OBESITY + PHYSICAL ACTIVITY
Over 36 percent of U.S. adults are obese. The Centers for Disease Control and Prevention (CDC) projects that by 2030 more than 40 percent of all adults will be obese and a CHOICES Project study found that 57% of today’s children will be obese at age 35. . Obesity is linked to higher rates of chronic diseases such as heart disease, diabetes, some cancers, arthritis and poor mental health – the top causes of mortality and morbidity in the U.S. Obesity and weight-related diseases are currently the second leading preventable cause of death in the United States, second only to tobacco. Health care costs related to obesity are estimated to be $147-$200 billion per year.
CHOICES Project researchers identified three interventions that would more than pay for themselves by reducing healthcare costs related to obesity: an excise tax on sugar-sweetened beverages; elimination of the tax subsidy for advertising unhealthy food to children; and nutrition standards for food and drinks sold in schools outside of school meals. Implemented nationally, these interventions would prevent 576,000, 129,100, and 345,000 cases of childhood obesity, respectively, in 2025. The projected net savings to society in obesity-related health care costs for each dollar spent would be $30.78, $32.53, and $4.56, respectively.
POLICIES & PRACTICES
Consumption of nutritious, healthy foods, maintaining a healthy body weight, and regularly engaging in physical activity are important aspects to promoting health and reducing obesity and chronic disease. Local communities are taking action to help their residents do just this.
INCREASE HEALTHY FOOD ACCESS AND CONSUMPTION
HEALTHY FOOD PROCUREMENT POLICIES
Healthy food procurement policies are strategies aimed at ensuring the availability of healthy food options in governmental agencies – or other settings, such as hospitals or schools. Such policies or guidelines give city residents and employees who work at these locations opportunities to make smarter food decisions, which can help them achieve and maintain a healthy weight. Cities can improve access to healthy foods by mandating that a certain percentage of food and beverage options offered in government-funded meetings and events or in vending machines on city property meet healthy nutritional standards.
HEALTHY SCHOOL MEALS
Early child care education and day care programs, as well as schools at all levels, can promote healthy eating by meeting or exceeding federal nutrition standards for school meals, and promoting participation in the National School Lunch and Breakfast programs. They can also ensure food and beverages offered outside these school meal programs is appealing, nutritious, and complies with Dietary Guidelines for Americans. School health guidelines provide advice on how they can assess their healthy eating policies, and increase access to, and increase intake of, nutritious foods such as fruits and vegetables.
ENSURING FOOD ASSISTANCE PROGRAMS SUPPORT HEALTHY EATING
At the local, state, and federal levels, policymakers should ensure that food assistance programs, such as Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC) incentivize healthy choices, and allow recipients to purchase at a variety of vendors, such as farmer's markets.
The District of Columbia Department of Health Produce Plus Program helps low income residents purchase healthy foods by offering recipients of SNAP, Medicaid Temporary Assistance for Needy Families, and Supplemental Security Income, up to $10 per day for visiting a local farmers market. The additional funds supplement the purchase of fresh fruits and vegetables that support positive health for families.
ZONING TO INCENTIVIZE AVAILABILITY OF HEALTHY EATING OPTIONS
Zoning is a means of planning how land is used and can incentivize the development and use of land to promote healthy eating. For example, zoning can be used to limit the number and density of fast food restaurants in a particular area or restrict fast food restaurants within a specified distance from schools or hospitals. Zoning can also be used to foster access to healthier foods, with the creation of farmer’s markets, stands or urban farms, which can also be part of a strategy for increasing household food security and eliminating hunger.
TAXES TO REDUCE INTAKE OF ENERGY-DENSE, NUTRIENT-POOR FOODS
Sugar sweetened beverages are the largest source of added sugar in the U.S. diet. The frequent consumption of these drinks has been linked to higher rates of obesity and a variety of other chronic diseases, including diabetes, heart, kidney and liver diseases. Taxes such as an excise tax (a fee per ounce) or a sales tax (a percentage of the product’s price) have been shown to be effective in reducing consumption of high calorie, nutrient-poor sugar sweetened beverages. An added benefit is that funds generated by these taxes can be invested in other programs that improve public health such as those that make healthy foods more affordable.
In a study of 15 US cities, the CHOICES Project found that “SSB excise taxes of $0.01/ounce will prevent 115,000 cases of childhood and adult obesity in 2025, prevent many new cases of diabetes, increase healthy life years and save more in future health care costs than the intervention costs to implement. Revenue from the tax can be used for education and health promotion efforts and that implementing the tax could also serve as a powerful social signal to reduce sugar consumption.”
INCREASE PHYSICAL ACTIVITY
Cities use a variety of strategies to increase the number of people who meet the physical activity guidelines for Americans.
Schools play a key role in providing youth the opportunity to be physically active and in turn achieve and maintain a healthy weight. Schools can help students become more active by increasing the length of physical education (gym) classes, as well as integrating physical activity into lessons in other classes, and during breaks between lessons. Opportunities to be active should be paired with health education, which teaches students about the importance of engaging in regular physical activity to decrease the risk of adverse health outcomes, as well as encourage physical activity outside of school.
Like other communities across the country, San Antonio is grappling with childhood obesity. In response, they have adopted an effective multi-component school-based obesity program. Rather than focus only on traditional PE classes, their approach includes adoption of a physical education curriculum called SPARK, teaches children about healthy eating, and extends to after-school and family activities. The Win-Win Project, an initiative of the Center for Health Advancement at the Fielding School of Public Health at UCLA, used this San Antonio model to predict outcomes in five locations across the country if similar programs were funded and implemented. Their modeling consistently shows that cities investing in such programs will see positive results in health and education outcomes.
ENCOURAGE ACTIVE TRANSPORTATION THROUGH SAFE ROUTES TO SCHOOL AND COMPLETE STREETS
The Safe Routes to School Program promotes safe, active transportation, including walking and biking, to and from school in order to increase physical activity. Cities can ensure students have safe traveling routes to school through city planning and engineering. These programs can also teach community members about road and traffic safety and reduce unsafe driving, biking and walking behaviors.
Complementary complete streets programs ensure that all community members – regardless of age or ability - are able to travel safely, whether they are walking, cycling, driving or taking public transit. Built environment measures, such as bike lanes and street lights ensure safe transit conditions. By expanding public transportation systems, such as buses, light rails and subways, cities can reduce motor vehicle travel and provide additional opportunities for physical activity such as biking or walking to or from the bus or train stop.
CREATING ENVIRONMENTS THAT ENCOURAGE PHYSICAL ACTIVITY
Healthy built environments are outside spaces where children and families can safely play and exercise. Having safe, well-lit parks or other ‘green space,’ helps community members meet recommended levels of physical activity, while at the same time decrease sedentary activity and screen time activities. Local government sectors, including transportation, urban development and planning, public health, environment and education can collaborate on the best design elements that create safe places for community members to be physically active, as well as increase access to healthy foods.
Multi-component worksite nutrition and physical activity programs include providing information and education to increase employee knowledge about a healthy diet; using behavioral and social strategies (e.g., counseling, skill-building, rewards) to foster positive beliefs and social support; modifying the physical environment to enable access to healthy foods and physical activity at work; and implementing policies or procedures that promote physical and mental wellness.
RESOURCES AND TOOLS
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Note: These are highlights of selected activities going on in cities across the country, and are not meant to be comprehensive.