State School Nutrition and Physical Activity Policy Environments and Youth Obesity

In this first-ever study designed to analyze which school policies regarding childhood obesity have been enacted at the state-level across the U.S., the data reveal states are more likely to have adopted guidelines regarding food and nutrition than guidelines regarding physical activity or weight assessment. Notably, the study also found states with the highest rates of childhood obesity were overall more likely to have adopted school-based obesity prevention policies.

With childhood obesity at epidemic levels, there is interest across the country in enacting policies within schools that promote healthy weights in kids. Using data from the 2006 School Health Policies and Programs Study, this study identified distinct policy actions and organized them into broad topic areas for analysis: 100 elements of Food Service and Nutrition Policies; 146 elements of Physical Activity and Education Policies; and two Weight Assessment Policies. Then, based on the 2003 National Survey of Children’s Health, this cross-sectional analysis compared the prevalence of obesity in children ages 10-17 in each state to each state’s adoption of various anti-obesity policies.

Key Findings:

  • On average, states adopted about half (49%) of the food service/nutrition policies identified by the study; 38 percent of the physical activity/education policies; and 17 percent of the weight assessment policies.
  • States with the highest prevalence of childhood obesity (most notably those in the South and Southeast including WV, KY, TN, NC, TX, SC and MS), were more likely than other states to have adopted food service/nutrition policies.
  • There was no correlation between childhood obesity prevalence and the adoption of physical activity/education or weight assessment policies at the state level.
  • Only three states—LA, KS and NC—had “comprehensive policy environments” encompassing both food service/nutrition and physical education/activity policies.
  • The most commonly adopted food service/nutrition policies were related to nutrition education, collaborating with others to improve nutrition, and nutrition infrastructure; the least adopted were related to nutrition counseling and food assistance programs. On average, states also adopted most of the physical education/activity policies related to PE adaptation for kids with disabilities; establishing PE standards; and collaborating with others. Weight assessment and reporting policies were among the least adopted overall.

This study is just the beginning of analyzing the relationships between state-level school policies and childhood obesity prevalence. For example, this study did not look at the temporal relationships between policy enactment and childhood obesity. The data raise many questions, such as whether policies caused obesity or were in response to obesity, and whether policies are actually being enforced or effective. But overall, the authors find the lack of state efforts, especially for physical activity/education, to be “disturbing.” There is clearly a preference for enacting food service/nutrition policies which may be due to public attention being focused on school food and the fact that physical education changes can impact academic time. The authors call for a long-term, longitudinal study of the enactment and enforcement of school policies and their impact on the weight and behaviors of children.