DrG's Medisense Feature Article

Healthy California May Start With Children, Streets and Laws
by Ann Gerhardt
December 2012
Print Version

Bottom Line at the Top:  Obesity prevalence in other states increased, while in California it remained stable.  Tough school lunch laws, encouraging non-motorized transportation and improving access to healthy food might actually be working.

CA went from being the 25th most obese state to 39th (the 12th LEAST obese state) between 2007 and 2011.  Does this translate into a leaner California?  Not really, though the statistics give that appearance.  In spite of the better ranking, we really didn’t reduce obesity rates.  

Approximately 25% of CA residents are still obese.  Other states’ residents just increased their girth more than we did.  But staying the same is at least better than following the national trend of ever-increasing obesity.

While it’s hard to prove what has made a difference, a few changes in CA’s approach, particularly with children and transportation, might have helped.  

CA is one of 16 states with Complete Streets laws. "Complete streets" are roads designed to allow all users – bicyclists, pedestrians, drivers, and public transit users – to access them safely.   Signed into law by Arnold Schwarzenegger in 2008, the Complete Streets law requires that cities and counties ensure that the needs of all roadway users are accommodated, when updating plans for roadways and traffic flows.  

To do this, communities might include sidewalks, bike lanes (or wide, paved shoulders), special bus lanes, comfortable and accessible transit stops, frequent crossing opportunities, median islands, pedestrian signals and curb extensions. A complete street in a rural area will look quite different from a complete street in a highly urban area. But both are designed to balance safety and convenience for everyone using the road.

CA is one of 20 states with school meal standards more rigorous than the U.S. Department of Agriculture (USDA) requirements.  By law, food portions served in California schools must abide by maximum limits of:
•    35% of calories from fat (excluding legumes, nuts, nut butters, seeds, eggs, non-deep fried vegetables, and cheese in individual packets.)
•    10% of its calories from saturated fat (excluding eggs and cheese packaged for individual sale).
•    35% sugar by weight (excluding fruits and vegetables).
•    175 calories for items sold in elementary schools.
•    250 calories for items sold in middle and high schools.
Individually sold entrees may not have more than:
•    4 grams of fat per 100 calories
•    400 calories

After-school snacks and beverages sold on campus must satisfy similar requirements.  The state restricts when and where competitive foods, outside the formal meal programs, can be sold.

According to University of Illinois study data, CA students eat 160 fewer calories per day than students in states without nutrition standards.  

CA is also one of 21 states with legislation that requires weight-related screening assessments for children and adolescents.  It is one of 26 states with farm-to-school programs that engage students in understanding the origin of their food.  

Cities have also gotten into the act.  The California Center for Public Health Advocacy (CCPHA) reports that over 142 California cities have passed resolutions and policies related to healthy land use, healthy food access and worksite wellness.  CCPHA’s Healthy Eating Active Living (HEAL) Cities Campaign provides training and technical assistance to help city officials adopt policies that improve their community’s physical activity and retail food environments.  

It will be very difficult to measure the impact of each public health effort on such a global outcome as population obesity.  Who knows?  Maybe the Five a Day program or the First Lady’s Let’s Move initiative are working better than Complete Streets and healthy school lunches.  Programs have proliferated since 2007, and we may never know what worked the best.  Maybe it’s the proliferation of similar messages coming from a variety of sources that’s getting through to at least some people.   
Or it’s a statistical anomaly.

With respect to health, success is an elusive concept.  The goal and means are imperfect and implementation is often a problems, but herding people toward a healthy destination is a process, not an event.  We might know it when we get there.