View From Washington

A National Grade on Childhood Obesity

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP     

As we contemplate the annual back to school migration, it’s timely to consider our national grade on childhood obesity. The good news is that our mark for effort is improving - with much national momentum and new leadership from both federal and state governments, schools, philanthropy and other key stakeholders.  

The recent passage of the Affordable Care Act catalyzes the potential to address the obesity epidemic through a number of prevention and wellness provisions, expanding coverage of clinical preventive services to millions of uninsured Americans, and creation of a mandatory and reliable funding stream through the creation of the Prevention and Public Health Fund. Perhaps most specifically the law authorizes new Community Transformation grants which have the potential to expand existing evidence-based disease prevention programs; provides $25 million annually in grants for childhood obesity demonstration grants created by the CHIP reauthorization; requires chain restaurants to implement menu labeling; and specifies that children gaining new coverage should receive the range of obesity screening and counseling included in the Bright Futures guidelines. 

On a separate front, President Barack Obama created a White House Task Force on Childhood Obesity, which issued a new national obesity strategy with specific roles for nearly every federal agency. First lady Michelle Obama also launched the Let's Move! initiative to solve childhood obesity within a generation. This level of White House leadership is unprecedented.

States are also taking action. The recent annual “F As in Fat” report issued by the Trust for America’s Health reports that “twenty states and DC set nutritional standards for school lunches, breakfasts and snacks that are stricter than current United States Department of Agriculture requirements. Five years ago, only four states had legislation requiring stricter standards. Twenty-eight states and DC also have nutritional standards for competitive foods sold in schools on à la carte lines, in vending machines, in school stores, or through school bake sales. Five years ago, only six states had nutritional standards for competitive foods.” The report also highlights that very state has some form of physical education requirement for schools, but notes these requirements “are often limited, not enforced or do not meet adequate quality standards.” Additionally, 20 states have passed requirements for body mass index screenings of children and adolescents or have passed legislation requiring other forms of weight and/or fitness related assessments in schools. Five years ago, only four states had passed screening requirements.

Despite these major efforts, our outcomes are not matching our intent. TFAH reports that in the past year adult obesity rates increased in 28 states, while only DC recorded a decline. By now, nearly everyone is aware that nationally, two-thirds of adults and nearly one third of children and teens are currently obese or overweight. The alarm bells have been ringing about the tripling and quadrupling rates for children, and the threat this poses to our national future. 

Here at AMCHP, we’ve been looking to engage and apply the MCH capacity within state public health agencies to provide leadership in implementing policies and programs that prevent and reduce the burden of obesity and related chronic diseases across the lifespan. We are exploring opportunities to work with partners to identify and highlight opportunities for states to create environments that promote healthy eating and active living; to intervene early to promote healthy nutrition and physical activity habits in families with young children; and enhance efforts to promote healthy weight among women of reproductive age.  

We are also highlighting state MCH programs that help lead community efforts to address chronic disease, including obesity in women, children and families. Based on the 2005 Title V Needs Assessments we know that of the 59 states and territories, 48 have identified addressing obesity, promoting nutrition, or increasing physical activity in children and families as one of their top Title V MCH program priority needs. We expect the current round of needs assessments will expand this priority to virtually all states.

We’ve also highlighted that while state MCH programs recognize the priority, they have been severely hampered by eroding resources. The reduction of the Title V MCH Services Block Grant by nearly $70 million over the past seven years has forced states to make cuts when they should be re-doubling efforts to address this threat. Additionally, the limitations in the CDC budget require that less than half of all states receive a grant for a core physical activity, nutrition and obesity prevention program.

As we look to the future, AMCHP will continue to advocate for adequate resources to help states and communities optimize opportunities to prevent obesity across the lifespan.