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.

Food and beverage marketing in schools: school superintendents' perspectives and practices after the healthy, Hunger-Free Kids Act.

OBJECTIVE: Children are surrounded by ubiquitous forms of unhealthy food marketing at home and in schools. The US Department of Agriculture now restricts food and beverage marketing that does not meet Smart Snacks in School standards. School superintendents, as districts' top administrators, play a critical role in ensuring marketing policies are implemented and adhered to; however, there is limited research involving this stakeholder group. The current study examined superintendents' perspectives on food marketing in schools and the marketing provision in wellness policies, as well as experiences with the implementation of such policies. DESIGN: Qualitative focus groups and follow-up interviews (with focus group participants) were conducted by trained researchers. SETTING: Focus groups occurred at The School Superintendents' annual meeting; follow-up interviews were over the telephone. PARTICIPANTS: Superintendents and assistant superintendents (n 39) from twenty-three states participated. Interviews were recorded and professionally transcribed; transcripts were team-coded in Atlas.ti using an iteratively revised coding guide to facilitate theme generation. RESULTS: Despite common concerns that marketing to children was 'insidious', superintendents reported a wide range of food and beverage marketing policies. In addition, the main issue is fundraising - such as 'restaurant nights' - that results in marketing that occurs on- and off-campus and afterschool. CONCLUSIONS: Discrepancies between perspectives and practices point to the challenges that superintendents face with budgetary constraints, as well as relationships with parent-teacher organisations. These findings provide important insights about superintendents' perspectives and challenges, particularly for government and child health advocates supporting school districts, to implement these policies.