Role of Government Policy

The use of policy to alter the environments in which individuals make food choices can have a significant impact on the healthfulness of these decisions. A three-pronged approach for tackling obesity prevention at the policy level is recommended, involving “altering relative food prices, shifting exposure to food, and improving the image of healthy food while making unhealthy food less attractive” (Frieden, Dietz, & Collins, 2010, p. 357). Policies with these aims can target various aspects of the environment, including the media, food industry, and pricing.

Media

Youths and adolescents are prime targets of food and beverage advertising in the United States. Advertisers spend an estimated $10 billion on food marketing to youths annually (McGinnis, Gootman, & Kraak, 2006). Most of this marketing is contrary to recommendations for a healthy diet and instead focuses on energy-dense junk foods. More than half of the advertisements youths view promote foods, particularly fast food, sugar- sweetened beverages, and low-nutrient snack foods (McGinnis et al., 2006; Story & French, 2004), which is particularly troublesome because youths have difficulty distinguishing between entertainment, information, and the persuasive intent behind advertisements (Kunkel et al., 2004). Government policy interventions for obesity prevention could include restrictions on child-targeted advertisements for unhealthy junk foods (Graff, Kunkel, & Mermin, 2012) or the implementation of media messages that promote healthier physical activity and nutrition behaviors.

Food Industry

Policy could also mandate that the food industry take steps to promote healthier eating. Fast food and other restaurants could include nutrition information on all food products, and the number of healthier options could be expanded. Indeed, although more research is needed on the impact of nutrition information labeling, some studies have indicated that individuals choose meals with significantly fewer calories when nutrition information is displayed (Bassett et al., 2008; Roberto, Larsen, Agnew, Baik, & Brownell, 2010), although other research has found no change (Elbel, Kersh, Brescoll, & Dixon, 2009). In addition, food labels could be changed to represent the actual amounts contained in the package (e.g., an entire bottle of soda). These policies would be beneficial to counselors, who could use nutrition information as tools to empower youths to make healthy decisions about dietary intake.

Pricing

Individuals' consumption patterns are largely dependent on the cost of foods. Currently, the price per calorie of foods containing excess dietary fat and sugar is less expensive than the cost per calorie of healthful foods such as fruits and vegetables (Drewnowski & Darmon, 2005). Implementing food taxes on less healthy, energy-dense foods could significantly affect youths' weight (Powell & Chaloupka, 2009). Junk food taxes are comparable to cigarette taxes, which have led to decreased adult smoking (Levy, Nikolayev, Mumford, & Compton, 2005). Brownell, Fairley, et al. (2009) supported taxes on sugar-sweetened beverages, such as soda. They suggested that revenue generated through these taxes could support obesity prevention programming or health care costs for those who are uninsured. Older children may be particularly affected by this taxation because they are likely to use their limited income on snack foods and leisure. Counselors could also work with youths to enhance awareness of the financial and physical costs of energy- dense, low-nutrient foods compared with the costs of healthy foods.

Community Interventions

Families' access to healthy food and adequate physical activity can depend in part on their neighborhood. Primary prevention at the community level aims to increase the availability of fresh fruits and vegetables and increase the safety of surroundings. Counselors can also aid in prevention that aims to help families think of solutions to these barriers.

Food Access

A major barrier to successful obesity prevention is community access to grocery stores. When healthier food options found at larger food retailers or farmers' markets are not readily available, community members may shop primarily at convenience stores or fast food restaurants, where they are likely to purchase energy-dense foods high in sugar and fat. This is particularly common in low-income neighborhoods, which are sometimes referred to as food deserts (Beaulac, Kristjansson, & Cummins, 2009). Assisting older children and caregivers with making healthy food choices within the accessible options could lessen this barrier.

Physical Activity Access

A barrier to physical activity is neighborhood safety. Unsafe neighborhoods lead to decreased opportunity for youths to be physically active outside and increased screen time (Burdette & Whitaker, 2005). Programs such as Safe Routes to School (Watson & Dannenberg, 2008) focus on removing the barriers that prevent youths from walking or biking to school. Helping youths and parents to establish safe times and spaces where youths can play or brainstorming active alternatives to screen time within the accessible options could help prevent pediatric obesity.

 
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