States that enacted bills identified approaches that were consistent with recommended strategies outlined in the IOM, with the majority presenting those in the school environment. A few states also identified strategies within a broader community context, especially in more recent years, such as (9) “food and beverage retailing and distribution policies; (13) “nutrition labeling system,” and (16) “health care and advocacy.” Preventive counseling as part of treatment of obesity was included in several health care bills with reference to National Institute of Health guidelines.7 As noted by other reviews, evidence-informed policy making is an incremental progression with public policies evolving over decades.5 As part of this review process, the author noted bill language to support that conclusion. As indicated from 2001 to 2004, the majority of bills enacted were related to establishing a taskforce, addressing school physical activity and nutrition, and coverage of surgical treatment of obesity. In 2005-2006, “bill language” evolved and became more focused, for example, by outlining specific standards for vending and model physical activity programs. Obesity prevention bills directed at the broader public (or community) began to enact in 2006. Although “Taskforce” bills were not evaluated toward specific IOM strategies (since their purpose is to set forth broad study of all strategies), legislation that establishes taskforces, coalitions, and councils can be an important first step for government to set objectives and prioritize strategies and standards that support systems and societal change for obesity prevention. While other publications provide analysis of state-level obesity legislation, this article's methodology reviews with “obesity”-specific enacted legislation defined as a purpose within bill language as a criteria (rather than “obesity-related) and outlines the successful bills (enacted) as they relate to the most recent IOM report.4
This analysis is subject to at least two limitations. First, this is not an exhaustive review of all obesity-related legislations introduced in state legislatures. Although not part of this review, many states have introduced and successfully enacted bills whose intent does not specifically address obesity but that seek to improve healthy food choices and environments that support active living and other IOM-recommended strategies. This review intended to capture the broader state effort toward obesity specifically. It is possible that obesity bills could have been missed in our search process, as the capacities of state databases to how states set the parameters for text searches of legislation vary.8
Over the past decade, state-enacted obesity legislation has evolved from taskforce and school bills predominantly to an increasing number of bills within the other sectors such as health care and the broader community. Also, bill language has become more explicit in describing the action needed to address obesity. in all categories of bills. The success of 30 states to enact legislation that includes elements of the IOM guidance for obesity prevention may provide guidance for other states that seek similar strategies. Moving forward, the IOM report can serve as a useful resource for states and localities as they devise strategies to prevent obesity.
1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord. 1998;22(1):39–47.
2. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010 [published online ahead of print January 17, 2012]. JAMA. 2012;307(5):491–497.
3. US Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2001. Available from: US GPO, Washington.
5. Brownson R, Chriqui J, Stamatakis K. Understanding evidence-based public health policy. Am J Public Health. 2009;99(9):1576–1583.
7. National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Institutes of Health; 1998. http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/index.htm
. Accessed June 2012.
8. Nguyen LM, Eyler AA, Kong J, Brownson RC. State legislation savvy: a primer and tools for online legislative research in the United States. Prev Chronic Des. 2100;9:E20.
Appendix: Institute of Medicine–Abbreviated Strategies (Strategies as outlined in IOM, Appendix B)
1. Physical and built environment
2. Physical activity-related community programs
3. Physical education and physical activity in schools
4. Physical activity in child care centers
5. Science and practice of physical activity
6. Sugar-sweetened beverages
7. Food and beverage options for children in restaurants
8. Nutritional standards for all food and beverages
9. Food and beverage retailing and distribution policies
10. US agriculture policy and research
11. Social marketing program
12. Food and beverage marketing standards for children
13. Nutrition labeling system
14. Nutrition education policies
15. Food literacy in schools
16. Health care and advocacy
17. Coverage of and access to and incentives for obesity prevention, screening, diagnosis, and treatment
18. Healthy eating and active living at work
19. Weight gain and breast feeding
20. School food and beverage standards
*Search conducted under previous system, database has been renamed, restructured, and rereleased as the “Chronic Disease State Policy Tracking System.” Cited Here...
legislation; obesity; policy; public health