Raleigh Report: General Assembly Addressing Childhood Obesity

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Childhood Obesity

Our state and nation currently face a childhood obesity/overweight crisis. The percentage of obese and overweight children is at or above 30 percent in 30 states. Nationally, more than one-third (34.6%) of children ages 10-17 are overweight (18.2%) or obese (16.4%). That’s approximately 25 million children. The obesity rates for children ages 2-19 have more than tripled since 1980. The lack of physical activity and poor eating habits are two of the major factors for this crisis.  Nationwide, less than one-third of all children ages 6 to 17 engage in vigorous activity, and only 19 states have nutritional standards for school meals. Moreover, 8 of the 10 states with the highest rates of obese and overweight children are in the South, as are 9 of the 10 states with the highest rates of poverty.

Before examining North Carolina’s statistics, it is important to explain the difference between obesity and overweight. The formula used to determine whether a child is obese or not is quite complex. It involves the calculation of a child’s Body Mass Index (BMI), which is based on the child’s weight and height. (For children and teens, BMI is age- and sex-specific.) The BMI number is then plotted on the BMI-for-age growth charts (for either girls or boys) to obtain a percentile ranking. A child with a BMI between the 85th and 95th percentile for age and gender is considered overweight, and a child with a BMI at or above the 95th percentile is considered obese. For example, a 10-year-old boy with a BMI of 18 would fall in the healthy weight category, but that same boy would be considered overweight if his BMI was 21 or obese if it was 23. To determine whether a child is healthy weight, overweight, or obese, you can use a BMI calculator found at http://apps.nccd.cdc.gov/dnpabmi/. For more information on this process see: www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html.

Unfortunately, the childhood obesity epidemic is drastically affecting North Carolina. In 2009, North Carolina ranked 14th worst in the nation in childhood overweight and obesity for children ages 10-17, with more than one-third (33.5%) of our children being overweight or obese. The percentage of obese children in North Carolina has increased steadily for more than a decade and shows no signs of slowing. The following table reveals the staggering growth in the numbers of obese children in the state.

High rates of obesity and overweight may be attributed to sedentary lifestyles and unhealthy eating habits among children. In 2008, 48.7 percent of children watched more than two hours of television on a typical day. Over half (54 percent) of the state’s high school students and 40 percent of middle school students were not physically active for a total of at least 60 minutes per day on five days of the week. Nearly 85 percent of high school students and 59 percent of children ate less than five servings of fruits and vegetables each day, the minimum recommended for good health.

It seems that race and ethnicity also play a factor in the childhood obesity crisis in our state. Among children and youth who are white, 28 percent were overweight or obese, compared with 41 percent of African American children. Among children of other minorities, 44 percent were overweight or obese. Additionally, the figure for Latino/Hispanic children is 43 percent, compared to 32 percent for non-Hispanics.

The negative effects of obesity appear in a variety of forms, but one thing they have in common is a lower quality of life. Obese children are almost six times more likely than children with healthy weights to have an impaired quality of life – equal to that of children undergoing treatment for cancer! Adverse consequences due to obesity include the following chronic diseases: diabetes, heart disease, kidney disease and failure, cancer, asthma, and arthritis.

“Reversing the childhood obesity epidemic is a critical ingredient for delivering a healthier population and making health reform work,” said Dr. Risa Lavizzo-Mourey, Robert Wood Johnson Foundation president and CEO. “If we can prevent the current generation of young people from developing the serious and costly chronic conditions related to obesity, we can not only improve health and quality of life, but we can also save billions of dollars and make our health care systems more efficient and sustainable.”

Despite medical advances, the life expectancy of children in the U.S. is likely decreasing due to overweight and associated diseases. Furthermore, obesity is poised to overtake tobacco as the number one cause of preventable death in North Carolina.Regardless of an individual’s health status, ultimately all North Carolinians suffer through increased healthcare costs. In fact,North Carolina taxpayers pay an estimated $2.1 billion annually for obesity-related medical expenses.

Task Force Report

Last year, the General Assembly established the Task Force on Childhood Obesity. In its report to the 2010 session, the task force members listed eight areas for addressing the problem of childhood obesity and encouraging healthy eating and increased physical activity among children. Those eight areas include: (1) early childhood intervention; (2) childcare facilities; (3) before and after-school programs; (4) physical education and physical activity in schools; (5) higher nutrition standards in schools; (6)comprehensive nutrition education in schools; (7) increased access to recreational activities for children; and (8) community initiatives and public awareness. The full report can be accessed at http://www.ncleg.net/documentsites/legislativepublications/Study%20Reports%20to%20the%202010%20NCGA/Childhood%20Obesity%20.pdf.

The following is a summary of bills introduced by the Task Force and updates on those for which there has been some activity.

H 1726/S 1287, Improve Child Care Nutrition/Activity, would require nutrition standards for child care facilities that include a prohibition on sugar-sweetened drinks, a limit of no more that four to six ounces of juice daily to kids over a year of age, and a requirement that reduced-fat milk be served to kids over two. In addition, the state would study how much physical activity kids have in child care facilities, with an eye towards whether they are getting enough exercise to prevent problems of overweight and obesity. (Update: H 1726 has passed second reading in the House. It was amended to include flavored milk in the prohibited foods and to clarify the wording regarding reduced-fat milk and juice.)

H 1756/S 1289, Update Statewide Nutrition Standards, would require statewide nutrition standards in public schools to meet recognized national standards. This includes adding all candy, snack food, and beverages sold or offered to the students (except those offered during a celebration) to the items that fall under the new standards. The standards would be reviewed and updated every three years, and new updates would be required as needed in order to meet any federal changes. Furthermore, the state would be required to make information about the standards and a system for reporting inconsistencies in implementation available free to the public on the Board of Education’s website. (Referred to House Health Committee and Senate Health Care Comm.)

H 1757/S 1296, Physical Education and Activity in Schools, would require the schools to use evidence-based fitness testing for grades K-8 beginning with the 2010-11 school year. (Update: H 1757, now titled Fitness Testing in Schools, has been amended to require the state to develop guidelines for the use of evidence-based fitness testing for students in grades K-8, but not to actually require its use. It has been re-referred to House Education.)

H 1774/S 1285, Eliminate Reduced Price School Meals/Funds, would allocate $5.2 million to eliminate the cost of reduced price lunches for students who qualify for reduced price meals, thereby making them free lunches. (Referred to House Education Committee and Senate Appropriations.)

H 1775/S 1151, Supplemental Nutrition Assistance Program, would require the Department of Health and Human Services (DHHS) to examine ways to expand and enhance the Supplemental Nutrition Assistance Program (SNAP) and provide a three-year plan to do so. DHHS would be required to report its findings and recommendations by September 1, 2011. In addition, DHHS would be required to solicit proposals from nonprofits for the implementation of new programs by April 2011 to educate consumers on nutrition, physical activity, and obesity prevention. (Update: S 1151 has been passed by the Senate and is up for a vote in the House.)

H 1776/S 1288, Electronic Funds Transfers at Farmers Markets, would require that $200,000 of the Division of Social Service’s funds for 2010-11 be used to issue the request for proposals to enable farmers markets to accept payments by electronic funds transfer. (Referred to House Health Committee and Senate Appropriations.)

H 1827/S 1153, Legislative Task Force on Childhood Obesity, would continue this task force until 2012 and require a final report to the 2012 session of the General Assembly. (Update: S 1153 has been passed by the Senate and is in the House Rules Committee.)

H 1832/S 1284, Farm to School Program/Funds, would appropriate funds and create a position in the Department of Agriculture to oversee the Farm to School program, which uses locally grown fruits and vegetables in public school meals. The Department would be required to report annually on the program. (Referred to House and Senate Appropriations Committees.)

H 1904/S 1286, Screen and Reduce BMI Levels in Children, would require the Department of Health and Human Services to explore the feasibility of requiring providers enrolled in Community Care of North Carolina to implement BMI screening for children who are enrolled in Medicaid or are participating in NC Health Choice. In addition, it would require the Department to consider establishing performance goals, developing a uniform protocol, and implementing reliable data collection methods that would assist in screening weight categories that may lead to health problems. (Update: S 1286 has passed the Senate and is in the House Rules Comm.)

On Other Matters

Indications are that an agreement has been reached on the state budget, and the report of the Conference Committee will come to the House and Senate this week. After adoption of a budget, adjournment is usually not far behind.

Here’s a status update on other bills of interest to Raleigh Report network members:

S 140, Protect Victims/Domestic Violence Shelters, has been signed into law.

S 704, Reform Low-Performing Schools, has been signed into law. It will permit local school boards, with approval of the State Board of Education, to reform low-performing schools according to one of four models, up to and including closing down the school entirely.

S 1015, Homeowner and Homebuyer Protection Act, would prohibit foreclosure rescue scams, a critical step at this time when so many NC homeowners have fallen behind on their mortgage and are desperately looking for ways to save their home.  The bill also addresses abusive real estate practices that take advantage of vulnerable North Carolinians looking for an alternative path to homeownership, such as “rent to own” contracts, and certain lease with an option to buy transactions. (Current status: S 1015 has passed the Senate and is in the House Judiciary 2 Committee.)

S 1216, Extend Emergency Foreclosure Program, continues and expands the State Home Foreclosure Prevention Project, which the NC Office of the Commissioner of Banks (NCCOB) and the NC Administrator of the Courts have administered since November 2008.  This program provides assistance to homeowners who have fallen behind on their mortgage, linking them with housing counselors and others who can work with them to save their homes. SB 1216 expands the reach and impact of this program by:

  • Expanding it to cover all home loans, not just subprime loans made between 2005-2007;
  • Extending it through May 31, 2013. It is now scheduled to end this November 1; and
  • Establishing a State Home Foreclosure Prevention Trust Fund, funded through a $75 pre-foreclosure filing fee, with funds allocated to:
    • NCCOB to cover the administrative costs of the program, including managing the Administrative Office of the Courts database, and
    • Non-profit housing counseling agencies & legal service providers for their foreclosure prevention services.
    • Any remaining funds would be directed to the NC Housing Trust Fund.

(Current status: S 1216 has been passed by the Senate and is now up for a floor vote in the House.)

S 1338, Fire Safe Cigarettes, has been re-referred to the Senate Finance Committee.

H 80, Ban Electronic Sweepstakes, has been passed by the Senate and returned to the House for concurrence the Senate bill. (The Senate took an unrelated bill and turned it into a ban on sweepstakes intended to circumvent the state’s ban on video poker). The bill is in House Judiciary I, which will recommend whether or not the House accepts the ban on electronic sweepstakes.

H 1682, Corporal Punishment for Children with Disabilities, has been amended to require reporting on the use of corporal punishment to include race and ethnicity (not just race) and the reason for the corporal punishment. It has been re-referred to the Senate Education Committee.

H 1803, Review NC Programs for Climate Change Impacts, has been amended to prohibit state agencies from implementing any recommendations growing out of this bill without authorization from the General Assembly. It has been re-referred to the House State Government Comm.

H 1804, Energy Policy Council Green Energy Study, has been amended to delete the study of a ban on new coal-fired power plants and to add a study of new nuclear power. In addition, the bill now calls for evaluating (but not necessarily increasing) the amount power companies would have to pay for renewable energy generated by consumers and put on the grid. The study also includes 3rd party administration of energy efficiency programs, taking these programs out of the hands of the companies which generate and sell electricity. It has been passed by the House.

H 1879, Study Raising Compulsory Attendance Age, has been re-referred to the House Rules Committee.

H 2015, Study Impact of Toxins on Health, would have required a study by the Environmental Review Commission. It has been amended to authorize (not require) such a study and to include the state’s departments of Environment and Natural Resources (DENR) and Health and Human Services (DHHS) as participants. It has been re-referred to the House Health Comm.

H 2076, Honor ADA 20th Anniversary, has been passed by the House and sent to the Senate. It honors people with disabilities and their advocates and commemorates the 20th anniversary of the passage of the Americans with Disabilities Act.

I hope you will allow me a personal word here. My best friend from our high school days until his death in 1989 (and the best man at my wedding) lived with a rare physical disease which confined him to his bed or his specially modified wheelchair for much of the last two decades of his life. His family moved to northern Virginia after he completed high school, and he became deeply involved in the disability rights movement. His death came about a year before the ADA was signed into law by the first President Bush, but his impact in securing its passage was such that his parents were invited to the White House bill signing ceremony in his honor. I took John to places all over the Washington, DC, area, and he always had to call ahead to find out if he could get in. For him, “just a couple of steps” might as well have been an eight-foot brick wall in terms of how much it limited his access. I learned from John and from his experiences of not being able to access public places just how much the ADA was needed, and I still marvel occasionally at how important it has been in improving the quality of life for those with physical and/or mental disabilities.

Giving credit where credit is due:

  • to Curt Lowndes, Council summer intern from Duke Divinity School, for the report on childhood obesity. Footnote citations are available upon request.
  • to the Center for Responsible Lending for the summaries of S 1015 and S 1216.

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