An initiative of the Robert Wood Johnson Foundation
Expert Perspective

Giving all Americans an Equal Opportunity to be Healthy

Dietary Guidelines School Meals SNAP WIC

John Auerbach

President and CEO, Trust for America’s Health


September 11th, 2018


The old adage, you are what you eat, tells part of the story, but to fully understand what’s driving America’s obesity epidemic, and, what to do about it, we have to coin a new phase: you are where you live.

We know that in order to achieve a healthy weight people need to consume healthy foods and be physically active. What we haven’t been able to do is provide all Americans equal access to healthful options and opportunities to exercise. Your zip code is likely to be an accurate predictor of your weight.

For example, while national obesity rates continue to climb—newly released data show that no less than one in five Americans have obesity in every state in the nation—rates are even higher in Black and Latino communities, in neighborhoods where more people have low incomes, and in rural areas. Such neighborhoods are likely to be “food deserts” where only unhealthful foods are readily available and affordable. They also are likely to lack accessible and safe places for physical activity.

We can imagine these issues intersecting during a child’s day. Can she safely walk to school? Once at school, is she served a breakfast or lunch that is nutritious and low in fat? Are physical education or recess part of her daily schedule? After school, does she have a safe place to play? Are recreation programs available? Are her parents or caregivers employed? Do their jobs provide health insurance? All these issues taken together are likely to affect a child’s weight.

If we expand those questions out nationally, we can see that the costs of obesity are enormous. Obesity drives an estimated $149 billion annually in directly related healthcare spending, and an additional $66 billion annually in lowered economic productivity such as lost work days. It also poses a national security vulnerability: one in three young adults is ineligible for military service because of being overweight. Investing in obesity-prevention programs will not only help make America healthier, it is also key to reducing run-away healthcare spending.

Obesity is a complex problem, so solving it will require evidence-based, multi-sector approaches. There is a growing body of evidence that policies and programs that align efforts across sectors—among health departments, transportation officials, schools, and businesses—can work.

What needs to be done now is to implement these programs in more communities, particularly the communities hardest hit by the obesity crisis. We must work to ensure that everyone has a fair and just opportunity to be healthy. That everyone has safe places to walk, ride bicycles and exercise, and that families can buy healthy, affordable foods in their neighborhoods.

Policies and programs that align efforts across sectors—among health departments, transportation officials, schools, and businesses—can work. What needs to be done now is to implement these programs in more communities, particularly the communities hardest hit by the obesity crisis.

Seven U.S. states had adult obesity rates at or above 35% in 2017, up from five states in 2016, and no state had a statistically significant improvement in its obesity rate over the past year, according to the 15th annual report State of Obesity: Better Policies for a Healthier America.

The 2018 State of Obesity report includes 40 recommendations for federal, state and local policymakers; the restaurant and food industries; and the healthcare system, including:

  • Support and expand policies and programs aimed at addressing obesity at the federal, state and community levels, including programs in the Centers for Disease Control and Prevention’s (CDC) Division of Nutrition, Physical Activity and Obesity, community health programs like the Racial and Ethnic Approaches for Community Health program (REACH), and programs that focus on school health in CDC’s Division of Population Health.
  • Maintain and strengthen essential nutrition supports for low-income children, families and individuals through programs—like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in the U.S. Department of Agriculture (USDA)—and expand programs and pilots to make healthy foods more available and affordable through the program.
  • Maintain nutrition standards for school meals that were in effect prior to USDA’s interim final rule from November 2017, as well as current nutrition standards for school snacks.
  • States should ensure that all students receive at least 60 minutes of physical education or activity during each school day.
  • The U.S. Department of Health and Human Services, in partnership with the U.S. Department of Agriculture, should ensure that the 2020-2025 Dietary Guidelines for Americans reflect the latest and best nutrition science, include recommendations for children ages two and under, are developed in a transparent manner, and are issued on time.
  • Actively support the recommendations of “Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities.”
  • Medicare should encourage eligible beneficiaries to enroll in obesity counseling as a covered benefit, and, evaluate its use and effectiveness.
  • Health plans, medical schools, continuing medical education, and public health departments should raise awareness about the need and availability of these services.
  • Food and beverage companies should eliminate children’s exposure to advertising and marketing of unhealthy products.
  • Hospitals should no longer sell or serve sugary drinks on their campuses; they should also improve the nutritional quality of meals and promote breastfeeding.

The time to invest in these policies and programs is now. If current trends continue, approximately half of today’s children will have obesity by the time they are 35, risking their health and driving up healthcare spending.


See the full set of policy and practice recommendations from Trust for America’s Health and the Robert Wood Johnson Foundation, included in the 15th annual report State of Obesity: Better Policies for a Healthier America.

About the Author

John Auerbach
President and CEO, Trust for America’s Health
John Auerbach is President and CEO of Trust for America’s Health (TFAH) a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Learn more about TFAH’s work at

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