body Mass Index (Arkansas enacted in 2003) Nutrition Menu Information for School Foods Taxes on Foods or Beverages with Minimal Nutritional Value

7. 7 Obesity – Legislative Responses  Physical Activity Topics Physical Education or Physical Activity in Schools Walkable communities - city planning, transportation Safe routes to school Partnerships with businesses to increase physical activity and healthy eating at workplaces

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9. 9 Obesity – Legislative Responses  General Obesity-Related Legislation Diabetes Screening and Management Insurance Coverage for Obesity Prevention and Treatment School Wellness Policies Obesity Task Forces, Commissions, or Studies Raising Awareness Limitations on Lawsuits Against the Food Industry

10. 10 Obesity Costs – Another View

11. 11 Nutrition Standards in Schools  38 states considered or enacted school nutrition legislation in 2005. This includes:  15 states that enacted school nutrition legislation in 2005: AZ, AR, CO, IL, KS, KY, LA, ME, MD, NM, OK, RI, SC, TX and WV. In UT a resolution encouraging passed the legislature and was sent to the lieutenant governor.  21 states that are considering or have considered school nutrition legislation in 2005: AL, AK, CA, HI, IN, IA, MA, MO, MS, MT, NE, NH, NJ, NY, NC, ND, OH, OR, PA,TN and VA. Information is updated periodically on the NCSL web site at: http://www.ncsl.org/programs/health/ChildhoodObesity-2005.htm

12. 12 Nutrition Standards Enacted- 2005  Comprehensive food and beverage guidelines that require healthy choices or restrict sale of competitive foods AZ HB 2544, AR SB 965, CT SB1309, KS SB 154, KY SB 172, MD SB 473, NM HB 61, OK SB 265, SC HB 3499, WV HB 2816  Encouraging school districts to adopt nutrition & wellness guidelines CO SB 81, WV HB 2816  Evaluation of nutrition services; celebrations allowed TX SB 42  Regulatory action on school nutrition standards TX (2004), NJ (2005)

13. 13 Body Mass Index (BMI) Legislation  13 states considered or enacted BMI legislation in 2005  Enacting BMI reporting – Tennessee, West Virginia  Legislation introduced - Alaska, Connecticut, Georgia, Iowa, Maine, New Jersey, New York, North Carolina, Oregon, South Carolina, and Texas  Considered repeal – Arkansas

14. 14 Diabetes Legislation  School child screening Enacted CA and IL – 2003 Considered NY and PA - 2004 Considered PA – 2005  At-school treatment and training of school personnel in diabetes management Passed both chambers of legislature – HI – 2005 Considered TX – 2005; CA, IL, MA, NJ, PA, TN, VT, VA – 2004  Diabetes awareness in schools Enacted resolution - CA – 2005 (SCR 4)

15. 15 Insurance Coverage – Obesity Prevention and Treatment  Insurance coverage option required – GA, IN, VA  States considering insurance coverage requirements or strengthening coverage requirements in 2005 – CA, CT, GA, IN, MD, MO, MS, TN  Insurance coverage required – Maryland

16. 16 Nutrition Content Information for School Foods Legislation  School nutrition information requirements considered 2005 California, Illinois, Massachusetts, and New York  School nutrition information requirements enacted 2005 Colorado, Kentucky, Maine, West Virginia

17. 17 Nutrition Education in School Curriculum  School nutrition education requirements considered 2005 Minnesota, New Mexico, New York, Oklahoma, Pennsylvania, Vermont, Virginia  School nutrition education requirements enacted 2005 Colorado, Kansas, Illinois (for food stamp, TANF recipients - passed both legislative chambers), Maine, South Carolina, Texas and West Virginia

18. 18 Physical Activity – Legislative Responses  Physical Education or Physical Activity in Schools 48 states require P.E. in schools, but scope of requirement varies 60% of states require schools to follow national or state P.E. guidelines. 80% require adapted or mainstream P.E. for IEP students. IL requires daily P.E. for K-12, but exemptions allowed. AL requires daily P.E. for K-8.

19. 19 Physical Activity – Legislative Responses  Physical Education or Physical Activity in Schools 8 states enacted or strengthened P.E. or physical activity requirements in 2005: AZ, CO, CT, KS, KY, MT, SC, TX 25 states introduced legislation to implement or strengthen P.E. or physical activity requirements in 2005: AL, AK, DE, GA, HI, IL, IN, IA, MA, MI, MS, MO, NE, NH, NM, NY, OH, OK, OR, PA, RI, TN, UT, VA.

20. 20 Physical Activity – Legislative Responses  Walkable communities – through community planning and transportation projects that encourage walking.  Safe routes to school - CA, DE, FL, OR, TX have state laws as of 2003.  Legislative role models – CO legislators participate in 10,000 Steps to Better Health and created Colorado Walking Wednesday urging parents and children to walk to school; WI legislators resolved to Lose a Ton.

21. 21 Nutrition and Physical Education – Food for Thought

22. 22 School Wellness Policy Legislation  Federal Child Nutrition and WIC Reauthorization Act of 2004 – Requires local school districts participating in the National School Lunch or Breakfast Programs to establish local wellness policies by the beginning of the 2006-2007 school year.  Statewide wellness policy legislation – considered in 2005 in CA, OH, TN.  Statewide wellness policy legislation – enacted in 2005 in CO, IL, RI.

23. 23 Task Forces, Commissions, or Studies  Six states previously enacted obesity task forces, commissions, or studies – Arkansas, Maine, New York, Texas, Rhode Island, Washington  Legislation introduced for obesity task forces, commissions, or studies in 2005 – Kansas, New Mexico, North Carolina, Virginia, and West Virginia

24. 24 Legislative Effort to Raise Awareness  California – A panoply of awareness raising efforts encouraged to increased physical activity and improve nutrition and wellness in all branches and levels of government, communities, schools, workplaces; healthy food options in restaurants, markets, and homes; and increased emphasis on health education and prevention of obesity and diabetes.  Maryland – Proposed November as “Obesity Awareness Month”

25. 25 Snack Tax Legislation  Nebraska – Proposed sales tax on snack foods to create a fund for school facilities.  Texas – Proposed snack and sweets tax to fund childhood obesity prevention programs.

26. 26 Additional Resources Links for NCSL and other resources on legislation and policy options to address childhood obesity are:  NCSL updated overview of childhood obesity policy options considered in 2005 at: http://www.ncsl.org/programs/health/childhoodobesity- 2005.htm http://www.ncsl.org/programs/health/childhoodobesity- 2005.htm  NCSL overview of childhood obesity policy options considered in 2003-2004 at: http://www.ncsl.org/programs/health/childhoodobesity.htm http://www.ncsl.org/programs/health/childhoodobesity.htm  NCSL information on access to healthy foods in communities at: http://www.ncsl.org/programs/health/publicHealth/foodaccess/i ndex.htm?CFID=614822&CFTOKEN=54359522 http://www.ncsl.org/programs/health/publicHealth/foodaccess/i ndex.htm?CFID=614822&CFTOKEN=54359522  Information about federal wellness policy requirements on the U.S. Department of Agriculture web site at: http://www.fns.usda.gov/tn/Healthy/wellnesspolicy.html http://www.fns.usda.gov/tn/Healthy/wellnesspolicy.html

27. 27 Thank you! NCSL Contact for Additional Childhood Obesity Policy Information: Amy Winterfeld Program Principal Health Program National Conference of State Legislatures 7700 East First Place Denver, Colorado 80230 amy.winterfeld@ncsl.org 303-364-7700, ext. 1544