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Reducing Childhood Obesity through U.S. Federal Policy

A Microsimulation Analysis

      Background

      Childhood obesity prevalence remains high in the U.S., especially among racial/ethnic minorities and low-income populations. Federal policy is important in improving public health given its broad reach. Information is needed about federal policies that could reduce childhood obesity rates and by how much.

      Purpose

      To estimate the impact of three federal policies on childhood obesity prevalence in 2032, after 20 years of implementation.

      Methods

      Criteria were used to select the three following policies to reduce childhood obesity from 26 recommended policies: afterschool physical activity programs, a $0.01/ounce sugar-sweetened beverage (SSB) excise tax, and a ban on child-directed fast food TV advertising. For each policy, the literature was reviewed from January 2000 through July 2012 to find evidence of effectiveness and create average effect sizes. In 2012, a Markov microsimulation model estimated each policy’s impact on diet or physical activity, and then BMI, in a simulated school-aged population in 2032.

      Results

      The microsimulation predicted that afterschool physical activity programs would reduce obesity the most among children aged 6–12 years (1.8 percentage points) and the advertising ban would reduce obesity the least (0.9 percentage points). The SSB excise tax would reduce obesity the most among adolescents aged 13–18 years (2.4 percentage points). All three policies would reduce obesity more among blacks and Hispanics than whites, with the SSB excise tax reducing obesity disparities the most.

      Conclusions

      All three policies would reduce childhood obesity prevalence by 2032. However, a national $0.01/ounce SSB excise tax is the best option.
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      References

        • CDC.
        Vital signs: obesity among low-income, preschool-aged children—U.S., 2008-2011.
        MMWR Morb Mortal Wkly Rep. 2013; 62: 629-634
        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • Lamb M.M.
        • Flegal K.M.
        Prevalence of high body mass index in US children and adolescents, 2007-2008.
        JAMA. 2010; 303: 242-249
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010.
        JAMA. 2012; 307: 483-490
        • Rossen L.M.
        • Schoendorf K.C.
        Measuring health disparities: trends in racial-ethnic and socioeconomic disparities in obesity among 2- to 18-year old youth in the U.S., 2001-2010.
        Ann Epidemiol. 2012; 22: 698-704
        • Serdula M.K.
        • Ivery D.
        • Coates R.J.
        • Freedman D.S.
        • Williamson D.F.
        • Byers T.
        Do obese children become obese adults? A review of the literature.
        Prev Med. 1993; 22: 167-177
        • Singh A.S.
        • Mulder C.
        • Twisk J.W.
        • van Mechelen W.
        • Chinapaw M.J.
        Tracking of childhood overweight into adulthood: a systematic review of the literature.
        Obes Rev. 2008; 9: 474-488
        • Eyler A.A.
        • Nguyen L.
        • Kong J.
        • Yan Y.
        • Brownson R.
        Patterns and predictors of enactment of state childhood obesity legislation in the U.S.: 2006-2009.
        Am J Public Health. 2012; 102: 2294-2302
        • Abraham J.M.
        Using microsimulation models to inform U.S. health policy making.
        Health Serv Res. 2013; 48: 686-695
        • Rutter C.M.
        • Zaslavsky A.M.
        • Feuer E.J.
        Dynamic microsimulation models for health outcomes: a review.
        Med Decis Making. 2011; 31: 10-18
        • Barlow S.E.
        • Expert Committee
        Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.
        Pediatrics. 2007; 120: S164-S192
        • Brennan L.
        • Castro S.
        • Brownson R.C.
        • Claus J.
        • Orleans C.T.
        Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity.
        Annu Rev Public Health. 2011; 32: 199-223
        • Maciosek M.V.
        • Edwards N.M.
        • Coffield A.B.
        • et al.
        Priorities among effective clinical preventive services: methods.
        Am J Prev Med. 2006; 31: 90-96
        • Barbeau P.
        • Johnson M.H.
        • Howe C.A.
        • et al.
        Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls.
        Obesity (Silver Spring). 2007; 15: 2077-2085
        • Burguera B.
        • Colom A.
        • Pinero E.
        • et al.
        ACTYBOSS: activity, behavioral therapy in young subjects—after-school intervention pilot project on obesity prevention.
        Obes Facts. 2011; 4: 400-406
        • de Heer H.D.
        • Koehly L.
        • Pederson R.
        • Morera O.
        Effectiveness and spillover of an after-school health promotion program for Hispanic elementary school children.
        Am J Public Health. 2011; 101: 1907-1913
        • Dzewaltowski D.A.
        • Rosenkranz R.R.
        • Geller K.S.
        • et al.
        HOP׳N after-school project: an obesity prevention randomized controlled trial.
        Int J Behav Nutr Phys Act. 2010; 7: 90
        • Gortmaker S.L.
        • Lee R.M.
        • Mozaffarian R.S.
        • et al.
        Effect of an after-school intervention on increases in children׳s physical activity.
        Med Sci Sports Exerc. 2012; 44: 450-457
        • Gutin B.
        • Yin Z.
        • Johnson M.
        • Barbeau P.
        Preliminary findings of the effect of a 3-year after-school physical activity intervention on fitness and body fat: the Medical College of Georgia Fitkid Project.
        Int J Pediatr Obes. 2008; : 3-9
        • Howe C.A.
        • Harris R.A.
        • Gutin B.
        A 10-month physical activity intervention improves body composition in young black boys.
        J Obes. 2011; 2011: 358581
        • Iversen C.S.
        • Nigg C.
        • Titchenal C.A.
        The impact of an elementary after-school nutrition and physical activity program on children׳s fruit and vegetable intake, physical activity, and body mass index: Fun 5.
        Hawaii Med J. 2011; 70: 37-41
        • Kelder S.
        • Hoelscher D.M.
        • Barroso C.S.
        • Walker J.L.
        • Cribb P.
        • Hu S.
        The CATCH Kids Club: a pilot after-school study for improving elementary students׳ nutrition and physical activity.
        Public Health Nutr. 2005; 8: 133-140
        • Madsen K.A.
        • Thompson H.R.
        • Wlasiuk L.
        • Queliza E.
        • Schmidt C.
        • Newman T.B.
        After-school program to reduce obesity in minority children: a pilot study.
        J Child Health Care. 2009; 13: 333-346
        • Matvienko O.
        • Ahrabi-Fard I.
        The effects of a 4-week after-school program on motor skills and fitness of kindergarten and first-grade students.
        Am J Health Promot. 2010; 24: 299-303
        • Pate R.R.
        • Saunders R.P.
        • Ward D.S.
        • Felton G.
        • Trost S.G.
        • Dowda M.
        Evaluation of a community-based intervention to promote physical activity in youth: lessons from Active Winners.
        Am J Health Promot. 2003; 17: 171-182
        • Robinson T.N.
        • Matheson D.M.
        • Kraemer H.C.
        • et al.
        A randomized controlled trial of culturally tailored dance and reducing screen time to prevent weight gain in low-income African American girls: Stanford GEMS.
        Arch Pediatr Adolesc Med. 2010; 164: 995-1004
        • Story M.
        • Sherwood N.E.
        • Himes J.H.
        • et al.
        An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study.
        Ethn Dis. 2003; 13: S54-S64
        • Wilson D.K.
        • Friend R.
        • Teasley N.
        • Green S.
        • Reaves I.L.
        • Sica D.A.
        Motivational versus social cognitive interventions for promoting fruit and vegetable intake and physical activity in African American adolescents.
        Ann Behav Med. 2002; 24: 310-319
        • Smith T.A.
        • Biing-Hwan L.
        • Jonq-Ying L.
        Taxing caloric sweetened beverages: Potential effects on beverage consumption, caloric intake, and obesity.
        ERR-100, U.S. Department of Agriculture, Economic Research Service,. July 2010;
        • Sturm R.
        • Powell L.M.
        • Chriqui J.F.
        • Chaloupka F.J.
        Soda taxes, soft drink consumption, and children׳s body mass index.
        Health Aff (Milwood). 2010; 29: 1052-1058
        • Duffey K.J.
        • Gordon-Larsen P.
        • Shikany J.M.
        • Jacobs Jr, D.R.
        • Popkin B.M.
        Food price and diet and health outcomes. 20 years of the CARDIA study.
        Arch Intern Med. 2010; 170: 420-426
        • Fletcher J.M.
        • Frisvold D.
        • Tefft N.
        The effects of soft drink taxes on child and adolescent consumption and weight outcomes.
        J Public Econ. 2010; 94: 967-974
        • Fletcher J.M.
        • Frisvold D.
        • Tefft N.
        Taxing soft drinks and restricting access to vending machines to curb child obesity.
        Health Aff (Milwood). 2010; 29: 1059-1066
        • Lin B.H.
        • Smith T.A.
        • Lee J.Y.
        • Hall K.D.
        Measuring weight outcomes for obesity intervention strategies: the case of the sugar-sweetened beverage tax.
        Econ Hum Biol. 2011; 9: 329-341
        • Dhar T.
        • Baylis K.
        Fast-food consumption and the ban on advertising targeting children: the Quebec experience.
        J Mark Res. 2011; 48: 799-813
        • Graff S.
        • Kunkel D.
        • Mermin S.E.
        Government can regulate food advertising to children because cognitive research shows that it is inherently misleading.
        Health Aff (Milwood). 2012; 31: 392-398
        • Carter O.B.
        • Patterson L.J.
        • Donovan R.J.
        • Ewing M.T.
        • Roberts C.M.
        Children׳s understanding of the selling versus persuasive intent of junk food advertising: implications for regulation.
        Soc Sci Med. 2011; 72: 962-968
        • Powell L.M.
        • Szczypka G.
        • Chaloupka F.J.
        Trends in exposure to television food advertisements among children and adolescents in the U.S.
        Arch Pediatr Adolesc Med. 2010; 164: 794-802
        • Chou S.Y.
        • Rashad I.
        • Grossman M.
        Fast-food restaurant advertising on television and its influence on childhood obesity.
        J Law Econ. 2008; 51: 599-618
        • Veerman J.L.
        • Van Beeck E.F.
        • Barendregt J.J.
        • Mackenbach J.P.
        By how much would limiting TV food advertising reduce childhood obesity?.
        Eur J Public Health. 2009; 19: 365-369
        • Andreyeva T.
        • Chaloupka F.J.
        • Brownell K.D.
        Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue.
        Prev Med. 2011; 52: 413-416
        • Wang Y.C.
        • Hsiao A.
        • Orleans C.T.
        • Gortmaker S.L.
        The caloric calculator: average caloric impact of childhood obesity interventions.
        Am J Prev Med. 2013; 45: e3-e13