Childhood Obesity Policy: From Brief to Community Action

Introduction: Childhood Obesity as a Public Policy Issue

The public policy issue examined in this paper is childhood obesity. This issue was selected because childhood obesity has a considerable and longstanding impact on the health of the public as well as on the cost of health care. It is becoming an increasingly significant concern in the public realm, as childhood obesity is a primary reason that children grow up into obese adults who may suffer a wide range of health problems. According to the Centers for Disease Control and Prevention (CDC) (2015), childhood obesity has more than doubled in children and increased fourfold in adolescents over the past three decades. Statistics indicate that by 2012, more than 33% of children and adolescents in the United States were obese or overweight — a trend that clearly signals the need for policy intervention.

Research studies have confirmed that childhood obesity is a highly relevant public policy issue. According to Karnik and Kanekar (2012), childhood obesity is a growing concern with regard to the health and welfare of children. The condition arises from a disparity between calorie consumption and calorie expenditure, and is influenced by genetic, environmental, and behavioral factors. The prevalence of childhood obesity is increasing in both developed and developing nations, and it is now ranked as one of the major global health problems. Augmented prevalence of childhood obesity can have detrimental health and mortality consequences in adulthood. Physical, psychosomatic, and social health complications are all associated with childhood obesity (Karnik and Kanekar, 2012).

Sahoo et al. (2015) indicate that overweight and obesity have a substantial influence on both physical and mental health. Children who are obese have a high likelihood of remaining overweight into adulthood and are more likely to develop non-communicable illnesses such as diabetes and cardiovascular disease at an earlier age. Environmental factors, lifestyle preferences, and cultural context all play fundamental roles in the growing prevalence of obesity across the globe. The problem of childhood obesity can be contained if society takes cognizance of its causes. Among the many contributing factors, a combined diet and physical activity intervention — one that begins at the school level and is steered by the community — is more effective at preventing obesity or overweight. Furthermore, if parents implement healthier lifestyles at home, many obesity-related complications could be avoided (Sahoo et al., 2015).

Reducing childhood obesity is a public health concern with significant health and economic benefits. According to the Global Health Institute (2014), over a lifetime, childhood obesity carries a financial burden of $19,000 per child compared to a normal-weight child, whose average lifetime health cost is approximately $12,600. The financial impact of childhood obesity is typically classified as direct — such as medical costs — and indirect, such as lost workplace productivity. Direct costs include annual prescription drug, emergency room, and outpatient costs of over $14 billion nationally, along with inpatient costs exceeding $230 million. Approximately 30% of obese children become obese adults, and the projected costs of treating obesity-related illness in adults amount to approximately $150 billion (Cawley, 2010). Successful policy change could therefore generate substantial per capita savings (Finkelstein et al., 2014). Policies that increase the price of products associated with obesity — such as an excise tax on sugar-sweetened beverages — can simultaneously decrease obesity rates and generate significant revenue for prevention activities. For instance, according to Arbor (2014), a one-percent tax increase would have produced almost $14 billion in tax revenue in 2010 alone.

From a personal perspective, health is a vital aspect of well-being, particularly for children who have many years ahead of them. The ethical principle underpinning this perspective is that of beneficence — the idea that policies and procedures should be designed with the primary aim of doing good for the people they affect. Addressing childhood obesity is important given that it contributes to severe health problems, including hypertension, orthopedic complications, hormonal imbalances, and adult obesity, as well as psychosomatic and social comorbidities (Perryman and Sidoti, 2015). The policy change proposed in this paper is intended to benefit the health of all obese and overweight children and to prevent them from becoming obese adults.

Policy Brief: Decision Maker, Challenges, and Interventions

Decision Maker and Why the Issue Requires Attention

The decision maker to receive this policy brief is Tim Scott, then senator of South Carolina. The state warrants particular attention to this issue because it has one of the highest rates of childhood obesity in the nation, with 21.5% of children classified as obese and 17.7% as overweight (Ogden et al., 2014). Additionally, nearly 67% of adults in the state are overweight, with a Body Mass Index (BMI) of 25 or higher, and 32% are obese with a BMI of 30 or higher (West, 2012).

Main Challenges of Addressing Childhood Obesity as a Public Policy Issue

There are several challenges involved in addressing childhood obesity through public policy. The first is political. According to Andersen (2011), policies that address obesity — such as restrictions on junk food advertising aimed at children — are likely to encounter political resistance. The United States has historically permitted minimal regulation of commercial speech. Accordingly, some organizations argue that banning or restricting junk food advertisements constitutes an infringement on civil liberties and does not address the root causes of obesity (Andersen, 2011).

A second challenge is the steadily increasing amount of time children and adolescents spend in front of screens. According to Powell (2013), television viewing plays a significant role in contributing to weight gain among children and adolescents in America — the more television they watch, the more their weight tends to increase. In the contemporary environment, children's engagement with television screens, computer screens, and mobile phones has increased dramatically. At present, children spend more than seven hours per day watching television, and the combination of sedentary behavior, exposure to food advertising, and mindless eating represents a mounting challenge in the effort to reduce childhood obesity (Powell, 2013).

Primary Options and Interventions for the Decision Maker

There are four primary policy options available to the decision maker. The first is implementing an excise tax on sugar-sweetened beverages (SSBs). This option would impose a per-ounce excise tax on SSB purchases, with the purpose of reducing consumption among children and adolescents. As prices increase, children and adolescents would be incentivized to substitute these beverages for options with fewer or zero calories, thereby improving nutritional intake and long-term health outcomes (Kristensen et al., 2014). Research by Kristensen et al. (2014) projects that a one-cent-per-ounce excise tax on SSBs would reduce obesity by 1.6 percentage points among children aged 6–12, and by 2.4 percentage points among adolescents aged 13–18, over the next 15 years. Applying the tax to all SSBs could reduce childhood obesity prevalence by as much as 2.9 percentage points.

The second option is a ban on television advertising for fast food products targeting children and adolescents. This would restrict fast food advertising with the goal of limiting children's consumption of high-calorie, low-nutrient foods. A key consideration is whether children aged 12 and under possess the cognitive capacity to recognize the persuasive intent behind advertisements and protect themselves from their influence (Kristensen et al., 2014).

The third option involves mandatory physical activity programs during or after school hours. Schools would be required to offer structured physical activity programs on specified days for students of all grade levels (Kristensen et al., 2014). The fourth option is zoning. Zoning restrictions can limit the concentration of fast-food establishments near schools and recreational areas by establishing buffer zones between these institutions and businesses such as fast-food restaurants, convenience stores, and mobile food vendors. Research suggests that a higher density of neighborhood fast-food establishments is associated with increased obesity, making zoning regulations a potentially effective tool for reduction (Frieden et al., 2010).

Legislative Pathway and Policy Evaluation

Recommended Course of Action

The first option — an excise tax on sugar-sweetened beverages and fast foods — is considered the most effective intervention. As with alcohol and tobacco, increasing prices through higher tax rates has been shown to reduce consumption. The proposed policy change is the implementation of a two-percent-per-ounce excise tax on sugar-sweetened beverages and fast foods. This tax increase would raise prices for these products, deterring consumption among children and adolescents and thereby reducing rates of overweight and obesity (Frieden et al., 2010).

The implementation of this policy requires a sequential legislative plan. The initial step is to present the policy brief to the senator, who has the authority to advance the proposal toward becoming law. The first phase involves introducing the bill in the House of Representatives, where it must be passed before being sent to the Senate. In the Senate, the bill would be reviewed by the Senate Health, Education, Labor, and Pensions Committee (Congress.gov, 2016). The committee would hold hearings on the public health implications of childhood obesity and on the specific proposal to increase excise taxes on sugar-sweetened beverages. The bill would then be developed further, with recommended changes submitted to the full chamber. Once approved, the bill would go to a conference committee representing both the House and the Senate. After ratification by both chambers, the bill would be signed into law (Congress.gov, 2016).

Evaluating the Success of the Policy: Top-Down Approach

The success of this policy will be evaluated using four criteria drawn from the top-down approach. First, the evaluation will assess the extent to which the actions of implementing officials and target groups aligned with the goals and procedures outlined in the original policy decision. Second, it will examine the degree to which policy goals were achieved over time, including the consistency of impacts on the target group. Third, it will identify the key factors that influenced policy outputs and outcomes, including political factors that may have affected success. Fourth, given that behavior change among target groups occurs gradually, the evaluation will examine how the policy was refined over time based on emerging experience and how those refinements affected overall outcomes (Sabatier, 1986).