Leveraging the Public School System to Combat Adolescent Obesity: The Limits of Arkansas's Statewide Policy Initiative.
PURPOSE
This study assessed the effectiveness of one of the earliest statewide policy initiatives to address obesity via schools-Arkansas's Act 1220 of 2003-on adolescent obesity. The Act required public schools in Arkansas to conduct body mass index (BMI) screening and reporting, restrict access to vending machines, and establish physical education and nutrition standards.


METHODS
To determine the effect of Act 1220 as a whole, this study analyzed data representative of adolescents in grades 9-12 from the Youth Risk Behavior Survey using the quasi-experimental method of difference-in-differences. Changes in adolescents' weight outcomes in Arkansas before (1999 and 2001) and after (2005, 2007, and 2009) the implementation of Act 1220 were compared to changes in weight outcomes for adolescents from the neighboring state of Missouri across the same time period.


RESULTS
Arkansas's Act 1220 did not significantly influence adolescents' BMI-for-age z-scores (-.017; 95% confidence interval [CI] [-.097, .063]; p = .68). Further, the Act did not lead to significant reductions in BMI-for-age z-scores among adolescents who were either overweight (-.003; 95% CI [-.043, .036]; p = .86) or obese (-.010; 95% CI [-.070, .051]; p = .75). Results remain robust to adjustments for self-report bias in height and weight as well as a set of alternative comparison states.


CONCLUSIONS
Preventing adolescent overweight and obesity is unlikely to occur through such large-scale policy initiatives alone.
['Gee|Kevin A|KA|']
D000293:Adolescent D001131:Arkansas D005260:Female D006291:Health Policy D006801:Humans D008297:Male D063766:Pediatric Obesity D012574:Schools D011795:Surveys and Questionnaires
Schools Adolescents Arkansas Difference-in-differences Obesity prevention