Childhood obesity in the state of Michigan (Rachel Korn & Emma Benzie)

Context

Reference to a current Michigan bill or law that relates in some way to your proposal:

House Bill No. 4278

Why this proposal will make a difference in the lives of students of all ages across Michigan, or a significant subgroup (by age, background, economic status, and/or region, etc.) of students in Michigan:

This proposal has the ability to prevent a wide variety of unhealthy beverages from being sold in schools. Currently, students are able to purchase a plethora of unhealthy drinks in schools. These beverages (including soda, juice, and energy drinks) are full of empty calories and sugar. Research has proven that these drinks can directly lead to obesity. It is especially important to remove these beverages from schools as schools are one of the few places legislation can enact laws to ban these dangerous beverages. Since children that are obese are significantly more likely to be become obese as adults, it is crucial to fight obesity in children in order to decrease obesity rates across the state of Michigan. This law will make a difference in the lives of students of all ages across Michigan. 

How and where did you learn about the issues underlying your proposal?

We have both been lucky enough to learn about obesity and nutrition in our school's since youth (through both health and physical education classes as well as from our families). We both think that proper nutrition is crucial to living a healthy, long, and productive life. After seeing a TedX talk by Dr. Abdul El-Sayed, Health Officer and Executive Director of the Detroit Health Department, we learned a great deal about many of the root causes of obesity among individuals of low SES. This TedX talk opened our eyes to the additional struggles individuals of low SES face when trying to obtain healthy food. After this talk, we became interested  in researching how best to fight obesity in schools, as we believe this is the best way to reach the most children in the state of Michigan as possible. After doing some initial research online, we learned that children consume nearly half of their calories in school, and we became dedicated to designing solutions aimed to fight obesity in schools. 

How has your service activity influenced your thinking about this proposal?

Through both of our service activities we have learned how schools can play a vital role in fighting obesity. This semester, both of us are tutoring individuals from the Washtenaw county who are not able to afford tutoring otherwise. Through this experience we have learned how expensive healthy food can be, and how the school place is a rare enviornment where children can be exposed to healthy foods at a lower cost. We have also learned how much children learn about nutrition from watching their peers and teachers. We have heard our students say "I watched my teacher eat that during lunch so I wanted to try it." Through this experience, we have learned how vital it is that healthy and affordable options are provided to students in school. 

Link to your media artifact(s) giving background on the issue:

Newspaper Article: Childhood Obesity in MI

Consultations

Talk directly with at least 3 real live people who have special knowledge about this topic or the impact your proposal would have, and summarize their comments. These may include people appearing in your media artifact (video, podcast, etc.).

CONSULTATION 1:

Erica Schulte M.S. is a fourth year doctoral student in the clinical psychology program at the University of Michigan. Erica is part of the Food and Addiction Science and Treatment Lab where she conducts research on identifying which foods or food attributes may be implicated in addictive-like eating. Ms. Schulte thinks that a top-down approach is key to fighting obesity in schools. She believes that it is difficult to put the pressure on kids to choose healthy options, especially if they have not received a proper education on the importance of eating a nutritious diet. Ms. Schulte thinks that the most effective approaches to fighting obesity in schools will stem from an education perspective (such as posting nutrition facts in cafeterias) as well as a restrictive perspective (which entails limiting unhealthy options all together in schools). Erica thought that our solution of limiting the advertising of unhealthy foods in schools can be extremely effective as it is a way to reduce potential cues in the environment that trigger the consumption of unhealthy foods. Ms. Schulte also thought that eliminating sugar sweetened beverages can be a good first step in improving the nutrition quality in schools, as people tend to get on board with this idea more than eliminating certain food groups altogether. However she thought that in our proposal we should be more specific as to what beverages should be allowed in schools as even beverages that are made of 50% fruit juice are still processed in our body as sugar. It is important to recognize that beverages that may seem healthy such as fruit juice and chocolate milk are still full of sugar and can lead to obesity. As to our last proposal, of mandating physical activity in high school, Ms. Schulte raised concerns that this approach places some of blame off of the food industry. The food industry has notoriously worked to place responsibility on physical activity rather than eating a healthy diet. 

CONSULTATION 2:

Mary Beno M.S.Ed. is the Regional School Health Coordinator for the Livingston Education Service Agency. Ms. Beno is in charge of 14 districts throughout the state of Michigan and is an advocate for mandating K-8 health education. She strongly believes that the root cause of childhood obesity is the lack of school health education. Ms. Beno went on to discuss the federal mandate that includes a local wellness policy. Due to lack of funding, there is no enforcement of this mandate from school administrators. A common problem that she often observes is educators reluctance to teach topics outside of the “core curriculum”. Persuading districts to loosen the reigns on the core curriculum has been one of the biggest challenges. Most recently, she has been trying to integrate health education and ELA. She believes that simply reading health related books in English class or taking the time to train ELA teachers on how to encourage children to eat and be healthy could have great effects in decreasing obesity rates in Michigan.  Ms. Beno felt that our first solution to limit “unhealthy” advertisements was a great way to reduce childhood obesity. Replacing the advertisements of unhealthy food with colorful posters of fruits and vegetables may even help encourage schools to include smart snacks and healthy options in the cafeteria. Ms. Beno also agreed that eliminating sugar-sweetened beverages in school would be extremely effective. To add to this solution, she also discussed the importance of faculty modeling these healthy eating behaviors in front of their students. If students see faculty drinking water instead of soda and eating salads rather than pizza for lunch, students will be more likely to mimic this behavior. Finally, as Ms. Beno majored in health education she is an advocate for more physical education. She has been pushing legislation to include the minimum amount of hours in a school day for physical education classes. Other states have implemented mandatory physical education and health classes, and it is time for the state of Michigan to implement these curriculum in their schools. 

CONSULTATION 3:

Jean DuRussel-Weston, M.S.,  is responsible for the overall direction, growth and sustainability of the organization "Project Healthy Schools" in over 50 schools in the state of Michigan. Project Healthy Schools (PHS) is a middle-school based program aimed to decrease childhood obesity and it's long-term health consequences. Ms. DuRessel-Weston firmly believes that physical education is the most important initiative to fighting obesity among children. She said that it is imperative that the state of Michigan require physical education in schools for all grade levels, as currently it is extremely easy for kids to opt out of P.E. She also believes that legislative solutions aimed to build environments that are conducive to physical activity are important. For example, having open green spaces and side walks are crucial to encouraging people to get exercise. Ms. DuRessel-Weston supported our idea to limit advertising of unhealthy foods in schools, and encouraged us to spread this to TV shows as well. Ms. DuRessel-Weston was a bit more critical of our solution relating to sugar sweetened beverages. She believes that fruit juices and chocolate milk should be allowed in schools as they are healthier alternatives to other choices, and we need to have drinks that are appealing to kids. Lastly, as to our third solution, she believes that we need to enact legislation to make sure that schools are offering physical education, and we need to ensure that P.E. includes actual moving, not just listening. 

Prospectus:

For the first time in history, experts warn that children have a shorter life expectancy than their parents due to the current obesity epidemic. Obesity is an especially important issue in the state of Michigan where childhood obesity rates are higher than the national average. Approximately 14% of children in the state of Michigan are currently obese. Children with obesity are predisposed to a plethora of dangerous and costly health issues including diabetes, hypertension, heart disease, cancer, and arthritis.

Researchers with the National Institute of Health have found that extreme obesity will shorten life expectancy by up to 14 years. In 2008, health complications arising from obesity cost the state of Michigan $2.9 billion dollars. The detrimental health consequences of obesity are creating a huge financial burden for the state of Michigan. In order to decrease obesity rates, it is crucial to prevent children from becoming obese. Research has found that 70 to 80% of obese children remain obese in adult hood, underlying the importance of preventing children from becoming obese early on. Decreasing the rate of obesity would improve the health of thousands across the state of Michigan and would reduce health care costs associated with this epidemic.

Although statistics confirm the importance of preventing obesity in children, children in Michigan are becoming more obese as they progress through the school systems. As students advance through school, they should receive greater education on how to live a healthy life making nutritious choices. Schools must play a vital role in providing and encouraging children to eat healthy foods, educating them on the benefits of living a healthy lifestyle. Since children consume approximately 50% of their caloric intake in school, it is evident that the obesity epidemic amongst Michigan children will not abate without addressing two issues: 1.) improving the quality of food served in school and 2.) augmenting nutrition education in our school systems. Educators, public health officials and physicians must focus on these issues in the classroom in order to stave off further health issues for adults.  

Sources:

http://www.nytimes.com/2005/03/17/health/childrens-life-expectancy-being-cut-short-by-obesity.html

http://stateofobesity.org/states/mi/

https://www.nih.gov/news-events/news-releases/nih-study-finds-extreme-obesity-may-shorten-life-expectancy-14-years

http://www.healthykidshealthymich.com/childhood-obesity-facts-and-statistics.html

Potential Solutions:

Describe three reasonable, feasible potential solutions or approaches that would help address this problem.

Solution 1:  Limit advertising of unhealthy foods

We propose that we limit all forms of advertising of unhealthy food in schools. Research has found that there is a strong correlation between advertising unhealthy foods and greater rates of childhood obesity. Exposure to food cues (such as advertising) has been found to influence an individual’s food purchasing behaviors, food consumption, and overall report of food cravings and desires. Without the cognitive skills to understand advertisements, children are at a higher risk of being susceptible to the tactics used by marketing experts of large food companies to promote unhealthy foods to children.

It is extremely difficult to regulate advertising on a large scale; however, schools are one important environment where it is possible to limit this harmful and dangerous marketing. Research has found that most children under 8 years old do not understand that advertising is meant to persuade them to consume a specific product. Since food companies spend less than half of 1% of their advertising funds on marketing healthy products such as fruits and vegetables, most of their money is spent on advertising unhealthy foods. Schools should not be allowed to post advertisements from companies whose goal is to persuade children to consume unhealthy foods that can be harmful to them long term.

Sources:

https://www.princeton.edu/futureofchildren/publications/docs/18_01_09.pdf

http://www.apa.org/topics/kids-media/food.aspx

http://www.npr.org/sections/thesalt/2016/01/29/462838153/food-ads-make-us-eat-more-and-should-be-regulated

SOLUTION 2: Eliminating sugar-sweetened beverages (SSB)

Research has found that one contributing factor to the worldwide obesity epidemic is the increased consumption of sugar sweetened beverages. Evidence has found that sugar sweetened beverages are extremely caloric and are typically consumed quickly The quick consumption does not lead to the sensation of an individual feeling full which in turn means that a child can still feel unsatisfied after consuming unhealthy calories.  Although medical experts suggest that the consumption of sugar sweetened beverages be limited, this still remains a problem in Michigan schools. We propose that a program similar to California Senate Bill 965 (also known as the healthy beverage bill) be implemented in the state of Michigan. This bill regulates the types of beverages that can be sold to children in public schools from half an hour before the commencement of the school day until thirty minutes after the completion of the school day. This bill mandates that only the following beverages are allowed in schools: “fruit-based and vegetable-based drinks that are at least 50 percent fruit juice without added sweeteners; drinking water without added sweeteners; milk products, including two-percent, one-percent, nonfat, soy, rice, and other similar non-dairy milk; and in middle and high schools, electrolyte replacement beverages that contain no more than 42 grams of added sweetener per 20-ounce serving.” Through this initiative, children will not be allowed to purchase drinks with empty calories (during school) with the intent to curtail the obesity epidemic.

Sources:

https://www.cdc.gov/obesity/downloads/LimitingAccesstoSSBs.pdf

http://www.who.int/elena/bbc/ssbs_childhood_obesity/en/

SOLUTION 3:  Mandating physical education in high school

Physical activity is crucial to fight obesity, promote a healthy heart as well  as improving concentration and cognitive functioning in school. In the state of Michigan, the Michigan Merit Curriculum mandates that high school students complete 0.5 credits in both physical education and health education prior to graduating. However, the state statute allows students who participate in a plethora of after school activities that are related to athletics be exempt from physical education in school. The goal of physical education is to provide students with the  “knowledge, skills, and attitudes necessary for lifelong physical activity.” By exempting certain students from physical education in school, we are preventing them from learning valuable skills that can help them live a healthier and more active life. The state educators of Michigan are doing a disservice by not requiring all students to partake in these classes; such classes are not purely physical in nature but emphasize the educational aspects of a healthy lifestyle. Physical education class teach students valuable skills that they will not learn in various after school activities which are purely related to physical activity. While partaking in athletics is important, it is imperative that students learn skills that will allow them to maintain a healthy life style well beyond high school and their experience on a sporting team.

Sources:

https://www.michigan.gov/documents/mde/MiMeritCurricPE9.07_479747_7.pdf

://crcmich.org/solving-michigans-obesity-problem-with-physical-education-programs/

Reaction or advice from a Topic Coordinator:

You must solicit a critique from a topic coordinator, and explain the impact that advice has had on the final draft of this proposal.

We discussed our proposal with Allie Lisner. Allie encouraged us to consult with an expert who does not agree with our proposal to learn about potential push backs.  Furthermore, Allie suggested that we consult with an expert in California regarding their Sugar Sweetened Beverage Bill. Since this conversation we have reached out to both experts in California, and experts we believe may not agree with our proposal to gain a greater perspective on this issue. Allie also encouraged us to clarify how food companies are advertising in schools as she was unaware of this. Similar to other discussions on the caucus, Allie encouraged us to think about the economic repercussions of eliminating sugar sweetened drinks as these drinks are often times the most affordable options. Going forward, we are going to take into account the economic complexity of eliminating these drinks, and how individuals of low SES could afford other beverages. Allie provided very insightful comments and feedback that have encouraged us to think about the larger scope of this problem while creating our final draft of the proposal.

Research process:

Describe your research process — indicate who you talked to (including but not limited to consultants), what you read, what your thinking was, how it changed over time, and how your consultants changed your thinking. This description of your research process definitely could include “dead ends,” or ideas you had that didn’t ultimately bear fruit.  In short, we want to know what you did and how it led to your legislation, and we also want you to give us a window into your thought process.

Through this process we have talked to various professionals and experts in the field, and done extensive research online to learn about how other states have worked to fight obesity in schools. We began our research process by researching how other states have worked to fight obesity, as well as examined various scientific articles that point to which clinical interventions are most helpful in fighting obesity. We reached out to various professionals in the area of obesity prevention in the Washtenaw county area and were able to speak with three consultants who all provided valuable opinions and advice. We first spoke to Erica Schulte who conducts research on food and addiction science and treatment at the University of Michigan. Erica told us that she believe that a top down approach would be most effective in fighting obesity, and that limiting unhealthy options all together in schools would be a good strategy. We discussed our idea regarding sugar sweetened beverages with Erica and learned that she believes that rather than eliminating just beverages that are fruit-based and vegetable-based and are at least 50 percent fruit juice without added sweeteners, we should eliminate all fruit juices from schools. Erica noted that beverages with a lot of calories like juice are processed in our bodies the same way as simple sugar is, and these beverages are empty calories that do not result in individuals feeling full. Erica strongly suggested that we make this solution stricter, and eliminate juices all together. Our second consultation was with Mary Beno, M.S.Ed., the Regional School Health Coordinator for the Livingston Education Service Agency. Ms. Beno provided us with extensive knowledge of how the school systems are trying to create legislation that fights obesity, and she agreed that eliminating sugar sweetened beverages would be extremely helpful in fighting obesity. Ms. Beno also suggested that increasing P.E. requirements is an extremely important step in fighting obesity in schools. We also spoke to Jean DuRussel-Weston, director of “Project Healthy Schools” in Michigan. Ms DuRussel-Weston was a bit more critical of our solution to eliminate sugar sweetened beverages from schools. She believes that fruit juices and chocolate milk should be allowed in schools as they are healthier alternatives to other choices that children may face. We appreciated Ms. DuRussel-Weston’s opinion and it was good to hear potential push-backs to our plan. Although we believe that fruit juice and chocolate milk are not the worst beverage to drink, they certainly aren’t the healthiest, and we think in order to cause serious change we need to employ stricter regulations in schools that eliminate all beverages that provide excess sugar and calories. 

Author contributions:

Rachel and Emma both did extensive research on childhood obesity prior to deciding on which topic we wanted to focus on for our proposal. We both came up with statistics and facts regarding obesity in Michigan and the USA and pooled these ideas together to create our media artifact. When coming up with possible solutions to enact, we decided to research ideas separately then come to together to discuss their feasibility. Rachel researched and wrote about the first and second solution (advertising and soda) and Emma researched and wrote about the third solution (PE requirements). We both reached out to various consultants and spoke to the consultants together. Emma took notes while we spoke to the consultants and Rachel made these notes into summaries for the purpose of the proposal. We worked on drafting language together, and worked as a team for the majority of the proposal. Rachel outlined the perambulatory clauses and operative clauses, while Emma focused on researching the possible counter arguments. We outlined the costs and funding together. 

===FORMAL PROPOSAL===

The sections below should comprise your final proposal language, submitted for consideration by your peers and potential inclusion in the MSC Platform.

Preambulatory clauses

These set up the PROBLEM, but not the solution.

WHEREAS, Michigan now has the 16th highest adult obesity rate in the nation.

WHEREAS, Michigan's adult obesity rate is currently 31.2%, up from 22.1% in 2000 and from 13.2% in 1990.

WHEREAS, Children who are obese or overweight are significantly more likely to remain overweight in adulthood. 

WHEREAS, Individuals who are obese face a higher-than-average risk of over 50 different health problems including heart disease, stroke, diabetes, and certain cancers. 

Operative clauses

These describe in detail, the solution you are proposing (not the problem itself; those should go in the "Whereas" clauses above).

THEREFORE BE IT RESOLVED....

1. That the state of Michigan regulates the types of beverages that can be sold to children in public schools from half an hour before the commencement of the school day until thirty minutes after the completion of the school day in order to decrease obesity rates among children. Limiting the availability of beverages that are high in sugar will force children to drink more water, as that is the most easily accessible beverage. Students will ultimately get used to consuming healthier beverages and will refrain from drinking beverages that are higher in sugar and beverages with added sweeteners when they return home from school. 

2. Only the following beverages will be sold in schools: drinking water without added sweeteners; milk products, including two-percent, one-percent, nonfat, soy, rice, and other similar non-dairy milk. Students would be less tempted to purchase beverages that are high in sugar if they were not available in school. Students should not be consuming such beverages daily and by reducing their presence on school grounds, it is possible that children will eventually stop drinking them.

3. Fruit juices are not allowed to be sold in schools as they typically contain a lot of sugar which can lead to obesity. Fruit juice is an easy way to consume a great amoung of sugar and calories very quickly. There are 160 calories in an 11.5 oz. bottle of Simply Orange with very few nutritional benefits. Banning fruit juices would make students re-evaluate the beverages that they are consuming. This solution would lead children to consume less calories from sweetened beverages, and there for possibly lose weight and remain healthier.

Counter-arguments:

What are three reasonable arguments against this proposal?

1. Added sugars, including sugar-sweetened beverages, are no more likely to cause weight gain than other sources of calories. We cannot pick and choose some foods/beverages to regulate and not others. Blaming one product is not an effective solution to a complex problem like obesity. Children may choose to consume a piece of cake everyday for dessert rather than an unhealthy beverage. Blaming one product is not an effective solution to a complex problem like obesity. There are no statistics on how many students are consuming beverages high in sugar or with added sweeteners compared to those who choose water.

2. There is not enough research to say what occurs when we take sugar sweetened beverages or place limits on these drinks. It is possible that people may find ways around these restrictions, or may continue so consume the same amount of calories from other sources. We must conduct research on how eliminating sugar sweetened beverages will effect obesity before installing this initiative in school systems. There is also the possibility that students may continue to consume the same amount of calories from other sources. We must conduct research on how eliminating sugar sweetened beverages will effect obesity before installing this initiative in school systems. 

3. This ban will infringe on individual's civil liberties. The United States is a country of freedom. Who are we to decide what people can and cannot drink? Children should have the freedom to decide what they want to drink. Many states have tried to tax beverages that were high in sugar and failed. Attempting to ban drinks such as fruit juice in school could certainly pose an issue for many Americans. Some students my need fruit juices in order to stay hydrated or to keep their sugar levels at a healthy level in the case that they have diabetes.

Costs and funding:

What will your proposal cost (in direct expenses, lost tax revenue, lost economic opportunity, and/or non-monetary costs)? How will you pay for your proposed legislation? Where will/could the funding for your proposal come from?  Who might object to dedicating resources to your proposal (competing interests)?  

This proposal is extremely cost effective. We predict companies that supply juice/other sugar sweetened beverages to object to this prosal. These companies would experience a decrease in sales in all public schools across Michigan if Michigan public schools began to limit and/or ban juices that are high in sugar. However, we believe that there will be little money lost in tax revenue as children who other-wise purchased sugar sweetened beverages will now purchase milk or water.

Furthermore, this proposal has the cabality to save costs over time. Obesity is an extremely expensive problem. The state of Michigan is expected to spend around 12.5 billion dollars on obesity related medical costs in the year 2018. By cutting down on obesity rates, the state of Michigan will spend less money on treating individuals with obesity related health complications. 

References:

http://stateofobesity.org/states/mi/

http://fortune.com/2016/01/25/child-obesity-global-crisis/

https://www.helpguide.org/harvard/how-excess-weight-affects-your-health.htm

http://healthland.time.com/2012/07/25/from-the-nyc-soda-ban-hearing-the-best-arguments-for-and-against/

http://abcnews.go.com/Health/pop-science-case-soda-ban/story?id=18713242

https://www.michigan.gov/documents/mdch/Obesity_BG_363659_7.pdf

 



 

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Total votes: 26

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