S C H O O L H E A LT H P O L I C Y

Lessons Learned While Implementing

a Legislated School Policy: Body Mass
Index Assessments Among Arkansas’s
Public School Students

MICHELLE B. JUSTUS, MSa

ABSTRACT
KEVIN W. RYAN, JD, MAb
BACKGROUND: To comprehensively address the childhood and adolescent obesity
JOY ROCKENBACH, BSEc
CHAITANYA KATTERAPALLI, MSd epidemic, Arkansas enacted Act 1220 of 2003. Among a series of community- and school-
PAULA CARD-HIGGINSON, BAe based interventions, the Act requires each public school student to have his/her body
mass index (BMI) assessed and reported annually to parents. The process of implement-
ing this policy on a statewide level and lessons learned are described in this article.
METHODS: A confidential, standardized protocol to measure student BMIs and
report results to parents was developed. Affordable, reliable, and durable equipment
was selected and school personnel who conducted BMI assessments were trained to
ensure standardization. To enhance the efficiency and ease of the measurement and
reporting process and promote long-term and locally based sustainability, during
the first 3 years of implementation, a transition from a paper-based system to a
Web-based system was made. Confidential, individualized Child Health Reports have
provided students’ parents with information about the health of their children.
RESULTS: Participation by schools and students has been high as a result of collabo-
ration between the health and education communities and the students and their
families. Childhood obesity has not increased since Act 1220 was passed into law.
CONCLUSIONS: Parents, schools, school districts, and the state are able to better
understand the obesity epidemic and track progress using detailed annual data.
Providing a standardized measurement protocol, equipment, and efficient data entry
and report generation options has enabled Arkansas to institutionalize the BMI
assessment process in public schools.
Keywords: public health; school nurses; policy; health policy, child and adolescent health.
Citation: Justus MB, Ryan KW, Rockenbach J, Katterapalli C, Card-Higginson P. Lessons
learned while implementing a legislated school policy: body mass index assessments
among Arkansas’s public school students. J Sch Health. 2007; 77: 706-713.
a
Policy Analyst, (justusmichelleb@uams.edu), University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement, 1401 W Capitol Ave, Suite 300,
Victory Building, Little Rock, AR 72201.
b
Executive Associate Director, University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement and Assistant Professor, Fay W. Boozman College of
Public Health, (ryankevinw@uams.edu), University of Arkansas for Medical Sciences, 1401 W Capitol Ave, Suite 300, Victory Building, Little Rock, AR 72201.
c
Formerly: Policy Specialist, University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement and Currently: Act 1220 Coordinator, Arkansas
Department of Education, (joy.rockenbach@arkansas.gov), 2020 W 3rd St, Suite 320, Executive Building, Little Rock, AR 72205.
d
Policy Analyst, (katterapallichaitanya@uams.edu), University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement, 1401 W Capitol Ave, Suite 300,
Victory Building, Little Rock, AR 72201.
e
Associate Director, (higginsonpaulac@uams.edu), University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement, 1401 W Capitol Ave, Suite 300,
Victory Building, Little Rock, AR 72201.
Address correspondence to: Michelle B. Justus, Policy Analyst, (justusmichelleb@uams.edu), University of Arkansas for Medical Sciences, Arkansas Center for Health
Improvement, 1401 W Capitol Ave, Suite 300, Victory Building, Little Rock, AR 72201.

706 d Journal of School Health d December 2007, Vol. 77, No. 10 d ª 2007, American School Health Association
P rior to the passage of Act 1220 of 2003 in Arkansas,
more than 60% of adult Arkansans were either
overweight (body mass index [BMI] 25-29.9) or obese
(BMI  30), ranking adult Arkansans as 14th heaviest
in the nation according to a 2002 Behavioral Risk
Factor Surveillance System survey.1 Nationally, over-
weight prevalence tripled among those aged 6-19
years between 1980 and 2002, while the 2003-2004
National Health and Nutrition Examination Survey
indicated that more than 17% of all US children and
adolescents were overweight.2 This trend has im-
portant public health implications because approxi-
mately 50% of adolescents with a BMI  95th
percentile become obese adults3 and 70% of these
adolescents are more likely to become overweight or
obese adults.4 In addition, childhood diabetes, hyper-
tension, and sleep apnea are more likely to develop
in overweight children.5,6
In response to the childhood obesity epidemic, the
Arkansas legislature passed landmark legislation—
Act 1220 of 20037—with the stated purpose ‘‘to
combat childhood obesity.’’8 A key strategy em-
ployed by Arkansas and increasingly adopted by
other communities9 is measuring the BMI of stu-
dents in schools. Arkansas was the first state to pass
legislation mandating statewide public school–based
BMI assessments8 and since 6 other states have fol-
lowed suit (Illinois, Maine, New York, Pennsylvania,
Tennessee, and West Virginia).10 This article describes
the process employed and lessons learned while
implementing the legislatively mandated school policy
of statewide BMI assessments among public school
students in Arkansas.
Legislation was passed in April 2003 with the
explicit expectation that public schools would con-
duct BMI assessments beginning in the 2003/2004
school year and report the results to parents. Arkansas
school districts receive general funding from the
state based on the average number of students
who attend the district; however, districts have dis-
cretion in how their state funds are spent. Further,
the structure of the Arkansas Department of Educa-
tion (ADE) allows school districts broad autonomy
in implementing policies and procedures. In passing
Act 1220, the legislature placed a series of health-
related performance requirements on schools but
did not provide additional supportive programmatic
funding. As such, schools were eager to find a pro-
cess that allowed them to adhere to the new policy
while minimizing financial and staffing resources
needed to comply.
At the respective request of the ADE and Arkansas
Department of Health, the Arkansas Center for
Health Improvement (ACHI) was asked to lead in
developing and implementing a statewide BMI
assessment process. While ultimately each school
district had autonomous authority to implement
Journal of School Health d December 2007, Vol. 77, No. 10
assessment processes at their respective discretion,
the ADE (through communications from the execu-
tive director) strongly encouraged them to follow
the standardized protocol developed by ACHI.
In the first year of implementation, for all districts
that elected to adhere to the standardized protocol,
ACHI calculated each district’s students’ BMIs and
generated Child Health Reports. As described below,
implementation of BMI assessments and reporting
has been successful.
METHODS
Equipment Selection
To ensure consistent measurements across all
schools, in fall 2003, ACHI evaluated and validated
scales and stadiometers through a research collabora-
tion with 9 schools; equipment was evaluated for
accuracy, durability, and cost (Table 1).11 The Tanita
(Arlington Heights, Ill) HD-314 scale was selected for
use in all schools. This scale measures up to 330
pounds, is lightweight, readily portable, and has
a digital readout that facilitates viewing and mini-
mizes interpretation errors. Because of difficulties
(ie, expense and availability of sufficient quantities)
in procuring prefabricated, affordable stadiometers,
the Arkansas Department of Corrections was com-
missioned to build stadiometers according to ACHI
specifications. Stadiometers were constructed with
an 84-inch metal ruler mounted to an 86-inch
white-painted wooden board accompanied by a plas-
tic carpenter’s square for the headpiece. These units
were portable, durable, and reasonably priced. Using
a grant from the Arkansas Department of Health,
scales and stadiometers were then distributed to
more than 1100 schools statewide at a total equip-
ment cost of $60 per site.
Protocol Development: Training and Certification
To develop a statewide protocol, pilot schools were
used to evaluate the necessity of repeated weight
and/or height measures and the accuracy of scales
and stadiometers.12 To standardize measurements
across the state, a height and weight measurement
training manual (adapted by J. Weber from Lohman
et al13) was developed and used to train and
certify a core group of community health nurses.12
A ‘‘train the trainer’’ teaching model was used.
Community health nurses were trained by a team
from ACHI and the Center for Applied Research
and Evaluation in the Department of Pediatrics,
University of Arkansas for Medical Sciences. Subse-
quently, the community health nurses trained
school nurses and other school personnel across the
state. In addition, a training video was developed
from the manual and given to each school after
d ª 2007, American School Health Association d 707
Table 1. Scale and Stadiometer Comparisons*

95% CI of the Mean of the Differences

% Times
LS Adjusted Means† Unadjusted Means Differences ‚0 (r2)

Scales
Different types of scales
Balance vs spring 1.30 to 1.58 1.28 to 1.59 91 (.99)
Balance vs digital 0.69 to 0.97 0.70 to 0.95 86 (.99)
Spring vs digital 0.75 to 0.47 0.74 to 0.47 70 (.99)
Different digital scale brands
Tanita HD-314 vs Taylor 7301 0.67 to 0.91 0.67 to 0.90 97 (.99)
Tanita HD-314 vs Health-o-meter HDL 11-60 0.15 to 0.26 0.15 to 0.27 47 (.99)
Tanita HD-314 vs Tanita BWB-800S 0.18 to 0.09 0.18 to 0.09 40 (.99)
Health-o-meter HDL 11-60 vs Taylor 7301 0.38 to 0.14 0.38 to 0.14 45 (.99)
Stadiometers
Different measures using same stadiometer
ACHI board 0.10 to 0.11 0.10 to 0.12 NA (.99)
Schorr board 0.13 to 0.18 0.13 to 0.18 NA (.99)
Seca 206 bubble 0.08 to 0.13 0.08 to 0.14 NA (.99)
Different types of stadiometers
Yard stick vs Stadi-o-meter 0.04 to 0.11 0.04 to 0.11 59 (.99)
Yard stick vs Schorr board 0.06 to 0.17 0.06 to 0.17 63 (.99)
Schorr board vs Seca 206 bubble 0.30 to 0.11 0.29 to 0.04 27 (.99)
ACHI board vs Schorr board 0.14 to 0.05 0.14 to 0.05 28 (.99)
Seca 206 bubble vs Yard stick 0.52 to 0.24 0.41 to 0.21 61 (.98)

CI, confidence interval; LS, least squares; NA, not available.

*Source: Adapted from Bost et al.11
†
Means were adjusted for age, gender, race, school, overweight classification, measurement device, and all significant interactions.

initial training was completed to ensure that all (5th percentile  BMI , 85th percentile), at risk for
measurers had access to a single set of instructions overweight (85th percentile  BMI , 95th percen-
on proper techniques. A BMI ‘‘hotline’’ was set up tile), or overweight (BMI  95th percentile). To
at ACHI to take calls from assessors in the field eliminate an unintentional comparison of normal
who needed assistance or had questions about the and abnormal, the term ‘‘healthy weight’’ is used in
protocol. The BMI hotline receives approximately all reports, rather than the CDC classification of nor-
400 calls a year (~600 the first year), with the mal weight. A BMI is not calculated for any student
majority of the calls from school nurses with ques- whose date of birth, gender, height, or weight is
tions regarding the process. In the first year, missing or for students whose records are marked as
approximately 100 parents called the hotline with ‘‘unable to be assessed.’’ Reasons students may be
questions about confidentiality of the assessments, classified as unable to be assessed include absentee-
options for opting out of the assessment, and ques- ism from school on day of assessment, physical dis-
tions about the Child Health Report. ability, student or parent refusal to participate, no
longer attending the school, pregnancy, could not
get 2 height measurements within 1 inch, and
Data Collected
weight exceeded the scale limit (reason added in
Early each school year, a data file of all public
year 4).
school students’ demographic information from the
ADE is provided to ACHI. To ease the data entry
burden on assessors, individual student-level data
collection forms are generated. Schools then report Data Entry and Management: Transition From Paper to
data to ACHI to generate Child Health Reports (see Electronic Data Entry
reports) for distribution to each student’s parents. For the 2003/2004 school year (year 1), a paper-
The mean of each student’s 2 measured heights and based reporting system was developed and imple-
1 weight measurement are used to calculate BMI as mented. Subsequently, to make the process more
(weight in pounds/[height in inches]2) 3 703. Cen- efficient for school personnel and more accurate, an
ters for Disease Control and Prevention (CDC) defi- electronic, Web-based data entry and reporting sys-
nitions of gender-and-age–specific BMI z scores and tem was developed and piloted in 2004/2005. Full
percentiles are calculated.14 Students are classified as implementation of this system began in 2006/2007
underweight (BMI , 5th percentile), healthy weight (Figure 1).

708 d Journal of School Health d December 2007, Vol. 77, No. 10 d ª 2007, American School Health Association
Figure 1. Data Collection—Transition From Paper- to Web-Based System

Year 1 Process

Dept of Ed ACHI generated individualized bar- Data collected on paper

transferred coded forms; mailed to schools forms by school personnel;
data to ACHI for data collection forms returned to ACHI

~422,000 CHRs distributed to

Data were parents via US postal system
entered using Individual CHRs
VBA program generated by
onto SQL server ACHI in Schools rec’d password-protected
specialized VBA Excel file with student data;
program passwords mailed separately

Year 2 Process
Paper-based System Pilot Electronic System
Paper Pocket PC
Schools print paper forms Collect data on paper; key Enter data on Pocket PC;
& collect data into Web site later upload to Web site

~442,000 5 schools (Watson 6 schools (North Little Rock

students Chapel District) District)
Outsourced data entry
~5 ,700 students

Data stored in secure

Data transfer to ACHI
Web-based system

Child Health Reports generated by ACHI

Schools access CHRs via secure Web site

Year 3 Process
Paper-based System Web-based Pilot System
Paper Pocket PC Web Access
Schools print paper forms Collect data on Enter data on Pocket Enter data directly
& collect data paper; key into PC; upload to Web into Web site while
Web site later site measuring
~304,000
students

Outsourced data entry 216 schools in 16 districts

~130,000 students

Data stored in secure

Data transfer to ACHI Web-based system

Child Health Reports generated by ACHI

Schools access CHRs via secure Web site

Journal of School Health d December 2007, Vol. 77, No. 10 d ª 2007, American School Health Association d 709
 In the first year (2003/2004), approximately
450,000 blank data forms were generated, printed,
and shipped to schools. Preprinted forms included
demographic information and school data. Trained
personnel measured students’ height and weight,
hand-entered data, and returned forms to ACHI for
entry into an electronic database. Once data entry was
complete and quality checked, an individual Child
Health Report was generated for each student. Report
generation and mailing were supported by grant fund-
ing, thus were sent at no cost to the schools.
In the second year (2004/2005), the majority
(98%) of Arkansas school districts continued to par-
ticipate in the paper-based assessment process. To
evaluate the efficacy of electronic data collection
options, in year 2, a Web-based program for data
entry was developed and tested in 11 schools. This
program offered schools 2 options for assessing stu-
dents: in addition to paper-based reporting schools
could (a) enter data into the Web-based program
after recording measurements on forms or (b) collect
data on pocket PCs then later upload data collected
into the Web-based program.
Data entry was outsourced to the University of
Arkansas at Fayetteville Survey Research Center
in year 2 for schools that continued using the
paper-based system. The Web-based system provided
interface-level error checking to screen some data
entry errors and to ensure all required information
was captured. The Web-based system also allowed
the school nurse on site to search for students miss-
ing from the initial assessment roster across the state
and transfer his/her name to the current school of
enrollment.
After data entry was completed and quality
checked, Child Health Reports for each respective
school’s students were made available to that school’s
personnel through a secure Web site. All options pro-
vided schools maximum control over students’ re-
cords and allowed schools to select their own method
for distributing reports to parents.
The success of and positive response to the Web-
based program, reported by those who participated,
encouraged the expansion of the program in year 3
(2005/2006) to 16 school districts (216 schools) en-
compassing 130,000 students. The 16 school districts
were geographically dispersed across the state and
ranged in the number of students. In addition to the
2 Web-based options available in year 2, direct data
entry into the Web-based system was made available
for schools during year 3. This option allowed the
assessor to select a student, pull up all pertinent
demographic information, and enter height and
weight measurements directly into the Web-based
system. The schools not participating in the Web-
based program continued using the paper-based sys-
tem as they did in years 1 and 2.
710 d Journal of School Health d December 2007, Vol. 77, No. 10
Reports
Act 1220 requires that schools report each child’s
BMI to parents annually. ACHI developed 5 types of
confidential, individualized Child Health Reports: 1
each, respectively, for students who were classified as
underweight, healthy weight, at risk for overweight,
overweight, or unable to be assessed. All reports ex-
plain the importance of collecting BMI information,
what BMI means, and the student’s height, weight,
and BMI classification (if available). Parents were ad-
vised to consult with their family doctor if they had
questions or concerns and were provided with the
American Academy of Pediatrics suggestions for a
healthy lifestyle, such as offering healthy snacks,
drinking fewer sodas and more water, limiting televi-
sion, and increasing family activities. In the second
year of the initiative, each type of Child Health Report
was translated into Spanish and automatically created
for those parents or guardians for whom Spanish was
listed as the primary language spoken at home accord-
ing to ADE records.
In addition to the Child Health Reports, ACHI
developed individual school and district aggregate
reports and an annual statewide report. Care was
taken in the creation and posting of these reports to
ensure that no individual child could be identified,
either by expressly or by implication. The school-
level report describes the school and its geographic
location and explains BMI assessments. The BMI
classification is presented for male and female stu-
dents by grade in both table and graphic form.
School district reports combine data on all schools
within a district. School participation in each district
is shown. Tables and charts report BMI classification
by gender and grade at the district level. All school
and district reports are available on ACHI’s Web site,
www.achi.net, and are made available to each
school and district annually.
RESULTS
School participation rates have been high each
year ranging from 94% to 99% of public schools
participation, while the submission of student assess-
ment forms ranged from 90% to 95% of all public
school students in the state. However, a BMI was
not necessarily calculated for every student who had
an assessment form submitted. Assessment forms
were submitted for those students that were unable
to be assessed, which represented 14-17% of the
assessment forms received across the years. Absen-
teeism was the most common reason that students
were unable to be assessed (of total reporting, 6.3%
in year 1, 7.7% in year 2, and 6.7% in year 3).
Annually, only 5-6% of students could not be
assessed because they or their parents refused to
allow participation. To be able to calculate a student’s
d ª 2007, American School Health Association
BMI, valid data for weight, height, age on the day of
assessment, and gender must be available. The num-
ber of students who had valid data, enabling a BMI
to be calculated has ranged from 82% to 86% of
those assessed.15
Once the BMIs are calculated, a Child Health
Report is mailed out to each student regardless of
his/her assessment status. In year 1, 422,000 reports
were mailed directly to parents or guardians with
the schools’ return address. In subsequent years,
reports were placed on ACHI’s Web site where they
were password protected at the school level. Each
school superintendent received a unique password
via registered and certified US mail at the beginning
of the school year. In year 2, the responsibility to
deliver reports to parents was shifted from ACHI to
each respective school. In year 2, 445,000 Child
Health Reports were created and 434,000 in year 3.
Year 4 reports became available to schools as soon as
the information was entered into the Web-based sys-
tem. Aggregated statewide results for year 4 are cur-
rently being analyzed.
Arkansas BMI assessment results show that child-
hood obesity is a significant concern for the entire
state, across all ethnicities, ages, and genders. Because
the BMI assessments have begun, the percent of
children who are overweight or at risk for overweight
has remained steady. In the first year, 38.1% of chil-
dren in Arkansas were either overweight or at risk
for overweight, with 38.0% in the second year and
37.5% in the third year.15
DISCUSSION
Act 1220 has afforded Arkansas parents detailed
information about their children’s health, and im-
portantly, communities, schools, and Arkansas policy
makers now have longitudinal data needed to fully
understand the scope of the obesity epidemic in the
state and to track progress made in combating this
epidemic.
In developing and implementing a statewide BMI
assessment process, lessons were learned that other
states might benefit from. Communication that was
regular, reliable, and systematic and that was dis-
seminated throughout all levels of the program was
very important. The exchange of information had to
be bidirectional—between program leadership and
staff conducting the assessments. The effort devoted
to effective communication is an important factor in
the success to date of the BMI initiative in Arkansas.
The importance of school personnel and parental
buy-in to this process is considered critical by many
stakeholders and participants.
Additionally, development and fielding of a stan-
dardized and simple measurement protocol was
demonstrated to be critical. Arkansas is able to pro-
Journal of School Health d December 2007, Vol. 77, No. 10
vide single-year crosscutting comparisons among
schools and districts in the state. Data collected pro-
vides a unique analytic resource allowing for analy-
ses of longitudinal trends. This robustness of analytic
potential would not be possible without the creation
of a standardized and dependable data set.
During this project, it was determined that re-
search-grade assessment equipment was not essential
to dependably measure heights and weights on school
children. In a state such as Arkansas with many rural
and frequently underfunded school districts, it was
critical that equipment be readily attainable, available
in large quantities, not costly, and easy to use. The
equipment discussed above met all these criteria.
Arkansas is now in its fourth year of assessing the
obesity risks of nearly half a million public school chil-
dren and transmitting that information confidentially
to parents. Schools presently have 2 options for partic-
ipation in the BMI assessment process: (a) direct,
Web-based data entry into the system or (b) data col-
lection on paper forms, which must then be entered
by school personnel into the Web site. Thus, schools
now perform all data entry, eliminating the cost of
and need for contracted data entry at the state level.
Of the 2 options presently available for schools, it
is believed that the Web-based system is the most
efficient as it requires only a single data entry with
the program performing immediate quality checks.
The Web-based system does require the schools to
have an Internet connection at their measurement
sites. While not as efficient, the paper-based option
does provide schools with more flexibility for mea-
suring students at multiple sites and conducting data
entry at a later time, although this feature may
result in transcription error.
Recently, in response to constituent concerns
regarding annual assessments (ie, time away from
class and impact on school personnel), the Arkansas
legislature amended the periodicity of BMI assess-
ments under Act 201 of 2007.16 As of the 2007/2008
school year, kindergartners and students in even-
numbered grades through the 10th grade will be
assessed. Students in odd-numbered grades will not
be assessed. However, the law still does not address
any penalties for those schools that do not partici-
pate. The amendment does address an opt-out
option for a student. Parents must provide the school
with a written refusal if they do not wish their child
to participate. Also, under this newly enacted modifi-
cation to the original statute, the community health
nurses will be primarily responsible for quality assur-
ance and adherence to the recommended assessment
protocols. Because of the collaboration between
health and education officials in the state and the
standardized reporting process, participation has been
high each year (Table 2).15 While the Arkansas pro-
gram was initially very labor intensive, the potential
d ª 2007, American School Health Association d 711
Table 2. Statewide Participation in BMI Assessments*
Year 1 (2003-2004)
Category Percent
†
Participation
Public schools 94.3 (1060)
Students (PK-12) 92.6 (426,555)
Student data available
Valid for BMI calculation 81.8 (348,710)
Not valid for BMI calculation 1.4 (5937)
Unable to assess‡ 16.9 (71,908)
*Source: Adapted from ACHI.15
†
Results include all data available for years 1 and 2, and data received by June 14, 2006, for year 3 analysis. Some public schools and districts merged after year 1 and year 2.
‡
The most common reason students were not assessed for BMI was absence from school (of total reporting, 6.3% in year 1, 7.7% in year 2, and 6.7% in year 3). Annually, only 5-6% of
students could not be assessed because they or their parents refused to participate.
for ultimate long-term sustainability will increase as
personnel time requirements decrease.
Interactions with parents indicate their desire for
dependable information regarding the health of their
children. Receptivity to the annual Child Health
Reports has been positive.17 To date, these reports
have served as single point-in-time assessments of
a child’s BMI status. In future years, the hope is to
report both current BMI results and linking to prior
year readings to show an individual student’s trend.
Additionally, a comprehensive child health assess-
ment that includes other health indicators routinely
monitored by schools (eg, vision, hearing) would
benefit parents by providing a detailed picture of the
health of their children.
The dramatic increase in obesity nationally across
all age bands demonstrates the need for substantive
interventions; that obesity is complex in its genesis
informs the need for such interventions to be multi-
factorial in their design and implementation. Arkansas
Act 1220 of 2003 was created to be a statewide,
school-based policy impacting child health through
a broad spectrum of channels (eg, BMI assessment
and reporting, vending machine restrictions, increased
healthy menu offerings). While it has yet to be deter-
mined which of these interventions has been most
efficacious in arresting obesity rate increases in Arkan-
sas (and ultimately, it may prove that these multiple
interventions serve to complement each other), their
merit and impact are demonstrated through the slow-
ing of the obesity epidemic in Arkansas.15
While ongoing study is required to determine if
this effect is sustainable, because early results are
promising, it is critical for Arkansas to continue in
these efforts, while other states should consider
implementing similar programs immediately. Due to
the press of other concerns and limited budgets of
most school districts, it is unlikely (and understand-
able) that such efforts would be undertaken volun-
tarily. As such, legislative mandates may be required
for other states to follow the example set in Arkan-
712 d Journal of School Health d December 2007, Vol. 77, No. 10
Year 2 (2004-2005) Year 3 (2005-2006)
Total Percent Total Percent Total
1124 98.7 (1115) 1130 98.6 (1090) 1106
460,611 95.1 (447,712) 470,571 90.2 (433,808) 480,811
426,555 83.2 (372,369) 447,712 85.5 (371,082) 433,808
426,555 1.1 (4784) 447,712 0.4 (1568) 433,808
426,555 15.8 (70,559) 447,712 14.1 (61,158) 433,808
sas. Creation and passage of this type of legislation
will require substantive grassroots activities and coa-
lition building on the part of child health stakehold-
ers and interest groups to secure success.
However, the long-term health of our nation
requires such all out efforts be initiated immediately.
The deleterious impact of childhood obesity on pres-
ent and future generations, in both their physical
and fiscal well-being, will become overwhelming
unless addressed. Interventions demonstrating im-
provement must be communicated and implemented
without delay; because of the mounting cost-related
obesity, failure to intercede in a timely manner may
result in irreversible harm to individuals’ health and
the long-term viability of the US health care system.
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