Fighting Obesity in the United States with State Legislation

1. Fighting Obesity in the United States with State Legislation Stephanie Chan, M.A., M.Phil. Pardee RAND Graduate School June 20, 2012 2012 USPHS Scientific & Training Symposium College Park, MD

2. Obesity Is a Serious Public Health Priority • Excess weight is associated with increased risk of many chronic conditions • Obesity prevalence has doubled for adults and tripled for children in the last 30 years • Disparities exist, but prevalence increased across all socioeconomic groups • Obesity cost $147 billion in 2009

3. The Environment Can Have a Profound Impact on Obesity • Larger food portions increase consumption • Higher availability of food reduces efforts to eat more • More sophisticated food marketing increases the quantity and frequency of food consumption • Sedentary lifestyle increases likelihood of weight gain

4. Given This, There Have Been Calls for an Ecological Approach “Many people believe that dealing with overweight and obesity is a personal responsibility. To some degree they are right, but it is also a community responsibility. When there are no safe, accessible places for children to play or adults to walk, jog, or ride a bike, that is a community responsibility. When school lunchrooms or office cafeterias do not provide healthy and appealing food choices, that is a community responsibility. When new or expectant mothers are not educated about the benefits of breastfeeding, that is a community responsibility. When we do not require daily physical education in our schools, that is also a community responsibility. There is much that we can and should do together.” – David Satcher, The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity,” 2001

5. Legislative Action Is Part of Ecological Approach Macro-level environments (sectors) • Government and political structures and policies • Food and beverage industry • Food and agriculture policies • Economic systems • Food production and distribution systems • Food assistance programs • Health care systems • Land use and transportation Legislative, Regulatory or policy actions Physical environments (settings) Social environment (networks) Individual factors (personal) Story et al. (2008) My research examined legislative approach

6. Today’s Research Addresses Three Questions • What method do we use for describing state legislation used to prevent and reduce obesity? • What do we find when we categorize state legislation to prevent and reduce obesity using that approach? • What do we find when we compare state obesity legislation to research-based recommended policies for preventing and reducing obesity?

7. Method Is Based on Primary Data Collection • Used Database of State Legislative and Regulatory Action (SLRA) as source of obesity legislation • Developed by Centers for Disease Control & Prevention (CDC) • Pertains to nutrition, physical activity, and obesity • Defined new variables to describe legislative landscape • Developed categories for each variable • Performed iterative process of sorting text to identify emerging themes

8. Data Collection Guided by Logical Framework Someone being intervened on (target) Someone intervening (intervener) Goal (Purpose) By an intervention

9. Data Collection Guided by Logical Framework Someone being intervened on (target) Someone intervening (intervener) Goal (Purpose) By an intervention

10. Limited Sample to Relevant Laws for 2001–2010 Number of Observations (CDC) N = 3,402 Number of Unique Bills N = 3,378 Enacted N = 1,409 Vetoed N = 36 Pending N = 391 Dead N = 1,542 Purpose Relevant N = 1,004 Purpose Unclear N = 128 Purpose N/A N = 186

11. Today’s Research Addresses Three Questions • What method do we use for describing state legislation used to prevent and reduce obesity? • What do we find when we categorize state legislation to prevent and reduce obesity using that approach? • What do we find when we compare state obesity legislation to research-based recommended policies for preventing and reducing obesity?

12. Interventions Seek Change in Different Ways

13. Interventions Analyzed Seek to Cause Change Mostly Through Requirements Of 1,004 bills, 5% of bills were Unclear and 4% of bills were Miscellaneous.

14. Targets for Interventions Can Include Numerous Stakeholders

15. Government Entities Are the Largest Group of Stakeholders

16. Interventions Can Target Physical Activity, Nutrition, or Other Obesity Areas

17. Most of Interventions Are Targeted to Physical Activity—Mostly Active Transport

18. Today’s Research Addresses Three Questions • What method do we use for describing state legislation used to prevent and reduce obesity? • What do we find when we categorize state legislation to prevent and reduce obesity using that approach? • What do we find when we compare state obesity legislation to research-based recommended policies for preventing and reducing obesity?

19. CDC Recommends Strategies Based on Literature and Subject Experts Academic Literature Literature Review Search Result: 270 Eligible articles: 94 Identified Strategies:179 Expert Panel Ranked Strategies Recommended Strategies: 24 Group into 6 Categories

20. We Rank the CDC Categories in Terms of the Prevalence of the Laws

21. Less Than Half the Laws Match CDC Recommended Strategies Meets at Least One Recommended Strategy (46%)

22. Of the 46% of Laws That Do Match, Almost Half Support Physical Activity

23. Summary • Obesity legislation seeks to cause change mostly through requirements • Most of the targets being directly affected are government entities • Physical activity is the largest intervention category • Less than half of enacted laws meet the CDC’s recommended strategies • Of those that do match, almost half of laws support support CDC’s recommendation on physical activity

24. Policy Implications • We need to find ways to bridge the gap between research and policy • Legislation can aim to influence other macro-level sectors • Some areas lend themselves to legislative influence more than others • Legislation is only one piece of the puzzle in preventing and reducing obesity

25. Contact: Stephanie Chan, schan@prgs.edu

26. Additional slides

27. Legislative Action Is Part of Ecological Approach Macro-level environments (sectors) • Government and political structures and policies • Food and beverage industry • Food and agriculture policies • Economic systems • Food production and distribution systems • Food assistance programs • Health care systems • Land use and transportation Legislative, Regulatory or policy actions Physical environments (settings) Social environment (networks) Individual factors Story et al. (2008) My research examined legislative approach

28. http://sallis.ucsd.edu/Documents/Sallis%20Houston%20obesity%20conference%20040909.pdf [accessed 3/12/12]

30. Number of legislation Bills by Year and Status

31. Number of Legislative Bills by Census Region

32. Number of Laws Enacted by Year

33. Number of Laws by Region

34. Percent of Purpose Sub-Categories

35. Purpose Sub-Category with Definitions

36. Criteria used by the Select Expert Panel to Rank Strategies

37. Percent of Match with Recommendation Before and After Year 2009

39. Match with Recommendations by Year

40. Purpose Vs. Match Recommended Strategies

41. Purpose Vs. Match Recommended Strategies

42. Intervention Vs. Match Recommended Strategies

43. Target Vs. Recommended Strategies

44. Progression of Prevention Strategies

45. Differences in decision making and persuasion among researchers and policymakers (Brownson et al 2006)

46. Given This, Researchers Are Shifting Toward an Ecological Model to Study Obesity • Previous efforts that focus on the individual through education and behavior treatment have failed • The focus also shifted from treatment to prevention • There are multiple levels of influence for behavior

47. Limitations of the Data • Referenced one data source of state legislation rather than cross-reference with other sources • Search terms for SLRA Database determined by CDC • SLRA Database used different search terms and included more legislative actions starting 2009 • Not all legislation are created equal