Patterns and predictors of state adult obesity prevention legislation enactment in US states: 2010-2013

How independent is the international food information council from the food and beverage industry? A content analysis of internal industry documents

Background

The International Food Information Council (IFIC) and its partner foundation (IFIC Foundation) widely disseminate nutrition information and participate in relevant policymaking processes. Prior research has established a connection between IFIC and large food and beverage companies, representing a potential conflict of interest. The authors reviewed public records documents to investigate the connection between IFIC and industry, and to describe how IFIC communicates policy-relevant information about nutrition science to the public.

Methods

The research team collected communications between IFIC and members of the research and policymaking communities by using state and federal transparency laws. The team analyzed the content of these documents with a commercial determinants of health framework while allowing for new themes to emerge, guided by the broad analytic questions of how and why does IFIC communicate nutrition information to policymakers and the broader public?

Results

IFIC employs self-designed research and media outreach to disseminate nutrition information. Communications from IFIC and its affiliates related to nutrition information fell within major themes of manufacturing doubt and preference shaping.

Conclusions

IFIC uses media outlets to preemptively counter information about the negative health impacts of added sugars and ultra-processed foods, and promotes a personal-responsibility narrative about dietary intake and health. IFIC and its affiliates disseminate a narrow subset of nutrition and health information consistent with corporate interests and in opposition to public health policies associated with improved population health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-022-00884-8.

Obesity prevention across the US: A review of state‐level policies from 2009 to 2019

Objective

Uniquely, state legislators may enact obesity prevention policies tailored to each state's needs and take diverse policy approaches to address obesity prevalence. The objective of this study was to identify and describe state-level obesity-related policies between 2009 and 2019.

Methods

Using a database of legislation covering 2009-2019, researchers categorized obesity-related legislation by status (proposed/enacted), topic, and environment impacted. Researchers determined the number of policies proposed; enacted, by political party control; obesity prevalence, by states over time.

Results

3256 obesity-related policies were proposed among 50 states and Washington DC between 2009 and 2019. Collectively, 18% (593) of policies were enacted; California (96), New and Jersey (57) enacted the most. Across environment and topics, the most enacted policies categorized in school environment (226) and school nutrition (150) topic area. Most policies were proposed (496) and enacted (77) in 2011. On average, Democrat-controlled states had higher enactment rates than Republican-controlled states, as did states with lower (vs. higher) obesity prevalence.

Conclusions

States have actively pursued obesity-related legislation across multiple topics and environments from 2009 to 2019, with mixed enactment rates. Evaluating the impact of these policies, alone and in combination, will be important to determine whether these state-level efforts reduce obesity.

Examining the policy process of sugar-sweetened beverage taxation in Ireland

Sugar sweetened beverages (SSBs) are a growing source of weight gain, obesity, and type 2 diabetes that contain high added sugar amounts and provide minimal nutritional benefit. Taxing SSBs are effective in reducing sugar consumption and increasing awareness about health effects. The 2014 European Union Action Plan on Childhood Obesity combined with neighboring SSB tax proposals in the U.K. and France helped stimulate political discussions in Ireland. Following this momentum, in 2015, public health groups lead by the Irish Heart Foundation proposed an SSB tax with earmarked funds for public health and worked with the Irish Health Department through a whole-of-government approach to convince the Finance Department to introduce an SSB tax. These efforts resulted in the Finance Department proposing the Sugar Sweetened Drinks Tax (SSDT) in September 2016, which taxes non-alcoholic, water-based and juice-based drinks, which have an added sugar content of 5g per 100mL and above. Opposing stakeholders including the Irish Beverage Council and Food & Drink Industry Ireland argued that the tax would not decrease consumption of SSBs or impact obesity, disproportionately impact individuals with a low socioeconomic background, and create illicit trade. However, health groups argued the tax would reduce sugar consumption, encourage consumers to purchase healthier options, and help reduce obesity levels. These efforts with political will helped Ireland become the 36th country in the world (9th in Europe) to implement an SSB tax policy in May 2018. While the government reportedly raised €16.5 million (20.012 million USD) in 2018 and €33 million (40.024 million USD) in 2019 from the SSDT, the tax was not earmarked for public health purposes nor has it been evaluated despite multiple requests by public health groups representing an important missed opportunity. While other countries should follow Ireland's lead in enacting an SSB tax, it is important to evaluate the tax's impact on reducing sugar consumption and ensure the tax has earmarked funds for public health to further maximize the impact of reducing sugar consumption, promoting health equity and helping curb the NCD epidemic.

Identifying Novel Predictors of State Legislative Action to Address Obesity

OBJECTIVE

There is wide variation in the number and types of obesity policies enacted across states, and prior studies suggest that partisan factors may not fully explain this variation. In this exploratory analysis, we examined the association of a broad array of state-level factors with the number and types of obesity policies across states.

DESIGN

We analyzed 32 predictor variables across 7 categories of state-level characteristics. We abstracted data from 1652 state obesity policies introduced during 2009-2014. We used multilevel regression models and principal component analysis to examine the association between state-level characteristics and policy outcomes.

MAIN OUTCOME MEASURES

Our outcome measures included whether bills involved topics that were public health-oriented or business interest-oriented, whether bills were enacted into law, and the number of introduced bills and enacted laws per state.

RESULTS

Numerous state-level characteristics were associated with obesity-related bill introduction and law enactment, and different state characteristics were associated with public health-oriented versus business interest-oriented policies. For example, state-level demographics, economic factors, policy environment, public programs, and the prevalence of obesity's downstream consequences were associated with the number of public health laws whereas obesity prevalence and policy environment were associated with the number of business interest laws.

CONCLUSIONS

Our results support the hypothesis that a variety of factors contribute to a complex state obesity policymaking environment, highlighting the need for future research to disentangle these key predictors.

GWAS reveal a role for the central nervous system in regulating weight and weight change in response to exercise

Body size and weight show considerable variation both within and between species. This variation is controlled in part by genetics, but also strongly influenced by environmental factors including diet and the level of activity experienced by the individual. Due to the increasing obesity epidemic in much of the world, there is considerable interest in the genetic factors that control body weight and how weight changes in response to exercise treatments. Here, we address this question in the Drosophila model system, utilizing 38 strains of the Drosophila Genetics Reference Panel. We use GWAS to identify the molecular pathways that control weight and weight changes in response to exercise. We find that there is a complex set of molecular pathways controlling weight, with many genes linked to the central nervous system (CNS). The CNS also plays a role in the weight change with exercise, in particular, signaling from the CNS. Additional analyses revealed that weight in Drosophila is driven by two factors, animal size, and body composition, as the amount of fat mass versus lean mass impacts the density. Thus, while the CNS appears to be important for weight and exercise-induced weight change, signaling pathways are particularly important for determining how exercise impacts weight.

The association between physical inactivity and obesity is modified by five domains of environmental quality in U.S. adults: A cross-sectional study

Physical inactivity is a primary contributor to the obesity epidemic, but may be promoted or hindered by environmental factors. To examine how cumulative environmental quality may modify the inactivity-obesity relationship, we conducted a cross-sectional study by linking county-level Behavioral Risk Factor Surveillance System data with the Environmental Quality Index (EQI), a composite measure of five environmental domains (air, water, land, built, sociodemographic) across all U.S. counties. We estimated the county-level association (N = 3,137 counties) between 2009 age-adjusted leisure-time physical inactivity (LTPIA) and 2010 age-adjusted obesity from BRFSS across EQI tertiles using multi-level linear regression, with a random intercept for state, adjusted for percent minority and rural-urban status. We modelled overall and sex-specific estimates, reporting prevalence differences (PD) and 95% confidence intervals (CI). In the overall population, the PD increased from best (PD = 0.341 (95% CI: 0.287, 0.396)) to worst (PD = 0.645 (95% CI: 0.599, 0.690)) EQI tertile. We observed similar trends in males from best (PD = 0.244 (95% CI: 0.194, 0.294)) to worst (PD = 0.601 (95% CI: 0.556, 0.647)) quality environments, and in females from best (PD = 0.446 (95% CI: 0.385, 0.507)) to worst (PD = 0.655 (95% CI: 0.607, 0.703)). We found that poor environmental quality exacerbates the LTPIA-obesity relationship. Efforts to improve obesity through LTPIA may benefit from considering this relationship.

Consolidated state political party control and the enactment of obesity-related policies in the United States

States play a key role in addressing obesity and its risk factors through policymaking, but there is variation in state activity nationally. The goal of this study was to examine whether the presence of a consolidated Democratic or Republican "trifecta" - when a state's governorship and both houses of the legislature are dominated by the same political party - or divided government (i.e., without a trifecta) is associated with obesity-related policy content and enactment. In 2016 and 2017, we gathered state bills and laws utilizing the CDC Chronic Disease State Policy Tracking System, and examined the association between state-level political party control and the enactment of state-level obesity-related policies in all states during 2009-2015. The three areas of interest included: policies specifically addressing obesity, nutrition, or physical activity in communities, schools, or workplaces using a public health framework; neutral policies, such as creating government task forces; and policies that employed a business-interest framework (e.g., Commonsense Consumption Acts that prohibit consumer lawsuits against restaurant establishments). Using divided governments as the reference group, we found that states with Democratic trifectas enacted significantly more laws, and more laws with a public health framework. Republican trifecta states enacted more laws related to physical activity, and in some states like Texas, Republican trifectas were exceptionally active in passing policies with a public health framework. States with Republican trifectas enacted a statistically similar amount of laws as states with divided governments. These findings suggest promise across states for obesity-related public health policymaking under a variety of political regimes.

The development of scientific evidence for health policies for obesity: why and how?

Potential obesity-related policy approaches have recently been receiving more attention. Although some have been implemented and others only proposed, few have been formally evaluated. We discuss the relevance, and in some cases irrelevance, of some of the types of evidence that are often brought to bear in considering obesity-related policy decisions. We discuss major methods used to generate such evidence, emphasizing study design and the varying quality of the evidence obtained. Third, we consider what the standards of evidence should be in various contexts, who ought to set those standards, as well as the inherent subjectivity involved in making policy decisions. Finally, we suggest greater transparency from both academics and policymakers in the acknowledgment of subjectivities so they can distinguish and communicate the roles of empirical evidence and subjective values in the formulation of policy.

Improving anti-bullying laws and policies to protect youth from weight-based victimization: parental support for action

BACKGROUND

Weight-based bullying is a prevalent problem among youth with overweight and obesity, but remains neglected in existing policy-level strategies to address youth bullying. Parental support is an influential catalyst motivating political will for policy decisions affecting youth, but has received limited research attention.

OBJECTIVES

To assess levels of, and predictors of, parental support for school-based policies and state/federal legal measures to address weight-based bullying in 2014 and 2015.

METHODS

Identical online questionnaires were completed by two independent national samples of parents in 2014 and 2015 (N = 1804).

RESULTS

Parental support for all policy actions was high (at least 81%) and significantly increased from 2014 to 2015 for legal measures that would a) require state anti-bullying laws to add protections against weight-based bullying, and b) enact a federal anti-bullying law that includes weight-based bullying.

CONCLUSIONS

These findings can inform policy discourse about remedies for youth bullying, and suggest that parental support for improved legal protections against weight-based bullying is present, consistent, and strong.

Legislating for weight-based equality: national trends in public support for laws to prohibit weight discrimination

The prevalence of weight discrimination in the United States has led to increasing calls for legal measures to address weight-based inequities on a broader scale. This study examined public support in 2014 and 2015 for three proposed laws prohibiting weight discrimination, and compared findings with public attitudes towards the same laws from 2011 to 2013. An online survey was completed by a diverse national sample of US adults (N=2411) in June-July of 2014 and 2015 to assess their support for anti-discrimination legislation. Public support increased for the anti-discrimination laws from 2014 to 2015, and at least 71% of participants expressed support for each of the laws in both years. Compared with public support documented in 2011-2013, there was a significant increase in support in 2014-2015 for legislation to extend disability protections to individuals with obesity and for laws that would include body weight in existing state civil rights statutes. Consistently, high levels of support (78%) were documented across this 5-year period for laws to address weight-based discrimination in employment. As public approval is a powerful catalyst motivating political will needed to make policy changes, these findings provide important insights and implications for advancing policy-level discourse about remedies for weight discrimination.

The Voices for Healthy Kids Campaign and US State Legislation to Prevent Childhood Obesity

We documented childhood obesity legislative activity in all 50 US states that occurred in parallel to the first year of Voices for Healthy Kids (Voices), a campaign to mobilize evidence-based legislation addressing childhood obesity. We identified 217 bills in the year before Voices (November 2012 to October 2013) and 304 bills at follow-up (November 2013 to October 2014). In states with active Voices grantees, the bill enactment rate was 50% higher (increasing from 10% at baseline to 15% at follow-up).

Health Care Systems and National Policy: Role of Leadership in the Obesity Crisis

Obesity, defined as a body mass index (BMI) of 30 or higher in adults and BMI in the 95th percentile or higher for children, is epidemic in the United States. The predominant culture of caloric excess and sedentary behaviors contributes to this problem. Obesity increases the risk of many chronic diseases and premature death. The broad response to this costly disease includes efforts from medical providers, local and federal governments, and nongovernmental agencies. Although obesity can be addressed on an individual basis, it is largely recognized as a public health issue.