Addressing Obesity and Health Disparities Through Federal Nutrition and Agricultural Policy

The American Public Health Association (APHA) aims to advocate for national policies that address the prevention of obesity and racial and ethnic disparities in health status.^1–3 Overweight and obesity now affect two thirds of the US adult population,^4,5 and one third of children are overweight or at risk of overweight.⁵ This situation increases the risk of diabetes, hypertension, and heart disease. African American, Native American, Native Hawaiian, and Latino populations face a disproportionate toll of overweight, diabetes, and cardiovascular disease.^6–8 

The risk for overweight and obesity has been linked with multiple factors, including food security and access to healthful foods.^9,10 Children and adolescents of lower socioeconomic status are less likely to eat fruits and vegetables and more likely to have a higher intake of total and saturated fat.^11,12 Food availability is influenced by federal subsidy policies for food production and assistance programs, such as the National School Lunch Program and the Women, Infants, and Children (WIC) program, which provide insufficient vegetables, fruits, whole grains, and legumes and overemphasize high-fat, high-cholesterol products.^13,14 Food commodity purchases determining what is available to food assistance programs, including schools, are often governed by market conditions rather than health considerations.^15,16 Considerable agricultural subsidies for meat, eggs, and dairy products ensure that foods high in fat, saturated fat, and cholesterol are cheap and widely available, whereas fruits, vegetables, legumes, and whole grains are less available.^17–19 

Changes in agricultural subsidy policy have the potential to mitigate rising chronic disease rates. In Poland, the withdrawal of large animal product subsidies led to decreased animal fat intake and increased fruit and vegetable intake, followed by a subsequent decrease in ischemic heart disease mortality.²⁰ Empirical simulations indicate potential health benefits of subsidies on certain classes of fruits and vegetables in the United States. Estimates suggest that the cost per statistical life saved through fruit and vegetable subsidies compares favorably with existing US government health-promotion programs.²¹

Although many African Americans, Latinos, Native Americans, and Asian Americans are lactose intolerant,²² nondairy beverages are limited or excluded in food assistance programs.^13,23 Lactase deficiency is present in up to 15% of persons of northern European descent, up to 80% of African Americans and Latinos, and up to 100% of American Indians and Asians.²²

Accordingly, the APHA endorses efforts (1) to support increased consumption of fruits and vegetables through school meal assistance programs and (2) to give schools the flexibility to decide what type(s) of milk to offer with school meals.²⁴ Therefore, the APHA supports efforts to address the obesity epidemic and reduce health disparities by— 

1. Basing food assistance programs administered through the Food and Nutrition Service solely on the health and food security needs of their constituents. 
2. Increasing access to healthy, culturally acceptable vegetables, fruits, legumes, grains, vegetarian foods, and healthful nondairy beverages in school lunches and food assistance programs.
3. Urging Congress to shift federal subsidies support to products low in fat, cholesterol, sodium, and sugar. 
4. Urging the federal government to change laws, specifically those governing the US Department of Agriculture, that promote agricultural interests over the interests of nutrition. 
5. Ensuring that federal standards for competitive foods in schools are set such that they do not preempt more stringent local standards for limiting fats, saturated fat, cholesterol, sugar and salt. Encouraging public health education in school settings, specifically addressing the obesity epidemic and the identification of healthy food choices, as listed in Point 2.

References

1. American Public Health Association. APHA Policy Statement 2006-19. Urgent call for a nationwide public health infrastructure and action to reverse the obesity epidemic. Washington, DC: American Public Health Association; 2006. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1343. Accessed March 13, 2007. 
2. American Public Health Association. APHA Policy Statement 2006-18. Reducing nutrition-related disparities in America through food stamp nutrition education and the reauthorization of the Farm Bill. Washington, DC: American Public Health Association; 2006. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1342. Accessed March 13, 2007.
3. Eliminating Health Disparities: Support Programs to Close the Gap Fact Sheet. Washington, DC: American Public Health Association. Available at: www.apha.org/NR/rdonlyres/65AC2696-5A9E-485E-90D4-7D669736D19C/0/disparitiesFactSheet.pdf. Accessed March 13, 2007.
4. Mokdad A, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–79.
5. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity among us children, adolescents, and adults, 1999–2004. JAMA. 2006;295:1549–1555. 
6. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Diabetes Information Clearinghouse. National diabetes statistics. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/#10. Accessed November 10, 2006. 
7. American Heart Association. Heart Disease and Stroke Statistics —2003 Update. Dallas, TX: American Heart Association; 2002.
8. Aluli NE. Prevalence of obesity in a Native Hawaiian population. Am J Clin Nutr. 1991;53(6 Suppl):1556S–1560S.
9. Sallis JF, Glanz K. The role of built environments in physical activity, eating, and obesity in childhood. Future Child. 2006;16(1):89–108.
10. Centers for Disease Control and Prevention (CDC). Self-reported concern about food security associated with obesity—Washington, 1995–1999. MMWR Morb Mortal Wkly Rep. 2003;52:840–842.
11. Neumark-Sztainer D, Story M, Resnick MD, Blum RW. Correlates of inadequate fruit and vegetable consumption among adolescents. Prev Med. 1996;25:497–505.
12. Krebs-Smith SM, Cook A, Subar AF, et al. Fruit and vegetable intakes of children and adolescents in the United States. Arch Pediatr Adolesc Med. 196;150:81–86.
13. US Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition, and Evaluation. Analysis of WIC Food Package Prescriptions, 1998–2002, Special Nutrition Program Report Series. No. WIC-06-PCFP. Alexandria, VA: Food, Nutrition, and Consumer Services, USDA; 2006. 
14. US Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation. School Nutrition Dietary Assessment Study—II Final Report. Alexandria, VA: Food, Nutrition, and Consumer Services, USDA; 2001. Available at: www.fns.usda.gov/oane/menu/Published/CNP/FILES/SNDAIIfind.pdf. Accessed December 6, 2007.
15. 42 United States Code § 1755a and § 1755c(1)(D).
16. 7 United States Code § 612c.
17. Environmental Working Group. Farm subsidy database. Available at: www.ewg.org/farm/region.php?fips=00000. Accessed November 10, 2006.
18. United Soybean Board. 2001 soy stats. Available at: www.soystats.com/2001/page_23.htm. Accessed November 10, 2006.
19. World Resources Institute, EarthTrends. Meat Consumption: Grain Fed to Livestock As a Percent of Total Grain Consumed. Available at: http://earthtrends.wri.org/searchable_db/index.php?theme=8&variable_ID=1834&action=select_countries. Accessed November 10, 2006.
20. Zatonski WA, McMichael AJ, Powles JW. Ecological study of reasons for sharp decline in mortality from ischemic heart disease in Poland since 1991. BMJ. 1998;316(7137):1047–1051.
21. Cash SB, Sunding DL, Zilberman D. Fat taxes and thin subsidies: prices, diet, and health outcomes. Acta Agriculturæ Scandinavica Section C. 2005;2:167–174.
22. Swagerty DL Jr, Walling AD, Klein RM. Lactose Intolerance. Am Fam Physician. 2002 May 1;65:1845–1850.
23. Public Law 108-265 § 102.
24. American Public Health Association. APHA Policy Statement 2003-19. Support for WIC and child nutrition programs. Washington, DC: American Public Health Association; 2003. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1257. Accessed March 13, 2007.

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