Lessons Learned


Back in 2003, the state of Arkansas embarked on an exceptional project whose object was to really do something about childhood obesity. Laying the groundwork was a huge job in itself. It required the cooperation and coordination of the legislators, their advisory body, school administrators, teachers, nurses, Phys Ed teachers, and cafeterias. And parents, of course, and definitely the students. The ambitious goal required everyone to be on board.

The idea of tracking such a project from its inception was music to the ears of the Robert Wood Johnson Foundation (RWJF). Here was a solid and irresistible opportunity to chart the progress of big, wide-ranging program, right from the jump.

RWJF funded “an evaluation of the process and impact of the law’s implementation.” They wanted to know in real time whether the blueprint was viable, and whether it was working. A research team scrambled to design the paradigm and parameters of the evaluation, and take care of all the other preparatory steps that result in a useful study.

What was proposed?

Act 1220’s original intention was to provide body mass index screenings for all students every year, and to have the parents notified of the BMI scores. Seems pretty straightforward. But resistance was immediate, vehement, and multi-faceted. The press contributed to misunderstandings and mistrust, with headlines seemingly designed to trigger the “Don’t tread on me” American.

The concept was to have the BMI score hand-carried home by the kids, and it met with objections on privacy grounds. It would be too easy for a bully to snatch a chubby kid’s report card and flaunt it around. Consequently, money had to be found to pay for postage to mail the reports, and the Arkansas Center for Health Improvement stepped up. Some critics felt that every year was too often, and that requirement was changed for older kids.

A belief that BMI scoring was mandatory angered many parents. The report explains:

The original legislation did not speak of parents’ ability either to opt in or out of their children’s participation in the school-based BMI assessment program; thus, parents and students always had an implied ability to opt out of the program. However, because the Commissioner of the ADE had issued several advisory letters to school district superintendents instructing them to comply with the mandates of Act 1220 and assess all students, there was at least some perception that participation was mandated.

In practice, parents who did not want an assessment and students who refused to participate were allowed to make that choice without consequence.

A number of school districts developed parental consent forms, which were completed by parents as a part of the annual registration at the beginning of each school year. However, a minority of school district officials and parents remained opposed and vocal in their dissatisfaction with the lack of a specific ‘‘opt out’’ provision in the statute.

This is the kind of roadblock the anti-obesity efforts ran up against, and it illustrates how complicated the quest for change can become. Even in one basic, seemingly unquestionably necessary part of the program, there was a lot of stuff to wade through. The example shows why it is so beneficial to have reports like this one.

(To be continued…)

Your responses and feedback are welcome!

Source: “Evaluation of Act 1220 of 2003: Lessons Learned, 2004-2012,” RWJF.org, Feb 2014
Image by Robert Wood Johnson Foundation

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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