Press Release  Audit of State Obesity Programs Finds Progress and Offers Recommendations

Somerville — State Auditor Suzanne M. Bump today released a performance audit of the various state programs and initiatives employed to combat childhood obesity. The report provides a culminating review of the efforts from the Departments of Public Health (DPH), Agricultural Resources, and Elementary and Secondary Education (DESE) to implement new laws, regulations, and programs. The review found significant progress in the implementation of nutritional standards, promoting physical activity, and providing access to quality food.

“Our children are our future and the state of childhood obesity has been troubling,” said Auditor Bump. “We have made progress, but with one in three children in our state either overweight or obese, we should be ever vigilant on the path towards a healthier Commonwealth.”

Partnering with Somerville Mayor Joseph Curtatone, and being joined by Massachusetts Public Health Commissioner Cheryl Bartlett, RN and other experts in nutrition and health, Auditor Bump used the completion of the audit to highlight a need for increased physical activity standards and opportunities.

“Nationwide, the trends in childhood obesity have slowed and begun to steady in recent years, but I urge community and local leaders not to become complacent on this issue,” said Mayor Curtatone. “As this audit also demonstrates, we are far from finished with this fight, and we need to continue to work collaboratively across municipal boundaries and through our community partners to create effective policy and curriculum that gets to the core issues of healthy eating and physical activity.”

Background
Obesity rates in Massachusetts and the nation have risen significantly in recent decades. Nearly a quarter of adults in the Commonwealth were reported to be obese in 2012. This level is projected to rise to encompass almost half of adults in Massachusetts by 2030 if current trends continue. Childhood obesity, in particular, has become an increasing problem. Within Massachusetts, 155,000 children under the age of 18 (10.6%) are obese, and an additional 203,000 (14%) are overweight. Childhood obesity has placed thousands of children at higher risk of serious physical health problems such as type 2 diabetes, cardiovascular disease, and asthma, as well as psychological issues including depression.

Audit Findings
In 2012, DPH established new healthier nutritional standards for food and beverages in school cafeterias, stores, and vending machines. Audit teams visiting and surveying a sample of 60 districts across the Commonwealth found compliance with DPH’s updated regulations. In addition, auditors found all sampled schools complied with the state’s standards of physical education (PE), and that the vast majority of schools were fully compliant in measuring student Body Mass Index and reporting that information to the state.

The audit also found that DPH is properly administering $22 million in federal funds to combat childhood obesity and promote overall health and wellness within local communities through its Mass in Motion initiative.

The report also detailed the state’s efforts to improve access to quality food through the promotion of acceptance of the Supplemental Nutritional Assistance Program (SNAP) at local farmers’ markets. Auditors found some farmers’ markets have implemented the use of SNAP benefits, but others resist the use of SNAP because of staffing cost and high transaction fees. Of an $80,000 grant received by the Commonwealth to promote SNAP at farmer’s markets funded by the U.S. Department of Agriculture, only $10,625 had been spent.

Physical Education
The audit showed compliance of schools having a PE element to their curriculum, but practices varied widely from school district to school district and from school to school. Specifically, the frequency and duration of PE at the elementary schools we visited/surveyed ranged from 38 minutes per week to 90 minutes per week. Similarly, PE levels at the middle and high schools that we reviewed ranged from 22 minutes per week to 168. 

The Surgeon General recommends at least 300 minutes of physical activity weekly for all children, with 150 of those minutes to occur during the school week. The National Association for Sport and Physical Education recommends 150 minutes per week of PE for elementary-school students and 225 minutes of PE per week for middle and high school students.

Auditor Bump recommended in her report that state education officials and the legislature consider implementing standards for the amount of physical activity in schools. She suggested schools could achieve these daily recommended levels of physical activity for children by instituting school-based programs that include mandatory PE class durations and classroom activity breaks.

“Our public education system is our society’s great equalizer. We should support complete wellness standards in our schools that foster the hearts, bodies, and minds of our young people,” said Auditor Bump.

Collaboration
Auditor Bump partnered with Somerville Mayor Joseph Curtatone for today’s announcement. Somerville’s Shape Up Somerville (SUS) program is a 15 year old strategy to build and sustain a healthy community. SUS began in 2002 as a CDC-funded research study to prevent obesity in first through third grades. Following the three-year study, SUS was adopted by the citywide and has since continued to evolve as a nationally-recognized model for obesity prevention.

“Somerville’s successes in these areas are the community’s successes, not a top-down policy implementation; Shape Up Somerville began as and remains a community-based strategy to combat childhood obesity,” Mayor Curtatone said. “Together, we’ve made changes throughout the City, such as placing more emphasis on pedestrian and bike safety infrastructure, adding fresh produce and whole grains into all of our schools, offering locally grown fruits and vegetables in two housing developments at affordable prices, and creating dynamic open spaces in our small footprint to support and encourage physical activity. As a result, data shows increases in physical activity at all age levels.”

 “The Department of Public Health is pleased to be able to partner with communities to promote access to healthy, affordable foods and increase safe opportunities for physical activity,” said Public Health Commissioner Cheryl Bartlett, RN, who spoke at today’s announcement. “Childhood obesity has begun to trend downward in our state. As Auditor Bump recognized today, innovative programs like Mass in Motion and our nationally-recognized school nutrition standards are making a difference.”

“I am proud that our schools have made great progress in fighting childhood obesity with healthier food options and higher nutritional standards,” said Secretary of Education Matthew Malone. “I do agree that there should be more physical activity time for students, as studies have shown this is beneficial for the mind as well as the body.”

Dr. Christina Economos, Vice Chair and Director of ChildObesity180, joined Auditor Bump at the announcement today.ChildObesity180, based at the Tufts University Friedman School of Nutrition, is an organization committed to cross-sector collaboration to reverse the trend of childhood obesity.

“The key is to create a culture in which healthier choices are the default,” said Dr. Economos. “It is truly possible to reverse the trend of childhood obesity within the next generation if we continue to roll out these programs across Massachusetts and across the country, building on the Shape Up Somerville model of which we’re so proud.”

The New Balance Foundation Obesity Prevention Center at Boston Children's Hospital is another leader in obesity prevention research, clinical care, education and advocacy.

“Promoting physical activity and physical education is one way to help kids, particularly non-athletes and overweight children get active and improve their overall fitness,” said director of community partnerships Christine Healey. “The Center has been working with community partners to find creative solutions to get more kids exercising and we're pleased to see the schools embracing these efforts."

Kyle McInnis, a professor of health sciences at Merrimack College, has been awarded a grant by the Robert Wood Johnson Foundation to expand physical activity in the after school setting. His model, called Active Science, developed in YMCA after-school programs creates technology-driven youth physical activity promotion and science, technology, engineering, and mathematics (STEM) educational experiences. McInnis said, “After school programs can provide an ideal opportunity to help children be physically active, yet more efforts are required to help increase the amount of time children spend being active, especially during ‘crunch time’ of 3 p.m. to bedtime.”

The Office of the State Auditor conducts technical assessments and performance audits of state government’s programs, departments, agencies, authorities, and vendors. With its reports, the OSA issues recommendations to improve accountability, efficiency, and transparency.

The Childhood Obesity audit is available here.

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