Weight Control | Weight Loss | Healthy Weight at WeightControl.com

My research focused on state responses to the dramatic rise in childhood obesity, especially with regard to the built environments of low-income and minority children.  Specifically, I was interested in what the scientific literature had to say regarding the relationship between the built environment and childhood obesity, and what types of legal strategies State’s are using to regulate the built environment to provide greater access to healthy food sources, decrease access to unhealthy food sources, and provide more physical activity resources for the most affected children.

What I found is that there is growing scientific evidence to support the connection between a child’s built environment and his or her risk of being overweight or obese.  Specifically, many studies indicate that low-income and minority children are more likely to live in neighborhoods characterized by higher crime rates, more abandoned and dilapidated homes, more trash and debris, more traffic and congestion, much more fast-food restaurants and convenience stores, less access to grocery stores, less access to green spaces, less access to physical activity resources, and less access to sidewalks and neighborhood connectivity.  Children who live in environments characterized by these physical attributes are much more likely to be racial minorities and/or low-income.  They are also much more likely to be overweight or obese than children whose physical environments don’t share these characteristics.

There are a number of ways that States and localities are attempting to regulate these built environments in order to provide greater access to healthy foods, decrease access to unhealthy foods, and increase access to green space and physical activity resources.  Some of these include creating task forces to reduce red-tape, expedite permitting, and provide low-cost financing for large grocery stores wanting to enter low-income markets.  The Pennsylvania Fresh Food Financing commission is a prime example of this type of initiative.  States are also passing laws promoting “Farm-to-School” programs where school children learn about growing food, cultivate school gardens, and learn how to create meals using the produce they grow.

Cities are also establishing initiatives for community gardens, and States are passing laws ensuring protections for communities that wish to have these gardens.  States are using zoning regulations to decrease the number and density of fast-food restaurants in low-income areas.  Los Angeles, California, for example, passed a moratorium on the construction of any new fast-food restaurants in certain areas of Los Angeles characterized by high fast-food density and low property values.  Oakland, California, recently made the news for passing regulations banning “Happy Meals” that offer children toys along with certain fast-food items.

States are increasing access to physical activity resources in several innovative ways.

• First, many States are passing laws allowing, and even encouraging, joint-use agreements which allow communities to enter into agreements with local schools so that community members may use school facilities and equipment before and after school hours and on weekends.  Some school districts are even using these agreements to help share the cost of developing new facilities with the local communities which will benefit from their use.  This is a simple and cost-effective way to create more access to physical activity resources in low-income areas.
•  Second, States, with the help of Federal money, are also encouraging children to walk or bike to school through initiatives such as the Safe Routes to School Program.  Forty years ago, the vast majority of children walked or biked to school.  Today, very few children are able to do this.  Safe Routes to School Programs provide money to repair or create physical infrastructure, such as bike paths and sidewalks, so that children can safely walk or bike to school.  These programs may also provide money for cross-walk guards and other monitors to ensure that children reach school safely.
• Third, States, such as California, are passing “Complete Streets” legislation mandating that new road construction must include bike-lanes and better accommodate alternative forms of transportation, including bikes, pedestrians, and mass transit.

Ultimately, I found that States are using legal tools in a variety of ways to try and combat the childhood obesity epidemic.  Some states, such as Delaware are focusing on education, while states such as Mississippi are mandating that insurers cover bariatric surgery.

Were any of the findings unexpected?

While childhood obesity is increasing in almost every demographic, it was quite alarming to see how disparately low-income and minority children are impacted compared to their white counterparts.  It was also interesting to see the wide spectrum of legal approaches states are using to try and combat childhood obesity.  This speaks to the genius of our federalist system where States can act as laboratories for legal strategies to see what works and what doesn’t.  The fact that many of the states hit hardest by this epidemic, such as Mississippi, haven’t enacted any of these laws was also very interesting.

What should clinicians and patients take away from this study?

For clinicians, I think having a more nuanced understanding of the problem is helpful in and of itself.  Patients and clinicians alike can also actively lobby their state representatives, city officials, and local school boards to try and get some of these initiatives enacted locally. What recommendations do you have for future research as a result of your study?

We still need much more in-depth studies to better understand the relationship between the built environment correlates and obesity.  Also, it is very difficult to quantify the impact that these various laws are having on the problem.  We need much better inter-disciplinary cooperation between scientists, lawyers, and other professionals that can help design, implement, and interpret studies geared toward measuring the impact of such public health laws on public health outcomes in a more precise manner.