VOLUME 18 SUPPLEMENT 1 | FEBRUARY 2010 | www.obesityjournal.org
nature publishing group
1Department of psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 2Department of Epidemiology, Fay W.
Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 3Department of Health Behavior and Health Education,
Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; 4Department of Biostatistics, Fay W. Boozman
College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. Correspondence: Martha M. Phillips (firstname.lastname@example.org)
Obesity is rapidly becoming one of the most critical health
threats facing the United States. Rates of obesity among adults
and children have increased at an alarming rate over the past
four decades. Currently, 63% of US adults (1) and more than
33% of children and adolescents (2) may be classified as over-
weight or obese. The short- and long-term health implications
of this epidemic are being considered with alarm by health pro-
fessionals and policy experts. Among adults, obesity is linked
to cardiovascular disease, hypertension, type 2 diabetes, oste-
oporosis, and some cancers. Even more alarming, children are
being diagnosed with health problems previously considered
to be “adult” conditions. Obese children are at greater risk than
their normal-weight peers for type 2 diabetes, hypertension,
high cholesterol, and orthopedic problems (3–5). The com-
plications associated with these conditions, if unchecked, will
follow this cohort of children, their health-care providers, and
their health-care funders, with many more years of increased
rates of morbidity and preventable mortality than preceding
generations of children.
Numerous experts, including the Institute of Medicine, have
suggested that schools provide a unique venue within which
to address childhood obesity (6–8). Schools provide access to
large numbers of children each year, and children spend a sig-
nificant portion of their time each weekday, each week, and
over their lives in school (8). Further, schools provide daily
meals for students; estimates are that more than a third of chil-
dren’s total energy intake occurs at school (9,10). In addition,
schools provide health, nutrition, and physical education, all
opportunities to teach and model healthy eating and physical
activity practices that can help children establish healthy life-
style practices (8,11,12). The importance of school-based obes-
ity prevention programs grows as children and youth spend
more time in school buildings, participating in preschool,
before-school, and after-school programs at unprecedented
Schools are responding to concerns over childhood obesity
by changing policies related to vending machine availability
and contents, measuring and reporting BMI to parents, caf-
eteria selections and food preparation methods, and physi-
cal education requirements (6). Many of these changes are
the result of local initiatives; others are being implemented
because of statewide legislation, and the quantity and diversity
are sufficiently great that the various initiatives are difficult,
Changes in School Environments With
Implementation of Arkansas Act 1220 of 2003
Martha M. Phillips1,2, James M. Raczynski3, Delia S.West3, LeaVonne Pulley3, Zoran Bursac4,
C. Heath Gauss4 and Jada F.Walker3
Changes in school nutrition and physical activity policies and environments are important to combat childhood
obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to
combat childhood obesity through school-based change. Annual surveys of principals and superintendents have
been analyzed to document substantial and important changes in school environments, policies, and practices. For
example, results indicate that schools are more likely to require that healthy options be provided for student parties
(4.5% in 2004, 36.9% in 2008; P ≤ 0.0001) and concession stands (1.6% in 2004, 19.6% in 2008; P ≤ 0.0001), ban
commercial advertising by food or beverage companies (31.7% in 2005, 42.6% in 2008; P ≤ 0.0001), and offer skim
milk options for students in cafeterias (white milk: 26.1% in 2004, 41.0% in 2008, P ≤ 0.0001; chocolate milk: 9.0%
in 2004, 24.0% in 2008, P ≤ 0.0001). They are less likely to have vending machines available during the lunch period
(72.3% in 2004, 37.2% in 2008; P ≤ 0.0001) and to include sodas in vending machines (83.8% in 2004, 73.5% in 2008;
P ≤ 0.0001). Other changes were noted in foods and beverages offered in the cafeteria, in classrooms, and at school
events, as well as in fund-raising and physical activity practices. A significant number of school districts have modified
physical education requirements for elementary schools and developed policies prohibiting the use of physical activity
as a punishment. We conclude that Arkansas Act 1220 of 2003 is associated with a number of changes in school
environments and policies, resulting from both statewide and local initiatives spawned by the Act.
obeSity | VOLUME 18 SUPPLEMENT 1 | FEBRUARY 2010
in assessing the impact and outcomes of Act 1220, the policy
changes were legislatively mandated to occur in all Arkansas
public schools. Further, some outcomes, e.g., BMI assessment,
would not be possible in a comparison sample of schools with-
out introducing active treatment components, since it would
likely be necessary to disseminate BMI and associated risk
levels to parents in any school in which the data were collected
due to ethical concerns about withholding this information.
Thus, interpretation of findings of this uncontrolled evaluation
of Act 1220 must be made cautiously. Finally, data reported in
this evaluation are self-reported by both school personnel and
family informants and are thus subject to the limitations inher-
ent in all self-reported data.
In summary, the evaluation of Arkansas Act 1220 suggests
that school policies and environments are changing signifi-
cantly. Although these changes cannot be attributed solely to
Act 1220, they are likely to be substantially a result of the Act,
given their alignment with the law and related rules and regu-
lations, and the timing of their development. Opportunities to
strengthen and enforce existing policies and adopt additional
policies to achieve additional changes in school environments
undoubtedly exist. Overall, our evaluation to date supports a
conclusion that changes to school environments to address
childhood obesity can be accomplished using a combina-
tion of state and local policy enactment. More comprehen-
sive approaches that engage parents directly would, however,
undoubtedly represent a more comprehensive and synergistic
approach to combating childhood obesity.
This project is funded by the Robert Wood Johnson Foundation, Project
The authors declared no conflict of interest.
© 2010 The Obesity Society
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