Running head: POLICY ASSIGNMENT

Policy Assignment
Sarah Fennewald
Fontbonne University

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Policy Assignment
Prevention of Childhood Obesity

Childhood obesity has reached epidemic proportions in the United States. According to
data from the National Center for Health Statistics, Centers for Disease Control and Prevention
(CDC), the occurrence of childhood obesity is 16.9% and 31.8% of children are overweight
(Ogden, Carroll, Kit, & Flegal, 2014, p. 808). When compared with data from 2003, there is not
much difference in the occurrence of overweight and obese children. This is significant because
obesity rates continue to remain high over time and current prevention efforts are not very
effective. While many children are being affected by obesity, research has found that those from
a low socioeconomic status have a higher risk of obesity (Wang, 2001, p. 1134). Children from
low socioeconomic families need to be the focus of prevention efforts and it is important to
understand that environment plays a role in obesity. Children who attend public schools are also
more likely to have a higher body mass index than children who attend private schools.
According to Li & Hooker (2010), children who attend public schools have a mean body mass
index 0.150 higher than students attending private schools (p. 99). Public schools are in a good
position to provide integrated, comprehensive nutrition services for children since they reach a
large number of children and these children are at risk of having a higher body mass index.
Childhood obesity prevention is an important issue in the United States because obesity
leads to long term health problems. Children with weight issues struggle with physical and
psychological health and even have an impact on the economy. Childhood obesity is linked with
type 2 diabetes, heart disease, and adult obesity (Li & Hooker, 2010, p. 97). The link between
obesity and chronic disease is important because it has a lasting effect on an individual and it
increases the cost of healthcare. The cost of healthcare due to obesity is already high and is

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expected to increase into the future. It is estimated that the direct and indirect costs of obesity in
the United States was close to $139 billion in 2003 alone (Finkelstein, Ruhm, & Kosa, 2005).
With the high rate of childhood obesity and the cost of healthcare rising, this is an extremely
important topic for dietitians and the public. Primary prevention is a successful and cost effective
way to prevent obesity and chronic diseases and therefore needs to be a part of a childs
education.
Current Legislation
Currently, there is legislation in the senate that addresses childhood obesity prevention
through schools. Bill S.418 Promoting Health as Youth Skills in Classrooms and Life Act was
introduced to the senate on February 9, 2015. It has been read twice and is currently referred to
the Committee on Health, Education, Labor, and Pensions. The bill is sponsored by Senator Tom
Udall from New Mexico and is cosponsored by Senator Barbara A. Mikulski from Maryland.
Currently no other bills are related to bill S.418. Overall, the bill aims to support and encourage
the health and well-being of elementary school and secondary school students by enhancing
school physical education and health education. It works to solve the problem of childhood
obesity by including health education and physical education as core academic subjects in
elementary and secondary schools. It also requires each state to determine the best way to assess
and measure students in health education and physical education. Lastly, it authorizes money for
the years 2016 to 2020 from the Carol M. White Physical Education Program, which provides
matching grants to institutions that expand and improve physical education programs. Providing
both physical and health education are important to preventing childhood obesity through
primary prevention methods.
Academy Position Papers

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There are several Academy Position Papers that align with and support the prevention of
childhood obesity. The Academy not only supports obesity prevention in children, but
specifically primary prevention and school-based interventions. Other position papers from the
Academy also support the role of nutrition in health promotion and provide nutrition guidance
for children. All of these position papers address the problem of childhood obesity and support
the bill S. 418.
The first Academy Position Paper that aligns with the prevention of childhood obesity
and bill S. 418 is titled Interventions for the Prevention and Treatment of Pediatric Overweight
and Obesity. The Academy of Nutrition and Dietetics recognizes pediatric overweight and
obesity as a significant public health problem in the United States and acknowledges that the
solution requires more than the skills of registered dietitians. While dietitians have the skills and
knowledge to help prevent obesity, the Academy believes that systems-level approaches that
include dietitians, as well as consistent and integrated messages and environmental support
across all sectors of society, are needed to achieve sustained dietary and physical-activity
behavior change (Hoelscher, Kirk, Ritchie, & Cunningham-Sabo, 2013, p. 1375). Schools are an
important part of providing environmental support and consistent health messages. The overall
focus of the position paper is to provide recommendations for interventions to prevent childhood
obesity, based on current evidence. After reviewing evidence on primary, secondary, and tertiary
preventions, with a focus on the effectiveness of school-based interventions, several
recommendations were made by the Academy of Nutrition and Dietetics. A number of the
recommendations align with bill S. 418 which aims to prevent obesity and promote health by
enhancing nutrition education and physical education in elementary and secondary schools.
Recommendations from the review of child obesity primary prevention literature include

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integrating education with supportive environmental change, a combination of nutrition

education and physical education, parental involvement, promotion of community engagement
in schools and childcare, policies that limit food availability, and more intensive and innovative
interventions (Hoelscher et al., 2013, P. 1380). It is important for primary prevention to include
more than just education; environmental changes need to take place in schools and in the
community and parents also need to be involved with obesity prevention efforts. Overall,
primary prevention offers many solutions to childhood obesity, but the most successful
prevention efforts include multilevel approaches that include the involvement of many different
systems.
Bill S. 418 is a way to integrate schools into the multilevel approach that is necessary to
prevent childhood obesity. The bill includes both nutrition education and physical education as
recommended. It also provides the opportunity for education agencies and community-based
organizations that serve kindergarten through twelfth grade students to receive grants, which
aligns with the recommendation to promote community engagement in schools. The passing of
bill S. 418 would be beneficial for children according to Academy recommendations and also
could lead to future improvements in the other areas recommended.
The second Academy Position Paper that aligns with the prevention of childhood obesity
and bill S. 418 is titled The Role of Nutrition in Health Promotion and Chronic Disease
Prevention. This position paper states, Primary prevention is the most effective and affordable
method to prevent chronic disease, and that dietary intervention positively impacts health
outcomes across the life span (Slawson, Fitzgerald, & Morgan, 2013, p. 972). The Academy
finds that proper nutrition plays an important role in obesity prevention and preventing obesity is
necessary to improve overall health, especially among children. Not only will proper nutrition

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improve overall health, but it will also result in potential cost savings. It is predicted that a 1%
decline in obesity could result in a drop of $84.9 billion in obesity-related medical costs by the
year 2030 (Slawson et al., 2013, p. 973). Another important aspect to health promotion is
physical activity, which should be incorporated throughout the lifecycle. Overall, chronic
diseases and health problems, such as obesity, can be prevented by creating healthy lifestyles
early in life. The Academy position on the role of nutrition in health promotion aligns very well
with the prevention of obesity and bill S. 418 by supporting health promotion and disease
prevention strategies early in life. Preventing childhood obesity and promoting the health of
children is the main goal of bill S. 418. Nutrition along with physical activity are integral parts of
a healthy lifestyle and the bill incorporates these two aspects into elementary and secondary
schools. Teaching nutrition and health education to children is very important in creating healthy
lifestyles and preventing obesity, which can ultimately lead to many chronic diseases.
The third Academy Position Paper that aligns with the prevention of childhood obesity
and bill S. 418 is titled Nutrition Guidance for Healthy Children ages 2 to 11 years. This position
paper aligns with obesity prevention by recommending the proper nutrition to promote health
and to prevent obesity in children. The paper also informs bill S. 418 by providing
recommendations for nutrition practitioners and teachers when working with children. The
Academy of Nutrition and Dietetics believes that children from the age of 2 to 11 should achieve
optimal physical and cognitive development, maintain healthy weights, enjoy food, and reduce
the risk of chronic disease through appropriate eating habits and participation in regular physical
activity (Ogata & Hayes, 2014, p. 1257). Again, the Academy focuses on preventing chronic
disease and obesity in children and emphasizes the importance of nutrition and regular physical
activity. Overall, children in the United States are not meeting the recommendations provided by

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the 2010 Dietary Guidelines for Americans (DGA) and there is a need for the children in the
United States to achieve more healthy eating patterns. Many children also do not meet the
current recommendations for physical activity. School-based interventions using several different
methods were effective in improving markers of obesity in children and more specifically
nutrition and physical activity interventions in school-based settings were effective in reducing
weight (Ogata & Hayes, 2014, p. 1258). Based on the Academys research, recommendations
include decreasing overweight and obesity by reducing overall calorie intake, shifting to a more
plant-based diet, reducing added sugars and solid fats from the diet, and meeting the 2008
Physical Activity Guidelines for Americans. Bill S. 418 will be important in reducing weight in
children and creating healthy children by mandating health education and physical education in
schools.

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Letter to Support Bill S.418

March 31, 2015

Sen. McCaskill
730 Hart Senate Office Building
Washington, D.C. 20510
Dear Senator Claire McCaskill:
My name is Sarah Fennewald and I currently reside in Maryland Heights, Missouri. As a
dietetics student at Fontbonne University and a constituent, I would like to bring to your
attention bill S. 418, which is called ``Promoting Health as Youth Skills in Classrooms and Life
Act''. It encourages the health and well-being of elementary and secondary school children
through physical education and health education. I would like to bring this bill to your attention
because childhood obesity has become a problem in our country and in our state. As someone
who is concerned with the health of our nation, I believe it is necessary to focus on the
prevention of childhood obesity and schools are in a good position to provide integrated,
comprehensive nutrition services for children.
The prevention of childhood obesity is an important topic to address since childhood obesity has
reached epidemic proportions and the associated medical costs continue to increase each year.
More than one-third of children and adolescents are estimated to be overweight or obese and
overweight adolescents have a 70-80% chance of becoming overweight adults, increasing their
risk for chronic disease, disability, and death. One way to address the problem of childhood
obesity is through primary prevention and Senate Bill 418 would provide this through schools.
The bill would aim to prevent childhood obesity by providing funding for physical education and
health education including equipment and staff and teacher training. Senate Bill 418 was first
introduced on February 9, 2015 by Senator Tom Udall of New Mexico. It has been read twice
and has recently been referred to the Committee on Health, Education, Labor, and Pension. This
bill will have an important impact on children from the age of five to the age of eighteen. It will
also have an important impact on the field of dietetics by providing the opportunity for more
education in healthy eating habits and good nutrition. Most importantly the bill will improve the
nutritional status of our country now and in the future and help to decrease the risk of chronic
disease, disability, and death. Lastly, I ask for your democratic support for Senator Tom Udall
and the bill.
As a constituent, I am asking you to help improve the health and well-being of our country by
supporting Senate Bill 418. The bill will directly improve the life of school-aged children by
reducing their risks for obesity and the chronic diseases that come with it. It will also have an
impact on many teachers and parents who will benefit from physical and health education too.
In the long run it will reduce the high medical costs that affect many individuals in the country.

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Thank you very much for your time and consideration of Senate Bill 418. Please feel free to
contact me with any questions or for any additional information.
Sincerely,
Sarah Fennewald
Sarah Fennewald
12106 Josephine Marie Dr.
Maryland Heights, MO 63043
(314) 583-9408
sfennewald@live.com

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References
Finkelstein, E., Ruhm, C, & Kosa, K. (2005). Economic causes and consequences of
obesity. Annu Rev Public Health, 26, 239-257.
Hoelscher, D. M., Kirk, S., Ritchie, L., & Cunningham-Sabo, L. (2013). Position of the
Academy of Nutrition and Dietetics: Interventions for the prevention and treatment of
pediatric overweight and obesity. Journal of the Academy of Nutrition and Dietetics,
113(1), 1375-1394. doi: 10.1016/j.jand.2013.08.004
Li, J. & Hooker, N. H. (2010). Childhood obesity and schools: Evidence from the
National Survey of Childrens Health. Journal of School Health, 80(2), 96-103.
Ogata, B. N. & Hayes, D. (2014). Position of the Academy of Nutrition and Dietetics: Nutrition
guidance for healthy children ages 2 to 11 years. Journal of the Academy of Nutrition and
Dietetics, 114(8), 1257-1276. doi: 10.1016/j.jand.2014.06.001
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood
obesity in the United States, 2011-2012. Journal of the American Medical Association,
311(8), 806-814. doi: 10.1001/jama.2014.732
Slawson, D. L., Fitzgerald, N., & Morgan, K. T. (2013). Position of the Academy of Nutrition
and Dietetics: The role of nutrition in health promotion and chronic disease prevention.
Journal of the Academy of Nutrition and Dietetics, 113(7), 972- 979. doi:
10.1016/j.jand.2013.05.005
Wang, Y. (2001). Cross-national comparison of childhood obesity: The epidemic and the
relationship between obesity and socioeconomic status. International Journal of
Epidemiology, 30, 1129-1136.

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Appendix A

United States Senators

1.) Claire McCaskill-5850 Delmar Blvd., Ste. A, St. Louis, MO 63112
2.) Roy Blunt-7700 Bonhomme, #315, Clayton, MO 63105
United States Representative
3.) Ann Wagner (Maryland Heights Representative)-301 Sovereign Court, Suite 201,
Ballwin, MO 63011 or 435 Cannon House Building, Washington, DC, 20515

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