The global prevalence of childhood obesity/overweight in children and adolescents aged between 2 and 19 has risen rapidly over the past 30 years to epidemic proportions. According to Ogden, Carroll, Kit, and Flegal (2014), up to 16.9% of the children in the US could be diagnosed as obese (BMI≥30.0) while the population that is either overweight (≥25) or obese stands at 31.7%.
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Further, obesity-related costs consume a significant portion of the public health budget, estimate at $150bn yearly (Ogden et al., 2014). In addition, childhood obesity increases the risk of chronic disease and leads to poor physical/social health outcomes. The rising recognition of the role of preventive interventions should be followed by systematic policy actions to reduce childhood obesity. Enacting a vending machine policy would ensure schoolchildren consume healthier food to curb the obesity epidemic.
My choice of the childhood obesity issue for this paper was informed by its serious physical and social consequences on the child, impacts on public health spending, and the apparent policy gaps in addressing it. An elevated BMI in childhood is considered a risk factor for chronic conditions, such as heart disease, certain cancers, and hyperglycemia (Karnik & Kanekar, 2012). In addition, obese or overweight children lead poor a quality of life owing to constant harassment, bullying, low self-esteem, and social exclusion. The proposed policy action entails replacing unhealthy snacks and beverages in vending machines with nutritious alternatives in schools.
The childhood obesity issue is relevant to public health in two ways: its effects on child health outcomes and public health costs. According to Ogden et al. (2014), obesity affects up to 16.9% of American children and young people (2-19 years) with a prevalence increase of 13.1% among 6-11-year-olds from 1980 baseline. Childhood obesity contributes a significant economic burden to our public health system, estimated to be $150bn yearly (Ogden et al., 2014).
It is also a significant risk factor for hyperglycemia, hypertension, colorectal cancer, and cardiovascular disease, among others (Karnik & Kanekar, 2012). These non-communicable diseases (NCDs) account for the high co-morbid illnesses and premature deaths in children. Thus, childhood obesity is a serious public health problem that needs effective policy action.
An effective childhood obesity policy, such as a school nutrition law, could save the country millions in expenditure for managing obesity-related chronic disease or NCDs. The cost-effectiveness of a policy action, whether additional or incremental, determines its feasibility for public funding. The annual cost of obesity in the US is about $150bn, equivalent to 9% of entire health care spending (Troiano, Briefel, Carroll & Bialostosky, 2006).
Child admissions due to obesity-related type 2 diabetes and sleep apnea have increased the annual hospitalization costs to over $127 million (Troiano et al., 2006). Thus, a cost-efficient program could help reduce the financial burden of NCDs related to childhood obesity. State appropriations for nutrition funding could be the source of funds for the childhood obesity policy.
While I support public health programs for reducing childhood obesity, I do not find the idea of the government assuming a stewardship role in the childhood obesity policy to be appropriate. Two values shape this personal perspective. First, I believe in the non-coercion of individuals into adopting healthy lifestyles. Second, I do not support the idea of developing and implementing interventions without the involvement of the affected populations or age groups.
Ethical Principal or Theory
The ethical principle underpinning my libertarian perspective is autonomy. Individual autonomy gives the affected populations the right to choose their medical care. In the case of minors, parental involvement in policymaking may be justified. This principle calls for informed consent or agreement with the parents or community subgroups before implementing a childhood obesity intervention. This approach would ensure a combined and stakeholder-informed preventive action to reduce childhood obesity.
Effective policy change at the state level requires a top-down approach that will see an enactment of school nutrition legislation. The decision-maker who will receive this policy brief for initial consideration is Angus King, a member of the U.S. Senate from Maine, who will then forward it to the legislature for consideration.
The rising prevalence of childhood obesity is a public health threat in the US. Studies indicate that over 16% of children are obese, a dramatic increase from the 4% prevalence reported in 1970 (Troiano et al., 2006). This worrisome trend should thrust this issue into the attention of any legislator, including Angus King. Maine has one of the highest childhood obesity in the country, at 24.9% in all its 12 counties (Lehnert et al., 2013). The high prevalence of childhood obesity is a cause for public concern due to its impact on public health spending.
The cost implication of high BMI for public health spending is significant due to an elevated risk of NDCs and metabolic disorders. The prevalence of obesity-related chronic disease is rising with a significant impact on healthcare costs. The CDC estimated that obesity/overweight-related costs amount to $150 billion annually with half of this cost reimbursed through the Medicare and Medicaid programs (Troiano et al., 2006). As adolescents grow into young adults, the cost of adult obesity will continue to rise. Given its high economic impact, decision-makers should support a vending machine statute to reduce the obesogenic risks in the school environment.
Addressing childhood obesity through vending machine legislation may face challenges related to personal rights and funding constraints. Policy proponents often advocate for population-based policies, including interventions in schools, to support healthy dietary behaviors and physical activity in children (O’Connor, Yang & Nicklas, 2006).
They contend that the society has an obligation to vulnerable groups, including minors, from health risks. However, some groups, e.g., adolescents, may feel that state intervention is not justified, as dietary habits are a matter of personal responsibility. The policy could also face stiff opposition from schools as it limits the food product range and food vending in schools.
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There are also challenges at the community level. In low-income neighborhoods, the opportunities for nutrition education are limited, making it difficult to promote changes in dietary habits. The issue of affordability of nutritious food to children could also be a challenge to the vending machine legislation. Additionally, low-income households may find fresh organic food costlier than snacks. Thus, these communities may oppose a public policy that promotes healthier food options that are expensive to acquire.
The consideration of a public health policy for public funding depends on its cost-effectiveness. The decision-maker may face a challenge gaining federal support in terms of funding of this policy. State or federal appropriations are the main source of funding for childhood obesity interventions. Since the policy will seek to introduce healthier food choices in schools, additional costs will be incurred in terms of subsidies to the food supply chain to promote affordability and accessibility of low-calorie food in schools. Therefore, the source of funds to offset the additional costs may be a challenge to the implementation of this policy.
Besides school-based interventions, other viable options available to the senator include menu-calorie labeling, soft-drink levies, nutrition/physical education, and introducing standards for food advertising. A variety of alternative policies exists for reducing childhood obesity. The decision-maker could initiate a bill to enact menu-labeling laws that will ensure all food products meant for children to display calorie information (St-Onge, Keller & Heymsfield, 2003). He could also a legislative proposal to increase the tax on low nutritional products, e.g., soda, to reduce consumption.
Community nutritional education is another strategy for reducing obesity and related chronic diseases. A statewide policy to promote nutrition and physical activity through community-school partnerships could help curb the obesity epidemic in children. The senator can also support the passage of legislation requiring all television adverts targeting minor audiences to promote healthier foods.
A policy on responsible food advertising could help reduce childhood obesity as children mimic the dietary behaviors they see in these ads (St-Onge et al., 2003). A BMI surveillance legislation to compel schools to monitor the BMI of schoolchildren annually could support the effort to reduce obesity and related NCDs.
The selected policy option is the best among the aforementioned alternatives because it promotes healthy nutrition to schoolchildren. Schools have a moral responsibility to offer healthy food to children and promote physical activity (St-Onge et al., 2003). Therefore, interventions in schools cultivate healthier behaviors in children to help reduce obesity in adulthood. As the next step, the decision-maker should collect data on school diets and physical activity before organizing stakeholder workshops to promote buy-in and support for the policy.
Course of Action
Assessing the present distribution of the obesity burden in the school-going population in the country will provide key information for seeking legislative support for the vending machine legislation at the Senate committee level. In particular, gathering and disseminating information about the nutritional content of food sold through school vending machines could argue (evidence-base) the case for the enactment of the legislation.
The process should involve an integrated action, bringing together various stakeholders, including school management, food companies/suppliers, parents, student representatives, nutritionists, and the community (St-Onge et al., 2003). In this way, the challenge of acceptability will be overcome, as the stakeholders will participate in the policymaking process.
In developing the policy, an effective implementation plan is required. The decision-maker should seek to have complementary laws enacted at the state, county, and school levels with the support of lawmakers at these administrative units. Further specific actions include community and resource mobilization and advocacy initiatives to create awareness and build the capacity for implementation. The early resource mobilization will help overcome the funding constraints identified.
The plan should adopt a stepwise approach to enable implementers at the county level to adapt the policy to local situations and overcome implementation barriers, such as opposition from stakeholders (Minkler, Garcia, Rubin & Wallerstein, 2012). Further, the planning process should involve consultation and coordination with the community, private sector, and public health practitioners. The underlying philosophy is that involving the stakeholders in implementation will build the political support for the policy.
Success of the Policy Brief
The policy brief uses a top-down approach developed to achieve the ultimate objective of reducing childhood obesity. In a top-down approach, a policy originating from a person or regulatory authority is implemented in an authoritarian fashion with the affected people expected to comply (Minkler et al., 2012). The decision-maker will sponsor the bill in the Senate, which upon approval will be assigned to the committee on health for examination.
A bill passed by the committee is debated in the Senate and the House of Representatives to develop joint resolutions for assent by the president (Minkler et al., 2012). Therefore, the impact of the policy on childhood obesity will be assessed with a multi-level evaluation design to determine the success of the policy at the state or government and school levels. At the state government level, the indicators of the success of this policy will be the formulation of consistent messages to improve policy practice and remove obstacles to promoting healthy behaviors.
The local authorities/professional organizations will be required to develop complementary policies to the vending machine policy. In addition, they will create regulations to control the food supply chain to avoid food rich in sugars/saturated fats being sold in schools. They will also enforce this policy through the department of health or education. Therefore, the indicators of the success of this policy brief at the local authority level will be the formulation of complementary policies, food supply regulation, and enforcement.
Organization or Community
The Maine Center for Public Health (MCPH), a non-profit organization dedicated to public health promotion, has expressed interest in the vending machine legislation policy to control childhood obesity in the state.
Summary of Expressed Interest
The Center’s interest in this policy issue relates to its role in promoting preventive health habits in the Maine community to lower the risks of chronic diseases due to lifestyle factors. It considers childhood obesity/overweight an epidemic in America due to a twofold increase in prevalence in 6-17 year-olds over the past three decades (CDC, 2016).
Thus, if left unabated, childhood morbidity and mortality in children could rise dramatically. According to the Center, adolescents have more than doubled their soft beverage intake at the expense of milk and fruit consumption (Action Packet, 2012). Further, the Center feels that nutrition-related issues, including childhood obesity, are a community responsibility.
I will use three CBPR principles to work with the MCPH to address a policy change for the childhood obesity issue. The first principle is the recognition of the “community as a unit” (Minkler et al., 2012, p. 1). The community, in this case, will comprise of students, family members, teachers, school administrators, and food service personnel, among others. The second CBPR principle I will use is leveraging on “community resources and strengths” to build the policy (Minkler et al., 2012, p. 2). The third principle is collaboration/partnerships involving the community members and shared accountability throughout the policymaking process.
Approach and Collaboration
My plan for approaching and collaborating with MCPH involves is to convene stakeholder meetings to discuss the childhood obesity issue in Maine. Specific invitations will be sent to interested organizations, including MCPH. Subsequently, a committee on the vending machine policy will be constituted with members drawn from various organizations. The collaboration will encompass the formulation of a model vending machine policy, piloting, evaluation, and dissemination across Maine.
The goal of MCPH’s initiative is to strengthen the capacity of physician practices to control obesity/overweight through training of teams and community linkages (Action Packet, 2012). The goal of the vending machine policy is to reduce childhood obesity by replacing non-nutritious food in vending machines in all schools with healthy alternatives. While MCPH’s goal centers on improving physician-community linkages, it is aligned with the goal of vending machine policy in the sense that they both emphasize on linking communities with schools.
A sample action step for achieving the goal of this policy is having all schools adopt the CDC list of allowable items that can be sold in schools. The school committee must sanction additional food products not included in this list. Additionally, items offered through the vending machines should be sourced from certified food suppliers. Food promotions or dissemination of food items to students within or near schools should be prohibited.
Officials from the MCPH will be part of the policy-drafting committee. As the people involved in promoting healthy community practices, their role in the committee will be two-pronged. The first set of roles will be problem-solving tasks. This will entail identifying ways of working with interested groups collaboratively and anticipating the political dynamics related to the policy. The second set of roles will be capacity building and civic engagement to promote awareness. The officials will organize public hearings involving youth/community groups, the private sector, and experts to create awareness on childhood obesity risk factors.
Key Elements of Evaluation Plan
In developing an evaluation plan, a collaborative approach will be adopted in determining the minimum nutritional rule for snacks sold in schools. This process resonates with a CBPR principle that emphasizes on co-learning and capacity building with respect to policy development and evaluation. Identifying the nutrients to be assessed in the food items will bring together school administrators, dietitians, parents, and MCPH. Other evaluation elements will include the policy-making process and its impact on health measures for schoolchildren.
The success of the organization (bottom-up) plan will be evaluated based on three indicators. First, the number of people attending the public hearings/meetings will indicate a high acceptability of the childhood obesity policy. Second, an active participation of the community groups and schools in the policy-making process will be an indicator of community support for the policy. Third, a mutual acceptability of the minimum nutritional value rule to all parties will be another indicator of the plan’s success.
Strengths of Each Approach
The involvement of the Senate/authority in the top-down approach has the advantage of fostering compliance. In addition, the approach attracts vast capacities, human resources, information, and funding to bolster the implementation of the childhood obesity policy (Minkler et al., 2012). The strengths of the bottom-top approach lie in its uncomplicated administrative system, collaborative nature, shortened decision-making process, and enhanced linkages (Minkler et al., 2012).
Challenges of Each Approach
Top-down implementers face challenges of a complex administrative structure and varied interests, which may derail the implementation of the regulatory policy. In contrast, the bottom-up approach is limited by inadequate capacities. However, due to its distributive nature, its financial cost is low.
Most Effective Approach
Both approaches have limitations that influence the implementation process. While the top-down approach may ensure a rapid and extensive adoption of the childhood obesity policy, its administrative complexity and authoritarian model could lead to opposition from community groups. I would recommend the bottom-up approach because its collaborative model may ensure a more lasting and elaborate impact on childhood obesity in the country.
Action Packet. (2012). The Soda/Snack Vending Machine Policy Initiative.
Centers for Disease Control and Prevention [CDC]. (2016). Childhood Overweight and Obesity: Obesity Facts.
Karnik, S. & Kanekar, A. (2012). Childhood Obesity: a Global Public Health Crisis. International Journal of Preventive Medicine, 3(1), 1-7.
Lehnert, T., Sonntag, D., Konnopka, A., Riedel-Heller, S., & Konig, H. (2013). Economic Costs of Overweight and Obesity. Best Practice & Research in Clinical Endocrinology & Metabolism, 27(2), 105-115.
Minkler, M., Garcia, A., Rubin, V., & Wallerstein, N. (2012). Community-Based Participatory Research: A Strategy for Building Healthy Communities and Promoting Health through Policy Change.
Nicklas, T., O’Neill, C., & Kleinmen, R. (2008). Association between 100% Juice Consumption and Nutrient Intake and Weight of Children aged 2 to 11 Years. Achieves of Pediatric and Adolescent Medicine, 162(6), 557-565.
O’Connor, T., Yang, S., & Nicklas, T. (2006). Beverage Intake among Preschool Children and its Effect on Weight Status. Pediatrics, 118(4), 110-118.
Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. Journal of the American Medical Association, 311(8), 806-814.
St-Onge, M., Keller, K., & Heymsfield, B. (2003). Changes in Childhood Food Consumption Patterns: A Cause for Concern in Light of Increasing Body Weights. American Journal of Clinical Nutrition, 78(6), 1068-1073.
Troiano, R., Briefel, R., Carroll, M., & Bialostosky, K. (2006). Energy and Fat Intakes of Children and Adolescents in the United States: Data from the National Health and Nutrition Examination Surveys. American Journal of Clinical Nutrition, 72(5), 1343-1353.