Childhood Obesity: The Role of Health Policy - Association of ...

The report by Nestle & Jacobson identified seven domains for policy action (see Exhibit 3 and health
care was included. Four health care recommendations were noted; two calling for health professional
training approaches, one calling for the development and funding of a research agenda on the causes of,
and treatments for, obesity, and one to revise Medicaid and Medicare to provide incentives for providerbased
nutrition and obesity counseling and other related services.
The second review was conducted under the auspices of the Partners in Program Planning for
Adolescent Health (PIPPAH) initiative partners and published in 2004. 7 This review summarized the
existing policies of 10 organizations who are members of the National Coalition on Adolescent Health
or PIPPAH partners (see Exhibit 4). Policies covering both healthcare aspects (e.g., reimbursement for
treatment and screening, evaluation and treatment), as well as broader issues (e.g., food labeling and
school nutrition), were mentioned by one or more of these organizations.
The most common domain included in these organizations’ statements was physical activity and sports;
49 recommendations were identified, of which 16 were targeted at clinical interventions with individual
patients and 33 were focused on the scope, content and nature of physical activity programs, often
within the school setting (see Exhibit 5). Only two organizations had a position on reimbursement for
treatment of obesity. A content analysis 8 of those recommendations revealed that the recommendations
revealed that they focused about equally on clinician actions at the individual patient level (92 recommendations)
versus calling for broader policy actions on the part of clinicians, schools, or other
stakeholders (111 recommendations). However, nearly 70% of these broad policy recommendations
statements focused exclusively on the school’s role in nutrition, food labeling or advertising, or physical
activity. These two types of recommendations were often woven together in linked statements, e.g.,
“Pediatric dentists should provide dietary counseling in conjunction with other preventive services for their
patients. School health education programs and food services should promote balanced, low caries-risk diets.”
In our own review of the policies or initiatives of 30 organizations, we found that only 14 had a formal
position or policy on childhood obesity (see Appendix B for complete list of organizations). Many more
had programs or initiatives or were in the process of developing a statement. For those organizations
with a formal policy/statement, several common themes related to health care emerged:
Exhibit 5: Domain & Target of Policy Recommendations Included in Statements
Domain
Organizations
(N)
Recommendations
(N)
Target
Patient Policy
Diet & Nutrition: general 7 27 19 8
Education & Training 6 29 15 14
School Nutrition 6 27 1 26
Physical Activity & Sports 5 49 16 33
General Statements 4 11 2 9
Special Populations 4 14 12 2
Screening, Evaluation & Treatment 3 26 25 1
Food labeling & Advertising 3 14 1 13
Health insurance & reimbursement for treatment 2 4 – 4
Total 7 201 92 111
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