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Hawaii J Med Public Health. Mar 2013; 72(3): 102–106.
PMCID: PMC3602950

Insights in Public Health

The Childhood Obesity Prevention Task Force (ACT 269): Recommendations for Obesity Prevention in Hawai‘i
Monitoring Editor: Jay Maddock, PhD and Donald Hayes, MD, MPH
Jay Maddock, Office of Public Health Studies at John A Burns School of Medicine;
Monitoring Editor: Tonya Lowery St John, MPH and Ranjani Rajan, MPH
Hawai‘i Department of Health

Abstract

Obesity in both adults and children is a critical issue in Hawai‘i, as well as nationally and internationally. Today in Hawai‘i, 57 percent of adults are overweight or obese as are almost 1 in 3 children entering kindergarten. Each year, obesity costs Hawai‘i more than $470 million in medical expenditures alone.1 These staggering human and economic costs underscore the serious need for Hawai‘i to address obesity now.

Due to the urgent need to reverse the current trends in obesity Senate Bill 2778 was signed into law, on July 6, 2012, as Act 269 by Governor Neil Abercrombie, creating The Childhood Obesity Prevention Task Force. The task force was charged with developing policy recommendations and proposed legislation for the 2013 legislature. The task force ultimately identified eleven recommendations for the 2013 legislative session and one recommendation for the 2014 legislative session. When implemented together, these recommendations could profoundly reshape Hawai‘i's school, work, community, and health care environments, making healthier lifestyles obtainable for all Hawai‘i residents.

The Problem of Obesity in Hawai‘i

While Hawai‘i is considered one of the healthier states, like the rest of the nation, obesity trends have yet to decrease. In Hawai‘i, 21.9% or 230,190 adults and 13.4% of youth are obese;2,3 additionally, there are major health disparities across racial and ethnic groups.2,3 Unless the trends in obesity change, this generation of young people may be the first to live shorter lives than their parents.4

The rise in obesity has grave health and economic implications for Hawai‘i. Emerging economic studies show that unhealthy weight gain increases the risk for chronic and disabling health conditions, can reduce worker productivity, and require more medical interventions.57 Obesity increases the risk for chronic disease and disability and this epidemic is a setback to the advances made in healthcare to extend years of productive life. Poor nutrition, sedentary lifestyles, and obesity contribute to heart disease, stroke, diabetes, and some cancers. Obesity can also lead to disabilities such as osteoarthritis, infertility, asthma, sleep apnea, and premature death.8 The Centers for Disease Control and Prevention (CDC) estimates that obesity related medical expenditures cost an additional $1,429 per person a year.9 In Hawai‘i, this amounts to over $470 million in annual obesity related medical costs. In the United States, the annual cost is over $147 billion.1

Youth Obesity, Nutrition and Physical Activity Data

Youth data has yet to show steady improvements for risk or protective factors against obesity. Rates of youth obesity in Hawai‘i have remained below national targets, although wide disparities remain, with significantly higher rates of obesity among boys and certain ethnic groups (Filipino, Native Hawaiian, and Other Pacific Islander).3 Figure 1 depicts the prevalence of overweight and obesity among public high school students in Hawai‘i.

Figure 1
Obesity or Overweight Among Hawai‘i High School Students, 2011

A net increase in obesogenic behaviors have been observed with a corresponding decrease in obesity preventing behaviors. For example, only 21 percent of youth meet national recommendations for aerobic physical activity,10 and a full 61 percent of youth fail to meet American Academy of Pediatrics recommendations to limit screen time to no more than 2 hours per day.11 In fact, there has been a 34 percent increase in the percentage of youth spending 3 or more hours per day playing video or computer games or using the computer (other than for homework) in a two year time period, between 2009 and 2011.12 The 2008 National Physical Activity Guidelines For Americans can be referred to in Figure 2.13

Figure 2
2008 Physical Activity Guidelines for Americans

Evidence supports that children are eating less healthy foods than they were in the past. For example, the proportion of the State's high school youth consuming sugary soda each day (18%) is two times the percentage of those consuming milk 3 or more times per day (9%). Furthermore, only about 18 percent of our youth eat 5 or more fruits and vegetables daily.14,15

Adult Obesity, Nutrition, and Physical Activity Data

In 2011, only 24 percent of adults met the current national recommendations (Figure 2) for aerobic physical activity and muscle strengthening.16 A full 21 percent of adults reported no physical activity in the previous month.17 In terms of fruit and vegetable consumption, only 13 percent of adults reported eating fruit three or more times a day, and 19 percent reported eating vegetables three or more times a day.17 The full list of Dietary Guidelines for Americans can be accessed at http://health.gov/dietaryguidelines/2010.asp.

Hawai‘i's adult overweight and obesity rates are among the lowest in the nation, but they are rising. From 2000 to 2010, the percentage of adults considered obese increased 48 percent. Additionally, there are major health disparities across racial and ethnic groups. For instance, 44 percent of Native Hawaiians adults are obese compared to 14 percent of Japanese adults. Individuals with lower income, less education and on the neighbor islands are also more likely to be obese.2 Figure 3 depicts the prevalence of overweight and obesity among Hawai‘i adults.

Figure 3
Overweight and Obesity in Hawai‘i Adults, 2010

The Need for a Comprehensive Approach to Reduce Rates of Obesity in Hawai‘i

Overweight and obesity result from a complex interaction of biological and environmental factors beginning with infant feeding and continuing with the environment, food system, marketing, and polices and systems that have unintentionally created sedentary activities and less healthy food options as the easy choices. Over the last few decades, we have engineered physical activity out of our everyday lives and have increased our calorie consumption.

National organizations, including the CDC and the Institute of Medicine (IOM), recommend utilizing a comprehensive framework of policies to address obesity. In May 2012, the IOM released a report delineating these recommendations. This report, called Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, stressed the importance of a comprehensive approach because of the inherent complexity of the obesity epidemic. The recommendations call for a sustained effort noting:

“If leaders across all levels of society are engaged and implement this comprehensive approach within the next decade, physical activity will become an integral and routine part of most people's lives, and adults and children will have opportunities for enjoyable physical movement anywhere they spend time. Healthy foods will become the most visible, attractive, and easy-to obtain options anywhere food is sold or served.”18

Government has used public health policy in many different arenas to improve health outcomes and protect the public's health. Many of these government policy interventions have been extremely successful. Previous public health policy interventions include: air bag and seat belt requirements for automobiles, cell phone laws, vaccination requirements, and—most notable—prohibition and restriction of tobacco products. Due to a comprehensive framework of tobacco policies, including tobacco sales tax, public smoking laws, restriction of sales to minors, public education campaigns, and restriction of advertising near schools, tobacco use has dropped tremendously. Smoking rates among high school students in Hawai‘i decreased 65 percent from 2000 to 2011.19 A similar comprehensive framework of policies to encourage physical activity and healthy eating is needed to change social norms and create environments where healthy choices are the easiest choices for Hawai‘i residents.

Overview of the Childhood Obesity Prevention Task Force

On July 6, 2012, Senate Bill 2778 was signed into law as Act 269 by Governor Neil Abercrombie, creating The Childhood Obesity Prevention Task Force, to address the growing crisis of childhood obesity in Hawai‘i. The task force was charged with:

  • Assembling accurate research, fiscal and demographic information to support policy development, and tracking outcomes;
  • Researching other state, county, and organizational policy agendas and suggesting best practices related to childhood obesity prevention policies; and
  • Reporting its findings and recommendations, including proposed legislation, to the legislature no later than twenty days prior to the convening of the 2013 regular session.

The Childhood Obesity Prevention Task Force was comprised of twenty voting members, designated in the bill, representing the House, Senate, Governor, State agencies, University of Hawai‘i, and several non-profit organizations representing health and early childhood education. Additional representatives of organizations were invited to take part in the discussions, including health plans and other state departments. The meetings were open to the public, with time for public comment built into each meeting agenda. The task force met five times from August 2012 through December 2012.

The Childhood Obesity Prevention Task Force members reviewed national recommendations, peer-reviewed research, Hawai‘i data, and other States' obesity-related research and policy recommendations. The task force discussed the alarming rise in obesity among all age groups, and agreed that our State has become characterized by environments that promote physical inactivity and overconsumption of unhealthy food. Obesity affects all Hawai‘i residents, not only children. The task force concluded that addressing this complex, multifaceted problem urgently requires policy and environmental changes that reach the entire population. After reviewing and discussing the research, the members voted to expand their task to develop a comprehensive set of obesity prevention policies for Hawai‘i residents of all ages.

Overview of the Task Force Comprehensive Policy Recommendations

The Childhood Obesity Prevention Task Force chose to focus their policy recommendations in four critical settings based on recommendations by the IOM: Education, Community Design and Access, Healthcare, and Worksite Industry and Business.20 The task force members identified eleven priority recommendations for the 2013 legislative session and one recommendation for the 2014 legislative session as a comprehensive response to the complex issue of obesity. These recommendations, summarized in Figure 4, represent a multi-sectorial approach, of enduring quality, that together will create social changes. The summative goal of these recommendations is to mount a social change where healthy living becomes the norm.

Figure 4
Childhood Obesity Prevention Task Force Recommendations and Proposed Vehicle (Bill or Resolution)

The task force recommendations, when implemented together, have the potential to reshape the environments in Hawai‘i where people live, work, play, and learn. Hawai‘i schools will surround children with environments filled with opportunities for nutrition and physical activity. Healthy foods will become more visible, attractive, and easy to obtain in our communities, and unhealthy options will be less attractive and available. Our communities and streets will encourage and provide safe opportunities for physical activity and active transportation. Healthcare providers will be able to provide their patients with necessary knowledge and health management opportunities to improve their lifestyle behaviors. Employers will play an essential role in increasing physical activity and healthy food options for employees.

Next Steps

Establishing the Childhood Obesity Prevention Task Force has helped our state identify and move towards solutions for reducing obesity. Eight task force policy recommendations were introduced during the 2013 legislative session. The task force recommendations will also be utilized in the development of the 2013–2020 Hawai‘i State Physical Activity and Nutrition Plan which is currently being updated. Continued partnerships and collaboration among stakeholders and commitment from leaders will be necessary to educate and advocate for these important policy changes to create this urgent social change.

The full Childhood Obesity Prevention Task Force report can be accessed at: http://co.doh.hawaii.gov/sites/LegRpt/2013/Reports/1/ACT%20269.pdf.

Contributor Information

Jay Maddock, Office of Public Health Studies at John A Burns School of Medicine.

Donald Hayes, Hawai‘i Department of Health.

References

1. Trogdon JG, Finkelstein EA, Feagan CW, et al. State- and Payer-Specific Estimates of annual Medical Expenditures attributable to Obesity. Obesity. 2012;20(1):214–220. [PubMed]
2. Hawaii Health Data Warehouse, author. Behavioral Risk Factor Surveillance System. Weight - BMI Status. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20BRFFS/Weight/BRFSS_Weight%20Control_IND_00001.pdf.
3. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Risk Behavior Survey Module. Overweight and Obesity. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YRBSS/YRBS_Healthy%.
4. Olshansky SJ, Douglas PJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. NEJM. 2005;352(11):1138–1145. [PubMed]
5. Wang YC, McPherson K, Marsh T, et al. Health and Economic Burden of the Projected Obesity Trends in the USA and UK. Lancet. 2011;378:815–825. [PubMed]
6. Finkelstein EA, DiBonaventura Md, Burgess SM, et al. The Costs of Obesity in the Workplace. J of Occup Environ Med. 2010;52:971–976. [PubMed]
7. Finkelstein EA, Trogdon JG, Brown DS, et al. The Lifetime Medical Cost Burden of Overweight and Obesity: implications for obesity prevention. Obesity. 2008;16:1843–1848. [PubMed]
8. National Institutes of Health, author. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6(suppl 2):51S–209S. PR. [PubMed]
9. Centers for Disease Control and Prevention, author. Vital Signs: State-Specific Obesity Prevalence Among Adults — United States. 2009. MMWR. 2010;59:951–955. [PubMed]
10. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Risk Behavior Survey Module. Physical Activity. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YRBSS/YRBS_Healthy%20Lifestyles_IND_00001.pdf.
11. American Academy of Pediatrics, Committee on Public Education, author. Children, adolescents, and television. Pediatrics. 2001;107(2):423–426. [PubMed]
12. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Risk Behavior Survey Module. TV & Computer Time. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YRBSS/YRBS_Home%20Life_IND_00002.pdf.
13. US Department of Health and Human Services, author. 2008 Physical Activity Guidelines for Americans. 2008. Oct, [January 24, 2013]. ODPHP Publication No. U0036. www.health.gov/paguidelines.
14. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Risk Behavior Survey Module. Dietary Intake. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YRBSS/YRBS_Healthy%20Lifestyles_IND_00002.pdf.
15. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Risk Behavior Survey Module. Fruit & Vegetable Consumption. [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YRBSS/YRBS_Healthy%20Lifestyles_IND_00008.pdf.
16. Centers for Disease Control and Prevention, author. Behavioral Risk Factor Surveillance System - Hawaii. 2011. [January 24, 2013]. http://apps.nccd.cdc.gov/BRFSS/
17. Hawaii State Department of Health, author. 2011 Behavioral Risk Factor Surveillance System. [January 24, 2013]. http://hawaii.gov/health/statistics/brfss/brfss2011/demo11.html.
18. Institute of Medicine, author. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: National Academies; 2012. [PMC free article] [PubMed]
19. Hawaii Health Data Warehouse, author. State of Hawaii, Hawaii School Health Survey: Youth Tobacco Survey Module. Current Tobacco Use (All Types) [January 24, 2013]. http://www.hhdw.org/cms/uploads/Data%20Source_%20YTS/YTS_Prevalence_IND_00001.pdf.
20. Institute of Medicine, author. Report Brief: Accelerating Progress in Obesity Prevention: Solving the weight of the nation. [January 24, 2013]. http://www.iom.edu/~/media/Files/Report%20Files/2012/APOP/APOP_rb.pdf.

Articles from Hawai'i Journal of Medicine & Public Health are provided here courtesy of University Clinical, Education & Research Associates

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