Why We Need Local, State, and National Policy-Based Approaches to Improve Children’s Nutrition in the United States

  • Megan Lott
  • Marlene Schwartz
  • Mary Story
  • Kelly D. Brownell
Part of the Contemporary Endocrinology book series (COE)


Government agencies have the authority to improve public health through laws and policies. Childhood obesity is one of the most pressing health issues today, and government policies are a critical strategy to improve children’s nutrition and health. This chapter reviews evidence-based policies that can be implemented at local, state, and federal levels to improve children’s nutrition and weight. We discuss (a) why policy change may be more cost-effective and impactful than programs aimed at individuals; (b) how to strengthen federal child-feeding programs; and (c) which policies have potential to improve and change food industry practices.


Food policy Child nutrition WIC Federal feeding programs School lunch Food industry Marketing 



American Academy of Pediatrics


The Patient Protection and Affordable Care Act


The Child and Adult Care Food Program


The Children’s Food and Beverage Advertising Initiative


The Childhood Obesity Intervention Cost-Effectiveness Study


Cash-Value Vouchers


Dietary Guidelines for Americans


Farm to School


The Food Distribution Program on Indian Reservations


Fresh Fruit and Vegetable Program


The Farmer’s Market Nutrition Program


Foods of Minimal Nutritional Value


USDA Food and Nutrition Services


Federal Poverty Limit


The Federal Trade Commission


Fiscal Year


The Healthy, Hunger-Free Kids Act of 2010


Healthier U.S. School Challenge


Local School Wellness Policies


The National School Lunch Program


The National School Breakfast Program


Quality Rating and Improvement Systems


Summer Food Service Program


The Supplemental Nutrition Assistance Program


The 3rd School Nutrition Dietary Assessment study


Temporary Assistance for Needy Families


The Emergency Food Assistance Program


U.S. Department of Agriculture


The Special Suplemental Nutrition Program for Women, Infants, and Children


  1. 1.
    IOM. Local government actions to prevent childhood obesity. Washington, DC: Institute of Medicine, National Academies Press; 2009.Google Scholar
  2. 2.
    Jeffery RW, Drewnowski A, Epstein LH, Stunkard AJ, Wilson GT, Wing RR, et al. Long-term maintenance of weight loss: current status. Health Psychol. 2000;19(1 Suppl):5–16.CrossRefPubMedGoogle Scholar
  3. 3.
    Brennan LK, Brownson RC, Orleans CT. Childhood obesity policy research and practice: evidence for policy and environmental strategies. Am J Prev Med. 2014;46(1):e1–e16.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dietz WH, Solomon LS, Pronk N, Ziegenhorn SK, Standish M, Longjohn MM, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff (Millwood). 2015;34(9):1456–63.CrossRefGoogle Scholar
  5. 5.
    Brownell KD, Kersh R, Ludwig DS, Post RC, Puhl RM, Schwartz MB, et al. Personal responsibility and obesity: a constructive approach to a controversial issue. Health Aff (Millwood). 2010;29(3):379–87.CrossRefGoogle Scholar
  6. 6.
    Johnson EJ, Goldstein D. Medicine. Do defaults save lives? Science. 2003;302(5649):1338–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Falbe J, Rojas N, Grummon AH, Madsen KA. Higher retail prices of sugar-sweetened beverages 3 months after implementation of an excise tax in Berkeley, California. Am J Public Health. 2015;105(11):2194–201.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ. 2016;352:h6704.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    About WIC. 2016.; Accessed 6 Sept 2016.
  10. 10.
    Fox MK, Hamilton, W, Biing-Hwan L. Effects of food assistance and nutrition programs on nutrition and health: executive summary of the literature review. 2004; 19-3.Google Scholar
  11. 11.
    Cole N, Fox MK. Diet quality of American young children by WIC participation status: data from the National Health and Nutrition Examination Survey, 1999–2004. WIC-08-NH.Google Scholar
  12. 12.
    Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315(21):2292–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Institute of Medicine. WIC Food Packages: Time for a Change. Washington, DC: National Academy of Sciences, 2005.;
  14. 14.
    Food and Nutrition Service, Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Revisions in the WIC Food Packages, 2014; Final Rule, 7 C.F.R 246.Google Scholar
  15. 15.
    Andreyeva T, Luedicke J. Federal food package revisions effects on purchases of whole-grain products. Am J Prev Med. 2013;45(4):422–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Andreyeva T, Luedicke J, Henderson KE, Schwartz MB. The positive effects of the revised milk and cheese allowances in the special supplemental nutrition program for women, infants, and children. J Acad Nutr Diet. 2014;114(4):622–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Andreyeva T, Luedicke J, Middleton AE, Long MW, Schwartz MB. Positive influence of the revised Special Supplemental Nutrition Program for Women, Infants, and Children food packages on access to healthy foods. J Acad Nutr Diet. 2012;112(6):850–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Zenk SN, Odoms-Young A, Powell LM, Campbell RT, Block D, Chavez N, et al. Fruit and vegetable availability and selection: federal food package revisions, 2009. Am J Prev Med. 2012;43(4):423–8.CrossRefPubMedGoogle Scholar
  19. 19.
    WIC Farmer’s Market Nutrition Program. 2016. Accessed 6 Sept 2016.
  20. 20.
    FMNP and SFMNP Activity Map–June 2015. 2016.
  21. 21.
    Review of WIC Food Packages. 2017.; Accessed 29 Jan 2017.
  22. 22.
    Murphy SP, Yaktine AL, Suitor CW, Moats S. Child and adult care food program: aligning dietary guidance for all. Committee to review child and adult care food program meal requirements. Food and Nutrition Board, Institute of Medicine of the National Academies, 2011.
  23. 23.
    Child and Adult Care Food Program. 2016. Accessed 11 Sept 2016.
  24. 24.
    Food and Nutrition Service, Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger-Free Kids Act of 2010, 2016; Final Rule, 7 C.F.R. 210, 215, 220, 226.Google Scholar
  25. 25.
    U.S. Department of Agriculture. Scientific Report of the 2015 Dietary Guidelines Advisory Committee Report, 2015.
  26. 26.
    DeBoer MD, Scharf RJ, Demmer RT. Sugar-sweetened beverages and weight gain in 2- to 5-year-old children. Pediatrics. 2013;132(3):413–20.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Keller A, Bucher Della Torre S. Sugar-sweetened beverages and obesity among children and adolescents: a review of systematic literature reviews. Child Obes. 2015;11(4):338–46.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Taveras EM, Perkins M, Woo Baidal JA. Issue brief: The impact of the first 1,000 days on childhood obesity. 2016; 1089.Google Scholar
  29. 29.
    Kaphingst KM, Story M. Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States. Prev Chronic Dis. 2009;6(1):A11.PubMedGoogle Scholar
  30. 30.
    Shuell J. State quality rating and improvement systems. Strategies to support achievement of healthy eating and physical activity practices in early care and education settings. 2016; CAS020.Google Scholar
  31. 31.
    Health Impact Assessment: National Nutrition Standards for Snack and a la Carte Foods and Beverages Sold in Schools. The Pew Charitable Trusts. June 2012.
  32. 32.
    Johnston LD, O’Malley PM, Terry-McElrath YM, Colabianchi N. School policies and practices to improve health and prevent obesity: national secondary school survey results: school years 2006–07 through 2010–11. Volume 3. 2013; 2016:1–42.Google Scholar
  33. 33.
    Fox MK, Condon E. School nutrition dietary assessment study-IV. Alexandria, VA: Food and Nutrition Service, USDA; 2012. Google Scholar
  34. 34.
    School Meals, Healthy Hunger-Free Kids Act. 2016.; Accessed 11 Sept 2016.
  35. 35.
    National School Lunch Program: Participation and Lunches Served. 2016.; Accessed 11 Sept 2016.
  36. 36.
    National School Breakfast Program: Participation and Meals Served. 2016.; Accessed 11 Sept 2016.
  37. 37.
    Gordon AR, Crepinsek MK, Briefel RR, Clark MA, Fox MK. The third School Nutrition Dietary Assessment Study: summary and implications. J Am Diet Assoc. 2009;109(2 Suppl):S129–35.CrossRefPubMedGoogle Scholar
  38. 38.
    U.S. Department of Agriculture, Nutrition Standards in the National School Lunch and School Breakfast Programs, 2012; Final Rule, 7 C.F.R. 210, 220.Google Scholar
  39. 39.
    Johnson DB, Podrabsky M, Rocha A, Otten JJ. Effect of the healthy hunger-free kids act on the nutritional quality of meals selected by students and school lunch participation rates. JAMA Pediatr. 2016;170(1):e153918.CrossRefPubMedGoogle Scholar
  40. 40.
    Schwartz MB, Henderson KE, Read M, Danna N, Ickovics JR. New school meal regulations increase fruit consumption and do not increase total plate waste. Child Obes. 2015;11(3):242–7.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    School Meal Certification Data. USDA. Accessed 23 Sept 2016.
  42. 42.
    U.S. Department of Agriculture, National School Lunch Program and School Breakfast Program: Nutrition Standards for All Foods Sold in School as Required by the Healthy, Hunger-Free Kids Act of 2010; Interim Final Rule, 7 C.F.R. 210, 220.Google Scholar
  43. 43.
    Chriqui JF, Pickel M, Story M. Influence of school competitive food and beverage policies on obesity, consumption, and availability: a systematic review. JAMA Pediatr. 2014;168(3):279–86.CrossRefPubMedGoogle Scholar
  44. 44.
    Taber DR, Chriqui JF, Chaloupka FJ. Differences in nutrient intake associated with state laws regarding fat, sugar, and caloric content of competitive foods. Arch Pediatr Adolesc Med. 2012;166(5):452–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Alaimo K, Oleksyk SC, Drzal NB, Golzynski DL, Lucarelli JF, Wen Y, et al. Effects of changes in lunch-time competitive foods, nutrition practices, and nutrition policies on low-income middle-school children’s diets. Child Obes. 2013;9(6):509–23.Google Scholar
  46. 46.
    Harris JL, Hyary M, Schwartz MB. Effects of offering look-alike products as smart snacks in schools. Child Obes. 2016;12(6):432–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Welker E, Lott M, Story M. The school food environment and obesity prevention: progress over the last decade. Curr Obes Rep. 2016;5(2):145–55.CrossRefPubMedGoogle Scholar
  48. 48.
    Food Research and Action Center. Hunger doesn’t take a vacation: summer nutrition status report, 2016.;
  49. 49.
    Trust for America’s Health. F as in Fat: How Obesity Policies are Failing in America, 2009
  50. 50.
    Schwartz MB, Henderson KE, Falbe J, Novak SA, Wharton CM, Long MW, et al. Strength and comprehensiveness of district school wellness policies predict policy implementation at the school level. J Sch Health. 2012;82(6):262–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Nanney MS, MacLehose R, Kubik MY, Davey CS, Coombes B, Nelson TF. Recommended school policies are associated with student sugary drink and fruit and vegetable intake. Prev Med. 2014;62:179–81.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Lucarelli JF, Alaimo K, Belansky ES, Mang E, Miles R, Kelleher DK, et al. Little association between wellness policies and school-reported nutrition practices. Health Promot Pract. 2015;16(2):193–201.CrossRefPubMedGoogle Scholar
  53. 53.
    Local School Wellness Policy Implementation Under the Healthy, Hunger-Free Kids Act of 2010: Summary of the Final Rule. 2016; FNS-627.Google Scholar
  54. 54.
    Nanney MS, Davey CS, Kubik MY. Rural disparities in the distribution of policies that support healthy eating in US secondary schools. J Acad Nutr Diet. 2013;113(8):1062–8.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Kehm R, Davey CS, Nanney MS. The role of family and community involvement in the development and implementation of school nutrition and physical activity policy. J Sch Health. 2015;85(2):90–9.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Nestle M. Food politics. Berkeley: University of California Press; 2003.Google Scholar
  57. 57.
    Farley TA, Caffarelli A, Bassett MT, Silver L, Frieden TR. New York City’s fight over calorie labeling. Health Aff (Millwood). 2009;28(6):w1098–109.Google Scholar
  58. 58.
    Center for Science in the Public Interest. State and Menu Labeling Policies. 2014; Accessed 24 Sept 2016.
  59. 59.
  60. 60.
    Jalonick MC. FDA punts calorie labels on menus for another year-again. U.S. News and World Report, March 28, 2016.;
  61. 61.
    Larson N, Story M. Menu labeling: does providing nutrition information at the point of purchase affect consumer behavior? [Internet]. 2009:1–11.Google Scholar
  62. 62.
    Dumanovsky T, Huang CY, Bassett MT, Silver LD. Consumer awareness of fast-food calorie information in New York City after implementation of a menu labeling regulation. Am J Public Health. 2010;100(12):2520–5.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Antman EM, Appel LJ, Balentine D, Johnson RK, Steffen LM, Miller EA, et al. Stakeholder discussion to reduce population-wide sodium intake and decrease sodium in the food supply. Circulation. 2014;129(25):e660–79.CrossRefPubMedGoogle Scholar
  64. 64.
    NYC Health Sodium Initiative. 2016.; Accessed 13 Sept 2016.
  65. 65.
    Freifeld K. New York City can enforce rule on salt warnings in restaurants: court. Reuters, May 26, 2016.;
  66. 66.
    Kraak VI, Story M. The use of brand Mascots and media characters: opportunities for responsible food marketing to children, 2016; 1082. Durham, NC: Health Eating Research.
  67. 67.
    Healthy Eating Research. Recommendations for responsible food marketing to children, 2015; 1084.
  68. 68.
    Harris JL, Pomeranz JL, Lobstein T, Brownell KD. A crisis in the marketplace: how food marketing contributes to childhood obesity and what can be done. Annu Rev Public Health. 2009;30:211–25.CrossRefPubMedGoogle Scholar
  69. 69.
    Kelly B, Vandevijvere S, Freeman B, Jenkin G. New media but same old tricks: food marketing to children in the digital age. Curr Obes Rep. 2015;4(1):37–45.CrossRefPubMedGoogle Scholar
  70. 70.
    Elsey JW, Harris JL. Trends in food and beverage television brand appearances viewed by children and adolescents from 2009 to 2014 in the USA. Public Health Nutr. 2016;19(11):1928–33.CrossRefPubMedGoogle Scholar
  71. 71.
    Molnar A, Boninger F, Wilkinson G, Fogarty J. At sea in a marketing-saturated world: the eleventh annual report on schoolhouse commercialism trends: 2007–2008. 2008.Google Scholar
  72. 72.
    Infant and Toddler Marketing. University of Connecticut Rudd Center for Food Policy and Obesity. 2016. In Press.Google Scholar
  73. 73.
    CHOICES Project. 2015.; Accessed 13 Sept 2016.

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Megan Lott
    • 1
  • Marlene Schwartz
    • 2
  • Mary Story
    • 3
  • Kelly D. Brownell
    • 4
  1. 1.Duke Global Health Institute, Duke UniversityDurhamUSA
  2. 2.Rudd Center for Food Policy and Obesity, University of ConnecticutHartfordUSA
  3. 3.Department of Community and Family Medicine and Global HealthDuke Global Health Institute, Duke UniversityDurhamUSA
  4. 4.Sanford School of Public Policy, Duke UniversityDurhamUSA

Personalised recommendations