National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

Accelerating Progress in Obesity Prevention

SOLVING THE WEIGHT OF THE NATION

Committee on Accelerating Progress in Obesity Prevention
Food and Nutrition Board

Dan Glickman, Lynn Parker, Leslie J. Sim,
Heather Del Valle Cook, and Emily Ann Miller, Editors

INSTITUTE OF MEDICINE
      OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

THE NATIONAL ACADEMIES PRESS       500 Fifth Street, NW      Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Grant No. 61747 between the National Academy of Sciences and the Robert Wood Johnson Foundation and a grant between the National Academy of Sciences and the Michael & Susan Dell Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee on Accelerating Progress in Obesity Prevention.
    Accelerating progress in obesity prevention: Solving the weight of the nation / Committee on Accelerating Progress in Obesity Prevention, Food and Nutrition Board, Institute of Medicine of the National Academies ; Dan Glickman … [et al.], editors.
     p. ; cm.
   Includes bibliographical references.
   ISBN 978-0-309-22154-2 (pbk.) — ISBN 978-0-309-22155-9 (e-ISBN)
   ISBN 0-309-22154-4
   I. Glickman, Dan. II. Title.
   [DNLM: 1. Obesity—prevention & control—United States. 2. Environment Design—United States. 3. Needs Assessment—United States. 4. Program Development—United States. WD 210]

362.1963’98—dc23

2012007112

Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2012 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

WEIGHT OF THE NATION is a trademark owned by the U.S. Department of Health and Human Services (DHHS/CDC). Use of this trademark is not an endorsement by DHHS/CDC of a particular company or organization.

Cover photo credits: yellow squash (first column, first row) by DC Central Condition; people running up stairs (fourth column, second row) by Osman Meran; man pushing a stroller on the beach (fifth column, second row) by Michael L. Baird; watermelon (first column, fifth row) by Patrick Feller.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

 

 

 

 

 

 

 

 

 

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

COMMITTEE ON ACCELERATING PROGRESS IN OBESITY PREVENTION

DANIEL R. GLICKMAN (Chair), Executive Director of Congressional Programs, The Aspen Institute, Washington, DC

M. R. C. GREENWOOD (Vice Chair), President, University of Hawaii System, Honolulu

WILLIAM PURCELL, III (Vice Chair), Attorney at Law, Nashville, Tennessee

DAVID V. B. BRITT, Retired President and Chief Executive Officer, Sesame Workshop, Fernandina Beach, Florida

JAMIE F. CHRIQUI, Senior Research Scientist, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago

PATRICIA CRAWFORD, Director of Dr. Robert C. and Veronica Atkins Center for Weight and Health and Cooperative Extension Specialist and Adjunct Professor for the School of Public Health, University of California, Berkeley

CHRISTINA ECONOMOS, New Balance Chair in Childhood Nutrition, Friedman School of Nutrition, Science, and Policy, Tufts University, Boston, Massachusetts

SANDRA G. HASSINK, Director, Nemours Pediatric Obesity Initiative, Alfred I. duPont Hospital for Children, Wilmington, Delaware

ANTHONY B. ITON, Senior Vice President, Healthy Communities, The California Endowment, Oakland, California

STEVEN H. KELDER, Beth Toby Grossman Distinguished Professor in Spirituality and Healing; CoDirector, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, Austin Regional Campus

HAROLD W. (BILL) KOHL, III, Professor, Epidemiology and Kinesiology, University of Texas Health Science Center-Houston, School of Public Health, Michael & Susan Dell Center for Healthy Living, University of Texas at Austin

SHIRIKI K. KUMANYIKA, Professor of Epidemiology and Associate Dean for Health Promotion and Disease Prevention, University of Pennsylvania School of Medicine, Philadelphia

PHILIP A. MARINEAU, Operating Partner, LNK Partners, San Francisco, California

VICTORIA RIDEOUT, President, VJR Consulting, San Francisco, California

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

EDUARDO J. SANCHEZ, Vice President and Chief Medical Officer, Blue Cross and Blue Shield of Texas, Richardson

ELLEN WARTELLA, Al-thani Professor of Communication, Professor of Psychology and Professor of Human Development and Social Policy, Director of the Center on Media and Human Development at Northwestern University, Evanston, Illinois

Study Staff

LYNN PARKER, Scholar

LESLIE J. SIM, Senior Program Officer

HEATHER DEL VALLE COOK, Program Officer

EMILY ANN MILLER, Associate Program Officer

HEATHER BREINER, Research Associate

MATTHEW B. SPEAR, Program Associate (until July 2011)

ELENA OVAITT, Senior Program Assistant (from September 2011)

LAMIS JOMAA, Christine Mirzayan Science & Technology Policy Graduate Fellow (until December 2010)

ANTON L. BANDY, Financial Associate

GERALDINE KENNEDO, Administrative Assistant

LINDA D. MEYERS, Director, Food and Nutrition Board

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Jenna Anding, Texas A&M University

Leann L. Birch, Pennsylvania State University

John C. Cawley, Cornell University

Lilian Cheung, Harvard University

Antonio Convit, New York University School of Medicine

Lori Dorfman, Berkeley Media Studies Group

John R. Finnegan, Jr., University of Minnesota School of Public Health

Vincent Fonseca, Texas Department of State Health Services

Wally Gomaa, ACAP Health

W. Philip T. James, International Association for the Study of Obesity

Christine M. Olson, Cornell University

Tom Robinson, Stanford University School of Medicine

Kate Rogers, H-E-B Stores

Robert Sege, Boston Medical Center

Dianne Stanton Ward, University of North Carolina at Chapel Hill

Derek Yach, PepsiCo., Inc.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Cutberto Garza, Boston College and Enriqueta C. Bond, Burroughs Wellcome Fund. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

Preface

Obesity is a public health issue of monumental importance to the nation. I would argue that it is the most significant public health challenge we face at this time, both because of the huge number of people it affects and because of the ripple effects it has and will have on the development of debilitating and costly chronic diseases. Obesity is a major contributor to the health care cost challenges we confront today in the United States. These costs have the potential to become catastrophic and unaffordable unless all sectors of society take the need for obesity prevention seriously and act responsibly. It is untenable to wait any longer until people are already sick, requiring that most of our efforts and funding be devoted to crisis intervention for diseases that could have been prevented or made less severe.

This report is part of a series of publications dedicated to providing accessible and useful information and analysis to policy makers and others working to turn the obesity epidemic around. Funded by the Robert Wood Johnson Foundation (and the Michael & Susan Dell Foundation for the committee’s workshop and workshop report on measurement issues in obesity prevention), this report focuses on the areas of obesity prevention that are most important to pursue now to significantly accelerate progress against the epidemic. The committee reviewed the hundreds of recommendations that have been made related to obesity prevention, the evidence that supports them, and the progress that has been made in their implementation. I have become convinced through this process that the health of the nation and its children is inextricably linked to a complex web of influences on physical activity and diet. This truth must be communicated to individuals, families, communities, and the broader U.S. society so they can understand the nature of the threat and the multisector solutions that, working together, can make a real difference. We need to reach many different kinds of people with diverse interests and concerns—individuals moving through their daily lives

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

unaware of these issues, policy makers and others who make decisions that control physical activity and food environments, health care providers, the education community, and the business community/private sector. We also must ensure that individuals, families, and communities are empowered to work for change so their environment will support them in their efforts to achieve and maintain a healthy weight. We all need to maintain our commitment to progress and acceleration in the areas that can make the most difference.

The committee has many people to thank for their support in developing this report and its recommendations. We begin by thanking in particular Laura Leviton and James Marks from the Robert Wood Johnson Foundation and Aliya Hussaini from the Michael & Susan Dell Foundation for their encouragement.

We appreciate the extensive contributions of Ross Hammond, who was commissioned to provide technical insight into integrating, developing, and using systems mapping techniques to inform our deliberations and decisions. His insight and expertise added to the quality of our decisions and helped visually communicate the dynamic nature of the relationships we were considering and how they fit within the greater societal context. We also thank Eric Olsen from Feeding America for his important input as an unpaid consultant.

In addition, we want to express our gratitude to Shari Cookson, Nick Doob, John Hoffman, Ali Moss, and Sarah Teale from Home Box Office (HBO) Documentary Films for their contributions as unpaid consultants. These film producers drew inspiration and guidance from our work and discussions for a series of documentaries on obesity prevention that, along with the release of the recommendations in this report, will serve as the foundation for a major national public health campaign on obesity prevention. This campaign will be coordinated by HBO and the Institute of Medicine (IOM) in association with the Centers for Disease Control and Prevention, Kaiser Permanente, the Michael & Susan Dell Foundation, and the National Institutes of Health.

The committee greatly benefited from the opportunity for discussion with the individuals who made presentations at and attended our workshops and meetings. (See Appendix C for a list of workshop and panel presentations.) We would also like to thank Preston Maring and Ray Baxter from Kaiser Permanente, as well as Martha Coven from the Domestic Policy Council and Rogan Kersh from Columbia University, for their presentations. The experience and insights of all these speakers contributed immeasurably to our deliberations.

I want to express my sincere appreciation and thanks to the committee members for their extraordinary volunteer efforts in the development of this report. A

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

special thank you goes to Bill Purcell and M. R. C. Greenwood for their important role as vice chairs of the committee. Bill brought his immense experience as a public servant in government to the task and M. R. C. her vast knowledge of nutrition.

The committee could not have done its work without the outstanding guidance and support provided by the IOM staff: Lynn Parker and Leslie Sim, co-study directors; Heather Del Valle Cook, program officer; Emily Ann Miller, associate program officer; Heather Breiner, research associate; Elena Ovaitt, senior program assistant; and Lamis Jomaa, Christine Mirzayan Science & Technology Policy Fellow. Matthew Spear also provided highly skilled logistical support. Linda Meyers’ guidance and counsel were invaluable throughout our deliberations. In addition, we are indebted to others throughout the IOM’s office of reports and communications who patiently worked with us throughout external review, revisions of this report and report briefs, and the production process through final publication. They include Laura DeStefano, IOM report production manager; Vilija Teel, IOM report review manager; and Lauren Tobias, IOM communications director. And last but not least, the report greatly benefited from the copyediting skills of Rona Briere.

Daniel R. Glickman, Chair
Committee on Accelerating Progress in Obesity Prevention

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×

7  MESSAGE ENVIRONMENTS

Recommendation 3

Strategies and Actions for Implementation

Strategy 3-1: Develop and Support a Sustained, Targeted Physical Activity and Nutrition Social Marketing Program

Strategy 3-2: Implement Common Standards for Marketing Foods and Beverages to Children and Adolescents

Strategy 3-3: Ensure Consistent Nutrition Labeling for the Front of Packages, Retail Store Shelves, and Menus and Menu Boards That Encourages Healthier Food Choices

Strategy 3-4: Adopt Consistent Nutrition Education Policies for Federal Programs with Nutrition Education Components

Integration of Strategies for Accelerating Progress in Obesity Prevention

References

8  HEALTH CARE AND WORK ENVIRONMENTS

Recommendation 4

Strategies and Actions for Implementation

Strategy 4-1: Provide Standardized Care and Advocate for Healthy Community Environments

Strategy 4-2: Ensure Coverage of, Access to, and Incentives for Routine Obesity Prevention, Screening, Diagnosis, and Treatment

Strategy 4-3: Encourage Active Living and Healthy Eating at Work

Strategy 4-4: Encourage Healthy Weight Gain During Pregnancy and Breastfeeding, and Promote Breastfeeding-Friendly Environments

Integration of Strategies for Accelerating Progress in Obesity Prevention

References

9  SCHOOL ENVIRONMENTS

Recommendation 5

Strategies and Actions for Implementation

Strategy 5-1: Require Quality Physical Education and Opportunities for Physical Activity in Schools

Strategy 5-2: Ensure Strong Nutritional Standards for All Foods and Beverages Sold or Provided Through Schools

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR1
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR2
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR3
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR4
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR5
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR6
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR8
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR9
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR10
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR11
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR13
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR14
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR15
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press. doi: 10.17226/13275.
×
PageR16
Next: Summary »
Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation Get This Book
×
Buy Paperback | $67.00 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

One-third of adults are now obese, and children's obesity rates have climbed from 5 to 17 percent in the past 30 years. The causes of the nation's obesity epidemic are multi-factorial, having much more to do with the absence of sidewalks and the limited availability of healthy and affordable foods than a lack of personal responsibility. The broad societal changes that are needed to prevent obesity will inevitably affect activity and eating environments and settings for all ages. Many aspects of the obesity problem have been identified and discussed; however, there has not been complete agreement on what needs to be done to accelerate progress.

Accelerating Progress in Obesity Prevention reviews previous studies and their recommendations and presents five key recommendations to accelerate meaningful change on a societal level during the next decade. The report suggests recommendations and strategies that, independently, can accelerate progress, but urges a systems approach of many strategies working in concert to maximize progress in accelerating obesity prevention.

The recommendations in Accelerating Progress in Obesity Prevention include major reforms in access to and opportunities for physical activity; widespread reductions in the availability of unhealthy foods and beverages and increases in access to healthier options at affordable, competitive prices; an overhaul of the messages that surround Americans through marketing and education with respect to physical activity and food consumption; expansion of the obesity prevention support structure provided by health care providers, insurers, and employers; and schools as a major national focal point for obesity prevention. The report calls on all individuals, organizations, agencies, and sectors that do or can influence physical activity and nutrition environments to assess and begin to act on their potential roles as leaders in obesity prevention.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!