Act 1220 of 2003

Act 1220 of 2003, which launched comprehensive efforts to curb childhood obesity in Arkansas, established one of the nation’s first statewide, school-focused initiatives to help children reach and maintain a healthy weight.

Shaped largely by key legislators, including Senator Hershel Cleveland, with input from state and national public health experts, the act passed through the Arkansas General Assembly with strong support from the House and Senate under the administration of Governor Mike Huckabee. After passage, however, several components of the act faced vocal opposition. Opponents feared the largely unfunded mandates would strain educational and healthcare systems in addition to shaming overweight students. This vocal opposition prompted changes to the act in the years following its passage. Subsequent evaluation of Act 1220’s influence, however, showed that few of these negative effects materialized.

The regulations initiated by Act 1220 allowed for phased changes beginning in the 2004–05 school year. One of the most controversial provisions was that each school child’s body mass index (BMI), which is a measure of weight status and obesity risk, would be assessed and communicated to parents. Some parents felt that the release of this information as a part of the annual report card implied children were being “graded” on their weight. Amendments in 2004 required BMI notifications to be provided as a confidential child health report rather than grade card. With these provisions and extensive statewide training, the BMIs of 450,000 Arkansas children were assessed by June 2004. These measurements led to Arkansas’s first database of childhood weight statistics at the state, county, and school district levels and illustrated the magnitude of childhood obesity in Arkansas.

Prior to Act 1220, schools faced no state regulations prohibiting the sale of unhealthy foods to students. In many schools, including elementary schools, students had access to vending machines, school stores, and food-based fundraisers. Act 1220 required the removal of vending machines from elementary schools; placed restrictions on the sale of specific high-sugar, low-nutrient foods; and limited “competitive foods,” which are foods that compete with the National School Lunch Program (NSLP). The act also required schools to publicly report earnings from competitive foods and beverages.

In order to assist schools with mandated changes and work toward continuous improvement, several positions were established within the Arkansas Department of Health and Arkansas Department of Education, constituting the only funding allocated to support Act 1220. This included two statewide consultants to guide and evaluate effective programs and facilitate inter-agency communication. Five Community Health Promotion Specialist (CHPS) positions were created and housed in distinct regions of the state—Northwest, Northeast, Southwest, Southeast, and Central—to assist schools at the local level. The CHPS positions, phased in during 2005, provided guidance, training, and technical assistance to Act 1220–mandated Nutrition and Physical Activity Advisory Committees.

Another significant provision of Act 1220 was the creation of a Child Health Advisory Committee (CHAC). The committee was charged with reviewing Act 1220 initiatives, developing standards, and making recommendations on nutrition and physical activity policies to the State Boards of Education and Health. As originally established, CHAC members included representatives from the Arkansas Department of Health, Arkansas Dietetic Association, Arkansas Academy of Pediatrics, Arkansas Academy of Family Practice Physicians, the Fay W. Boozman College of Public Health at the University of Arkansas for Medical Sciences (UAMS), Arkansas Center for Health Improvement, Arkansas Advocates for Children and Families, University of Arkansas Cooperative Extension Service, Arkansas School Food Service Association, Arkansas School Nurses Association, Arkansas Association of Education Administrators, Arkansas Parent Teacher Association, and Arkansas Association for Health, Physical Education, Recreation, and Dance; in addition, one member jointly represents the Arkansas Heart Association, the American Cancer Society, and the American Lung Association.

Act 1220 underwent additional modifications in the years following passage. In 2006, opponents of the act complained that parents should be given the choice to opt out of the BMI assessment process. Some school administrators continued to complain that the requirements were burdensome for school staff. In response, the 2007 Arkansas General Assembly enacted Act 201 of 2007, which modified key provisions of Act 1220. The act modified the BMI assessment to be conducted only in even numbered grades through the tenth grade. A parental opt-out provision was clarified to indicate that parents had the right to opt out of the assessment. In what many viewed as another significant setback, Act 317 of 2007 reduced the Arkansas Department of Education physical activity requirements for grades 5–12.

The Robert Wood Johnson Foundation, Arkansas Center for Health Improvement, and UAMS College of Public Health provide evaluation and data on Act 1220 Initiatives. Since Act 1220 was enacted, school nutrition and physical activity policies are more prevalent, fewer high sugar and high fat foods are available in schools, and schools have continued to enact local targeted changes through wellness committees.

For additional information:
Act 317 of 2007. Arkansas State Legislature. http://www.arkleg.state.ar.us/assembly/2007/R/Acts/Act317.pdf (accessed September 8, 2021).

Act 1220 of 2003. Arkansas State Legislature. http://www.arkleg.state.ar.us/assembly/2003/R/Acts/Act1220.pdf (accessed September 8, 2021).

“Act 1220 of 2003 Year 4 Evaluation.” University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health.” https://publichealth.uams.edu/wp-content/uploads/sites/3/2012/06/COPH-Obesity-Evaluation-Report-4.pdf (accessed September 8, 2021).

“Phillips, Martha M., et al. “Obesity Changes in School Environments with Implementation of Arkansas Act 1220 of 2003.” Obesity: A Research Journal 18 (February 2010): S54–S61. Online at http://onlinelibrary.wiley.com/doi/10.1038/oby.2009.432/full (accessed September 8, 2021).

Raczynski, James M., et al. “Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Its Implementation and Impact on Child and Adolescent Body Mass Index.” Journal of Public Health Policy 30 (2009): S124–140. Online at http://www.palgrave-journals.com/jphp/journal/v30/nS1/full/jphp200854a.html (accessed September 8, 2021).

Christine McKnelly
Conway, Arkansas