Social Policy is Health Policy is Law
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Most of the legislation addressing obesity is developed at the state and local levels. For example, some school districts in the country are using newly implemented laws and or their existing legal authorities to improve nutrition, increase physical education programs, and monitor childhood obesity through BMI screening. A watershed year for such legislation, 2005, saw the passage of 17 state statutes relating to school-based nutrition and 21 related to physical education programs. Other legislation includes restricting access to vending machines, and introducing fresh, locally grown produce into school nutrition programs. To date, states have not imposed advertising and marketing limits on products that contribute to obesity rates, though we can anticipate such attempts in the future. In part because the laws have not yet been evaluated, they have not been widely adopted throughout the country.
Information Resources: An Assessment
In 2003, Arkansas was the first state to legislate statewide BMI measurements with school health report cards. These report cards provide parents with their child's BMI percentage by age, and the results of vision and hearing screening. Ifthe child is considered at risk for being overweight or is overweight or under-weight, parents are provided local resources and contact information for potential health care providers. The Arkansas program has had a mixed reception from parents, health practitioners, and the media. Critics of program have raised self-esteem, stigmatization, and disordered eating concerns. In 2005 and 2007, bills were proposed to repeal the controversial law, but neither was enacted. Instead, in 2007, a law was enacted which changes the frequency of BMI screening (from every year to every other year), and allows parents to opt their children out from screening.
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As noted above, we believe that a focus on the built environment is likely to achieve substantial gains in reducing obesity. Legal strategies should include incentives to facilitate individual behavioral change and simultaneously stimulate cultural change in behaviors that individuals can control. Steady changes in cultural attitudes played a significant role in reducing adult smoking, youth tobacco initiation rates, and smoking in public places. Legal intervention played an important role in facilitating those cultural changes, which needs to be replicated in reducing obesity rates.