How fitness professionals can help shape federal and state efforts to improve the health of our country’s citizens.
As Americans have continued to eat more and exercise less over the past decade, health and fitness experts have focused their efforts on inspiring healthful change one individual at a time. Unfortunately, this approach has not improved the nation’s obesity crisis, nor has it increased adherence to healthful eating habits and regular physical activity programs. This is not necessarily because people lack the willpower and motivation to change; it is more because our very environment discourages many health-promoting behaviors.
Americans now eat at least one-third of their daily calories away from home, according to the Center for Science in the Public Interest (CSPI 2009b). Worse yet, most diners are oblivious to the exorbitant calorie counts in some of the most popular restaurant offerings (who knew a Chipotle burrito contains nearly 1,000 calories? [Chipotle Fan.com 2009]).
At home, our highly impressionable kids are exposed to a barrage of ads on television that tout sugar- and fat-laden junk food. With modern conveniences, such as remote controls, elevators, car washes, washing machines, leaf blowers and drive-through windows, we expend 8,800 fewer calories per month than we would without these aids; over the course of a year, that equates to about 30 pounds of fat (Blair & Nichaman 2002). Given this toxic environment, it’s no surprise that Americans are constantly battling the bulge.
Fortunately, policymakers at all levels of government have taken note of this dilemma. With steps ranging from a trans fat ban in California restaurants to mandatory nutrition labeling in New York, regulators are changing federal and state policies to improve the health of the nation’s citizens. Here is a look at some of the most innovative and health-promoting policies on the books right now or in the works for tomorrow.
According to the American Medical Association (AMA), several policy strategies can be effective in helping the population improve nutrition and physical activity habits and, hopefully, in reducing obesity rates and enhancing overall health (Gostin 2007). The following sections outline these strategies, along with any relevant legislation and initiatives.
Imposing higher taxes on calorie-dense and nutrient-poor foods might lower consumption of unhealthy foods and generate revenue to subsidize programs that promote better choices.
New York Governor David Paterson sparked a firestorm last December when he suggested imposing an “obesity tax” on nondiet sodas and quasi-fruit drinks that contain less than 70% natural fruit juice (Chan 2008). Analysts anticipate that such a tax would generate more than $400 million per year for the state’s health programs while also reducing obesity rates (Chan 2008). Paterson claims that the tax could curb consumption of the drinks in question by 5%, but he has also acknowledged that it will take more than a surcharge on sugary beverages to address the country’s obesity crisis. The governor cited other necessary strategies, such as eliminating junk food in schools, increasing physical activity and boosting availability of healthy foods in low-income communities (Paterson 2008). Opponents argue that the proposed tax will not change behaviors and instead will lead to job losses at beverage companies and to unhappy residents.
To date, efforts to impose similar taxes in other states have fallen flat. The Maine State Legislature approved increased tax on sodas and sugary syrup, but voters overturned the measure. San Francisco Mayor Gavin Newsom considered imposing a new fee on large retailers that sell sugary drinks, but that measure has stalled as of this date (Chan 2008).
Other municipalities are finding ways to prohibit harmful ingredients in foods that pose a risk to the public’s health. New York City was the first U.S. city to impose a trans fat ban in all city restaurants, effective July 2008. Soon after, California passed a statewide restaurant ban on trans fat, which eateries must comply with by January 1, 2010. Boston, Philadelphia and several other jurisdictions have since followed suit.
These local bans have had a national impact. In May 2008, McDonald’s was the last of the major fast-food chains to eliminate trans fat from french fries, and from all foods sold in the chain’s New York restaurants. The company promised to entirely eliminate trans fat in all restaurants by the end of 2008, but several items on the menu still contain considerable amounts of the artery-clogging stuff (McDonald’s 2009).
Regulating the Food Marketed to Youth
A strategy that targets kids’ health in particular calls for restricting food advertising during children’s programs; funding counteradvertising to promote good nutrition and physical activity; and limiting use of cartoon characters. Although it may be unconstitutional to place an outright ban on ads for unhealthy foods, public pressure has inspired some manufacturers to self-regulate their products.
In 2006, the Better Business Bureau launched the Children’s Food and Beverage Advertising Initiative, which is intended to encourage healthier dietary choices and lifestyles among children younger than 12 years. Many of the largest food marketers in the country are members of the initiative, which requires that companies pledge to take these steps:
- Market to children only those foods that are healthy and are consistent with health claims authorized by the Dietary Guidelines for Americans, MyPyramid and the Food and Drug Administration (FDA).
- Reduce use of licensed cartoon characters to promote unhealthy foods.
- Agree not to pay for or seek food and beverage product placement in editorial or entertainment content directed toward young kids.
- Incorporate healthier foods into interactive games targeted to young children.
- Refrain from marketing foods or beverages in elementary schools (Council of Better Business Bureaus 2006).
Despite these pledges, some members of the initiative persist in marketing unhealthy food. For example, Nickelodeon continues to use cartoon characters, such as SpongeBob SquarePants and Dora the Explorer, to market unhealthy foods; what is more, 79% of foods the company advertises are of low nutritional value (CSPI 2008b).
Many school districts in the nation have already removed vending machines, provided healthier menus and offered more physical activity opportunities for schoolchildren. However, much work remains to be done. Over the past few years, several policies have been implemented to make the school environment healthier.
For example, the Child Nutrition and WIC [Women, Infants, and Children] Reauthorization Act of 2004 required school districts to develop local wellness policies to determine how schools could best foster an environment that would support healthful eating and physical activity. The act also required the U.S. Department of Agriculture (USDA) to assure that meals offered in schools receiving federal monies be consistent with standards provided in the Dietary Guidelines for Americans and the Dietary Reference Intakes (DRIs) (Institute of Medicine [IOM] 2008).
However, a review conducted by the IOM at the request of the USDA confirmed what most already suspected: current school food offerings continue to be inconsistent with both the Dietary Guidelines for Americans and the DRIs (especially for fruit, most vegetables, whole grains, trans fat, total fat intake and sodium) and may actually be contributing to the spread of childhood obesity.
In October 2009, the IOM is due to release the second part of its report on the state of school meal programs. This installment will recommend updated nutrition and meal standards. Meanwhile, Congress is due to reauthorize the federal Child Nutrition Programs by the end of June 2009.
The "Built" Environment
Yet another strategy for change involves creating zoning laws to limit the number of fast-food restaurants, expand recreational facilities and encourage healthier lifestyles in given areas. Such measures would especially benefit people living in poor neighborhoods where access to parks and healthy foods is severely limited. Because zoning and development fall under the jurisdiction of local governments, individual community members and leaders must step up to make the changes needed to foster a healthy lifestyle and a sense of community.
South Los Angeles made headlines last July when the city council banned construction of new fast-food outlets for at least a year within the city’s 32-square-mile area. The moratorium was in response to a growing obesity problem affecting 30% of South L.A.’s children, presumably due, at least in part, to limited access to healthy foods and ready access to an abundance of cheap, fattening fare (Hennessy-Fiske & Zahniser 2008).
In another example, Lakewood, Colorado, was recognized by the Environmental Protection Agency’s (EPA) Smart Growth Program for transforming a failing shopping center into a walkable downtown. The area’s new pedestrian-friendly blocks have 1 million square feet of shops, restaurants, homes and offices and 9 acres of parks and plazas, including an ice-skating rink. The Smart Growth program, designed to create and maintain great neighborhoods, is founded on 10 principles, one of which promotes walkability (for more information, visit www.epa.gov/smartgrowth).
The strategy of disclosure requires restaurants and food manufacturers to provide nutritional content information and health warnings so that consumers can make more informed decisions. While this strategy is currently applied only at the city and state levels, it is conceivable that the federal government could enact disclosure requirements at a national level.
Last September, California became the first state to require that calorie counts be shown on chain restaurant menus and menu boards. Although the bill does not take effect until 2011, restaurants in the state are required to make brochures with nutrition information available to diners in the meantime.
Similar laws are in effect in New York City, Philadelphia and the Seattle area, among other smaller jurisdictions. Legislation requiring statewide menu labeling in New York is pending.
Results from an informal poll of New Yorkers suggest that these kinds of disclosure laws should be adopted on a larger scale. When asked which McDonald’s item has the most calories, 85% of the 900 New York voters quizzed got it wrong (CSPI 2008a). (The correct answer is the large chocolate shake, which weighs in at 1,160 calories.)
Another tactic used to enforce change is filing lawsuits against companies like fast-food giants for selling “unreasonably hazardous” products. The theory is that legal action will force companies to voluntarily offer healthier alternatives and provide accurate information.
In the absence of voluntary change, class action suits have taken companies to task for making untrue claims about products. One such suit accused the Gerber Products Company of deceptive advertising for the way it packaged a product called “Juice Treats” (formerly known as “Fruit Juice Snacks”). While the package featured a photo of real fruit, the Gummi Bear–like “treats” contained large amounts of sugar and corn syrup but very little fruit juice concentrate. Other companies are currently facing similar suits for making unfounded health claims about particular food products.
Part of the problem arises from lax regulation and lack of oversight. Prior to 2002, “qualified health claims” (i.e., claims linking a food substance to prevention of a disease) could appear only on dietary supplement labels. Since 2002, health claims have been allowed on food labels as well, causing many consumers to be misled by false claims.
A 2008 report by the Government Accountability Office (GAO) found that the FDA had failed to effectively police food labeling. To help consumers make healthier food choices, the GAO has issued the following recommendations (GAO 2008), which are still pending as of this date:
- Eliminate qualified health claims from food labels.
- Implement a uniform front-of-package symbol system to help consumers select healthier foods.
- Establish criteria for characterizing the amount of whole grains in food.
- Prohibit “trans fat free” labeling on foods that contain substantial amounts of saturated fat.
- Require labels of foods commonly consumed in one sitting to show total calories per package instead of per serving size.
- Clarify the definition of “natural” as it applies to food.
In much the same way as health departments monitor infectious disease, states could begin monitoring chronic diseases linked to obesity, such as diabetes.
New York City has led the way in adopting surveillance measures to monitor the health and nutrition status of its residents. In 2004, the New York City Health and Nutrition Examination Survey (NYC HANES), modeled after the National Health and Nutrition Examination Survey (NHANES), randomly picked city residents to undergo a physical examination, clinical and laboratory tests and an interview (Thorpe et al. 2009). The survey results revealed that diabetes and prediabetes were more prevalent than expected, with more than one-third of New Yorkers showing abnormal glucose levels (Thorpe et al. 2009). In 2006, in an effort to improve the surveillance and management of diabetes in the city, the New York City A1C Registry was started. The registry collects blood sugar results from city laboratories; sends quarterly reports on patients to their health providers; and reminds patients to follow up with their doctors. In the future, resources such as free gym memberships and blood pressure cuffs for home use may be made available to city residents (New York City Government 2006).
Although other locales have yet to follow suit, an editorial in the medical journal Diabetes Care suggested that New York’s efforts provide “valuable information that may well serve as a model for the future” for other communities (Wilson & Narayan 2009).
Obviously, federal and state strategies such as these are designed to help change public policy at the highest level. But the fitness community need not stand on the sidelines and wait for others to mandate healthier communities. Quite the opposite: experts say that most change actually occurs at the community level. Individuals can network and form alliances at the grass-roots level to effect change and influence larger political and policy debates (Shortell & Swartzberg 2008).
Interventions that focus on changing physical activity behavior through building, strengthening and maintaining social networks are highly effective at increasing `activity levels and improving overall physical fitness (Task Force on Community Preventive Services 2002). Encouraging clients to work out in pairs or as part of a buddy system, making fitness “contracts” and starting activity (e.g., walking) groups are just a few ways for fitness professionals to get started (Task Force on Community Health Services 2002).
Women, minorities and those with lower socioeconomic status are less likely to be physically active. That is because they encounter a variety of economic and cultural barriers, such as less access to safe and affordable places to exercise; less leisure time and energy to exercise; and reduced exposure to norms and networks that support physical activity and exercise (Lee & Cubbin 2009).
Fitness professionals can take the following steps to help people overcome these barriers:
- Charge reduced rates to low-income community members.
- Extend operating hours.
- Offer free training in equipment use and health education activities, such as risk factor screening.
- Make inexpensive childcare available while parents are exercising.
- Form partnerships with workplaces and schools (Task Force on Community Preventive Services 2002).
Whenever possible, fitness professionals are encouraged to participate in large-scale policy debates and initiatives. Tips for how to get involved in shaping policy are included in the sidebar “Shaping Policy: A Primer for Fitness Professionals.”
Participation in regular physical activity is low among U.S. adults, and dietary habits are just as dismal. Now for the good news: fitness professionals are ideally positioned to inspire lasting improvements in health.
Efforts that extend beyond working with individuals to incorporate social, community, environmental and political change will go a long way in helping to make being fit, not fat, the nation’s norm. The voices of the fitness industry should reach into communities across America. It is time for you to speak up.