Health Advocacy Campaigns Addressing Childhood Obesity

Introduction: The Scale of Childhood Obesity

Most health issues that people face on a day-to-day basis do not become pandemics — but this is not the case with obesity. Over a billion people are affected by obesity worldwide (Miller, et al., 2004). The statistics are particularly discouraging for children. Children who have a body mass index (BMI) greater than the figures in the 85th percentile for their age and gender are considered overweight or obese (Miller, et al., 2004). During the past three decades, the number of children identified as obese under that standard has tripled (Miller, et al., 2004). In the United States, more than 30% of children are overweight or obese, with BMI measurements greater than the 95th percentile (Miller, et al., 2004). The International Obesity Task Force has estimated that, across the globe, 22 million children under five years of age are obese (Miller, et al., 2004). Incredibly, in some parts of Africa, obesity has replaced malnutrition as the predominant nutritional problem — the incidence of being overweight or obese is four times that of malnutrition in those regions (Miller, et al., 2004).

White House Task Force on Childhood Obesity

Solving the problem of childhood obesity is not going to be a simple process. Obesity among the nation's children is fundamentally a policy problem, which is why this paper focuses on a national program designed to address it. The White House Task Force on Childhood Obesity represents a comprehensive plan calling for action at the federal level, at the state and local level, and in the private sector. Recommendations from the Task Force are organized into five categories: (1) Early Childhood; (2) Empowering Parents and Caregivers; (3) Healthier Food in Schools; (4) Access to Healthy, Affordable Food; and (5) Increasing Physical Activity ("White House," 2010).

Accomplishments in Schools

Since February 2010, a number of recommendations made by the White House Task Force on Childhood Obesity have been implemented. The Healthy, Hunger-Free Kids Act was signed into law to ensure that students have access to healthier food at school, including healthy school lunches. The current effort in this area is to increase the number of schools that meet the Healthier U.S. School Challenge, and schools across the country have signed up in an effort to raise student activity levels. Three of the largest food service providers for the nation's schools have committed to improving the healthfulness of the food they provide — specifically, to meet recommended levels of fat, sugar, and whole grains over a five-year period, and to double the amount of vegetables and fruits served over a ten-year period.

Through the efforts of a coalition including the Fruit and Vegetable Alliance, the Food, Family, and Farming Foundation, and the United Fresh Produce Association, 6,000 salad bars will be established nationwide in schools over three years. A program called Chefs Move to Schools will pair 2,000 volunteer professional chefs with schools in order to engage entire educational communities in creating healthier school menus and to help educate students about making healthy food choices. Support is also coming from the private sector: All-Clad, for example, responded to this challenge by donating 1,000 demonstration cooking kits for chefs who volunteer in the Chefs Move to Schools program.

Accomplishments in Accessibility and Affordability of Healthy Foods

The Let's Move program is working with businesses to help parents bring better food choices home to their children. Walmart has established a Nutrition Charter designed to increase the amount of healthful and affordable foods available to the 140 million people who shop there each week. Within five years, the Healthy Weight Commitment Foundation — a CEO-led coalition with a mission to bring healthy foods to families — pledged to reduce annual calories in the national food supply by 1.5 trillion and to end childhood obesity by 2015. Over a thousand pounds of food had been produced under the White House Kitchen Garden initiative, renewing a practice dormant for decades and enabling children to gain firsthand experience seeing how food is produced.

Accomplishments in Physical Activity

Let's Move has set annual goals for the number of Americans who earn the Presidential Active Lifestyle Award (PALA). Organizations like the National Football League (NFL) are working to help meet these goals by signing up thousands of children. Disney, the National Hockey League (NHL), and Major League Baseball (MLB) are teaming up with Let's Move to spread the word about the program. Public service announcements (PSAs) are appearing on national channels as a result of these outreach efforts, inspiring children through their favorite athletes and celebrities to get active and play sports. Families and communities are also participating in the Let's Move Outside program, which encourages people to take advantage of outdoor opportunities available in every town and city. In addition, mayors and community groups are working with Let's Move to ensure that children have safe places to be active, including by building or adopting playgrounds. Safe Routes to School initiatives are being established in communities so that children can walk or bike to school.

Accomplishments in Spreading the Message

Over 500 American communities have signed up for Let's Move Cities and Towns, which brings local leaders and Let's Move together to support meaningful changes that foster healthful communities. New public service announcements are being released to engage parents and caregivers in increasing physical activity and making healthier food choices. The American Beverage Association, the Grocery Manufacturers Association, and the Food Marketing Institute are working to ensure that food and beverage packaging includes clear calorie information. Through the efforts of the American Academy of Pediatrics and the American Academy of Family Physicians, more children are being screened for BMI during well-child visits. The goal of these professional organizations is for 100% of physicians to screen for BMI; notably, the Affordable Care Act requires all new health insurance plans to cover childhood obesity screening and counseling. Faith-based and community-based organizations are participating in Let's Move Faith and Communities to complete 500,000 Presidential Active Lifestyle Awards, walk three million miles, and host 10,000 farmers' markets or community gardens.

Rev It Up! Coalition in Yakima, Washington

In contrast to the national childhood obesity task force activities, the Rev It Up! coalition program is localized to the region in and around Yakima, Washington. As a community coalition, the program is designed to provide successful strategies for creating partnerships among community members, agencies, and the state department of health. This broader base is intended to generate interventions that are active at all relevant levels — policy, community, organizational, interpersonal, and individual. Remarkably, the eastern Washington agricultural community of Yakima County had been ranked as the eighth "fattest city" in the United States.

The Yakima Health District (YHD) determined to address the obesity problem and established two major goals: (1) to decrease the incidence of childhood obesity in Yakima County, and (2) to establish a community coalition of experts and key stakeholders equipped to focus on solutions. Federal and state grants were applied for and awarded to the community coalition. Rev It Up! was officially launched with an initial recruitment event in September 2008. The Washington State Department of Health was invited to advise the coalition-building and action-planning processes. A Basic Food and Nutrition Education Program (BFNEP) provided support through the Healthy Choices program for schools. Through this program, school districts were helped to review their existing strategies and to implement changes in compliance with Washington State Substitute Senate Bill 5436. The BFNEP grant also helped fund the Coordinated Approach to Child Health (CATCH), an after-school program focusing on nutrition and physical activity for school-aged children. CATCH addresses four of the eight school health components established by the Centers for Disease Control and Prevention: family and community involvement, health education, nutritional services, and physical education.

Conclusion

The policy problem addressed in this paper concerns the effective implementation of established programs for addressing childhood obesity in communities. As Anderson et al. (2003) note, "there are reasons not to endorse the standard economic model's laissez-faire implications when applied to adults" — and even more reasons when the model is applied to children. Children's lives are governed by their parents and by schools, but social conditions and policies have contributed to circumstances in which childhood obesity thrives.

The provisions of in loco parentis may have more relevance today than ever before: schools must be enlisted to make meaningful changes that benefit the health of children and not just their intellect. The role of public health nurses in this arena is clearly one of advocacy — an advocacy supported by an enormous body of policy and public goodwill. It is only the political will — much of which resides at the local level — that is lacking.

References

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Miller, J., Rosenbloom, A., and Silverstein, J. (2004). Childhood obesity. The Journal of Clinical Endocrinology & Metabolism, 89(9), 4211–4218.

____. (2010). Solving the problem of childhood obesity within a generation. White House Task Force on Childhood Obesity: Report to the President. Retrieved from http://www.letsmove.gov/white-house-task-force-childhood-obesity-report-president