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While awareness of obesity as a public health menace has grown dramatically, nearly half of all states are failing to act against the problem, according to a new national survey of state-level initiatives.
Twenty-three states received a failing grade for doing little to fight obesity, and three states are doing nothing at all, according to a group of economists and health policy researchers at the University of Baltimore.
At the front line in the war against obesity: Arkansas, the only state to receive a "B" for its efforts. No state received an "A."
"Although a lot of states aren't doing much, almost every state is doing something," says Zoltan J. Acs, PhD, a professor of economics and entrepreneurship, who conducted the study with colleagues Ann Cotton, PhD, Kenneth R. Stanton, MBA, PhD, and others.
The group began by examining initiatives and proposals introduced in state legislatures across the country, and compiled measures into eight categories:
States were rated based on their achievement and given a grade that was a composite of their score in each category. In order to receive an "A," a law had to be passed and enacted. Partial credit was given for introducing legislation, which at least shows awareness of the issue.
Arkansas, which ranks 15th in terms of obesity prevalence, received the top score for passing and enacting legislation to set nutritional standards, limit vending machine usage, measure BMI in schools, mandate physical recess, and establish an obesity commission.
Ten states received a "C," 16 earned a "D," and 23 were given a failing grade for doing virtually nothing. No anti-obesity activity was noted in three states: Arizona, Utah, and Wisconsin.
The group did an analysis of the first five categories, which specifically address childhood obesity. When limited to this population, Connecticut joined Arkansas in earning a "B," but no state earned an "A."
HITTING THE RADAR
Obscured in the analysis are initiatives undertaken at the local levels of government. "Some urban areas are ahead of the curve, but [are] lost in the sampling," explains Acs. "New York City and Chicago have taken steps, including a rigorous program of nutritional standards, vending machine limitations, and exercise programs, but there aren't statewide measures."
Recent news coverage of obesity has brought the epidemic to the attention of state legislators. "It takes a long time to modify preconceived notions as to whether something is an issue," says C. Alan Lyles, ScD, MPH, RPh, a research team member from the school's Health Systems Management faculty.
Although slow to react to obesity as a public health crisis, state law-makers are scrambling to introduce a flurry of legislation. Whether the proposals are translated into action remains to be seen, according to Acs.
"We were surprised how many states had legislation introduced at some level," he says. "When we looked at Maryland in the fall of 2003, there was nothing on the books yet. No legislation had been proposed. Within a very short period of time, as this issue hit the national air-waves, legislators kicked in and realized that this is a real bad problem."
However, in many cases legislation doesn't produce more than good intentions. "The legislation is either pending, inactive, or hasn't been enacted," Acs says. "Most of it is proposed or inactive."
The report card covers the first 6 months of 2004 and will be repeated for the second half of the year. "This is a moving target," says Acs. "We're going to redo this every 6 months."
Efforts aimed at children are particularly urgent because obesity is "going to be a tsunami wave if it isn't addressed soon," says Lyles.
"This is the first generation in which our children will confront at an earlier stage the kinds of chronic and and fatal illnesses that we have confronted in much later years," he says. "It seems to be erasing the potential benefits from the knowledge we've gained from [the] Framingham [Heart Study] and other groundbreaking studies. It's just a sad state of affairs."
The report cards can be found at
www.ubalt.edu/experts/obesity/states.html.
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