|Proceedings of a Workshop—in Brief|
Defining Progress in Obesity Solutions Through Structural Changes
Proceedings of a Workshop—in Brief
The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a virtual public workshop, Defining Progress in Obesity Solutions through Structural Changes, on October 25, 2022. The workshop was the third and final in a series of three workshops that explored how to bridge evidence gaps within foundational drivers of obesity and translate knowledge toward actionable solutions.
This workshop focused on methods to assess progress in addressing structural drivers of obesity. Presentations explored innovative approaches and performance indicators that could be used to gauge progress in obesity solutions as well as strategies to hold leaders and decision makers accountable. Workshop sessions covered topics such as the science, strengths, and limitations of body mass index (BMI), and a review of structural drivers of obesity in a variety of systems—political and economic, environmental, health care, and sociocultural—along with current approaches used to measure progress in those systems.
Ihuoma Eneli, professor of pediatrics at The Ohio State University and director, Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, explained that the workshop series builds on a strategic planning process that the roundtable initiated in 2020, the same year that it held three public workshops to introduce system sciences and approaches that could be applied toward obesity solutions. The roundtable took a systems-oriented approach to identify foundational areas for obesity solutions, she said, which culminated in a causal systems map that depicts both drivers of and evidence-based solutions to obesity. The map was used to prioritize three cross-cutting foundational areas that the roundtable has since pursued, including through a three-part workshop series in 2021—structural racism, biased mental models and social norms, and effective health communication. Eneli said that the roundtable considered these areas to be deep leverage points that could bring about lasting, systems-wide change.
This Proceedings of a Workshop—in Brief highlights the presentations and discussions that occurred at the workshop and is not intended to provide a comprehensive summary of information shared during the workshop.1
1 The workshop agenda, presentations, and other materials are available at https://www.nationalacademies.org/event/10-25-2022/defining-progress-in-obesity-solutions-through-structural-changes-a-third-workshop-in-the-series (accessed December 8, 2022).
The information summarized here reflects the knowledge and opinions of individual workshop participants and should not be seen as a consensus of the workshop participants, the Roundtable on Obesity Solutions, or the National Academies of Sciences, Engineering, and Medicine.
THE SCIENCE, STRENGTHS, AND LIMITATIONS OF BMI AS A MEASURE
The workshop began with an introductory presentation that set the stage for the workshop. William (Bill) Dietz, chair of the Sumner M. Redstone Global Center on Prevention and Wellness at the Milken Institute School of Public Health at The George Washington University, discussed the science, strengths, and limitations of BMI as a measure of obesity.
Dietz maintained that BMI is a reasonable measure for assessment of obesity in children and adolescents and shared four points and corresponding data to support this position. First, BMI reflects the presence of increased body fat and is easy to calculate as it is not dependent on specialized equipment. Second, BMI >95th percentile increases risk of disease (Freedman et al., 2007). Third, increased BMI is associated with risk of persistent obesity, and risk of persistence increases with age and severity (Geserick et al., 2018). And fourth, BMI in children and adolescents is continuous with adult criteria; that is, BMI at the 95th percentile in late adolescence corresponds to a BMI of 30 in adults.
Dietz also provided rationale to support use of BMI for assessment of adult obesity. A reasonable correlation exists for BMI and body fat above BMI of 30, he said, and BMI is applicable across most ethnicities and throughout the life cycle, although its correlation with total body fat may differ by sex and ethnicity (e.g., BMI cutpoints for overweight and obesity are lower for Asian populations) (World Health Organization Expert Consultation, 2004). Dietz also pointed out that the lowest mortality across the distribution of BMI has been used to define a “healthy” weight.
Dietz clarified that BMI is associated with—but is not a direct measure of—body fat, and that it does not assess the concomitant presence of comorbid conditions, disease risks, or functionality. BMI’s association with health risk is inconsistent and varies with age, sex, and ethnicity, he added, and it does not assess risk related to body fat distribution. He also emphasized that BMI is not a diagnostic measure of obesity. Dietz shared a consensus statement from six leading organizations on obesity issues, which acknowledges that BMI is useful to screen for obesity, but it does not displace clinical judgment, nor does it measure body fat.
Dietz mentioned the Edmonton Obesity Staging System (EOSS), which he said represented a shift in how obesity’s comorbidities are assessed as it assigns an individual to stage 0, 1, 2, or 3 obesity based on co-occurring medical, mental, or functional clinical risk factors. In his view, one challenge with the EOSS is that every complication is given equal weight despite differences in risk of severe disease, risk of mortality, and costs.
Finally, Dietz observed that much discussion is occurring about how to use the term “obesity” and whether the term itself is stigmatizing. He raised doubt that one can avoid naming obesity from a medical perspective given the large body of technical support for the diagnosis, but contended that if “obesity” is indeed a stigmatizing term, “how do we talk about obesity if we can’t talk about obesity?”
PROGRESS IN OBESITY SOLUTIONS: POLITICAL, ECONOMIC, AND ENVIRONMENTAL SYSTEMS
In the workshop’s second session, five panelists discussed progress in obesity solutions that relate to political, economic, and environmental systems.
Jamie Chriqui, senior associate dean and professor of health policy and administration in the School of Public Health at the University of Illinois Chicago (UIC) and director of health policy research for the UIC Institute for Health Research and Policy, discussed obesity prevention policies. She described such policies as upstream, population-level strategies for effecting changes to environments, communities, and behaviors.
Assessing progress in obesity prevention policies calls for considering actions on both sides of the energy balance equation, Chriqui said, explaining that measuring policies calls for consideration of policy adoption, policy change, policy implementation, and policy effects (i.e., impact). The choice of measures depends on the policy’s jurisdiction, she added, which is relatively easy at the federal level because typically only one or two laws or regulations are necessary to evaluate. In policy surveillance, one studies the variability of policies across the country and examines what is in statute compared to what is implemented and its impact.
The fact that policy is politically fraught creates challenges for policy adoption and implementation, Chriqui indicated, and she posited that policy implementation is often a critically overlooked component of measuring policy impact. She appealed for measures of policy implementation that capture whether the policy is being implemented, how implementation is happening (e.g., equitably or not), and whether implementation is sustained over time. She reminded participants that “what gets measured, gets changed” and that understanding and measuring the implementation and impact of existing policies can provide insights into why they are or are not working as intended. With respect to policy impact, Chriqui raised the importance of examining both proximal (e.g., changes in access to nutritious foods or to safe places to be active) and distal (e.g., change in health outcomes such as chronic disease incidence) outcomes.
Jason Block, associate professor and director of research in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, discussed the politics of obesity prevention, appropriate outcomes to measure in policy evaluation, and study designs for evaluating obesity prevention policies. Obesity prevention policies seem to be highly fraught with politics and are often perceived as “nanny state,” he observed, submitting that this has resulted in the U.S. approach of enacting single, one-off policies for obesity prevention rather than implementing a comprehensive, coordinated strategy. A challenge of the so-called piecemeal approach is that it limits the ability to evaluate a policy’s impact, Block explained, because typically, limited information to evaluate policy effects is available either before or after policies are enacted.
Block clarified that obesity prevention policies are not intended or structured to decrease the U.S. national prevalence of obesity. In contrast, he elaborated, their relatively small intended effects are expected to reduce incidence of obesity and help reduce the rise in prevalence over time. This distinction is “incredibly difficult” to communicate, he admitted, and it also complicates what success looks like. Obesity prevention policies often target proximal outcomes such as dietary intake or quality, which Block said are more feasible to measure on the time horizon and with the type of data typically available to evaluate policies. A key question, suggested Block, is whether it is fair to require a policy to demonstrate effects on longer-term health outcomes instead of the proximal outcomes that are more directly linked to the policy.
Block offered a few comments on study designs for evaluating obesity prevention policies. Randomized controlled trials (RCTs) are usually not an option, he said, particularly for national or state-level policies. RCT experiments in virtual settings are possible, he remarked, but challenging to implement in the real world. Block reported that evaluations of nutrition policies have used interrupted time series and natural experiment approaches and suggested that the utility of these designs for evaluating obesity prevention policies should be further explored.
James Krieger, executive director of Healthy Food America and clinical professor at the University of Washington School of Public Health and School of Medicine, proposed seven dimensions of progress to consider when assessing progress in obesity prevention policies.
The first, Krieger began, is identifying policies that are effective—as well as those that are not effective. The definition of effectiveness can vary among interest groups, which he explained results in multiple dimensions or measures of effectiveness for a given
policy. Using Seattle’s sugary drink tax as an example, Krieger recalled that policymakers viewed the tax as making progress based on its effect on raised revenues that were invested in marginalized communities, not necessarily on its effect on BMI or prevalence of obesity.
A second dimension of progress is implementing policies that address upstream causes of obesity. If factors such as corporate behaviors, power imbalances (between people from various racial and ethnic backgrounds and white people, or between low- and high-income communities), and structural racism are deemed contributors to obesity, he reasoned, then it is important to have metrics that assess changes in those upstream factors.
Krieger moved on to a third dimension of progress: scaling effective policies. An indicator of progress could be to measure the reach of an effective policy and identify which populations are benefiting. Going even further, an effect size could be calculated and multiplied by reach to produce the effect impact.
A fourth dimension is identifying and mitigating an obesity policy’s unintended and negative consequences, such as weight stigma. A fifth dimension, Krieger continued, is optimizing co-benefits. For instance, he said, an obesity policy might have potential to improve overall diet quality or build community capacity to enact and implement future policy change. A sixth dimension is to use efficient, effective, and just approaches to policy adoption and implementation and assess whether equitable policy adoption and implementation is increasing.
Krieger’s seventh and final dimension is applying an equity lens to policy adoption, implementation, and evaluation. An equity lens, he clarified, is a process for analyzing or diagnosing the impact of the design and implementation of policies on underserved and marginalized individuals and groups. An increase in policies that are centered in equity would constitute progress, he explained, which is why measuring a policy’s differential impacts by race, income level, or intersectional identities is often considered when assessing its equity impact (Annie E. Casey Foundation, 2014; King County Government, 2016; University of Minnesota, University Policy Library, 2022).
Carlos Crespo, dean of the College of Applied Health Sciences and professor of Kinesiology and Nutrition at the University of Illinois Chicago, discussed environmental systems and physical activity. A key point, he emphasized, is that a combination of built and social environment factors impacts capacity to be physically active. Social environments at the neighborhood level have been examined for their impact on physical activity, he said as an example, listing crime and safety, social cohesion and social capital, sense of place, and disorder and incivilities as measurable characteristics of neighborhood social environments. Crespo explained that built environments comprise housing, food systems, natural environments, transportation networks, and neighborhood design (CDC, 2011).
He elaborated on four elements of built environment systems—transportation, land use, service facilities, and urban design—and provided examples of measurable factors within each element that could be used to assess progress in obesity solutions. For transportation, he listed bike facilities, walkability, street connectivity, public transit stations, and urban greenways. For land use, he mentioned green open space (i.e., land suitable for being physically active), population density, and diversity of mixed-use space (i.e., where people can feel comfortable walking). For service facilities, he listed shops and stores, recreation and fitness facilities, and food markets. Lastly, urban design included neighborhood design, urban sprawl, and urban renewal projects.
Crespo also discussed a report of the Community Preventive Services Task Force that recommended park, trail, and greenway infrastructure interventions combined with additional interventions, such as structured programs or community awareness, to increase physical activity. The report concluded that built environment approaches that combine new or enhanced transportation systems (e.g., pedestrian or cycling paths) with new or enhanced land design (e.g., access to a
public park) are effective in promoting physical activity (The Community Guide, 2017).
Kristine Madsen, professor at the University of California, Berkeley School of Public Health, discussed elements of food environments that contribute to obesity. She touched on food marketing and advertising, food availability and portion sizes, and nutrition labeling on food packages and restaurant menus. Dramatic shifts in the rise of obesity and diabetes are unlikely without meaningful changes in food environments, she contended, then pointed out that the decline in cigarette smoking and eventually in lung cancer deaths occurred in the wake of tobacco taxes, smoke-free restaurant and workplace policies, warning labels, and advertising bans (American Cancer Society, 2017; CDC, 2021).
Madsen discussed two major approaches that have been taken to modify food environments and how those approaches have been measured. Key metrics of interest for the first approach, sugar-sweetened beverage (SSB) taxes, include change in price, change in volume sold, change in product availability, and changes in calories and/or grams of sugar in taxed products as a result of reformulation. About 70 percent of SSB taxes are passed through to consumers, she relayed, adding that if demand is viewed as a function of price, the price elasticity of demand is a helpful measure. SSB taxes in the U.S. have reduced demand by about 20 percent in the jurisdictions where they were implemented, which Madsen called a “huge effect size” that reflects major population-wide behavior changes (Powell et al., 2021).
Madsen discussed front-of-package labels as another major approach to modify food environments. Key measures of impact include demand (i.e., do the labels affect intake of the nutrients that are highlighted by the label), product availability, and product reformulation. Studies of front-of-package label effectiveness show a wide range of impacts, she said, which are strongly influenced by the label design. Madsen highlighted examples of voluntary label schemes that she described as aesthetically appealing, but not easy to interpret or use for food decision making. She contrasted these with examples of mandatory front-of-package labels that look like black stop signs imprinted with the words “high in sugar,” “high in saturated fats,” “high in sodium,” or “high in calories.” These warning-style labels require no prior education or additional context to interpret, Madsen pointed out, and have been associated with statistically significant declines in per capita daily intakes of the dietary elements disclosed on the labels (Taillie et al., 2021).
In closing, Madsen emphasized that no single food environment approach will be sufficient for effecting meaningful progress in obesity, and that a continued piecemeal approach without a broader strategy or roadmap will undermine potential for progress in obesity prevention.
PROGRESS IN OBESITY SOLUTIONS: HEALTH CARE SYSTEMS
The workshop’s third session featured two speakers who discussed progress in obesity solutions with respect to health care systems.
Said Ibrahim, senior vice president of the medicine service line for Northwell Health and chair of the Department of Medicine and David J. Greene Professor of Medicine in the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, discussed osteoarthritis care as an example of the intersectionality of obesity/high BMI and use of treatment for this condition in underrepresented communities. Osteoarthritis of the knee and hip is the leading cause of disability in older adults, he said. Ibrahim explained that the increased prevalence of this condition reflects the aging of the population as well as the rise in prevalence of obesity.
Patients from racial/ethnic minority groups are 40 to 50 percent less likely than white populations to undergo elective knee or hip replacement, Ibrahim reported, despite similar or higher (for knee osteoarthritis) prevalence of the condition in African American populations and expansion of the procedure in the U.S. overall. Ibrahim posited that high BMI or obesity confounds treatment of these patients and their access to joint replacement. The average patient who undergoes knee or hip replacement in the U.S. has a BMI of 35, he said, and surgeons are less likely to offer
the procedure to patients with BMI greater than 40 because of concerns about complications. But evidence is lacking, he suggested, to demonstrate that higher BMIs are associated with higher surgical complication rates. Prevalence of obesity varies by race/ethnicity, Ibrahim continued, and he questioned if patients with high BMI and from underrepresented populations are stigmatized and experience unequal access to care.
Ibrahim’s other key point was that many health systems have not yet established a comprehensive solution to weight management and obesity. He shared insights from his own health system of more than 20 hospitals and 850 ambulatory care centers that serve a highly diverse patient population with high prevalence of obesity and weight-related conditions. Northwell is still struggling to establish a comprehensive strategy to deliver care focused on this population, he admitted, although it has a weight management center, a bariatric center, and other relevant programs. Yet these resources are not under a single umbrella, he pointed out, and this calls for more coordinated, seamless care for weight management.
Fatima Cody Stanford, obesity medicine physician scientist and associate professor of medicine and pediatrics at Massachusetts General Hospital and Harvard Medical School, began by underscoring the complexity of obesity as a chronic disease. Obesity is a complex multi-factorial disorder, Stanford elaborated, with links to genetic, environmental, developmental, and behavioral causes and contributors. Whereas dozens of factors both inside and outside of a person contribute to obesity, namely by influencing either energy intake, energy expenditure, or both, she contended that some factors receive much attention while others are neglected (The Obesity Society, 2015).
Stanford shifted to discuss BMI, which she described as a problematic metric for ascertaining weight status and insufficient by itself for defining one’s health. Some patients at the higher end of the BMI spectrum may be in better health, she said, than some with “normal” weight status. She pointed to an analysis that proposed redefining BMI cutpoints for obesity by sex and race/ethnicity based on association with metabolic disease (Stanford et al., 2019).
Stanford transitioned to discuss weight stigma, which she said is perpetuated by health systems and, in particular, physicians. Weight stigma often leads to stress that then affects eating and physical activity behaviors and causes biological responses such as elevated blood pressure, she explained, leading to adverse physiological health effects (Puhl et al., 2016). Weight stigma also compromises health services, she explained, in ways that result in poor treatment adherence, diminished trust in health care providers, avoidance of follow-up care, delay in preventive health screenings, and poor communication (Puhl et al., 2016). These outcomes also drive negative physiological effects, as well as psychological (e.g., depression and substance abuse) effects (Puhl et al., 2016).
According to Stanford, the U.S. comes up short in terms of its treatment of obesity as a chronic disease. For example, she reported that only 1 percent of individuals that meet criteria for treatment of obesity with anti-obesity medications actually receive them (Claridy et al., 2021), and only 2 percent that meet criteria for metabolic and bariatric surgery actually receive these effective treatments (American Society for Metabolic and Bariatric Surgery, 2022).
The economic consequences of obesity are borne out in health care spending, Stanford relayed, as the economic impact of overweight and obesity is rising as a percent of U.S. gross domestic product (GDP) (Okunogbe et al., 2022). The U.S. is expected to have the world’s highest average annual health expenditure per capita due to obesity from 2020–2025—14 percent of total health expenditures—she said, yet lacks national obesity policies (Statista, 2019).
PROGRESS IN OBESITY SOLUTIONS: SOCIOCULTURAL SYSTEMS
The fourth and final session of the workshop discussed progress in obesity solutions in sociocultural systems.
Tongtan (Bert) Chantarat, research scientist at the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, discussed the Center’s effort to measure structural racism. He began with a definition of structural racism: “the totality of ways in which societies foster racial
discrimination, through mutually reinforcing inequitable systems . . . that in turn reinforce discriminatory beliefs, values, and the distribution of resources, which together affect the risk of adverse health outcomes” (Bailey et al., 2017).
Chantarat called for measuring structural racism as a whole, which he suggested is bigger than the sum of its parts—such as residential segregation, employment inequity, income inequity, and criminal justice inequity—that work concurrently and reinforce each other to contribute to health inequities. The latent construct approach that his team applies to measuring structural racism uses latent class analysis, he explained, clarifying that the approach allows researchers to identify qualitative, multidimensional typologies.
Chantarat described an in-progress study of birth inequities (preterm birth, low birthweight, and small-for-gestational-age birth) in which multidimensional structural racism was used to predict birth outcomes for U.S.-born Black, foreign-born Black, and white Minnesotans (Chantarat et al., 2022). The analysis produced three structural racism typologies which were each linked to birth outcomes: preterm birth, low birthweight, and small-for-gestational-age birth. Chantarat shared the results specific to the third outcome. Results indicated that age-adjusted risk for small-for-gestational-age was lowest for white individuals in all three typologies, he reported, and that for people in the same racial group who are exposed to different patterns of structural racism, the same level of risk was observed.
With respect to policy implications, Chantarat explained that the dimension of education inequity was high in two of the three structural racism typologies identified by the study. This might suggest that eliminating education inequities would lead to all groups having the same health outcome, he said, but the study’s findings suggest that risks for adverse outcomes do not change across the three groups if only one dimension is changed. It appears that intricate interactions occur across multiple dimensions of structural racism, he said, which means that it is important to address all dimensions to effectively eliminate racial inequities.
Kierra S. Barnett, research scientist in the Center for Child Health Equity and Outcomes Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, discussed engaging communities to address health inequities. Engaging communities is not easy, she admitted, and often takes more time than funders, policymakers, and researchers prefer. Three categories of community entities that are often engaged in community-based research are organizations or institutions with whom researchers work; stakeholders or champions in the community, who can provide windows into the community’s lived experiences; and community members, who can share their own daily experiences.
Barnett offered three reasons to support the importance of engaging communities. The first is that context matters, she began, and unpacking the complexity of the systems in which people live calls for uplifting and seeking to understand people’s lived experiences. Talking with community members can help researchers understand their values, needs, and priorities, Barnett added, so that the research can be designed accordingly.
A second reason to engage communities, she continued, is that it helps researchers improve their work. Talking with people with lived experiences helps refine research questions, measures, and/or potential solutions. Community engagement also helps to identify a community’s assets and strengths, such as resources and allies, that can be leveraged and promoted to build better solutions.
A third reason to engage communities is that it increases community buy-in. The goal is to build trust with a community, Barnett clarified, yet a history of injustice in most marginalized communities has led to distrust of both medical and research communities. Rebuilding trust requires authenticity, which she suggested that researchers can demonstrate when they explain the purpose of the research and describe how community input will be used to better inform it.
Barnett described a continuum of five levels of community engagement: inform, consult, involve, collaborate, and empower (Harvard Catalyst, 2022). The extent of both difficulty and public impact increase as one moves from left to right along the continuum, she explained. She observed that researchers often operate in the first two levels where information is shared with community members in a top-down fashion (“inform”) and/or their input is solicited and considered (“consult”). Information-sharing is bilateral in the third level (“involve”), and in the fourth level (“collaborate”) the community is engaged from square one to co-create each stage of the research process and participate in decision-making. The fifth level (“empower”) allows community members to have control over both decisions and implementation of those decisions.
Ijeoma Opara, assistant professor in the Department of Social and Behavioral Sciences at Yale School of Public Health and the director of the Substances and Sexual Health (SASH) Lab, discussed the value of community-based participatory research (CBPR) for identifying meaningful solutions to health-related issues. Opara elaborated on the characteristics of CBPR, which she conveyed as an approach—not a research method or design—for conceptualizing a study and working collaboratively with a community at each stage of the process. She explained that work takes place in the community setting and is done with and immersed in the community, versus on the community. CBPR emphasizes the importance of co-learning, seeks to identify and leverage community assets and strengths, acknowledges mistrust of researchers stemming from the country’s history of unethical research practices carried out on people of color, and calls for equitable partnerships (i.e., community members have equal decision-making authority for research decisions that affect the community).
Opara described three strategies for engaging in CBPR. The first is to think about planning, which she suggested framing as “What does this community need from me?” instead of “What do I need from them?” Planning should be driven by the community needs and wants, she suggested, encouraging investigators to allow their preconceived research questions and intervention plans to evolve and adapt. The second strategy is to foster relationships with communities. Opara suggested planning or participating in a town hall meeting or attending a coalition meeting to learn what issues are pressing in the community and what relationships might be important to cultivate. The third strategy is to use community-level data to empower communities. Opara appealed for cultivating active citizenship by bringing research data back to the community where it was collected and empowering members to use those data to create positive change in the community.
Opara ended with a list of key takeaways for obesity solutions. She called for investment in CBPR and reiterated its value for understanding what the community perceives to be its primary issues and potential solutions. One-size-fits-all approaches won’t work, she maintained, but an approach that works in one community may be suitable for adaptation in another. She reiterated the importance of identifying community assets and strengths (an anti-deficit approach) and actively listening to the community to understand contextual, historical, and sociocultural factors that contribute to its obesity situation.
Bruce Lee, professor of health policy and management at the City University of New York School of Public Health and executive director of the university’s Public Health Informatics, Computational and Operations Research (PHICOR) initiative and Center for Advanced Technology and Communication in Health (CATCH), provided closing remarks that included a list of key takeaways from the third workshop. First, measures of progress are critical because it is not possible to fix something that cannot or has not been measured. Furthermore, Lee called for a systems approach to developing a complex series of measures to capture progress in the various sectors that influence obesity.
Lee recapped the characteristics of measures and approaches to measurement that workshop participants suggested are needed: measures that get at root causes of obesity; proximal measures (e.g., neighborhood
availability of healthy foods) that can provide earlier feedback on the effectiveness of an intervention than waiting for longer-term outcomes to materialize (such as changes in BMI); measures that promote long-term, sustainable solutions; measures that cross multiple scales of influence (e.g., genetic, behavioral, social environments, built environments); and measures that are accessible and understandable to diverse stakeholders given that public health problems are ultimately societal, not individual, problems.
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DISCLAIMER This Proceedings of a Workshop—in Brief has been prepared by EMILY A. CALLAHAN as a factual summary of what occurred at the meeting. The statements made are those of the rapporteur(s) or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.
REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by GABRIELLE JOHNSTON, American Council on Exercise, and KRISTEN SULLIVAN, American Cancer Society. LESLIE J. SIM, National Academies of Sciences, Engineering, and Medicine served as the review coordinator.
SPONSORS This workshop was partially supported by the Academy of Nutrition and Dietetics; Alliance for a Healthier Generation; American Academy of Pediatrics; American Cancer Society; American Council on Exercise; Bipartisan Policy Center; Blue Shield of California Foundation; General Mills, Inc.; The JPB Foundation; Kresge Foundation; Mars, Inc.; MedTech Coalition for Metabolic Health; National Recreation and Parks Association; Nemours Children’s Health System; Novo Nordisk; Obesity Action Coalition; Partnership for a Healthier America; Reinvestment Fund; Rudd Center for Food Policy and Health; Robert Wood Johnson Foundation; SHAPE America; Society of Behavioral Medicine; Stop & Shop Supermarket Company; The Obesity Society; Wake Forest Baptist Medical Center; and Walmart.
STAFF HEATHER COOK, AMANDA NGUYEN, CYPRESS LYNX, and MARIAH BRUNS, Food and Nutrition Board, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine.
For additional information regarding the workshop, visit https://www.nationalacademies.org/event/10-25-2022/defining-progress-in-obesity-solutions-through-structural-changes-a-third-workshop-in-the-series.
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Defining progress in obesity solutions through structural changes: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/26895.
Health and Medicine Division
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